LCQ5: Prevention and control of epidemics and influenza winter surge
Last month, the Centre for Health Protection of the Department of Health reported the fourth case of human infection of avian influenza A (H7N9) in Hong Kong since the onset of this winter. On the other hand, the statistics released last month by the Hospital Authority (HA) have shown that the medical inpatient bed occupancy rates of various public hospitals in this winter were close to or even beyond their capacities (e.g. such rates of the Prince of Wales Hospital and the United Christian Hospital were as high as 114 per cent and 109 per cent respectively). Regarding the prevention and control of epidemics, will the Government inform this Council:
(1) of the public expenditure on prevention of epidemics last year and, of such expenditure, the various types of expenses dedicated to the prevention and control of avian influenza epidemic (including expenses on virus testing and staffing);
(2) whether it knows the measures taken by HA in this financial year to cope with influenza peak seasons, including the numbers of hospital beds and healthcare personnel added; how such measures compare with those taken during the same period of the last financial year; whether HA has assessed the effectiveness of such measures; if HA has, of the details; and
(3) whether it knows the average distance between the beds in medical wards of public hospitals in this winter, and how such figure compares with international standards; of the additional measures put in place by HA to prevent an outbreak of epidemic in crowded wards?
My reply to the question raised by Dr Hon Pierre Chan about the prevention and control of epidemics and influenza winter surge is set out below.
(1) The Government has all along adopted a multi-pronged strategy for prevention and control of diseases, such as seasonal and avian influenza.The Food and Health Bureau is responsible for formulating and overseeing the overall strategy, whereas the Hospital Authority (HA), the Department of Health (DH), the Agriculture, Fisheries and Conservation Department (AFCD) and the Food and Environmental Hygiene Department (FEHD) are responsible for the implementation of the preventive and control measures.
The winter surge of the HA's service demand usually lasts from December to April of the following year and overlaps with the influenza season. The winter surge of this year has begun. Given the ageing population, cold weather and increasing activity of influenza, seasonal influenza affects elderly patients and chronic patients, especially those with heart or lung diseases, most significantly. Past experience shows that the demand of these patients for HA services, particularly at the Accident and Emergency (A&E) and medicine departments, will increase after long holidays. On the other hand, human infection cases of avian influenza A(H7N9) have no significant impact on the in-patient services of the A&E and medicine departments so far.
The HA strives to adopt appropriate measures to prevent and control avian influenza by implementing the strategy of "early testing, early notification and early isolation". On hospital laboratory testing support, the HA has earmarked about $1.8 million a year to provide subsidy, on an accountable and reimbursement basis, for hospital laboratories to purchase avian influenza test reagents. The level of subsidy will be adjusted according to the situation of neighbouring areas and the number of suspected local cases. Manpower will be deployed among cluster laboratories to meet the testing workload. The HA has also implemented the special honorarium scheme to cope with the manpower requirement for conducting urgent influenza tests. Moreover, to tackle avian influenza, all hospitals have maintained a stockpile of protective personal equipment sufficient for 30-day use. The HA will monitor the consumption of protective personal equipment and make timely replenishment to ensure proper use of resources.
The Centre for Health Protection (CHP) of the DH is responsible for the co-ordination and implementation of public health programmes on disease prevention and control, including disease surveillance, outbreak management, health promotion, risk communication, emergency preparedness and contingency planning, infection control, laboratory services, specialist treatment and care services, and training and research. There are six functional branches under the CHP, each has its own specific duties. They collaborate and communicate on a regular basis regarding the prevention and control of communicable diseases in order to support and implement multi-disciplinary health protection programmes. The work includes surveillance, port health measures, risk communication and information dissemination, liaison with other health authorities, as well as promotion and public education.
With regard to the prevention and control of avian influenza, the Government has put in place the Preparedness Plan for Influenza Pandemic (the Plan), which adopts a three-tiered response level system based on the risk assessment of influenza pandemic that may affect Hong Kong and its health impact on the community. The Plan has already covered the specific response measures during an outbreak of influenza pandemic caused by a novel avian influenza virus. As the prevention and control of avian influenza is an integral part of the overall work of the CHP in preventing and controlling communicable diseases, the CHP does not have a breakdown of the expenditure by disease or category.
The AFCD's expenditure on avian influenza prevention and control was $49.5 million in 2015-16. The work included carrying out surveillance of the hygiene condition of local farms, wholesale poultry market and pet bird shops, conducting regular inspections of local farms to ensure supply of healthy poultry in the market, combating illegal keeping of backyard poultry, and taking samples from the live poultry supply chain, the environment and wild bird carcasses for avian influenza tests. In the same year, the expenditure of the FEHD on related work was about $13.53 million. The work includes conducting surveillance and inspection of imported live poultry at the Man Kam To Animal Inspection Station, inspecting registered farms in the Mainland that export poultry to Hong Kong, and taking environmental samples from live poultry retail outlets for testing. The FEHD also carries out cleaning operations and inspections at live poultry retail outlets in markets.
(2) To cope with the continuous and dramatic increase in service demand that may happen during the winter surge, the HA started to make preparation in August 2016. It has drawn up a series of measures to address the surge. The major strategies include enhancing infection control measures, managing service demand in the community, strengthening gate-keeping measures to reduce unnecessary hospitalisation, improving patient flow, optimising service capacity, reprioritising core services and enhancing communication with the public.
In particular, to further enhance service capacity, the HA has provided 231 additional beds and will recruit more healthcare staff in 2016-17. It is projected that there will be an increase of 158 doctors, 372 nurses and 216 allied health professionals as compared with 2015-16. In addition to over 200 new beds, the HA has reserved resources to build up capacity for providing over 500 temporary beds during the winter surge. As far as I know, some of these temporary beds have already been added for use.
During long holidays, including Christmas, Chinese New Year and Easter holidays, the service quotas of general out-patient clinics (GOPCs) will be increased by a total of around 5 000. Moreover, the HA plans to increase the service capacity of GOPCs during the influenza winter surge and provide around 18 000 additional service quotas.
Besides, to improve patient flow, the HA will also increase ward rounds by senior doctors during evenings, weekends and public holidays, and enhance the capacity of related supporting services. Virology service for patients with community-acquired pneumonia and those in intensive care units will also be strengthened.
The HA attaches great importance to communication with the public. Press conferences are held to inform the public of its response plan. Besides, the HA's website and the HA Touch mobile application also serve as one-stop portals to provide information about the waiting time for A&E service, lists of private clinics, etc. for public reference.
Since December 2016, we have been closely monitoring the service statistics of all acute hospitals. Recently, after Chinese New Year holidays and with the dropping of temperature, attendances to A&E departments and occupancy rate in medical wards of public hospitals have started to increase during these two days.
(3) As the in-patient bed occupancy rate in medical wards generally exceeds 100 per cent during the influenza surge period, we may not be able to ensure to maintain the distance of three feet between beds. The public may find some wards are rather crowded if they visit public hospitals. This situation makes our colleagues work harder.
As mentioned in part (2), the HA has enhanced the virology service for influenza during the winter surge this year. Polymerase chain reaction test is conducted for all high risk patients having symptoms of influenza to expedite diagnosis of influenza A or B virus infections. This will help increase patient flow and relieve the crowded condition in wards.
Ends/Wednesday, February 8, 2017
Issued at HKT 19:05
Issued at HKT 19:05