The risks relating to pregnancy
I'm going to talk here about the risks associated with getting H1N1 swine flu during pregnancy. Although it's not been officially confirmed, it's understood that the first person with H1N1 swine flu to die in Britain was a 38-year-old mother who had given birth prematurely.
The patient, who has not yet been named, was admitted to hospital with swine flu and gave birth earlier this month to a premature baby. The child was born at 29 weeks gestation.
Few details have yet been confirmed by the Scottish authorities; they have so far said only that the patient had "underlying health conditions". Her death is very sad news, and everyone's thoughts must be with her family, friends and the medical staff who cared for her.
Before I go on to discuss the elevated risks of swine flu associated with pregnancy, it's important to stress, as I do repeatedly, that the vast majority of people who contract this virus have a mild disease which lasts a few days. Many will have no symptoms at all.
The official figure for the UK is 1,261 cases and this is the first death. But there will have been hundreds - maybe many thousands - of cases which have gone unrecorded. So instead of being one death in 1,261 cases, it is undoubtedly a lot less than that.
With around 700,000 babies born in the UK each year, I know that many women and their partners will be concerned. So please be reassured that the vast majority of pregnant women who get infected will be okay, as will their unborn children.
Having put all those caveats in place, it is true that pregnancy is a risk factor for swine flu.
The director general of the World Health Organization, Margaret Chan, had this to say about pregnancy last week, in her speech declaring a flu pandemic:
"Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups."But remember that pregnancy is also a risk factor for seasonal flu, especially in the last trimester. Flu poses a threat both to the mother and to the unborn child. Among the complications, the fever associated with flu can lead to a premature delivery. Health advisers recommended three years ago that pregnant women should be among the groups offered a seasonal flu jab.
When a vaccine for H1N1 swine flu becomes available in the autumn, pregnant women may well be among the first "at risk" groups offered the jab.
What about antiviral drugs and pregnancy? During pregnancy, the concern with any drug is that it may pass through the placenta and affect the baby. There is a risk factor especially during the first trimester.
Oseltamivir (currently best known as the brand name Tamiflu) is not usually recommended for pregnant women because the side-effects are unknown. But the lesser-known inhaled drug Relenza (a brand name for zanamivir) can be prescribed on medical advice, according to the Department of Health.
The NHS website has this to say:
"An expert group reviewed the risk of antiviral treatment in pregnancy, which is extremely small - much smaller than the risk posed by the symptoms of swine flu."
There are more details on pregnancy and swine flu on the government health pages.
I'm 
© MMIX~RS~q~RS~~RS~z~RS~20~RS~)
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Give pregnant women massive priority. The health authorities are dealing with two people, not one. Pregnancy and childbirth is a high risk time all of the time. If it is unwise to give certain antiviral drugs to pregnant women then it stands to reason, to reduce unnecessary contact with the rest of us until such time as the baby is born. We can reduce the risk to pregnant mums by keeping well away if we have been in contact with or have this new flu.
Shopping for food online is a bit safer than the weekly scrum in the supermarket. Get someone else to do the supermarket run. Anti natal appointments could be run from an alternative location away from the germ ridden doctors surgery. Luckily, most hospitals for childbirth are set apart from the general hospitals. Home deliveries are risky at the best of times and should not be an alternative for safe hospital delivery, where specialists are always at hand.
Pregnant mums may already have a toddler at the local nursery, playgroup or school. Other mums could reduce the risk of flu contact, by making sure their own children do not have symptoms of flu or other infectious diseases before sending them of to school each morning. It only takes two minutes to check a temperature. Schools and nurseries could be more pro-active and less politically correct and simply refuse to allow a child to attend if they are obviously ill. The temptation will be, to allow a child back to nursery before the child has got over the infectious stage, if the child appears apparently well.
Don't forget, if you knowingly take risks, you risk the health of others.
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Fergus,
Well done.
