Swine Flu - the air transport perspective
Ruwantissa Abeyratne
The Influenza A (H1N1) virus, formerly called the Swine flu virus, is
a mutated strain of the common flu virus and therefore an infection
caused by this virus cannot be treated by the seasonal flu vaccine
administered in most countries in the latter part of the year. However,
two antiviral that appear to be effective in treating this illness are
oseltamivir (Tamiflu) and zanamivir (Relenza).
The World Health Organization (WHO) has now declared that the spread
of the virus is at level 6 which denotes a pandemic. However, this does
not mean that the severity of the virus has increased. It merely means
that there are instances of fatalities in more than one continent.
The World Health Organization has also announced that, as at June 17,
2009 there were 39672 cases of infection worldwide of which 167 ended in
fatalities.
Although the WHO does not advise travel restrictions and screening at
the present time, it advises that it is prudent for people who are ill
to postpone international travel and for people developing symptoms
consequent upon undertaking international travel to seek medical
attention, in line with guidance from national authorities.
The most important measure to be taken to ward off the virus is to
wash hands thoroughly with soap and water on a regular basis. Should one
develop flu like symptoms, which are reflective of an upper respiratory
tract infection, coughing, high fever, severe fatigue and muscle strain
(added to which could be headaches, nausea and vomiting) one should,
according to WHO Guidelines, seek medical attention.
Pork products
It is also a fact that there is no risk of infection from this virus
from consumption of well-cooked pork and pork products.
The fundamental difference between the avian flu strain and the H1N1
strain is that the former was mainly transmitted within the bird
population (with a rare case of human to human infection), the latter is
transmitted from human to human, making it a stronger candidate for a
Pandemic (according to WHO, an influenza pandemic occurs when a new
influenza virus capable of causing severe disease transmits easily among
humans).
Therefore, with the Avian Flu, while we were at Phase 3 of the
Pandemic Preparedness Alert of WHO - which is the phase where there is
no general human to human transmission of the virus - we quickly went to
Phase 4 on April 29, 2009 (which is the phase that recognizes that there
is human to human transmission of the virus in a country of one WHO
region resulting in death) to Phase 5 on April 29, 2009 (which is the
phase that recognizes that there is human to human transmission in more
than one State in a region and resultant deaths).
The last phase - Phase 6 - recognizes that there is a full blown
influenza pandemic - and this phase occurs when there has been human to
human transmission of the virus resulting in deaths in more than one WHO
region).
The primary strategy of the WHO to mitigate the risks from a
communicable disease is to contain the disease within the outbreak area.
The main containment activities include heightened awareness of the
public, mobilization of risk mitigation efforts by the community,
including social distancing in the outbreak area (isolation and
quarantine) and the application of prophylactic medication and
vaccination.
To increase the effectiveness of this approach, the aviation sector
can assist by reducing the likelihood of an individual with a
communicable disease travelling outside the outbreak area.
Communicable disease
This may require the establishment of traveller screening procedures
at airports, medical assessment of travellers determined by screening as
potentially infected by the disease in question, and communication with
the public so that they are aware of the risks before setting out on
their journey.
The H1N1 virus is clearly a communicable disease which is transmitted
through air travel, in view of the fact that it has infected North
America, Europe and Asia. It is therefore important to address pandemic
preparedness from the perspective of air travel.
The International Civil Aviation Organization (ICAO) works closely
with the WHO in this regard, particularly in view of the fact that the
Convention on International Civil Aviation, an international treaty
signed at Chicago in 1944, prescribes that member States of ICAO agree
to take effective measures to prevent the spread by means of air
navigation certain communicable diseases as such States from time to
time decide to designate.
WHO, like ICAO, is a specialized agency of the United Nations.
However, whereas WHO concentrates on health related issues, ICAO’s main
area of interest concerns aviation. With respect to reducing the risk of
spread of disease by air transport, neither organization can efficiently
act alone, because detailed knowledge of relevant aspects of both health
and aviation is required to develop an effective strategy.
ICAO and WHO work closely to complement each other in creating
awareness of the risk of disease and its adverse effects.
Both Organizations believe that, by jointly developing technical
guidance and operational procedures, the aviation sector should to be
better prepared to respond to potential health risks which could spread
through air transport and adversely affect the public health and
aviation interests of different countries
With regard to responding to the spread of communicable diseases by
air transport, ICAO has reviewed its Standards and Recommended Practices
(SARPs) of relevance to Article 14 of the Chicago Convention and has
updated them in view of the contemporary risks to human health from
communicable diseases. New SARPs have been written that are in alignment
with the latest revision of the WHO International Health Regulations.
Although the SARPs describe the obligations on Contracting States,
they do not explain in detail how they can be met.
Accordingly, ICAO has sought the assistance of specialist
organizations such as the WHO, Centres for Disease Control and
Prevention (CDC), Airports Council International (ACI) and the
International Air Transport Association (IATA) in order to formulate
guidelines for States that would assist them in developing their own,
national, preparedness plans.
Air traffic
ICAO has advised States that National aviation authorities need to
ensure that they are fully involved in the planning process to ensure
that their expertise is available to the national public health
authority.
In this regard, it is believed that the chief medical officer of the
national aviation authority is likely to be an important resource as
he/she will have knowledge of most aspects of health and aviation
operations that are relevant to developing a preparedness plan for
aviation.
An area where specific expertise from the national aviation authority
will be required is that of air traffic management. Several issues will
need to be considered, such as procedures to ensure flight safety when
aircraft are diverted because of a suspected case on board, the reliable
notification of the national public health authority by air traffic
control after receiving information of a suspected case from a pilot,
and how air traffic operations can be sustained when many personnel are
simultaneously absent from work, possibly for several weeks.
In addition, the medical department of a national aviation regulatory
authority is primarily concerned with ensuring that licence holders i.e.
aircrew and air traffic controllers, are medically fit.
However, because it has expertise in both aviation and health, such a
department can play an important role in providing the link between
public health and aviation interests.
The regulatory authority’s medical department is well placed to
ensure that health risks are managed in a consistent and proportionate
manner across the airports in its State.
Further, during public health emergencies the chief medical officer
can be a valuable source of information for the national focal point
with respect to the aviation sector, and can assist in the efficient
management of such an emergency.
Health risk
The main challenge to developing a management plan is to ensure that
communication between the relevant stakeholders and partners is easy and
rapid.
Traditionally, many organizations have worked in a vertical manner,
meaning that inter-organizational communication links may not have been
developed to the level necessary to adequately manage any health risk.
In particular, the national public health authority may not have
developed efficient lines of communication with the national aviation
authority (particularly with its medical department), with airport and
airline operators, or with the media.
ICAO is working at an international level with the WHO to develop
such communication links and is encouraging States to develop reliable
communication networks between stakeholders and partners. |