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Keeping a sense of proportion about swine flu

Fergus Walsh | 14:14 UK time, Friday, 31 December 2010

Scary headlines about swine flu can risk distorting the real threat posed by the H1N1 virus. There also seems to be a collective amnesia among many in the media about previous coverage of the virus.

The plain facts are these. So far, 39 people are known to have died with flu since October, the vast majority being infected with the H1N1 virus. That compares with nearly 500 deaths in the 12 months following the arrival of swine flu in April 2009.

That means we have been here before. Remember the media focus on swine flu in Britain in July 2009? It was intense for a few weeks. Then it dropped away.

Strangely, there was comparatively little media interest in the story in autumn 2009, despite there being three times the number of people critically ill than in the summer. I get the impression that many felt we had done enough on swine flu. Indeed there was criticism in the media that the whole issue had been overblown.
Well here we are again.

One key difference now, and it is of concern, is the sharply higher numbers in intensive care. Figures for England show that there are more than 700 people critically ill with suspected flu. That is many times the number last winter. But the level of flu in the community is higher as well. Flu rates vary from year to year so it really should not come as a huge surprise.

About one in five critical care beds (intensive care and high dependency) is taken up with flu cases, but the number of beds could be nearly doubled if necessary.

Dr Bob Winter, president of the Intensive Care Society said: "The majority of those we are seeing in critical care are either pregnant women, people who are overweight - usually spectacularly so, and those with underlying health conditions.

It is easier for us to cope with a big flu outbreak over Christmas and New Year than at any other time. This is because there is less elective (planned) surgery, such as big cancer operations. These account for many of those who are cared for in critical care and these operations do not usually happen at this time of year. So we are under pressure but we are coping."

Several thousand people a year die from the complications of flu, but in the past it was mostly the elderly and infirm. Since the advent of swine flu that changed. Of the 39 people to have died since October, all but one were under 65 and four were under the age of five.

That makes immunisation of at-risk groups, especially those under 65, extremely important.

Twenty-three of those who died were in an at-risk group for vaccination. The Health Protection Agency says where vaccination status is known of those who died, two out of 33 people had received their jab. Last year's pandemic vaccine was received by one person out of 30.

Last night the Joint Committee on Vaccination and Immunisation (JCVI) said it did not believe that healthy children under five should be given the flu vaccine.

Professor Andrew Hall, chairman of the JCVI said: "The committee considered the issue of offering vaccination to healthy children either 0-4 years and/or 5-15 years of age. However, although there is a high incidence of influenza-like illness currently in these age groups, a significant proportion of this is due to other viruses such as Respiratory Syncytial Virus (RSV). In addition, only a very small proportion of those with severe disease are in these age groups. Based on previous seasonal influenza epidemiology, it would be hoped that influenza circulation will have subsided within a month.

We do not believe that seasonal or pandemic vaccine should be used for these or other healthy person groups. The greatest gain will be achieved in increasing vaccine uptake in the clinical risk groups."

The JCVI urged those with chronic respiratory, neurological, heart and kidney disease, diabetes, the immunosuppressed and pregnant women to get immunised.

What about the rest of the population? Swine flu can strike down, and even kill healthy people - this was demonstrated last year. Fifteen of those who have died since October were not in at-risk groups. Just as in previous winters, flu jabs are available from large pharmacies for those who want to protect themselves from the virus.

But - and I feel like a scratched record here - the majority who get infected with swine flu (other strains are circulating too) will have an unpleasant illness which will resolve itself after a few days in bed, with plenty of fluids and if appropriate, some paracetamol. Another huge group who catch swine flu will show no symptoms at all - lucky them.

So it is worth keeping a sense of proportion about influenza. It has never been something to dismiss as trivial. But it is a sad fact that every winter some people do get seriously ill and even die after catching flu.

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