PROTECT phase questions and answers
Back to PROTECT phase information
- Why has Australia developed the new PROTECT response phase to manage the outbreak of H1N1 influenza 09 (Human Swine Influenza)?
- Who made the decision to recommend going to the new phase?
- What are the main elements of the new PROTECT phase?
Why has Australia developed the new PROTECT response phase to manage the outbreak of H1N1 influenza 09 (Human Swine Influenza)?
The PROTECT phase recognises that the Human Swine Influenza virus is not as severe for the general population as originally envisaged. The overwhelming majority of people are making a quick and full recovery.
The new phase focuses on protecting those people in Queensland who are most at risk of developing severe illness from Human Swine Influenza.
The PROTECT response phase is designed to be a proportionate response to the risk the virus poses to the community.
Who made the decision to recommend going to the new phase?
A decision was made by the Australian Government to move to a new Australian phase called PROTECT based on the advice of the Australian Chief Medical Officer and the Australian Health Protection Committee, which includes all state and territory Chief Health Officers.
This advice is based on national and international scientific and medical evidence on the outbreak.
What are the main elements of the new PROTECT phase?
The key elements of the new PROTECT phase are:
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Identification and early treatment of influenza in vulnerable groups or those with moderate or severe disease. Vulnerable groups include:
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Pregnant women
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People with respiratory disease (eg. asthma)
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People with chronic diseases (eg. Diabetes, heart disease, renal disease, morbid obesity or immunosupressed)
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Indigenous people
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Control of outbreaks, including diagnostic testing in high-risk institutional settings, such as special schools.
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A refocusing of testing for the virus to institutional outbreaks and people with severe or moderate disease. This will help to monitor the behaviour of the virus.
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Voluntary home isolation for those who have mild illness. However, contacts will not be placed into quarantine or provided with antivirals.
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Antivirals will not be provided to those with mild disease, unless they belong to a vulnerable group or are from a high risk setting.
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There will no longer be a school exclusion policy for students returning from areas of concern (for example -USA, Canada, Japan, Mexico, Panama, Chile and the state of Victoria). The policy will cease at the end of the current school term - Friday, 26 June.
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More sharply focused monitoring of outcomes such as hospitalisations, surveillance of institutions, outbreaks and people with moderate or severe disease.
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Health care workers [*] who develop an influenza like illness will be required to stay away from work for 7 days or until their symptoms have resolved, which ever is longer.
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The current border control measures will cease.
Who are the vulnerable groups?
Vulnerable groups include:
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Pregnant women
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People with respiratory disease (eg. asthma)
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People with chronic diseases (eg. Diabetes, heart disease, renal disease, morbid obesity or immunosupressed)
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Indigenous people
What is different about the new phase compared with the previous CONTAIN phase?
The new PROTECT phase is focussed on protecting those who are the most vulnerable and who may experience moderate to severe illness. The CONTAIN phase was focussed on limiting the spread of the disease in the community.
What, if anything, should people do differently under the new PROTECT phase?
People should continue to take prevention measure and maintain good hygiene. These measures include:
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stay home when you are sick;
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wash your hands frequently with soap and water or use an alcohol based hand gel;
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wash your hands prior to touching your eyes, nose and mouth;
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when coughing or sneezing, cover your mouth and nose with disposable tissues which should be disposed of immediately;
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don't share items such as cigarettes, glasses or cups, lipstick, toys or anything which could be contaminated with respiratory secretions;
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maintain at least one metre distance from people who have flu-like symptoms such as coughing or sneezing;
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consult your doctor if you have a cough and fever and follow their instructions, including taking medicine as prescribed;
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if attending a medical practice or hospital Emergency Department, telephone beforehand so that they can arrange for you to be seen away from other people.
People who fall into the identified vulnerable groups should follow the above advice, be mindful of flu-like symptoms and consider avoiding mass gatherings.
Isn't the fact that the response is an admission that the Government and health authorities have overreacted to the disease?
Not at all. It recognises that Human Swine Influenza is not as severe for the general population as the viruses Australia had planned for in the 2008 Australian Health Management Plan for Pandemic Influenza (AHMPPI). This document and other State Government plans were designed to guide a response to a much more severe pandemic virus.
What do people, particularly those in high-risk groups, need to look for if they feel they may have been infected with Human Swine Influenza? What are the symptoms?
Human Swine Influenza symptoms are characterised by fever with cough and/or sore throat. Other symptoms may include fatigue, headache, muscular aches, joint pains, rigors or chills. Diarrhoea and/or vomiting have been reported in around 25 per cent of cases. People with these symptoms who begin to have respiratory difficulty will need medical advice. People in vulnerable groups should seek medical advice.
