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Predictions should come with a health warning

Fergus Walsh | 11:45 UK time, Friday, 3 July 2009

A lot of people got quite a shock yesterday when Andy Burnham, the health secretary, predicted that there could be 100,000 people a day infected with H1N1 swine flu by the end of August.

liam donaldsonAnd then on Newsnight, the chief medical officer for England, Sir Liam Donaldson was asked whether that meant that 40 people a day might be dying from swine flu:

"Well we can't be sure about the death rate, nor can we be absolutely sure about the number of cases that will be occurring by the end of August. But these are scientific projections, the numbers could be lower than that, they may be even higher.'"

So there you have it. Predictions, projections, but not facts. The only facts we have are that there have been around 7,500 lab-confirmed cases of swine flu (thousands more unconfirmed) and three deaths. That makes a death rate of one per 2,500 cases or 40 per 100,000.

Could the 40 deaths a day figure be accurate? The US experience may help us. They are about one month ahead with swine flu and the CDC reckons (here comes another estimate) that at least one million Americans have had swine flu. They made that prediction when there had been 127 deaths in the US. So, using the American figures, that would give us a UK death rate of one per 7,800 cases or 12 deaths a day come the end of August.

Which goes to show that predicting death rates, and even case numbers, is an inexact science, and such predictions should come with a health warning.

One figure which people should not be surprised by is the number of cases. One hundred thousand a day seems perfectly possible at the peak of a national epidemic. The real surprise will be if it comes in August, even before children return to school.

government's pandemic plan from November 2007This large "attack rate" of a pandemic virus is to be expected when so many are exposed to a new virus. The government's pandemic plan from November 2007 predicted (oops, there we go again) that 25% of the population might get infected. That's 15 million people.

The infection will probably come in a few waves spread over about two years. A daily rate of 100,000 infections would take you to 10 million people in 100 days. I'm not predicting that, just doing the maths. I certainly think it's too early to predict eventual death rates with any certainty.

What no-one has quite worked out yet is the number of people who are asymptomatic - that is, they have the virus in their system but show no (or few) signs of ill-health. This rate must be pretty high and it helps explain why the disease is spreading so quickly, because symptomless people are less careful when mixing with others. It's another reason why basic hygiene is crucial.

Let's stick then with what we do know. The majority of people so far infected have had a mild illness and recovered completely without the help of antiviral medicines. Some with swine flu will simply feel a bit grotty for a few days. For very many, uncomplicated swine flu will still be an unpleasant experience - laid low in bed with a sudden fever and cough.

Add to that a selection of the following: headache, aching limbs, lethargy, joint pain, diarrhoea, stomach upset, chills - I could go on. That still classifies as a mild illness, because after a few days in bed feeling awful, you get over it. Those with underlying health conditions and pregnant women are certainly at greater risk but they too should not be unduly alarmed, but vigilant for the symptoms.

And once again, as per medical advice, please turn down any invitations to swine flu parties (do they really exist?). It does not pay to expose yourself to this virus about which much is still unknown, and you could spread it to others who are less robust. Remember that about a quarter of the deaths so far in the US have been among people who had no health problems. I would prefer not to risk my health, but hold tight for the vaccine.


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  • 1. At 12:33pm on 03 Jul 2009, Sutara wrote:

    A daily rate of 100,000 infections, even if realised, isn't that huge a deal in light of the UK population currently being about 61 million

    And, presumably, the asymptomatic cases, those who have had 'almost' asymptomatic episodes and those who had a more unpleasant illness, will all have gained immunity. Now if the rate of asymptomatic cases is high, then that might put a hole in that 100,000 figure anyhow -i.e. some of that 100,000 might have immunity.

    But let's go with that figure and let's say the flu lasts for 10 days, then that would give a rate of about 1 million down with this flu on any one day or about 1.64 per cent of the popluation.

    A portion of those will be outwith the working population, so the 'absent from work' figure, at any one time, should be somewhat lower, although, it will be pushed upwards again by those taking time off work to care for sick children / other dependents.

    Yes, it IS all 'back of cigarette packet' stuff, but it gives some idea.

    Surely, most organisations can continue o.k. with a one to one-and-a-half percent additional absense rate?

