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BBC BLOGS - Newsnight: Susan Watts

Are swine flu parties a good idea?

Susan Watts | 17:38 UK time, Tuesday, 30 June 2009

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A lot of people have been asking me about "swine flu parties"... are they a good idea, or not?

Well at risk of giving credence to what is probably now more than an urban myth, the official line is a resounding "no, no, no - a very bad idea".

But let's look at the logic here.

From parents' point of view, perhaps with a couple of children in local schools, it might make sense that they would prefer their children to catch the virus now, when it is arguably easier to cope with than in the coming autumn and winter when it will certainly be more miserable to be ill; local healthcare resources are more likely to be swamped as numbers of infections rise; and the virus could have changed to become more dangerous.

And many experts agree that even if the virus alters between now and then, those who catch it earlier will develop some immunity to whatever comes later.

But these same experts are having to balance that narrow logic against broader public health concerns.

And on balance, they say, the greater public good still weighs heaviest.

They might concede that most children who catch H1N1 may get over it after just a couple of days of a slight fever, a sore throat and aches and pains - easily sorted out with a few doses of pain killers and some early nights.

But, for vulnerable groups flu is still a killer, and so is this new one.

Friends of those infected at a swine flu party might have asthma, or grandparents unlucky enough to catch the virus - even though their age groups has some immunity from similar viruses circulating a few decades ago.

And asthmatics and older people who DO catch this flu have a higher chance of a severe illness - and complications.

And by seeking out infection, rather than sticking to the wash your hands, "Catch it, Kill it, Bin it" routine, the fear is that the numbers of infections could, as one expert put it to me today "go large" over the summer .

Statistically, having a larger number of infections around raises the likelihood of seeing more really serious cases.

And that is what the government wants to avoid.

In fact Sir Liam Donaldson, the government's chief medical adviser, was candid last week when he said that the whole strategy of containing the spread in areas least affected, and managing it in areas with widespread transmission, is designed to buy time until there is a vaccine in place to boost the immunity of the rest of us - the "herd" - and dampen down the whole bell curve shape of this pandemic.

The driving thought here is that the fewer infections we see overall, the smaller the impact on public services, and the economy as a whole... and an NHS better able to help those with serious complications.

So whilst there is an inarguable internal logic to the position that for some individuals it might be better to catch this new flu now than later, it may not be better for the UK population as a whole.

And as for that logically-minded parent - perhaps it makes sense not to actively seek out infection (even if the mythical swine flu party actually exists), but instead to take news of cases at their child's school with a common sense shrug of the shoulders.

It might also help not to rush around demanding Tamiflu, the anti-viral drug, unless of course they have concerns about asthma or other long term conditions in their offspring.

This was underlined last night with reports that a patient in Denmark has developed resistance to Tamiflu. Though he has now fully recovered, this could mark the start of a significant change in the new H1N1 virus.

What happens in the next few days will be key.

This case could be a one-off, with no further cases in the community. Or, Danish authorities, who will by now no doubt be scrutinising patients closely, could report more cases.

In that situation we could be witnessing the beginning of what many scientists have long described as inevitable - the emergence of a Tamiflu-resistant strain of the 2009 pandemic virus, and the chance that it will become the dominant strain.

Of course this may not happen. Often in the past, viruses that develop resistance to Tamiflu have also been weaker specimens, fizzling out before they become widespread.

But last year a group of H1N1 viruses emerged that were not only resistant to Tamiflu, but showed no compromised abilities.

One interesting concern crossed my radar last night. I hear that Health Protection Agency staff are getting reports of "pack-splitting" of Tamiflu by parents at schools where the drug has been given out to classmates as a prophylaxis.

Hard to guess at the reasoning, but perhaps the aim was to treat two siblings, when only one was given a packet of the drug, or perhaps to treat a child with half the dose now, saving the rest for the winter months.

It is worrying the authorities because it is just the sort of approach that can allow resistance to Tamiflu to develop.

They still hope that we won't see widespread Tamiflu resistance before the autumn, and a vaccine on offer.

