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Influenza A/H1N1: Questions and Answers (18-Oct-2009)
Sunday, October 18, 2009

Port of Spain, Trinidad and Tobago, October 18, 2009

The following are detailed questions and answers on H1N1 excerpted from a Ministry of Health Press Conference held on Sunday October 18th, 2009:

Dr. Avery Hinds, Medical Epidemiologist, Ministry of Health:

What are the flu-like symptoms?
Fever, cough, sneeze, sore throat; additional symptoms are diarrhea, nausea, tiredness, general weakness and fatigue.

Who is a high risk patient?
High risk categories include pregnant women, children under five years of age, persons with chronic medical conditions, including asthma and other lung conditions, sickle cell anemia, heart disease, diabetes, obesity, HIV/AIDS and any other condition affecting the immune system.

I have flu-like symptoms. What do I do?
If you are a low risk patient: stay at home and avoid social interactions. If your Panadol or Tylenol does not break your fever by Day 2 or 3, then seek medical assistance. If at any time you have shortness of breath / difficulty breathing or any other emergency warning sign, then you need to go to the hospital immediately.

If you are a high risk patient, please seek medical care.

What are the emergency warning signs?

In children

  • Fast breathing or trouble breathing
  • Not drinking enough fluids
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In adults

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting

What should I expect on my first visit?

  • You will be assessed by the clinician according to your level of risk.
  • There is no one specific set of interventions for every individual.
  • Patients are managed and treated on a case by case basis.

Is there a new strain of the H1N1 virus in Trinidad and Tobago?
There is currently no evidence whatsoever that a new strain of the H1N1 virus exists --locally or internationally. The H1N1 virus, as it has presented itself thus far worldwide, is indeed a serious virus and can cause severe illness and even death.

Dr. Helmer Hilwig, Head of Accident and Emergency, Eric Williams Medical Science Complex:

When am I to be tested? Who makes the decision on getting swabbed?
Swabbing when not necessary will not help. Clinical management does not depend on swabbing. Tamiflu may be administered by a doctor, even without the confirmatory results. It is the decision of the physician to test or not and how to manage the patient.

What does it mean to be tested?
The nasal swab is just a tool to assist in the clinical management of patients. Physicians do not necessarily need swabs and/or H1N1 confirmatory results in order to manage and treat patients. In fact, 95% of people who may have H1N1 are successfully managed at home.

When should I expect to get Tamiflu?
Tamiflu is administered to high risk and severely ill people. Persons with mild illness do not need Tamiflu. The decision of the administration of the drug lies with the physician.

When should I expect to be admitted at the hospital and when should I expect to be treated at home?
H1N1 cases presenting a mild illness will be treated at home. When at home, persons should times monitor their progress and if there are any emergency warning signs they should seek medical attention.

Patients with severe illness and exhibiting emergency symptoms will be admitted to the hospital and managed as aggressively as necessary. There is proper infection control at the hospital, therefore patients will be isolated.

When should we sanitize our homes/schools/businesses?
Sanitization of entire buildings, schools or office spaces is unnecessary, even if someone at the office has been diagnosed or treated for H1N1. The virus does not survive on surfaces for more than 24 hours.

However, you need to clean surfaces and items that are more likely to have frequent hand contact. Use the routine day-to-day cleaning agents to sanitize surfaces that are frequently touched e.g. kitchen/pantry surfaces, bathroom surfaces, telephones, door-knobs.

While more frequent surface cleaning during the day may be helpful, use of additional/ special disinfection agents beyond routine cleaning is not recommended.

Ventilation of rooms is highly recommended. (Open doors, windows and let the air go through the room).

Dr. Anton Cumberbatch, Chief Medical Officer, Ministry of Health:

What is the relationship between the Public Health sector and the private institutions with the responsibilities to the management of the H1N1?
Influenza A H1N1 is a public health problem and in terms of prevention and treatment and management the entire health care system, just like in the rest of the world, must get involved.

This means working closely with the private sector.  Before Trinidad and Tobago had its first (Index) case of Influenza A H1N1 the private sector was contacted and discussions held on how to handle the virus.  Since then they have been collaborating with us and with respect to diagnosis and management.

The private sector and private hospitals have been utilizing the public sector lab and also information from the Ministry of Health.  They have been requesting Tamiflu from us and we have been supplying for free.

Soon we will formalize that relationship with all private sector hospitals which would allow them to request from the Ministry of Health a stock of Tamiflu to keep on their compound. Currently they contact the CMOH in their district and are given the Tamiflu on a case by case basis.

This must be dispensed in keeping with proper protocols and they must provide it free of charge.