That's the first time - as far as I'm aware - that anyone from government, or any journalist, has actually admitted that there may well be a significant difference between the 'official' figure and the real figure of infections.
Now, as has already been stated on these blogs, the official figure is the number of reported and confirmed cases - and it may be relevant to consider that some, perhaps even many, of these persons have recovered from the infection and would no longer be an infection risk to others.
So in terms of people assessing how likely it is that they will come into direct or indirect contact with an infectious person and thereby risk becoming infected - these figures are particularly useless in many respects.
And isn't that really what people want some idea about? The risk to them?
In fact, I almost wonder why the government is bothering to constantly publish these figures and the media report them!
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Well, not even all newspapers today mentioned that the woman was pregnant when she contracted the virus, let alone that she gave birth to premature baby before passing away days later. There is very little information about the virus and pregnant women in general, and I notice that even though there is a lot of data already collected by WHO about the cases (and disproportinately high number of cases involving pregnant women) the official documents regarding the virus have not been updated since they were first issued. It is appalling that only with the first lethal case some more information is siphoning through the media, though barely adequate.
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Here is an idea to chew on.
A mad, random, scientific idea is that bacteria make the rain fall. The info is on the BBC site today and is on radio 4 tonight at 9 pm. As a child, when it rained, I was always told to wear a rain mac, dry my hair thoroughly, take an umbrella with me or I 'would catch my death of cold' if I got wet in the rain. It always used to puzzle me because the same restrictions were not in place when I went to the beach and enjoyed bathing in the sea.
Are viruses able to temporarily host on the bacteria that 'seed' the rain and possibly make rain fall?
It is interesting, because if bacteria can alter the temperature that rain freezes, then it might explain why antifreeze works or why salt prevents water freezing at zero. The bacteria are being killed or attenuated by the salt and alcohol.
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Fergus, I would echo Sutara's comment above.
Far more relevant than the historic number of recorded cases is the number of recent cases within any geography. It may be, for example, that H1N1 has practically died out in some regions or countries that have previously reported cases, but we the public, can't tell.
Could the BBC please issue a revised map of cases within the past 10 days, or some medically relevant period? It can't be that difficult to produce based on the statistics published already.
Duncan
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The double tragedy has moved me to tears this morning. My deepest condolences for the family and friends.
At the end of the day, people matter, not maps, not numbers, not who is right and who is wrong, just people.
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sensibleoldgrannie
I completely agree that this family now has to try to come to terms with an especially tragic situation, at a time when they expected to be celebrating the baby's arrival home.
And it is because people matter that many just want some clear idea about the risks involved, presented to them in a straight-forward way, neither hyped up, nor dumbed down.
In the final analysis most people want to be self-determining and want the information so that they themselves can "manage" the risks involved to the best of their ability.
Unfortunately, probably for a whole number of reasons including the operational cultures of Health Trusts and civil servants, the information being published isn't actually particularly helpful to the metaphorical man on the Clapham omnibus.
People don't want "command and control" from the authorities, they just want clear useful informaton.
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Additionally, they want to understand basic things like how long people are infectious for, so that they don't accidentally endanger themselves or those near and dear to them - especially if that would involve anyone from a 'high-risk' group.
You know, most of the decision-making that will make most difference to managing this outbreak, won't be done by doctors, nurses, or a government Health Secretary, it will be done by ordinary people in homes, offices, shops, etc., up and down the country.
At risk of sounding cynical, the authorities have lost control of this infection, so it's time to empower the ordinary people to deal with it the best they can. Knowledge is power.
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Sutara, I understand your concern about incubation and infection times. I am not an expert on this matter but I have information about flu types in general.
My information is from a published source, not intended for the general public but for health agency workers in the field.
Normal flu has an incubation time of about 2 days which can stretch out from 1-4 days. A new flu like H1N1 may behave differently and could range from 2-5 days, possibly 8, who knows?