If we do, then they will have the alternative drug, Relenza, to hand. Though questions remain about whether we have enough of this drug in the UK stockpile.

Flu vaccine dilemmas

Susan Watts | 15:33 UK time, Friday, 26 June 2009

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My on-air "swine flu" update was trimmed back last night. Reports of Michael Jackson's heart attack and possible death were beginning to filter through the news ether just as Newsnight went on air. So here's the bit I didn't have time to say.

It's about the vaccine against this new flu virus, which the government sees as its most powerful weapon in holding back a potentially overwhelming tide of infections - whether mild or severe. The Health Secretary, Andy Burnham, yesterday confirmed that the Government has contracts with Glaxo SmithKline and Baxter for vaccine for the whole UK population, and that some of this will arrive as early as August.

But in the very next breath we learned that only 60 million of the 120 million doses on order will be ready by this winter. At the estimated two doses apiece to provide protection, that's enough for only half of the UK population. I think many people are expecting a vaccine out there sometime soon with their name on it, should they want it. That will not now be the case for everyone.

It may be that trials show some people gain protection from only one dose, so it's possible there may be more doses to go around. But the Government is clearly going to have to decide who gets the vaccine first, as it comes off the production line. That judgment's a fine balance between the needs of the individual against those of the public at large. High-risk groups such as those with asthma, diabetes or suppressed immune systems, for example, have a strong case for early vaccination. But there's also logic in early vaccination for children, because they're notorious "super spreaders" of influenza.

Sir Liam Donaldson, the Chief Medical Officer for England, made it sound as if this was all part of the master plan, pointing out that pandemics typically last two to three years, so we're going to need vaccine stock in subsequent years. The public may not see it like that if we really do reach the tens of thousands of cases a week he's predicting for this autumn and winter, especially if the virus changes in a way that makes it more dangerous.

As Margaret Chan, director general of the World Health Organization, reminded us at the start of all this, flu viruses are notoriously unpredictable, and can change rapidly. One piece of news I was told last night is typically ambiguous. Flu specialists in the US now estimate that as many as 30 to 40 per cent of infections may be completely symptom-free. Good news if you happen to be one of those with such a mild response, but tricky for scientists trying to track and model the spread of infections to help officials who are planning ahead.

Scientists learn more about this virus every day, and plans put in place assuming the pandemic virus would resemble H5N1 "Bird flu", with its 60% mortality, are having to evolve. So what may appear to many of us to be policy-making on the hoof, could turn out to be common-sense tweaking as the world tries to make sense of who's getting infected, and how badly.

Possible unease over climate model stretching

Susan Watts | 11:24 UK time, Thursday, 18 June 2009

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There is a big government launch on Thursday of research showing the possible impacts of climate change here in the UK, looking out towards the end of the century.

It is Environment Secretary Hilary Benn's day. His aim is to show us all what might lay ahead for our children, depending on how successful we are at cutting back greenhouse gas emissions.

Some might say to "worry" us into changing our behaviour.

This is an update on similar research from seven years ago, both spearheaded by the Hadley Centre's climate change team.

This time round there will be an interactive website for consumers, so we can all find out about the likely warmer, wetter winters or hotter, drier summers where we live.

The scientists have apparently divided up the UK into a grid of 25km (16 mile) squares.

The only trouble is that by offering up such a fine grid as this, instead of the region-by-region break down of 2002, there is necessarily less certainty about the changes that might be felt in each square.

The head of climate change at the Hadley Centre, Vicky Pope, tells me this larger uncertainty is "reflected" in the results.

She may find she struggles to get this across later on Thursday.

She told me the grid is designed to help satisfy "users", such as insurers who deal in say the risk of extra flooding, or local planners deciding where to build schools and hospitals.

But she also concedes that using climate models in this way necessarily stretches them as far as they can: "so there will be some unease", she says.

There may be even more unease tomorrow, when the Environment Agency publishes its strategy on current flood risks, and what it is going to cost to cope with climate change.

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