Number of cases continues to rise
At first glance, the latest weekly swine flu figures for England look worrisome. Cases are up by more than 50% and several hundred people are in hospital. Northern Ireland and Scotland (see below) have also seen big increases.
In England at least, look a bit closer and the overall picture is somewhat reassuring. Yes, cases are continuing to rise, but not at the rate we saw in July when there was a doubling of cases each week. That dramatic growth could still happen - and the trend is upwards - but we are well below the levels of flu in the community of three months ago. The biggest increases continue to be among school-age children.
Here are some of the main points from the weekly briefing of Sir Liam Donaldson, chief medical officer for England.
Figures for England:
• Estimated cases 14,000 - up from 9,000 the previous week
• School outbreaks since autumn term began - 79
• 39 of those in Yorkshire and Humber
• 286 people were in hospital with swine flu on 30 September
• 36 of those were in critical care
• Total number of swine flu related deaths so far in England - 72 - two more deaths in the past week
• Total deaths in the UK so far 84 (one in Wales, nine in Scotland and two in Northern Ireland)
Now for a few graphs.
Influenza-like illness: Weekly GP consultation rate England and Wales
It's the red line that you need to look at here. Yes, the rate is up on last week, but still way below that in July when it was above 150 per 100,000. So we are still in the foothills of the second peak of swine flu and should expect it to rise - at some point - way above 200 per 100,000 (see Northern Ireland below).
Age distribution of fully investigated deaths
Of the 84 deaths - the biggest proportion have been among the 16-44 age group, though there have been deaths among people of all ages. A quarter of the deaths have been among the over 65s - a much lower proportion than with seasonal flu.
Underlying conditions information for fully investigated deaths
This shows that around half the deaths have been among people with severe underlying health conditions (such as leukaemia). Around one in five of those who died had been entirely healthy.
A more detailed UK weekly epidemiology update can be found here.
Immunisation of the first at-risk groups is drawing nearer, but there is no firm date yet. Sir Liam Donaldson: "If everything goes well it will be in the second half of October but we are not tying ourselves to any date."
And a word of caution from the Department of Health's head of immunisation, Professor David Salisbury who made clear that the start date for immunisation depends on when they get sufficient supplies of vaccine:
"We have not got GSK vaccine in stock yet, but the critical step is the licensing step. There were delays in the initial production process but we've been assured that we'll have sufficient stocks for the priority groups. But we are dependent on the manufacturers to supply it."
I've written a lot about the technique called ECMO which involves adding oxygen to the blood outside the body. It's a treatment that is used for the most dangerously ill patients whose lung function has totally failed. The only adult unit is in Leicester and has five beds (which are also used for treating children).
Sir Liam said that an expert review led by Dr Judith Hulf has approved the doubling of capacity in Leicester. There are also paediatric ECMO units at three other UK hospitals which have a total of 10 beds between them. But it remains to be seen whether the doubling - to 10 beds - of capacity in Leicester, will be sufficient. That would make a total of 20 ECMO beds in the UK.
Australia, which has just gone through its first winter with swine flu, found ECMO to be a life-saver. At one stage there were 23 people on ECMO machines, most of them adults. Australia's population is around a third of that of the UK.
Swine flu cases in the rest of the UK
Northern Ireland now has the highest level of swine flu in the UK. Figures show that there has been a marked increase in cases every week since the schools went back. GP consultations for flu-like illnesses have reached 208 per 100,000.
The chief medical officer for Northern Ireland, Dr Michael McBride said:
"The number of contacts for flu-like illness made to GPs during this period has risen again over this last week, reaching the highest level for nine years. The rate remains highest in the 5-14 age group. Although, calls made to GPs Out of Hours for flu like illness have risen for the fourth week in a row, primary care services continue to cope well despite the increased demand on their services. The ongoing increase in swine flu activity suggests that we are in a second wave. This is something we are monitoring closely."The full weekly flu bulletin is available from the Department of Health, Social Services and Public Safety and NIDirect. Finally a note on swine flu cases in Scotland. The Scottish government released figures suggesting almost 14,000 people contracted swine flu in the past week. That's almost double the figure for the previous week, but may be partly due to a change in the way information is gathered.