Reflections on swine flu

As most of you know, APNA is based in Melbourne, Victoria and in recent times we have been somewhat in the grip of a swine flu outbreak!
Last Wednesday night, my 14 year old daughter Lucy woke us up in the wee hours with a high temperature and sore throat. Over Thursday she remained unwell and developed a cough. Being the usual offhand Mum that I am, I just let her sleep it off. I stayed home however just to keep an eye on her but I was not overly concerned as the swine flu was in the northwestern suburbs and we live in the east of Melbourne.
I had been asked earlier in the week to attend a teleconference on the Thursday evening at 6pm with the Chief Medical Officer Dr Jim Bishop along with other Presidents or CEOS of the different GP related groups - RACGP, AMA, RDAA, AGPN etc. It was with a slight sense of irony that I had to ask to have the call made to my home as I was home looking after my daughter with "flu-like' symptoms.
The teleconference was very interesting and there was alot of talk about the impact on practices, what practices should do to minimise risk to patients and staff, supplies of protective equipment and how to identify a swine flu positive patient who is 'going bad'. As most of you know, we have had a mild version of the swine flu in Australia but for those overseas who have died, they went downhill very quickly, as in 48hrs. there was much discussion about the communication with the community and it was at this point that I raised my confusion. As a relatively well-educated health professional, even I was confused as to what I was supposed to do with Lucy. I was not concerned about her clinically, but she fit the criteria of flu-like symptoms. She had no known contact at that stage but it was not unfeasible (is this a word?) that she may have come into contact with some of the girls at another girls highs school which did have confirmed cases- there had been a Yr 9 social at the local boys high school which most of Lucy's friends all attended. I had rung my general practice in the morning but the message was that if I felt comfortable looking after her, don't bring her in.
After the teleconference, I was more uncertain. 6 of Lucy's friends had all now experienced the same symptoms. I called Nurses-on-call who were trying to reassure me about her condition, but as I kept explaining I was not 'worried' about her or that she might have swine flu, I was concerned about the notion of spreading it around.
On Friday, I ended up taking her to the GP. She refused to sit in the special waiting room section with a mask, so we had to sit in the car until the receptionist rang us. we then put on masks and rushed through to a designated consulting room. She was tested and swabbed and we were ushered out the back door - nothing like feeling somewhat undesirable!
Over Friday, we heard that 2 more local schools had had confirmed cases. As the rest of us were starting to feel unwell, we basically took it easy and stayed at home. On Saturday, daughter number 1 woke up with swollen tonsils and feeling very unwell. Took her to the GPs, same procedure except the practice nurses saw us first to establish our story - all of us and nurse wearing masks etc. The GP looked at Elly, established that she had tonsillitis and this meant that swine flu was unlikely for some reason so all masks and gowns etc removed. We were allowed to exit through the front door this time!
Saturday - not test results. One of Lucy's friends confirmed as swine flu but Lucy had not had direct contact with her since a couple of days before she got sick. GP rang at lunchtime to say we would not get the results till late Monday or Tuesday. the advice was that as we had not had direct contact with a confirmed case, we were not required to be quarantined and I went out to supermarket to get some food. It still frustrated me though that if she turned out to be positive, we would have been roaming around the local shopping centre etc.
Tests results came through Sunday morning- Influenza A not swine flu. Doctors advice that likely that we all had it.
Thankfully we could all come out of our voluntary quarantine but it made me think - the kids were sicker with this influenza than some of their cohorts have been with swine flu. Did we prevent some other innocent patient from getting influenza A in the waiting room? I hope so! Even though I have a public health background, I have not really given that much thought to the practicalities of worrying about my family or I being a source of some infection for others. I hope this whole episode makes practices rethink their protocols for all infectious conditions not just pandemic flus. And for the kids to think it is normal and not embarrassing to wear a mask in the surgery if you are potentially contagious. Maybe they can make Scanlan and Theodore masks.
Alls' well that ends well- back to work and APNA.