BBC BLOGS - Newsnight: Susan Watts

Archives for April 2009

Experts say swine flu picture is 'classic'

Susan Watts | 09:00 UK time, Thursday, 30 April 2009

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It feels as if this is all moving very fast. But the experts tell me that the way the swine flu picture is unfolding is "classic", with all the signs of the pandemic they've been expecting for years now.

Within the space of a few days the virus has spread rapidly, from a few cases in Mexico to worldwide infections. New countries join the list daily. In less than a week this virus has become sufficiently threatening for the World Health Organization (WHO) to move us all, last night, onto pandemic threat level five. That means a "strong signal that a pandemic is imminent".

Compare that with the years we've all spent pondering the H5N1 bird flu virus, as it moved through bird populations, then to people. This virus is "already worse than H5N1", according to Dr Alan Hay of the Influenza Centre in Mill Hill, one of the WHO's four main laboratories, it may not yet be as lethal yet, but it is spreading far faster.

Last night, hers was the voice we did not want to hear - Margaret Chan of the WHO told us in no uncertain terms: "All countries now should immediately activate their pandemic preparedness plans".

There are still a lot of unknowns. The number of infections that might eventually be linked to this virus is impossible to predict. In an average year, with seasonal flu, 2,500 Europeans will be infected. We still can't tell if this virus will cause fewer infections than this, or more - perhaps tens of thousands more.

And we don't know if the infection will become embedded here in the UK - it may not. All we know now is that 80 people are being tested, and we have five cases confirmed. For the time being, all are linked to travel from Mexico - that's a good sign because it indicates that so far there's been no spread from person to person in the UK.

Swine flu - which might not be called that for much longer - for this is now a human disease - will run its course, and scientists here and around the world will learn more about how fast it can spread, how lethal it can be and more about its chances of perhaps changing as it spreads - to become more, or less, dangerous.

But there's a problem with all that. As one of the UK's leading flu experts put it to me: "We'll understand what's happening - but it will already be happening".

The beginning of a pandemic?

Susan Watts | 09:23 UK time, Monday, 27 April 2009

The Health Protection Agency now says it only a matter of time before the first cases of the new strain of swine flu are confirmed here.

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It feels as though the world could be on the brink of something momentous, but no one dare quite imagine that.

It was a little eerie yesterday, as everybody continued to go about their weekend, with the whispered threat of a flu pandemic in the background... The vibes from the experts aren't good. I spoke to Dr John MacCauley, a virologist at the World Influenza Centre in Mill Hill.

His visions of a possible future are some of the darkest.

Remembering, of course, that there are always reasons why such "possible" scenarios might never play out, what he had to say after catching up with colleagues working on the new virus was unnerving. The fact that this virus is showing pretty efficient human-to-human transmission is what worries him.

"I suspect this is what the beginning of a pandemic looks like".

We discussed the WHO pandemic-alert levels - 1 to 6. The world is already sitting at threat level 3 as a result of the H5N1 bird flu that we've come to know (sporadic cases or small clusters of disease in people, but no sustained human-to-human transmission). Tomorrow, the WHO is expected to reassess that level, with the arrival of this Swine Flu virus.

At the weekend it was thought that might rise to 4, but Dr MacCauley thinks the world is already at 5 (human-to-human spread of the virus into at least two countries in one WHO region). Might sound technical, but what that actually means, according to the WHO check list, is a "strong signal that a pandemic is imminent".

Certainly, governments are beginning to react as if that's a possibility. Yesterday, the US mobilised a quarter of its stockpile of anti viral medicines. Dr MacCauley expects we'll do the same here soon.

He talks in unnerving terms about the numbers of "excess deaths". What does that mean?

"It could be anywhere between one million and 50 million. I couldn't really place it along that line."

His laboratory expects to receive samples tomorrow from the US Centers for Disease Control - so that it can create a swift diagnostic kit, learn more about the genetic make up of the new virus, and advise on a possible vaccine.

So are there reasons to be cheerful?

Some. The UK is home to some of the world's leading experts on influenza, and has one of the best pandemic preparedness plans in the world.

The virus appears to be causing only mild symptoms, so far, outside of Mexico. Some of us may have some protection from this new virus because similar H1N1 viruses have circulated in recent decades.

Experts concerned about potential flu pandemic

Susan Watts | 18:00 UK time, Saturday, 25 April 2009

Experts are clearly extremely concerned about the new swine flu virus which the World Health Organisation warned today has the potential to cause a pandemic.

The virus has killed at least 60 people in Mexico and appears to have infected more than 1,000. The same virus also appears to be behind infections in Texas and California, with suspected cases reportedly being tested in New York.

Dr Alan Hay, director of the World Influenza Centre in London, told me this afternoon that we must take this seriously: "It looks pretty ominous, one has to say. It's difficult to look on the bright side at the moment." He stressed, though, that it's still early days, there's a lot we don't know and he doesn't want to be alarmist.

What's most worrying is that this new virus is affecting young, healthy adults - the same group affected by the pandemic flu virus of 1918. Those usually vulnerable to flu, the elderly and the very young, were at less risk then and, it appears, now.

According to Dr Hay this is key in trying to assess the likelihood of this virus causing a pandemic: "That was the unusual feature about 1918, it was the healthy young adults that suffered most... and I think everybody understands the implications," he said.