We have been working closely with the Ministry of Education at all levels.  Every country is facing the problem of school infections, but the norm is that at this time there is no benefit to the closure of schools and offices due to a suspected H1N1 case.

We have sent protocols to the Ministry of Education but we want to reinforce that on a case by case basis the Ministry of Health works with the Ministry of Education

With respect to closure there must be demonstrated in each case, active transmission of the virus within the school setting before we make a recommendation to close classes or buildings.

Dr. Kumar Sundaraneedi, Director of Medical Programmes, Ministry of Health:

A National Plan has been established and every hospital has its own micro plan which is guided by the national plan.

Health services have been prepared with an operational response plan to the hospitals and the counties and this addresses the surge capacity that might build up during a pandemic situation.

Each hospital has a capacity of between 20-40 beds to deal with such a surge.

There is also a trained qualified professional that manages the patient in the ICU and high-dependency units. Added to this there is also an additional ventilator which was used on standby during the summit of the Americas.

There has been an increase in the stock pile of personal protective equipment in the hospitals, health centres and also nursing homes. Community health services have also increased their patient capacity.

Dr. Carol Boyd Scobie, PAHO/WHO Local Representative:

  • Tamiflu is not a vaccine, it is a tablet that is used to treat people who are having complications or likely to have complications.
  • People who are at higher risk need to recognize they are at higher risk.
  • High risk persons showing symptoms should visit doctor and should get started on the Tamilfu.
  • Tamiflu is not used to prevent H1N1 or guard against getting it if you are exposed.

  • Trinidad had made arrangements with PAHO to get vaccine; negotiations are still ongoing.

  • Pandemic preparations began in 2000.

  • A pandemic hits the world every 50 years.

  • The pandemic plans are designed to minimal societal description.

  • PAHO ensures the Ministry has right info to properly prepare their pandemic preparation plan.

  • T&T is doing a good job in reporting cases of H1N1

  • Lab personnel have been trained on how to conduct testing for the H1N1.

  • PAHO assisted Ministry of Health running clinical management training courses.


Minister of Health, Senator the Honourable Jerry Narace:

The Ministry of Health did not say that the vaccines would be administered in October. We said we had an offer for vaccines to be available by October, we met with the Director General of PAHO in Washington and was assured that we will receiver two hundred and sixty thousand (260,000) vaccines to arrive mid November.

I would like to reiterate that thus far there have been reported 163 laboratory confirmed H1N1 cases in the country and four deaths.

The Ministry of Health has noted a media report which accounts for the final days of one of the diseased. The media report states that the person visited a private doctor twice and the San Fernando General Hospital before he succumbed to his illness. The Ministry is investigating this case to verify the occurrences reported and act accordingly.

As you know, I have already instructed the Chief Medical Officer (CMO) to conduct thorough investigations of the clinical processes followed at the public hospitals, the private clinics and the private doctors who have treated these patients. Thus, the Chief Medical Officer is currently investigating the fatalities and our epidemiological investigation is also ongoing.

At this point what we should all be concerned about is the prevention of the spread of the virus and ensuring that the public has all the information it needs to help us achieve that.

It is also useful to remind the public that the persons who passed away, were admitted at the hospital at a late stage in the course of their illness and they all presented respiratory distress. Moreover, the deceased also had serious underlying risk factors that rendered their management a lot more complicated than the average case of H1N1.

The rest of the H1N1 cases treated in our country thus far have been relatively mild and as the doctors already explained, most of them were managed at home and returned to their normal activities within seven to ten days.

We also flagged yesterday in our media release that reporting on H1N1 deaths without following the proper confirmatory process has serious international implications for Trinidad and Tobago. Misinformation and/or misguided assessments of events can be dangerous to the citizens of Trinidad and Tobago and can have dire consequences in the international arena. We would appreciate the media’s cooperation in that regard.

  • We have done everything to ensure that the system is ready to respond (also see Dr. Scobie’s statement)
  • Training--Extensive training for our clinicians with expert from Mexico early on--late June-July
  • Next week another set of training for primary care professionals giving an update on clinical management & treatment of H1N1 patients.

Message to Citizens

At this point we wish to once again urge the public to take all necessary precautionary measures to minimise the risk of contracting the H1N1 virus.

Persons attending mass gatherings - such as church services, sporting and social events, school, and day care centres, as well as the high risk categories are particularly alerted to follow all recommended guidelines.

The Ministry of Health appeals once again to all citizens to adhere to all recommended guidelines regarding hygiene and respiratory etiquette. Social distancing is important, even for the common cold.

All parents, teachers and students are urged to follow the established protocols from the Ministry of Health and the Ministry of Education (available at

All citizens are further asked to seek official information on the Influenza A H1N1 through the Ministry’s:



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