What does the new phase mean in terms of using antivirals to treat people who have been infected?
The new phase signals a move to identifying those people in whom disease may be severe and providing medical care and interventions to reduce likely suffering. People who will be given antiviral therapy in the PROTECT phase are:
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People with moderate or severe symptoms from Human Swine Influenza, particularly those who are deteriorating, or experiencing respiratory difficulty
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People with infection who are more vulnerable to severe influenza
Vulnerable people should be diagnosed and treated according to clinical judgement.
Will front line healthcare professionals be given access to antiviral medication?
The new phase signals a move to identifying those people in whom disease may be severe and providing medical care and interventions to reduce likely suffering. People who will be given antiviral therapy in the PROTECT phase are:
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People with moderate or severe symptoms from Human Swine Influenza, particularly those who are deteriorating, or experiencing respiratory difficulty
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People with infection who are more vulnerable to severe influenza
Vulnerable people should be diagnosed and treated according to clinical judgement.
Who will get antivirals?
In this new phase the use of antivirals from the National Medical Stockpile will be limited to those people with moderate or severe disease or whose underlying conditions, after appropriate clinical assessment, could make them vulnerable to Human Swine Influenza.
State and Territory health authorities have made a request to the Chief Medical Office to access the stockpile and already Professor Bishop has released both antivirals and personal protective equipment (PPE) to a number of states.
State and territories have a range of arrangements in place for access and distribution of PPE and antivirals, including making provision for their availability to GPs where practicable.
Queensland Health is making PPE and antivirals available to ensure it is available to assist in the care and treatment of vulnerable groups.
Will more people be tested under the PROTECT response, or does it mean a scaling down of testing?
Under the PROTECT response, pathology testing of all potential cases will not be required or desirable. This is because confirmation is no longer required to inform clinical decisions about quarantine or use of antivirals; most cases are mild and do not require treatment. In addition, high levels of testing are not needed with this Phase.
For outbreaks in 'closed' environments where individuals are at increased risk of more severe influenza (e.g., schools, cruise ships, military facilities), respiratory tract sampling and testing should be done quickly to identify the cause of the outbreak.
What does the new response mean for mass gatherings?
Wide-scale community social distancing measures such as cancelling mass gatherings are not part of the response. Such gatherings, sporting events, interstate travel and tourism generally should continue unrestricted, given the moderate nature of the infection. However, people who are vulnerable to serious complications of influenza need to reconsider their attendance at such events as contact with large numbers of people can increase the risk that they come into contact with the infection. In addition, elite athletes may decide to exclude themselves from their sport to protect themselves or other team members from Human Swine Influenza.
Will all States and Territories be moving to the new PROTECT response at the same time?
All States and Territories will move to PROTECT next Monday making the health response to this disease uniform across Australia.
However, Queensland will keep its policy of school exclusions and school closures in place until the end of the school term on Friday 26 June.
What border health measures will be in place in PROTECT?
The PROTECT phase means a return to normal operations at Australia's international airports.
Airlines will still be required to provide mandatory reporting of sick travellers in order to identity and provide medical assistance to those travellers.
All other advanced screening measures that have been put in place at Australia's major international airports in response to Human Swine Influenza will be removed.
What does the PROTECT response mean for initiatives already in place such as positive pratique, thermal scanners, clinical presence at airports, and health declaration cards?
Border measures including thermal scanners, positive pratique, clinical presence at airports and health declaration cards will not form part of the new response.
These measures are being adjusted due to the fact that we now have cases of this disease being transmitted in Australia and that we are seeing a disease that is mild in most, severe in some and moderate overall.
When will these new border arrangements come into effect?
The new arrangements will be rolled out from now at Australia's major international airports and all should all be in place by Monday (22 June 2009)
Why are you winding back border health measures?
For now, we are winding back border health measures because there is now community transmission of Human Swine Influenza in parts of Australia.
Australia's border health measures were intended to delay the entry of pandemic influenza into Australia, but now that we have cases within the country, and that we are seeing a disease that is mild in most, severe in some and moderate overall, it is more prudent to now focus our response to managing local cases.
What are the new arrangements for arriving ships into Australian ports?
Ships continue to operate under their normal Positive Pratique arrangements at all times.
Cruise ships will also continue to operate under a heightened system of prevention and preparedness to minimise any transmission of influenza-like illness. Unlike aircraft, cruise ships also include on-board medical staff and point-of-care testing arrangements.
Doesn’t the winding down of border measures indicate that the border measures were a complete failure in preventing the virus entering Australia?
Australian health authorities placed enormous efforts into delaying the entry of this virus into Australia and to contain its spread in this country once it did arrive.