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  • 2. At 12:41pm on 03 Jul 2009, wanderingeejit wrote:

    Interesting article Fergus.

    Not much mention of the vaccine though and whether there will be actually time/reason to distribute it. I understand it will be given to front line health workers as a priority then who knows...

    Just wondering what you thought of the Irish Goverments announcement that they have pre-ordered 7.7million doses of the vaccine. Enough to treat the population twice!

    Is it likely the UK will do similar or given the astronomical numbers predicted, will it be no longer worthwhile?

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  • 3. At 12:42pm on 03 Jul 2009, MajorGallagher wrote:

    Fergus, what I don't understand is you mention "a few waves spread over two years" but surely a vaccine will be available to the entire population within a few months so how would the two year timescale fit?

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  • 4. At 12:45pm on 03 Jul 2009, CuriousAddition wrote:

    I still find the whole "100,000 new cases a day by late August" rather far-fetched. If they had said "by November", I would find that much more easier to accept. But this current prediction is just utterly baffling.

    And why exactly are we affected more than any other place in Europe? The rest of Europe does not seem particularly affected by this virus and certainly not to the extent seen over here so far.

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  • 5. At 12:50pm on 03 Jul 2009, eledfan wrote:

    what seems to be obvious is that this has never been 'controlled' despite official announcements it has spread throughout the country despite controls that were in place.
    it seems to me that probably 1000s of people have already had it and not bothered to go to the doctors - we think we have had it here as had fever, chills fatigue, aches and bad cough but may be not - I guess we wont know until we do get it? and thats despite a good hygeine practise here

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  • 6. At 12:54pm on 03 Jul 2009, Drrokk wrote:

    I think your mortality rate is an underestimate if you are using the US figures. If you use the WHO's global figures, of 70000 confirmed cases and 300 deaths, the mortality figure is close to 0.5%, or 1 death per 200 cases. A lot more scary than 1 death per 7000 which you have quoted.

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  • 7. At 12:56pm on 03 Jul 2009, random_thought wrote:

    #4 CuriousAddition

    A couple of thoughts on why the disease has spread faster here than in the rest of Europe.

    1. A lot of British families took holidays in the US over half-term and brought the bug back with them. I suspect US holidays are more popular here than elsewhere, and I don't know if many other European countries have a concept of half-term. I can't help thinking that it would have been wise to have requested any children going to the US on holiday to take a week off school on their return - a bit late now though.

    2. Maybe this bug needs hotter, drier weather than your typical flu in order to kill it off, and the weather in the UK has just not been Hot and dry enough? In that case maybe the current heatwave might just have slowed it down a bit? Or maybe that's just wishful thinking.

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  • 8. At 1:31pm on 03 Jul 2009, shaunyh1 wrote:

    One of the interesting aspects of the pending acceleration in the number of cases of swine flu that I don't believe has been looked at, is the places where sufferers are likely to pass on the virus. The advice has been for schools to close for seven days if a case is confirmed and for patients with symptoms of swine flu to stay away from public places like hospitals etc. In effect we have been trying to isolate confirmed sufferers as best we can to prevent the spread of swine flu.

    The advice now as we move from a containment phase to a treatment phase, is that patients are being advised to self-treat in mild cases, taking to their beds and dosing themselves with paracetamol, aspirin or ibuprofen. As a pharmacist I am concerned that pharmacies could become one of the main locations where the virus is spread. It is estimated that 6 million people visit pharmacies every week, more than all the other health profession put together and now we are advising potential swine flu sufferers to visit their pharmacies!I don't have a solution to this potential problem but I do fear that as the virus spreads one of the groups most at risk to infection will be pharmacists and their teams and what inpact will this have on the supply of medicines across the UK?

    Shaun Hockey B Pharm (Hons) MRPharmS

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  • 9. At 2:00pm on 03 Jul 2009, niccodeamus wrote:

    the reported infection rate appears to be doubling every week. this would quite reasonably take the rate to over 100000/day, a classic exponential rise, by the end of august. This doesn't take into account natural immunity building in the population etc. but it is not an outlandish prediction. the existing data on the death rates has to be inconclusive as the sample is too small to be of statistical significance at the moment.

    what I find curious is this attempt to postpone infection for as long as possible. I understand the vaccine arrival can or might help many (if the strain has not mutated, and this may be an argument for containment or rapid release of vaccine) but surely it must be a better strategy to get the population infected and recovered before the weather deteriorates and the 'flu season begins. what is certain, is that the problem will be far worse in the winter months when general health is poorer and death rates from 'flu are at a seasonal high.

