Guidelines for suspected cases of Swine Flu April 2009 1. Make sure that the patients fulfil the criteria for further investigation and antiviral treatment – ie. they’re showing proper flu-like symptoms and they’ve recently been to one of the suspect areas. 2. Contact the Health Protection Agency to notify them of the case – telephone 01622 710161 3. Tell the patients to stay at home, to avoid spreading the infection. Anybody who lives with them should stay home too – eg. don’t send the children to school. 4. Organise a home visit to take nasal and throat swabs. Chlamydia swabs can be used, but the Microbiology Dept at Preston Hall can advise (01622 224040 ask for Mark Hollands) can advise. 5. The Health Protection Agency are meant to organise collection of the swabs by courier. 6. When making the home visit, the GP is supposed to wear protective clothing – mask, gown and gloves – and the patients are supposed to wear masks. The best thing is to get the patients to move back more than a metre after they open the front door, so that you can put the gear on inside the house, thus avoiding all the neighbours ringing up the newspapers to say they think there’s a case of swine flu in the area. 7. The antivirals are in the Kent & Canterbury Hospital at the moment, and have to be collected from there and delivered to the patient. We’re supposed to organise this – I got a man called Ian Blackford of I B Couriers to do it – telephone 01892722401. But I found him on Google, so if he’s not available you can look on Google for someone else. (The health protection agency promise that they will reimburse courier expenses.) 8. The Kent and Canterbury Hospital are only supposed to release antivirals on a named patient basis and to authorised personnel, so give the courier a letter (on surgery headed notepaper) with the patient’s name and address details on it – something along the lines of “This is to authorise the bearer of this letter to collect a package on behalf of the above patient, who is registered with our surgery”. 9. Tell the courier to go to the Pharmaceuticals Dept at the Kent & Canterbury and ask for Heather McAdam (01277 868711). Ring her beforehand to explain who you’re sending. She should already know about the patient in question, because the HPA should notify each patient to her as the need arises. 10. Don’t tell the courier what this is all about, although they’ll probably guess. And instead of delivering the package in person, tell them to just pop it through the front door (otherwise they might get infected). 11. Tell the patient to ring the surgery when the antivirals have been delivered – just in case the courier pops them through the wrong front door. If you don’t get a phonecall, chase to find out what has happened. Notes: 1. Home visits for all suspected swine flu patients may become impracticable if there are lots of cases being reported. Under these circumstances patients could possibly be asked to come to the surgery, with appropriate precautions, at a time when no other patients are around. 2. Our patient was living in the same house with his partner and her children, who were all registered with a different surgery. We felt that each GP should organise his own swab for his own patient(s), but in retrospect it would have been an idea to liaise with the other surgery, because a single courier could have brought over antivirals for the whole family if they were required. 3. It would be nice if a supply of antivirals could be moved somewhere closer – for example to Preston Hall – and then maybe they could be delivered by the same courier service which comes to the surgery to collect the swabs.