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The true scale of swine flu

Tom Feilden | 10:32 UK time, Wednesday, 1 July 2009

The official figure for the number of people who've contracted swine flu stands at 6,538.

But it seems increasingly likely that this "official statistic" significantly underestimates the true scale of the problem.

The figures are compiled by the Health Protection Agency, and are based on the number of laboratory confirmed cases - that's people who have undergone a swab-test for the virus that has proved positive for infection.

But if you ring your GP today and try to make an appointment complaining of flu-like symptoms, the chances are you'll be told to stay at home, try and get your fever down, and get some rest.

A man blowing his noseIn the vast majority of cases, where the infection is proving to be quite mild, that's good, sensible advice. It certainly helps to minimise the spread of infection around the doctor's surgery, but obviously if no test is conducted no report is forwarded to the Health Protection Agency and the case doesn't show up in the official statistics.

The result is that there's really no way to be sure exactly how many people have contracted the swine flu virus. Although it seems likely that the true scale of the epidemic is significantly higher than the official estimate.

So does that matter?

It should be stressed that in most cases a bout of swine flu seems to produce only mild illness - fever, fatigue, lack of appetite and coughing. In only a very small number of cases the symptoms have been more serious, requiring admission to hospital, and there have been three deaths across the UK.

Anyone experiencing more serious symptoms, including prolonged high fever, nausea and vomiting, or who may be in a high risk category or suffering from an underlying medical condition, is still being urged to seek medical attention.

But for most people it seems, a bout of swine flu may result in less serious illness than traditional seasonal flu.


  • Comment number 1.

    Your comments are exactly our experience!! My wife went down with a fever and cough quite suddenly last Thursday. Having read the information on the NHS website relating to the symptoms of I thought there was a reasonable chance of her having contracted it, though heaven knows where from - we don't live in one of the areas where infection is rife.

    NHS direct were more interested in fending off requests for Tamiflu, which she / we don't want anyway. Their website was useless, kept falling over.

    The GP, whom she called on Monday was most interested in ensuring she didn't visit the surgery, understandably, but nobody seems interested in establishing whether the illness is, or isn't the "dreaded" swine flu.

    Many others must have encountered similar experiences, so I would suggest, given the fragile state of the NHS Direct website at the weekend, that probably there are thousands dealing at home, themselves, with a minor infection - that has, in this case, lead to a pretty nasty cough at the tailend.

    I's still yet to be convinced that in it's current form, this isn't one enormous storm in a teacup. I for one would love to catch it now whilst it's mild, but sadly, I have yet to manage to - perhaps I'm immune!!

  • Comment number 2.

    My experience too. Husband and daughter have both had flu in recent weeks. Also had two friends who have had it. In each case, either didn't go to GP, or (in my husband's case), the GP insisted on talking on the phone and didn't carry out any tests.

    I have no idea on what basis they decide to carry out tests. It seems to me they must be vastly underestimating the incidence.

  • Comment number 3.

    The advice out there seems to be very scant, sometimes conflicting - and very unclear. It feels that the vagueness is almost intentional so as to prevent a run on Tamiflu.

    I've just had the same - one day fine, next day a number of the key symptoms all in one. We all know to take sensible precautions and take the appropriate remedies - but when you don't normally suffer from summer colds or hay fever, it seems reasonable to seek reassurance.

    I can't say that I was too reassured by the practice nurse that I spoke to who had to go and find the latest guidelines which still mentioned contact with those from affected countries. Aren't we one of the most affected countries in the statistics known?

    I do have a fear that the great british reluctance to 'make a fuss' will lead to older people suffering more as the information and advice can be conflicting and not easy to access.

  • Comment number 4.

    I think it's only fair. Maybe it's not the best solution for the statistics, but I think the virus would spread even faster if at the first symptoms, everybody went out to the doctor, coughing in the buses and sneezing in taxis and stuff. I've been told the exact same thing, and only this morning, when I woke up feeling like hell, with fever and a nasty cough. I think the idea is to encourage patients not to panic. The moment an ambulance rings your door, your mind is telling you you're ill.

  • Comment number 5.

    Yesterday we had to take our daughter, age 2, to the GP for coughing, fatigue, raised temperature and lack of appetite. Exactly the sort of symptoms that we are told we should be looking out for. We were told it was probably viral and sent home with a prescription for liquid paracetamol. There is to be no follow-up, swabs or blood tests. It could well be swine flu, but we will never know. And of course, my daughter won't feature in the official government statistics, not even as a possible case.