    The best strategy of all would be to vaccinate now and stop the disease before it has a chance to mutate, failing that, it must make sense to contract the disease while the elements and odds are in your favour.

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  • 10. At 2:52pm on 03 Jul 2009, Eveline van der Steen wrote:

    Can we please stop panicking? It's only flu, for Christ's sake.....

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  • 11. At 3:08pm on 03 Jul 2009, RuariJM wrote:

    As a matter of interest, how does the calculation methodology compare with The Lancet's methodology for deaths in Iraq? (Reports that have been rubbished by the government, of course, though scientifically rigorous).

    100,000 new cases a day by August does seem rather high - how is it arrived at?

    And is the death rate 1/200 as claimed above and the figures seem to bear out, or 1/7000?

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  • 12. At 3:18pm on 03 Jul 2009, Fergus Walsh (BBC) wrote:

    Thanks for all your comments.

    In response to 2. it's expected that people will need two jabs so the Irish government's contract for 7.7 million doses announced earlier this month should make better sense.

    MajorGallagher: we may have enough doses for half the UK population by the end of the year, but that still leaves 30 million people. The vaccine will be refused by many and is likely to be ineffective in some who opt for it.

    Furthermore, the virus may mutate - as all flu viruses do. That's the reason why a new seasonal flu jab is needed each year. So a new vaccine might be needed for winter 2010. So, all in all, there will be plenty of people in the community who can be infected a year from now.

    Comment 6. The WHO figures are a huge underestimate of cases because many countries are not testing their populations.

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  • 13. At 3:27pm on 03 Jul 2009, Sutara wrote:

    9. At 2:00pm on 03 Jul 2009, niccodeamus wrote:

    "... failing that, it must make sense to contract the disease while the elements and odds are in your favour."

    If you choose to have a swine flu party, there are two major problems. Once you are infected, you have little control over how you pass on the infection - unless you put yourself into an intensive isolation ward with everyone around you using barrier nursing techniques. So 1 person taking that choice might mean 2, or 5, or 12, or who knows how many other people infected who did not make that choice.

    The second problem is that you may consider yourself to be reasonably fit and o.k. and that the odds are in your favour, but you have no idea of how vulnerable some of those other might be - the odds might be very much against some of them.

    Many people go about their day to day business not giving away the fact that they are diabetic, or have well-controlled asthma, or have heart conditions or dozens and dozens of other underlying health problems.

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  • 14. At 3:46pm on 03 Jul 2009, Michael wrote:

    1) How are we in terms of stocks of antibiotics etc for complications? How about just paracetamol and children's pain relief?

    2) I note there is no discussion of hospitalisations - I suspect there is no where near the resource needed for the likely numbers needing respiratory support and even cannulation.

    3) The whole way through this outbreak there seems to have been very tight control of information to I assume avoid adding the risks of panic to that of the disease itself but this means the average individual has to do a lot of digging to get any feel of hat is going n (current exhibit A for this the stress on each death about the 'underlying health problems').

    4) A penultimate question, the emphasis on over 65s being less affected and thus there likely to be fewer deaths. Surely this group do not mix so frequently so any spread in to this community is likely to be slower than for school children (the peak age group impacted to date)?

    5) And a final question - is it not worth testing a statistically significant group of the population at large for resistance to get an understanding of how widespread the infection actually as and the real reporting, hospitalisation and mortality rates?

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  • 15. At 3:49pm on 03 Jul 2009, viviennemm wrote:

    I'm no mathematician, but surely this is a curve of some sort - exponential, perhaps? If we are going to be up to 100,000 new cases a day by the end of August, surely the curve will go on steepening? Maybe we'll all have had swine flu by Christmas. Can some numerate person assist?
    Even at 100,000 a day, we should all have had it in two years - 600 days.
    What I'm really waiting for is (bird flu + swine flu) = flying pig flu?