After beginning in the Americas on 25 April 2009, Human Swine Influenza has now spread in less than two months to 74 countries. The Australian Government has stated on many occasions that this is an infection spreading around the world and that cases appearing in Australia were inevitable.
The placement of various measures at Australia's international airports did delay the entry of this virus for several weeks. Australia has vigorously tackled the spread of Human Swine Influenza with measures that were proportionate and appropriate when the World Health Organization first notified the appearance of this new disease to which no-one had immunity.
Australia's first case was a test result in a woman in Brisbane on 9 May. This person had been ill in the United States and was well when she travelled to Australia. Australian health authorities in multiple States then conducted significant contact tracing to ensure there were no other cases arising from contact with this person. The next cases to be discovered, which were unrelated to the 9 May case, were in Victoria and NSW on 20 May. This led to a school closure in Victoria and other intervention measures such as the administration of antivirals to close contacts and home quarantine in an attempt to further limit the spread of the disease. Unfortunately, the disease still spread - that is the nature of dealing with infectious diseases.
Health authorities have taken prudent, appropriate and proportionate steps in managing cases and contacts.
What are we doing with domestic travellers?
Because there are so many ways in which people can move around Australia, it is not feasible to put in place measures to limit the movement of symptomatic travellers. Rather, influencing people to adhere to good influenza prevention and hygiene management behaviours will be the most efficient and appropriate way of minimising spread domestically.
How many people come into the country each day?
At this time of year, approximately 28 000 to 30 000 people a day enter Australia.
Will the management of cruise ships change given we are moving to PROTECT?
A cruise ship protocol has been developed which will remain in place throughout the winter. However, its focus will move to concentrate on preventing the embarkation of sick travellers, minimising transmission on board and good management of symptomatic travellers.
Will there be changes in the Australian Government’s advertising campaign to reflect the change to PROTECT?
New print and radio advertising will begin nationally on Thursday reflecting the new themes of the PROTECT response - that the disease is more serious among those people who are vulnerable, that mild cases may not be tested or provided with antiviral drugs, and advise on simple hygiene measures as the best protection against Human Swine Influenza.
What is the situation with isolation and quarantine?
Isolation is recommended for people who have influenza-like symptoms. They are urged to stay at home if they are unwell while they have symptoms. In particular people who are unwell should avoid close contact with anyone who is in the vulnerable category and is more likely to suffer severe complications of influenza. The practices outlined in the Australian Health Management Plan for Pandemic Influenza 2008 for caring for a person at home who is unwell will assist in preventing transmission of the infection to others.
Quarantine describes the restriction of movements of people who are well but who may be incubating the disease following their exposure to a case. Mostly, quarantine will not be required during the PROTECT phase. However, the PROTECT phase represents a basket of measures that can be applied to suit the local and particular circumstances. For example, in a region where there are few cases of disease, health authorities may choose to limit the introduction and spread of disease by asking contacts of cases to go into voluntary home quarantine. The PROTECT phase is about protecting the vulnerable, at times quarantine will assist to do this.
What is the difference between the Modified SUSTAIN and the new PROTECT phase?
The Modified SUSTAIN phase, instituted in Victoria, recognised the 'mild in most nature' of the disease and that limits on schools closures and mass gatherings that would be instituted in a severe disease during SUSTAIN were less important. Case treatment and contact tracing in modified SUSTAIN was the same as SUSTAIN with an emphasis on diagnosis of cases and antiviral medication and quarantine for their household contacts.
PROTECT does not require that contact tracing be undertaken for cases of disease, nor that every case of disease should be treated with antivirals. PROTECT recognises that mild disease in most people does not need management other than treatment of symptoms for comfort. PROTECT narrows the focus of the intervention to protect those most likely to suffer from severe disease.
What is community transmission?
Community transmission means that people become unwell with influenza but have no idea from whom they got the infection. When a person acquires the illness from a family member or a work colleague, the link to another case of the disease is clear. When this link is not clear, for more than a minority of cases, the disease is described as community transmission. The person became unwell from spread somewhere in the community, perhaps from surfaces contaminated with the virus or from people coughing close to them in the community.
When/how will we know when/whether this virus has become this year’s seasonal influenza?
Throughout winter viral testing will continue to identify if the variant Human Swine Influenza is the predominant virus causing infection or whether other seasonal influenza viruses are causing infections as well. These data are routinely included in the weekly influenza report each year which will identify if there is a dominant strain. There is no way to predict whether this virus will replace seasonal influenza this year or whether it will be an added burden on top of the usual influenza infections.
* - In this context, health care workers include all staff who have direct patient/client contact (within 1 metre) who are identified as vulnerable. These staff may include medical, nursing and health practitioners, as well as front line administrative and operational staff.
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