Wednesday, December 21, 2016

Hong Kong: Early Flu Surge Puts Pressure On Local Hospitals


Hong Kong's superb public health system - which includes both the CHP and their 17 public hospitals - has long served as an important early warning system for novel flu viruses coming out of Mainland China.

Not only are they well equipped to detect and isolate cases, Hong Kong has an enviable record for rapidly reporting all findings to the public. 

As the chart above indicates, Hong Kong's winter flu season doesn't usually ramp until January, but local hospitals are already getting slammed. Yesterday the Hospital Authority (HA) held a press conference to discuss this early winter surge, and has begun to release daily updates.

This from the Hong Kong Standard:

Pressure mounts on crowded public hospitals
Carain Yeung Dec 21, 2016
Public hospitals are grappling with the effect of winter that includes a surge in flu cases. That has seen patient bed occupancy rates exceeding 100 percent in the past two weeks, Hospital Authority officials said. 

And the strains come as the Centre for Health Protection confirmed an imported case of the H7N9 strain of bird flu in a 75-year-old man who had been in Guangdong - the first such case this winter. 

Hospital Authority executive Ian Cheung refused to be drawn on the suggestion that the squeeze in hospitals is shaping up to be worse than last year, but he did say: "It is definitely not optimistic."

(Continue . . .)

Hong Kong notably often sees a biphasic or `double peaked’  flu season (see Hong Kong Girds For More Flu), and some years the summer flu season lingers, and can even meld into the winter season.
On Monday, the HA reported Prince of Wales Hospital hardest hit with an occupancy rate of 121%, followed by United Christian Hospital (117%) and Queen Elizabeth Hospital (116%).

All of this flu activity, at the same time that avian flu is ramping up on the mainland, poses several concerns.
  • First, the background `noise' of seasonal flu makes it more difficult to identify and isolate novel flu cases. 
  • Crowded hospitals and A&Es may also discourage those with mild-to-moderate flu from seeking medical treatment (and hence, testing).
  • Long waits in crowded hospital waiting rooms can contribute to the spread of influenza, including novel strains - something we've seen with MERS in South Korea and Saudi Arabia. 
  • Crowded hospitals also mean backlogged lab testing, meaning novel flu cases may not be identified as quickly, increasing the risk of nosocomial spread. 
  • And while least likely, the heavy co-circulation of seasonal flu provides novel flu subtypes increased opportunities to co-infect a human host, and potentially produce a hybrid reassortant virus.  
While rare (see EID Journal: Human Co-Infection with Avian and Seasonal Influenza Viruses, China), it can and does happen.

As a side note, we are also starting to see reports of heavy seasonal flu activity in Mainland China, Eastern Europe and Russia - again earlier than usual - and so areas that have yet to see flu may still be in for a heavy flu season.

A reminder that it isn't too late to get the flu shot.

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