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  • 16. At 4:10pm on 03 Jul 2009, sciencemedia wrote:

    As always, a clear, calm and concise summary of the situation. Keep it up! :-)

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  • 17. At 4:12pm on 03 Jul 2009, Sutara wrote:

    15. At 3:49pm on 03 Jul 2009, viviennemm wrote:

    If we are going to be up to 100,000 new cases a day by the end of August, surely the curve will go on steepening?

    The clue is perhaps in the fact that once a person has had this flu - whether they know they have had it or not - they (generally) have a resistance to it. The second clue is that - so I am given to understand - a person is only infectious (in terms of spreading it to others) for about the same amount of time as they are unwell, which I understand is generally up to about 10 days maximum.

    Those being the case, a) you don't have an ever-increasing number of people infecting others and b) you do have an increasing number of people not getting infected, because they've already had it.

    Does that do some way to explain the logic?

    Basically, at 100,000 infections a day you would roughly have the same number of people per day ceasing to be unwell and ceasing to be infectious to others (see also my #1).

    So the number of people unwell with this flu at any one moment would probably peak at about 1 million (assuming they are unwell for a 10 day period).

    Similarly though, using the same assumptions, every ten days about another million people would become immune to the infection, by virtue of having already had it.

    That tends to reduce the infection rate until eventually there are no new people to infect.

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  • 18. At 5:10pm on 03 Jul 2009, sensiblegrannie wrote:

    I am more worried about the vaccine than the flu. At least with the flu I know roughly what to expect. More scary is the though of having a vaccine that, although going through 2 months of clinical trials, has no track record of safety yet. Now if we were talking about H5N1, that is a different story, I would want to be jabbed up to the eyeballs to protect me from that.

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  • 19. At 6:16pm on 03 Jul 2009, wooster2000 wrote:

    A very simple mathematical model of infection would go something like this:

    Let 'y' be the fraction of the population infected and 'r' represent the infection rate
    The value of y tomorrow will be given by
    r x y x ( 1 - y )
    The 'r x y' part alone would give you exponential growth in the fraction of the population infected. Since only uninfected people can become infected the factor
    ( 1 - y ) is introduced; this is the fraction of the population who are uninfected.

    This would lead to near-exponential growth in 'y' early on with a flattening out later on. This is sigmoid growth - it looks a bit like an S on its side.

    I've ignored all sorts of things here, for starters not everyone will be susceptible and if the government start vaccinating the equation would need to be revised.

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  • 20. At 6:23pm on 03 Jul 2009, 27weeks wrote:

    I am finding it increasingly frustrating that one day this virus is milder than seasonal flu and the next it is a medical emergency with reason to be concerned. Although everyone is potentially ' at risk ' it is continuously repeated that those with underlying medical conditions and pregnant women are at higher risk.. This may be helpful to those who actually write these comments - however as i suffer from asthma and i am also pregnant i am finding the whole thing terrifying! So if i am at ' high risk ' i would really appreciate being told how i am to be more vigilant? do i lock myself away? Positive and factual feedback welcome

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  • 21. At 6:45pm on 03 Jul 2009, BLT wrote:

    I agree with several of the above posts and there are a couple of issues I would like to mention.

    Firstly I do not understand how the UK is so badly affected compared to Europe in particular and many other countries worldwide with alomost as many cases as Mexico. We have TEN TIMES more cases reported than the next highest in Europe - how have they managed to keep their rates so low? We're an island for goodness sake which should give us much better control of who comes in with what illnesses. I can only asssume that it is not a coincidence that the two nations who within the first week of the virus starting to travel said that it could not be contained - the US and the UK - have some of highest infection rates.

    I still think that we can try to contain it outside of the hotspot areas but the UK government never has had the balls to try anything drastic. Other countries have and still are shutting schools for longer, closing badly infected areas etc. Oh the cost to the economy if businesses were required to close or if parents had to pay for childcare etc I hear them cry, but with so many people likely to get the flu what do they think the cost to the economy is going to be now!!!

    I can't help feeling that Britain has got it wrong somewhere along the line and is pretty badly off comparatively.

    Secondly, I agree that information is pretty tightly controlled and each unfortunate death or serious case is instantly linked with 'underlying health problems'. Does the government think that is reassuring - how many millions of people must there be out there with conditions, let alone those that don't even know they have them? Information for these groups on exactly what the risks are and where to get help is needed urgently.