  • Comment number 6.

    I doubt very much if we are going to get another flu pandemic that (in most cases and so far) seems to have such mild symptoms. Surely there should be in place a procedure to send out swab kits so we can swab ourselves and send them to a lab for later analysis rather than being turned away by our GPs. The data I'm sure would be vitally important in assessing whether the containment measures have been effective or at least give a more accurate figure for the number and rate of infections. If there is to be a UK wide immunisation then perhaps a swab could be taken at the same time?

  • Comment number 7.

    The idea of an official statistic needs to be completely abandoned, at least in terms of what is reported to the public. No doubt an estimate of how many people infected is useful for health professionals and government officials trying to organise the dissemination of resources to areas hard hit by an outbreak (I could write for days on the uselessness of Tamiflu, given the fact it is useless after 48hours of a patient showing symptoms. In my experience, I only ever seek help having been ill for days, because I am confident in my immune systems ability to beat diseases. And yes I know about cytokine cascades, but the scientific understanding of when and how that happens in a person is not comprehensive enough for me to live in fear of dying of every disease I contract defeating my body.)

    It seems in this instance that the statistic is just being used as a futile way of reassuring the population that they are not facing imminent death. If there are only 5,000 confirmed cases, then the logic would state that it is unlikely you will get the virus. Of course, very few people are facing imminent death from H1N1. But that isn't because only a small portion of the population are carrying the illness. The statistic is well off the mark. I know this because when I rang NHS Direct to report the possibility of a pretty large outbreak at my University over the past week, the person didn't seem very interested in that. (In her defence she was concerned about my symptoms. The problem with that is, had I severe symptoms, I wouldn't be ringing the NHS Direct number to wait hours to speak to an adviser. I have not seen a doctor or been tested, but the friend I believe I caught the illness from is a lab-confirmed case.)

    I find it very odd that no where in the literature published about preventing flu, there isn't more emphasis on the importance of citizen nutrition in prevention. This should be at the forefront of people's minds (High Vit A, D, C and E, Omega 3, Zinc). Yes, it is important that people cough and sneeze into tissues, but a healthy population would have little to fear from this current outbreak. And before people point out that in Mexico it was previously healthy people who were dying, there is a massive difference between having no chronic or underlying medical issues to being genuinely healthy. This nation of binge drinkers, fast food eaters and fad dieters are set for a very tough winter, should there be a surge in cases.

  • Comment number 8.

    I was a little surprised to read your first statement as it contained no reference as to where the numbers applied. I gather that you are reporting for the UK. Interestingly, the substance of your comments applies equally to Canada. When looking at the data for Canada, remember Hospitals in the provinces report to soveriegn Provincial Governments who in turn voluntarily report to the Federal Government which cause delays. The geographic spread of Canada's 33 million inhabitants is a significant factor, as the UK land mass would fit into the province of Quebec, for example, about seven times.

    As of June 29, 2009, as reported by the Public Health Agency of Canada, a total of 7,983 laboratory-confirmed cases of H1N1 flu virus have been reported in all provinces and territories in Canada (see Table 1 below). To date, 538 hospitalizations and 25 deaths have been reported among laboratory-confirmed cases. (See: )

    Interestingly, it is the 20-30 year olds who seem to be having the most critical or severe reaction to the viral infection. And this is the age group who are only beginning to learn they are not invincible, who do not normally seek influenza vaccination even when it is made available at no charge. However, apparently intelligent they are, they have trouble connecting the dots when they do get influenza with the fact that they did not get a flu shot.

    I see little hope in slowing down the epidemic as I see no evidence that sick people are sufficiently knowledgeable about the mechanisms of spreading the virus, or responsible enough to isolate themselves. Instead, they are doing stupid things like taking public transportation to an emergency ward and thereby exposing themselves to 200 more people along the way.

  • Comment number 9.

    Near the begining of this outbreak a girl in my area brought swine flu back from Mexico. I use the same bus as the children from that school. 4 or 5 days later I had a mild flu come out - my first flu since 1976. I suspect this is not coincidence, but it was a very mild flu and didn't keep me off work even and mostly just made me shivery and have a blocked nose and sore throat. It was very highly contagous and everyone I worked with got it from me, but only one was ill enough to have time off work. It was after all, a very odd time of year to have mass flu infections! The one who was more ill was just told by her doctor that it was "a virus" and not tested, just advised to have a week off work.

