Victoria officially has the highest per-capita rate of swine flu, with the tally now standing at 1,011 cases. The Australian reports this number is fewer than the US, Mexico and Canada, but enough for the Malaysian newspaper New Sunday Times to describe the state as a swine flu “epicentre”.

The Singapore Government has advised against non-essential travel to the state, adding that essential travel should be accompanied by “a high standard of personal hygiene”.

The Victorian Government has made the decision to move the response from “contain” to “sustain” — acknowledging the virus is in the community, and now we’re protecting the most vulnerable.

Swimming Australia has this morning cancelled this month’s grand prix, with chief executive Kevin Neil explaining, “School age swimmers would usually make up a large percentage of the competitors at this event, and various State Government advice that students would need to be excluded from school and isolated for seven days, means travelling to Melbourne would not be ideal”.

The ABC’s swine flu map has a nice graphic showing the number of cases around Australia — illustrating the number of cases in Victoria far outstrips the numbers in other states.

But what is it about Victoria that makes it so prone to the H1N1 virus? Is the Garden State turning into a pigsty? Or do Victorians simply enjoy wearing scarves and going to the doctor? Crikey intern Margaret Paul spoke to Victoria’s chief medical officer, Dr Rosemary Lester and child health and vaccinology professor, Dr Kim Mulholland.

Victoria decided last week to step up the influenza plan from contain to sustain — what does this mean for Victoria?

LESTER: We’re moving away from intensively testing everyone, to a more clinically-based strategy. We’ve circulated to GPs and hospitals a set of symptoms that suits swine flu. Now, we’re hoping to slow the spread of the virus. The previous response was to find, through testing, every case of the virus. Now we’re treating everyone presenting with the symptoms, reducing the infectivity and, ultimately, the number of people who will get ill.

There are currently 1011 cases in Victoria. From now on, we’ll only be testing high-risk groups — such as those in aged care facilities and hospitals, and protecting them by treating early.

We’ll be relying on our sentinel surveillance program — where GPs throughout the state have taken swabs, so we know what the level of influenza-like illness is in the community, and we can compare it to previous years.

MULHOLLAND: Well, it’s in the southern hemisphere, for a start. Most of the other countries that are reporting it — I think there are probably more countries that aren’t, but those that are — are in Europe and North America, where it’s summer. And the flu doesn’t travel well in the summer, we don’t know why. The southern hemisphere is now entering flu season, so it’s going to be worse here than in the northern hemisphere.

At the moment, the situation is worse in Victoria than in other states. But eventually, rates of swine flu will be the same across Australia, the virus is spreading around. Imagining that you can stop the spread of flu in a country like Australia is, well, it won’t happen.

And there are many people around Australia who will be infected with the virus and not know it. We’ve got no way of knowing, if we’re honest. But I think, in the months to come, the other states will catch up.

And how is it shaping up in comparison to previous years?

LESTER: We have seen a spike in the last week or so. We’re coming into influenza season, and there’s definitely a rise in testing. But it is clear we’re coming into the influenza season.

Why does Victoria have the highest per capita rate of swine flu in the world?

LESTER: We have had a very aggressive testing policy. If you look at other countries — in the US for example, after 300 cases they stopped testing the community cases and only tested the hospitalised ones. Because this virus is new to Australia, we needed to take a very aggressive stance with testing and quarantine, and we would actively seek out cases and contain the virus as much as we could. But now the virus is in the community without external links, we are moving into the sustain phase.

Victoria’s quite dry — that’s an understatement — because of the drought, and we know the flu does circulate better in drier conditions, and we’re colder than NSW and Queensland. I think it’s inevitable that we’ll see the virus more in other states too.

With the quarantining of rugby players, and the cancelling of Swimming Australia’s grand prix, do you expect further sporting events to be cancelled?

LESTER: I would certainly hope not. The virus has been mild, there’s no reason not to come to Victoria, or to cancel sporting events.

MULHOLLAND: Flu circulates every year. The Australian public health community has been primed by the fear of bird flu. But there are no signs with this virus that it’s particularly serious for individuals.

I’ve been surprised by people’s reactions so far. The notion you can contain it is unrealistic, and a lot of what we’ve seen so far has been responses aimed at containing it.

Is swine flu just a bad cold?

LESTER: It’s not just a bad cold, and there are people for whom it’s quite serious — people over 65 and people under 65 with chronic medical conditions. So this is why we have a program to help those people at risk. But for the majority of people, they do recover on their own in a few days.

MULHOLLAND: No, it’s a flu. The flu is transmitted in the same way as a cold, but the main difference is that a flu is more likely to produce a high fever. It’s a more serious illness.

The cold is what’s known as a “rhino virus”, and there are many kinds of that. There are a range of other respiratory viruses, including influenza A, B and para-influenza, which is a very powerful illness.

So there are a range of viruses that can cause respiratory infections, most of which are indistinguishable from a bad cold.

What should people do if they feel sick?

LESTER: If you develop flu-like symptoms, please don’t go to work, or to school, or to crowded places. If you’re feeling moderately unwell, go to a GP, but we are suggesting that people call first. Only go to an emergency department if you’re very unwell.

Peter Fray

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