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  • 22. At 7:13pm on 03 Jul 2009, 27weeks wrote:


    Couldn't agree with you more! I believe something has gone wrong somewhere as other european countries do seem to have the situation under control... I am finding it strange that we are in the middle of our summer season and the amount of people infected is extremely high whereas other countries in the southern hemisphere who are in their winter season have the same amount if not less cases than us! What's going on? I think it's about time we got some answers.. for god's sake the economy is suffering but arn't peoples lives and health alot more important than that.. At the end of the day yes we need money but i would prefer to have my health anyday!

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  • 23. At 7:15pm on 03 Jul 2009, wooster2000 wrote:

    The UK is a massive air travel hub with two of the busiest airports in the world. We also have one of the highest population densities in Europe. These two factors when combined with our relatively large population would lead to a larger number of predicted cases than our European neighbours.

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  • 24. At 8:01pm on 03 Jul 2009, niccodeamus wrote:

    in response to comment 13 , Sutara

    it is irrelevant who you pass the disease on to. more the merrier.
    my conjecture is that it is better to catch the disease while the weather and disease itself are mild, the consequences will be far better than having it go through the population in the winter when other health and environmental complications conspire to wreak far greater havoc.
    i am not considering my own health here, but that of the population as a whole. the logical call is to get it through the population now, in the summer, so when winter arrives, herd immunity provides protection.

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  • 25. At 11:14pm on 03 Jul 2009, George Hale wrote:

    40 deaths a day sounds scary - till you remember that about 1400 people die each and every day in Britain, and that's a historically low figure.

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  • 26. At 00:15am on 04 Jul 2009, Readza wrote:

    While swine flu may appear relatively mild in most cases, the real danger is not in the number of people who get infected per se, but the timing of when they get infected. Most people in the UK are susceptible to this new strain, so the attack rate (the proportion of people likely to be infected during this initial epidemic) is estimated to be about 30-40%. It may seem a good idea to support the notion of 'swine flu parties', but encouraging the spread of this infection will have the effect of bringing the peak of the epidemic forward and making it of greater magnitude. In other words, the date when this peak happens will be sooner and the number of people infected at once will be greater.

    The biggest real danger of this infection (and of course for all infections that are newly emerged and have pandemic potential, so most people have little or no immunity and can be infected) is that a lot of people could be sick and off work, all at the same time. Add to that those off work caring for dependents who get sick. Also, account somehow for those ill that can no longer care for dependents; who cares for them now? Worst case scenario for pandemic flu is that up to 25% of the workforce, in *all* sectors of employment, are off at once for a whole week, at the peak of an epidemic. This is flu afterall and not a mild cold. That's everyone: supermarket shelf stackers, delivery & distribution people, essential service maintainence staff, the armed forces, etc. Possible exceptions are heathcare workers as they're most likely to come into contact with infected people first and in greater number than the average person? They may have all got infected and recovered before the peak in the general population, ideally.

    Ok, I admit. This is a overly gloomy perspective, and ignores possible intervention and mitigation stragies, such as vaccination. However, the deliberate encouragement of the spread of this flu would only serve to make this scenario more likely. But Im all right Jack, eh?

    As an aside, theres lots of talk of swine flu parties, but how much is it based on reality? Anyone here been to one? Seriously contemplating one? When you actually have flu, would you really be in the mood for visitors, let alone a party??

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  • 27. At 10:35am on 04 Jul 2009, Barnaby_Dawson wrote:

    The calculation of the US case fatality rate in this post has a major error. The deaths reported in the USA are not an estimate of the total deaths. They are merely a count of those deaths that have been rigorously proven to have been caused by the new H1N1 strain and hence really a lower bound.

    If the same rule used to calculate the WHO confirmed death figures was used to estimate annual seasonal flu deaths in the USA the figure would be found (in error) to be about 2,000. As the true figure is closer to 36,000 this is not an insignificant error. The truth is that recognizing that a death was caused by the flu is very hard (for many reasons including a high level of background pneumonia deaths and many flu deaths resulting from secondary infections and complications more than a week after the initial infection).