  • Comment number 10.

    I am sorry, but I am scared stiff of Swine Flu,and I don't know why. I am 27, an insulin dependent diabetic with good control, my partner is 32, and has to use warfarin due to blood cloting and we have a 5 year old boy, who was born 2 months premature. Who are most at risk? They say certain people are, but is that me or mine? Why wasn't teh borders with Mexico closed when this first happened or why have the Government stopped closing schools when an outbreak occurs? While there are many deaths each year from seasonal flu, we don't have the panic as I suppose its expected. I suppose I am looking for reasureances from someone in the know?
    Please help- no sign of any flu like symthems here yet though :-)

  • Comment number 11.

    There is a very real possibility that swine flu might cross-mutate with avian flu at some point when they eventually meet up. Influenza viruses can mutate quickly and aggressively.Avian flu does not have a human component yet but might pick it up from swine flu.So far the deaths from swine flu have been minimal but the death rate for avian flu is 60%. If these two forms of flu "marry" they could produce a brand new type of flu.
    I have read reports that during the Spanish flu of 1918-1919 some individuals could die in two hours of contacting it.This flu started out mildly in the Spring and returned in a more deadly form in the autumn.
    I can see from many of the blogs I have read that many people think the present pandemic is a storm in a teacup. While no one knows for sure what will happen next I think we should not be dismissive or even scornful about the potential for a serious escalation of this disease.There are so many variables and unknowns in this equation that anyone who is looking for hard and fast answers to all their questions will be unlikely to find them.
    Being vigilant and being prepared for the worse makes a lot of sense.Presently I feel that the media is not sensationalising the issue and if anything they are showing a lot of restraint.
    Let us hope that with luck we dodge this scary bullet this time around.

  • Comment number 12.

    The figures posted by the HPA are meaningless. From the HPA's own website, they are a cumulative total for laboratory-confirmed cases. The figure of 6,538 was as of Tuesday, but it doesn't take into account all those people included in that count who have recovered, so the real figure is certain to be much lower than 6,500. But.....

    It also doesn't take into consideration all those people who have contracted the virus without confirmation of laboratory tests, nor those who have recovered.

    All in all, we have no idea of the *real* extent of swine flu in the UK. Better that incorrect and misleading figures are not published

  • Comment number 13.

    A VERY rough calculation for how many are actually infected might go something like this. USA reckons about 1 million have been infected. There have been about 150 deaths in the US, and 3 here. 150 divided by 3 is 50, 1 million divided by 50 is 20,000.

    20,000 probably isn't too bad an estimate; an expert recently said the true figure was at least double the published figures (currently about 7000).

  • Comment number 14.

    In its present form the H1N1 variant is rather mild. However, I think it's far too early for people to be suggesting that this whole incident is a storm in a tea cup. During previous pandemics, the virus has spread in waves. The first wave has tended to be less lethal than subsequent waves. This wave could be succeeded by a far more virile variant. For instance, the H1N1 version could mutate with the seasonal flu virus to produce a hybrid version. It was the second wave of the Spanish Flu pandemic which produced the most fatalities.

    Whilst people shouldn't be automatically alarmed by this, I think the "storm in the tea cup" mentality could prove problematic because it promotes an attitude whereby people think that they don't need to take precautionary measures.If we are presented with a far more virilant variant in a successive wave, then people might not be equipped to deal with it, which could result directly from their denial.

    We live in what is an essentially utilitarian society, the government will seek a balance between preventing the spread of the disease and preventing a mass panic. Mass panic has it its own deleterious consequences. If panic ensued, people could refuse to work which may lead to supply difficulties for essential products and services. Therefore the government has to be extremely careful when diseminating information relating to pandemic flu, especially with its choice of language. What one ought to bear in mind is that this information doesn't necessarily promote the best chance of survival at the level of the individual but the best chance of survival for the group.

    Presently this flu pandemic is mild but it might not remain that way. Do not panic, plan correctly, educate those around you, wash your hands frequently. You might want to be careful when handling money and using cash point, think about avoiding public phones and shared computers. If you do use them, clean them first. You may want to carry alcohol gel in your bag so you can clean your hands after using cash machines and after handling money or whenever you have come into contact with a surface or person, because the virus can stay alive on surfaces for many hours. There is good information out there form organisations like the Red Cross. Plan wisely but don't panic.


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