Hospitals warned on reporting swine flu

Health professionals voice confusion over the law on reporting the disease.

// The UAE's efforts to combat swine flu will not succeed unless public and private hospitals report every confirmed infection, a regional adviser at the World Health Organisation said yesterday. That assessment came on the heels of a warning this week of legal action against hospitals and clinics that do not diligently report cases of H1N1 infection.

Tracking the spread of the swine flu virus is essential to ensuring that the UAE and the region have a clear picture of the pandemic's development and, therefore, where to focus resources, said Dr Hassan el Bushra, the regional adviser on surveillance, forecasting and response at the regional office of the WHO. Dr el Bushra reiterated this week's message from the Ministry of Health warning private hospitals to co-operate with all reporting and treatment regulations.

"In some countries, the private sector is very strong, with more than 70 per cent of people being treated there," Dr el Bushra said. "That's why it is so important to always get data from the private sector, particularly on things such as the H1N1 virus. "This is often governed by national public health laws. They refer to certain notifiable diseases that have to be reported; otherwise it will be a problem for the institution itself and the country."

He said that proper disease monitoring allowed health officials to spot any sudden increases in the occurrence of a disease and take action. Monitoring "allows people to locate cases and find out where they are coming from and also identify those who are at risk", he said. "There is no country where the reporting is 100 per cent, but we are aware of that." Diligent reporting of cases by hospitals and clinics gives public health officials a fighting chance, he said.

This week, the ministry said hospitals and clinics faced legal action if they did not abide by federal laws concerning pandemics. Dr Ali bin Shakar, the director general of the ministry and chairman of the committee managing the response to swine flu, did not respond to queries about the specifics of the law. The ministry also declined to say whether any hospitals had been found to be in violation of laws relating to pandemics, either by not reporting confirmed cases or by refusing to treat people.

It was reported in Qatar this week that a local man died of the H1N1 virus in a hospital in Doha. The reports said he had been in Dubai the previous week and had visited a hospital twice but that his infection was not diagnosed. The warning from the ministry and the H1N1 supervisory committee followed a meeting to discuss the measures being taken in the country to prevent the virus spreading. The advisory, released by the state news agency, WAM, said "the ministry will take legal actions against any healthcare institution if it failed to fall in line with the ministerial directives as per the Federal Law No. 270/1981 pertaining to prevention of epidemics".

The warning has caused some confusion among officials at private hospitals, who said the directions were unclear and could lead to a misdirection of resources. The managing director of a large private hospital group said he was not aware of the ministry warning and would like to know more about the law. "Old laws often came out in Arabic and were given to someone at a hospital who put them in a file; they were not seen by anybody after that," he said.

"I am aware of certain rules relating to pandemics and communicable diseases, especially notifying and reporting cases, which takes time." He said he would be surprised to hear that a hospital or clinic had not reported a case of swine flu, unless it feared being reprimanded for not handling the case properly. "I actually think, at the moment, people would like to be caught up in the excitement of it," he said.

"[But] it's no longer exciting when you are overburdened by 600 flu cases." A doctor in a private clinic said she was concerned the warning would either make private hospitals more reluctant to deal with suspected H1N1 cases or focus too much on the virus. "I am not aware of the law myself, but it is a bit worrying to hear legal action being mentioned," she said. "This is a new situation for a lot of countries to deal with, and I think people are doing their best to manage it. So far, I thought it was working, but maybe it is not.

"If people are scared of legal action, they might be too keen to diagnose, in case they miss something. "Or there is a risk that they might not want to deal with any of the virus cases at all. I think many places will keep doing what they are doing, though." According to the ministry, the UAE has had about 200 confirmed cases of H1N1 infection. The figure includes 65 patients who were released from hospitals last week after treatment. Fifty-five patients were still receiving treatment.