    The likelihood is surely that many deaths caused by the new H1N1 strain are also being missed. The numerator in the calculation could be an underestimate by as much as a factor of 20. That would make the CFR more like 0.25%. Or the the factor error may be different here. The point is that mixing estimated figures with lower bound figures in a calculation will cause big errors and should be avoided.

    Further information on flu death estimation can be found at the CDC site:

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  • 28. At 1:07pm on 04 Jul 2009, mjseaman wrote:

    H1N1 Swine flu is spreading rapidly but (thankfully) the mortality rates are low.

    H5N1 Bird[*] flu (remember that?) never did spread very fast, but the mortality rates in people were much higher. Presumably Bird Flu is still as much of a risk as it ever was, but the media spotlight is (understandably) focused on the active pandemic so we hear nothing much about it.

    We know that a common mechanism for new diseases to emerge is inter-species transfer followed by rapid selection for human-to-human transmissible strains. An important factor in influenza is hybridization -- novel viruses generated when someone catches two different strains simultaneously and the genes in the different strains get shuffled together.

    Does widespread human infection with H1N1 make it that much more likely that H5N1
    strains could cross-infect people and so leap the species boundary? Could the admixture of genes from H5N1 make H1N1 a real killer?

    [*]Actually, calling it 'bird' flu makes as much sense as calling H1N1 'mammal' flu -- it's much more like H5N1 waterfowl and domestic poultry flu...

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  • 29. At 10:58am on 05 Jul 2009, rosienona wrote:

    A few weeks ago I estimated we could see a total of 6 million cases by the end of September and my sceptical family laughed at me!! I was simply doing the maths. I work for the NHS and if I am going to catch this....and let's face it I stand a good chance.........I want to get it sooner rather than later. My gut feeling is that this virus could cause all sorts of chaos! What do you think will happen with regards to travel, national and international, by the time this gets really widespread.....are there guidelines? Also the return to schools and Universities in the will that work?

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  • 30. At 7:55pm on 06 Jul 2009, BLT wrote:

    ENOUGH IS ENOUGH. It is about time the Government came clean about what its stock response to all the swine flu deaths has been - that they all had underlying health problems. SO DO MILLIONS OF PEOPLE. Sir Liam Donaldson blatantly ignored the question in his Q&A. I think we have a right to know in more detail what exactly these conditions were/are. Despite the fact that these poor people had underlying health conditions, they all contracted swine flu somehow - implying that they had contact with others probably outside of their homes. Therefore they were perhaps not so chronically unwell that they couldn't go out. This to me implies that the serious conditions are perhaps more common conditions that many people have not something that only a few people have as I think the government is hoping to imply.

    And this 'game' that the government us playing is pretty damn dangerous. Most people are not taking swine flu seriously. I went out at the weekend and people are coughing and sneezing everywhere. A woman I work with wanders around blowing her nose and touching all the office equipment - great. It is making people blazee and it is about time it stopped.

    As for the morons advocating swine flu parties - how utterly ignorant and selfish can you get?! Typical of most people unfortunately though. It's all 'as long as I'm alright' and 'what's best for me', never mind that you could pass it on to someone at much greater risk.

    I wonder how easy it would be for someone who did not attend a swine flu party to sue someone for holding one if they contracted it as a result.

    People have ben prosecuted for knowingly spreading contagious diseases......

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  • 31. At 8:53pm on 06 Jul 2009, luv_n_haight wrote:

    "The calculation of the US case fatality rate in this post has a major error. The deaths reported in the USA are not an estimate of the total deaths. They are merely a count of those deaths that have been rigorously proven to have been caused by the new H1N1 strain and hence really a lower bound."

    Well I don't know exactly how the US figures work, but the UK figures so far have included EVERY person who's died and had swine flu, because seriously ill people are being tested for it specifically. I can see how the number of deaths due to normal flu can easily be underestimated, but not so sure this definitely applies in the case of swine flu.

