Replies to LegCo questions
LCQ5: Prevention and control of epidemics and influenza winter surge
Following is a question by the Dr Hon Pierre Chan and a reply by the Secretary
for Food and Health, Dr Ko Wing-man, in the Legislative Council today (February
8):
Question:
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?
Reply:
President,
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
NNNN
LCQ5 Annex