Infection time for normal flu is up to 5 days in adults and stretching out to about 10 days in children. Again, this is all depending on circumstances.
It has been known for flu to last from 2-3 weeks, but that would be an exception and not the rule.
How do you package that information into a sensible format that is not overreactive, straight forward and doesn't confuse or alarm people?
Being overcautious is as harmful as not cautious enough!
We all have to interact with each other and continue normal lives. The economy is dependent on our ability to make sensible decisions and be available for work.
A good piece of advice would to maintain a social distance of 1 meter wherever possible. The flu virus has difficulty infecting you at a further distance.
Masks are suitable only for preventing your sneeze mixture of bodily excretion and virus, expelling out and jumping the 1 meter distance to infect someone else.
A clearer idea of incubation time and infection time for H1N1 may be coming out of America where they would have been busy gathering statistics to plan for future outbreaks.
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sensibleoldgranny.
I reckon it's quite easy - you find a term, say 'stimated current infection rate'.
Based on the reported positive cases and when they were reported, you publish a figure, country by county in the UK, of the estimated current percentage of the population who are currently infected, perhaps that would be those whose infection was between 1 and 10 days old.
You provide a simple explanation of the figure, clarify that it isn't written in 'tables of stone', and that it needs to be regarded as indicative only.
Even if someone says their flu started last Monday, when it really started last Tuesday, it doesn't matter as you work on the basis that such errors will either cancel out or have a fairly consistent effect on the figure.
So you might then end up with a figure for Scotland of say 0.01%, one for England of whatever, etc.
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Whoops - that should have been 'estimated current infection rate'.
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Sutara,
Unfortunately it's not quite that simple. New cases reported on a particular day are really the cases that were confirmed in lab tests from the day (or night?) before. The swabs for the tests would have been taken from patients presented to a doctor or nurse (for testing) at some point from say 12 hours prior to up to 48 hours, possibly more, before. How long depends on how fast the labs work, how long it takes for samples to reach them and be performed. Also, suspected cases will have been swabbed at different points in their infection. The cases that the postitive tests refer to could have started their infections anything from the day before to up to 7 days previously (assuming it took them 5 days to be tested and 3 days for test to run and processed), possibly longer ago.
There is also natural variation in how long incubation and infectious periods last in different people, even for a short lived infections like flu; the upper and lower limits of these periods are still uncertain for the new H1N1 flu strain.
So to calculate when confirmed cases first became ill accurately you need to know several processes with high precision, and mostly these are unknown currently. Frustrating, but that's the trouble with asking good, tricky to answer questions! Of course, one could always ask the cases themselves when they first got symptoms, which I'm sure has been done by the HPA and other.
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I have just found out I am pregnant - about 4 weeks. I have two children already. I always thought I'd be pleased to have a third child, but I found out on the same day that the pregnant woman in Scotland died. Now I am very worried about the pregnancy and how I have placed myself in a very vulnerable position. I am even giving serious consideration to ending the pregnancy before it gets any more advanced. I'd be pregnant right through the winter, when a surge in cases of swine flu is predicted. I just don't know what to do. I also have mild asthma which is an added worry. Am I overreacting?
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A new paper has just been published about antiviral drugs and pregnancy:
"Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women" (reported at promedmail: http://www.promedmail.org/pls/otn/f?p=2400:1001:701203233572257::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,77991)
I wonder if that will change the drug of choice? It shows there's not much in it, perhaps.
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Worriedofessex, try not to worry, I know that sounds trite but it is not. There are over 60 million people in this country and very few have complications of flu. I am sure you will not have problems. Keep yourself fit and well, eat sensibly, don't overwork and over-stress yourself, get a sensible night sleep and stay away from too many parties and nights on the tiles. You see, you probably do all of the right things anyway.
Plan your next few months carefully and accept help where it is offered. Accept this humble bit of advice from a grannie who also worries about her grandchildren and family.