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  • 32. At 5:07pm on 09 Jul 2009, coldtoeschronic wrote:

    I think some very good points have been made about the lack of information on who is vulnerable. Yes, many people walk around with diabetes or asthma without revealing that to anyone. Who can be sure of whether our underlying condition, that we may have lived with all our lives, might make us vulnerable? If we have underlying infections or viruses, like herpes(cold sores), then that must be a key factor if we contract the H1N1 virus. I have been considering this issue of underlying infections in my blog

    There is also the question mentioned above;
    "Could the admixture of genes from H5N1 make H1N1 a real killer?" Well,possibly - it seems that H1N1 has been evolving from the 1918 flu and is connected to swine fever and bird flu. They are calling it a 'dynasty'. See this clear graphic from recent research published by the American National Institute of Allergy and Infectious Diseases:

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  • 33. At 00:19am on 10 Jul 2009, BarnabyDawson wrote:

    luv_n_haight: It may be true that there is more testing than normal. But its also true that the requirements for reporting a death from swine flu is stricter than that for seasonal flu.

    Furthermore many people who die from seasonal flu no longer have the virus in their system once they present to the NHS (flu causes many deaths via secondary infections and worsening existing conditions). In that case no test is going to detect the flu but it will still have been the real cause of death. If swine flu is similar then it may not make such a big difference that there is more testing going on than normal.

    Factors such as this may make a significant difference in our detections of deaths or they may not. But its foolish to assume they will without any empirical evidence for that assumption. In the past surveilance data has been essentially useless for death counts. Remember this a factor of 20 error not some little 10% error. Things may have changed enough to start using this data to make estimates but I for one am skeptical.

    Its certainly rubbish to claim that only X people have died based on this data as many are doing.

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  • 34. At 6:40pm on 11 Jul 2009, hollibobs1 wrote:

    last week a friend with swine flu stayed at our house for 1 night. within the following week all 5 of the people who live here were ill with swine flu, including a pregnant woman and also 7 friends who visited the house while he was here. out of the 11 new people infected only one rang NHS direct, none visited their GP, none stayed in quarantine and none took or were offered tamiflu. i also caught it. it has been defined in everyone by 1-2 days of high fever and sickness, and 4-5 days of coughing. it is the MOST contagious virus i have ever experienced. it does not surprise me in the slightest that 100,000 people a day might catch it by august.

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  • 35. At 08:36am on 17 Jul 2009, KNIGHT-DE-TEMPLAR wrote:

    I have read with obvious concern for both my own health and that of others as to the severe health risks we may all face.

    The predictions whether alarming or alarmist are without doubt a consequence of the ever rising number of cases and the increasing reports of related deaths.

    Some bloggers have questioned why we appear to have so many more cases per capita than other countries. I refer to blog 8 - where we catch it..

    This country has allowed the supermarkets to create in-house Pharmacies -encouraging the sick to shop in the same place that we buy our food. Surely there is a Health and welfare issue here that needs urgent redress.

    There is no sensibility in encouraging hundreds if not thousands to buy food in the same place as we treat the sick. Surely the policy of putting pharmacies in the place where hundreds congregate each day to buy their food will eventually lead to a new virus - spread faster and more deadlier than before.

    When I go into my local supermarket will I be bringing home the weekly shop - Or will I be bringing home an extra I didn't pay for? And then pay the penultimate price!

    I advocate that Pharmacists should return to the high street.

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  • 36. At 12:31pm on 17 Jul 2009, DavidShamash wrote:

    I am concerned that if we are suspected of having Swine Flu we will not be allowed to see a Doctor as Doctors are not prepared to risk being infected. Up to now Doctors visited people even if they had infectious diseases.

    I think it is very difficult to do a diagnoses over the phone for Swine Flu. It would be even more difficult for me as I have Asperger Syndrome.
    By the way I am very plesed that there is a Computer firm going to employ people with Autism.

    Not seeing patients who are suspected of having Swine Flu has two serious disadvantages.
    People will be staying at home with bad colds and that could close the UK down unnecessarily.

    The more important disadvantage is that some people who are suspected of having Swine Flu could have other diseases such as Pneumonia.
    The Medication on offer for people with Swine Flu would not help people with Pneumonia. Many people with Pneumonia would die if not taken to hospital.

    I wonder what they are going to do with people who live in the streets and catch Swine Flu.
    Will they be put in isolation hospitals which is the equivalent of Pest Houses which were used to quaranteen homeless plague victims in the olden days.
    David Shamash.

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