He described the situation in Mexico as "totally different" from the intermittent cases of H5N1 bird flu among people, because it appears to be spreading so fast. Sporadic bird flu infections in people have alerted the world to the possibility of a pandemic, but Dr Hay said this H1 swine flu virus is "already worse than H5", in terms of "the number of cases, the number of deaths and the locality of the area affected...This isn't sporadic, this is human".

Dr Hay stressed that it may turn out that the situation is less alarming than it appears now, but this will be hard to assess until experts know clinical details of the cases in Mexico, such as the length of time from infection to death.

Dr Hay's laboratory in north London expects to receive samples from the new cases next week, via the US Centers for Disease Control. His team can then help to advise on the best possible vaccine. Already, his team and others around the world are working on a fast diagnostic test so that labs likely to see new cases can confirm whether or not people have the virus, as soon as possible. Speed will be of the essence in containing infections.

There are eight genes in the flu virus. According to Dr Hay, this new one has six genes from swine flu viruses already known to have been circulating in the US, and two from swine flu viruses from Europe and Asia. The US swine flu virus genes in this new virus are themselves mixtures of swine flu, bird flu and human flu viruses - what's described as a classic "re-assortment" - a combination feared most by those watching for a flu pandemic. Experts around the world have been warning for years that this is inevitable. The last pandemic was in 1968 and killed around a million people worldwide.

The next few days and weeks will be crucial. One possibly hopeful sign is that of the eight cases in the US there has been only one hospitalisation, and no deaths. So it may turn out that there is some other kind of infection at work in Mexico, as well as the new flu virus.

When will the government respond to blood inquiry?

Susan Watts | 14:12 UK time, Friday, 24 April 2009

Yesterday, as the furore of the Budget entered its second day, a quieter debate was taking place in the House of Lords.

This was on the infection of thousands, haemophiliacs and others, with Hepatitis C and HIV from the NHS blood products used to treat them in the 1970s and 80s.

It's nine weeks since Lord Archer of Sandwell published his thorough examination of this terrible saga, why it happened and what can stop it happening again. The government has yet to respond.

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There were several powerful speakers. All implored the government to accept Lord Archer's recommendations - aimed primarily at redressing years of financial hardship among the families involved, and measures to avoid repeating the same mistakes.

Lord Rooker left the strongest mark: "Governments are judged in some ways on the big issues of the day - yesterday's Budget is a good example - but they are also judged in people's hearts and minds and, in the minds of opinion-formers, by the smaller matters of how they deal with people who cannot help themselves. There may be 100 people here, 50 there, 1,000 there, whose lives are devastated and harmed because of the state doing its function."

Lord Morris of Manchester secured yesterday's Lords debate, and was the prime impetus behind Lord Archer's inquiry. He's been a lifelong champion of the disabled and disaffected, taking on issues from Thalidomide to autism to dyslexia.

He commended the campaigners seeking redress for those infected by contaminated blood. He said that in none of his parliamentary campaigns had he felt so strongly that such campaigning should not have been necessary, describing haemophiliacs and their families as "a small and stricken community for whom acquaintance with grief, recurrent and abject grief, is an inescapable fact of life".

He read out Lord Archer's conclusion that Crown immunity had "rescued" NHS organisations from taking responsibility for their part in the tragedy. Since Crown immunity no longer exists, he argued, it's time for this government to review the claims of the victims. Those affected have received some payment. But this was described yesterday, again by Lord Rooker, as "a pittance". In many cases it amounts to roughly the same as the £24,000 second home allowance for MPs.

Successive governments have refused a public inquiry, Lord Morris said, leaving haemophiliacs with no hope of independent assessment until Lord Archer's report. Yet the Canadian and Irish Governments have found ways of compensating victims by "more than anything even contemplated by ministers for NHS-infected patients here".

Yesterday's speakers seek: a statutory committee to advise the government on issues of concern to haemophiliacs; proper financial recognition of their need; an end to the injustices in today's complicated system of ad-hoc payments and funds to support the work of the Haemophila Society. Many want an apology.

And then there's the question of protecting today's blood supply, from infections we already know about - such as vCJD - and infections we have yet to identify. Already one haemophiliac was recently confirmed, post mortem, as having contracted vCJD.

Baroness Thornton, speaking for the government, said it is still reviewing the use of a blood test to help protect the supply in the first place, and possibly filters to remove the prion infectious agent from donated blood. She seemed genuinely embarrassed that she was not able to respond in this debate to the detail of Lord Archer's recommendations, though she went out of her way to stress that they are being taken seriously by government.

Over the past two years, campaigners, and Lord Archer's team, have had to wrestle documents out of the Department of Health - vital evidence for the inquiry. Baroness Thornton apologised yesterday for the department's poor record keeping, and said this was all just the beginning of a process of accountability for the government. It's not the end for the campaigners either.

Baroness Thornton concluded, on behalf of the government, by saying ".... how sorry we are and how much we regret the events that resulted in the tragic outcomes for their families".

This won't be enough for Lord Corbett of Castle Vale. He had earlier referred to a former constituent, Sue Threakall, whose husband died at the age of 47 in 1991, having been infected by HIV and hepatitis B and C in 1977.

"Mrs Threakall does not want sympathy; she finds it offensive. She wants relief from the shattering poverty to which she is condemned because her breadwinner husband, Bob Threakall, who was given dirty blood, died on the wrong date in the wrong country. "
Lord Rooker reminded us all of the role of governments yesterday, and how, in the end, they're judged:

"The question is how they react when the small people are damaged by them - how they handle not the big financial and industrial issues of the day, but these issues."

So how will this Government react?

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