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Thank you sensibleoldgrannie for your reassurance. It is very easy to hear the news everyday and read everything on the internet and become very hyped-up over it all. I am seeing my GP tomorrow to talk things over with him.
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sensibleoldgrannie & worriedofessex
Hi, I am also very worried about the current outbreak of swine flu! One minute it's ok the next minute you have to be worried for one reason or another and never quite know what to believe. As a pregnant woman who also suffers from mild asthma which is controlled by inhalers i also find it worrying. I feel there is not enough information or readily available support for us even though we are in the ' at risk group '
As i am in my third trimester i am finding all of this stressful along with the worry that my daughter who attends primary school and my partner who constantly works with alot of members of the public! Sensibleoldgrannie though with all due respect has actually given some refreshing and positive information and i agree with her we have to get on with our lives... but it is hard when one thge other hand we are advised to ' try our hardest not to catch swine flu ' worriedofessex although we are apparently more at risk think how many other pregnant women are in this world at the moment, not all will get it and if they do although they do have slighlty weaker immune systems we are still very much able to fight infection and the majority will be just fine! It is absolutely terriblew what has happened to the scottish lady and her baby but unfortunately she was just extremely unlucky and we don't know what her underlying health conditions are.. Do exactly as sensibleoldgrannie has said.. look after yourself and if you feel at all unwell get in touch with your GP asap. Please don't put your life on standstill and think about that beautiful life inside of you.. Taake precautions and be sensible and i am sure you will be just fine XXX
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And also when the WHO mentioned on their website 'a disproportinately high number of cases involving pregnant women' Does that mean out of the number of people worldwide that have contracted the illness and recovered or the amount of pregnant women who have became actual victims and died??
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Isn't the 'disproportionately high number of cases involving pregnant women' likely to be because pregnant women, if unwell, are more likely to take the precaution of visiting their doctors, while if they weren't pregnant they would simply ride it out?
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returnofmotherjones
No idea?? That is just a comment made by Margaret Chan on the WHO website.. And being pregnant myself i find it quite frustrating that they don't ellaborate on what they are saying.. Could it be that out of the people who have suffered/recovered already from the virus that a large number of them were pregnant and that's where the info regarding ' disproportionately high number of cases involve pregnant women ' or are they in actual fact talking about the number of deaths.. it's very worrying we don't have alot to go by really - only our own instincts but is that enough???
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Please help. Should pregnant women take RELENZA which is inhaled as it doesn't then directly affect the foetus (something I am not convinced about) rather than Tamiflu which is ingested and should in fact be avoided? Would a kind expert please confirm or deny this. We are not being properly prepared.
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I think one of the key issues about swine flu complications is the nature of pneumonia it causes, whether it is viral, caused by the flu itself or a bacterial complication. Bacterial pneumonia can be succesfully prevented by prophylactic antibiotic administration. I think it would be wise for GPs to prescribe antibiotics for the high risk groups even if it is not active on the virus but it would prevent the most feared complication, bacterial pneumonia. In my opinion, in our century, nobody should die of bacterial pneumonia, regardless of the underlying health problems, because even if it is sometimes difficult to treat, especially when the medication is administered in an advanced stage of the disease, prevention is a very simple, handy and efficient measure which could save the life of many people.
Because, let's face it: how many of us can say that they don't fall in any risk category? In a country where diabetes, obesity, cardiovascular diseases are at fairly high rates, i think a lot more of us should be worried than it is suggested by the media. And i have not mentioned yet pregnant women, newbornes, the elderly and so far and so on.
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To continue my idea about prevention of pneumonia, i am pregnant too, i'm also suffering from hyperemesis which a very weakening condition, having a young son in school, so if by any chance i'll get the flu, i think i'm going to take a course of antibiotics too (there are some completely safe during pregnancy) and i will not rely solely on antivirals. I could even say that i am not very sure if i would take antivirals as there is very little data available about the safety regarding the fetus.
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27 weeks, i think you made a very good point here.
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