For several years now, public health practitioners have been asking, lobbying, nagging and cajoling general practices, hospitals, councils, non-government organisations and businesses to prepare for an influenza pandemic.

Stockpile protective masks, gowns and goggles, we advised. Have a designated isolation room, we requested. Develop, test and refine your business continuity plan, we suggested, have procedures in place for communication of public health messages to your patients, students, clients and customers, we begged.

It has been mission impossible. There has been complete lack of interest at best, and active resistance at worst.

Meanwhile, public health workers have been planning and preparing for a pandemic event with a large number of unknowable variables. Not just with documents, but with training in Emergency Management processes, designated spaces for Emergency Operations Centres, identifying logistical needs such as PCs, telephones, physical space and management systems and getting them ready to go at a minimal notice.

Each state has only a handful of people normally employed to deal with infectious illnesses like influenza — in the smaller states only one or two people. As part of the public health response to this new virus, emergency operations centres have been set up in each state and dedicated “swine flu” call centres in the busiest states, Victoria and NSW. For weeks, these received over 1000 calls a day primarily from GPs, but also from hospitals, schools and members of the public.

Staffed with 20-40 people, over 12 hours a day, seven days a week, phones ran hot and the problems needing solving were complex and varied. People staffing these centres were taken from their normal jobs, brought in as agency nurses or temps, not an ideal situation, but there is no stockpile of spare health professionals sitting around waiting to be called upon. The public health officials coordinating the responses in each state have worked around the clock.

The GP response to this service provided to them has been interesting. Some have been patient and grateful for the advice, and many have themselves been working long hours and diligently following all the appropriate infection control protocols. Those who resisted or ignored attempts to get them to prepare for exactly this type of event have found themselves caught short. These are the ones blaming government for not doing enough.

This in and of itself does not surprise me. But what I take offence to is the notion that public health workers are just “sitting around on their arses” as one GP accused a colleague of doing a few weeks ago.

The criticism by doctors in the Weekend Australian this weekend just added to my frustration.

The “inconsistent responses” from states are due to the fact that unlike other ‘mass casualty’ incidents (fire, flood, cyclone etc) a pandemic event leaves no capacity to draw in staff and resources from other states, as an infectious illness, by its very nature, will affect the whole county at once. Each state and territory will have to fend for itself, thus the bulk of the planning and preparing has been done at the state/territory level using the existing resources of that state. The states need to activate different phases of their plans at different times depending how each one has been affected.

Naturally there will be problems and mistakes when trying to roll out complex plans against a virus with so many unknowns. But state and federal governments are not the only ones who have been involved in pandemic influenza planning — if GPs are not coping they have to take some of the responsibility for their own poor planning and preparation — and be prepared to be part of the solution, not just criticise from the sidelines.

Before swine flu even hit Australian shores, pharmacies had sold out of Tamiflu and other antivirals. Why? Because GPs were prescribing it unnecessarily to the worried well and those about to travel — against clinical guidelines. So when the virus did enter Australia the community supply was exhausted and governments had to release a significant amount from the national stockpile.

GPs also sent off numerous tests for patients with flu-like illnesses (the exact same flu-like illnesses they see every winter for which their response is normally to tell people to go to bed and keep up the aspirin and fluids) thus clogging up the privately run laboratories and stretching them beyond capacity leading to delays they also now blame government for.

The GP quoted in the Weekend Australian delayed test results for her patient by not following DHS (Vic Department of Human Services) advice. By sending the swab to a private lab which was overloaded and sending excess swabs interstate for testing, she delayed the findings by nearly a week. Had she waited one day until the boy’s classmate had been confirmed as having the virus — DHS would have authorised the swab to be sent to the public laboratory which had a turnaround of 24-48 hours. State government health departments have no control over private laboratories and cannot ‘speed up’ their processes as she requested.

She also complained that the department would not give Tamiflu to her patient. She neglected to mention there was absolutely nothing stopping her from prescribing the drug to her patient the first time she saw him without waiting for lab results — pharmacies were stocked again by then. Her practice is in Toorak — one of the wealthiest suburbs in Melbourne — but she didn’t suggest they pay for the drug — she expected government to provide it free. Another example of scarce resources being wasted.

The federal government announced it will spend $4mil to provide ‘extra support’ for GPs. Maybe this will help them to begin the planning we asked them to do years ago.