UK cases double in a week; US cases top 1m
The sun has been shining, the temperature rising, and it really does feels like summer. So it's not the traditional time one would expect a flu virus to flourish.
UV light cooks the viral goose pretty quickly, and people are outside more, rather than being huddled together swapping germs (let's not spoil this theory by mentioning air conditioning or public transport).
But the H1N1 swine flu virus is not like seasonal flu.
It's sufficiently novel and contagious that it is continuing to spread despite the warmer weather. Let's look at what's happening in the UK and USA.
The number of cases of swine flu in the UK has doubled in a week. Laboratory confirmed cases stand at 4,322. England saw its biggest daily increase today with 535 new cases, most of them coming because of a surge in London and the west Midlands.
Both areas now have more cases than the whole of Scotland, where the virus continues to flourish in the Glasgow area.
With the virus now very firmly established in London, it's likely that further big increases will follow. And remember that many cases are going unreported.
Does that mean a peak in cases - a full-blown national epidemic - will come earlier than expected, perhaps in late August or September? Possibly, but the expectation is that once the school holidays begin, there could be a pause with a peak coming from autumn onwards.
Then we could see tens of thousands of cases a week and every part of the UK will be affected. At present, in Wales, north-east and north-west England, there's still hardly any flu at all, so the virus is still not fully embedded here.
Now to the United States. The CDC in Atlanta has given another of its very helpful briefings to journalists.
Dr Anne Schuchat set out the situation there: 27,717 laboratory-defined cases with more than 3000 hospitalisations and 127 fatalities.
"This virus is not going away," she said, "and the reported cases are the tip of the iceberg. We are estimating there have been at least one million cases in the United States - not perfectly accurate but a ball-park figure."
That estimate is based on some telephone polls asking people whether they'd had flu-like symptoms in the past three weeks (not the most accurate way of estimating illness) and some community surveys which suggested 6% of people in hot-spot regions may have had the virus.
While not terribly accurate, the CDC appears confident that at least one million Americans have been infected.
If so, that is very reassuring news because it means the fatality rate is really very low. North America is about a month or so ahead of the UK with its outbreak so what happens there is a good guide to what may happen here.
So who is getting H1N1 swine flu in the US? Dr Schuchat said the virus was affecting mainly younger people rather than the elderly and made these points:
(1) nearly 80% of those hospitalised have been under 50;
(2) average age for hospitalisation is 19;
(3) average age for those who've died is higher, at 37;
(4) about 75% of those who have died have had underlying health conditions ;
(5) there have been very few cases in people over 65, so they are very unlikely to be infected - but when they do get it, elderly people have a higher risk of complications and death.
So how mild is mild and what sort of symptoms do people have? Dr Schuchat said that most had a fever and respiratory symptoms, a cough, a cold, with some having diarrhoea. People may be miserable in bed for a few days, but the illness clears up on its own.
The US, unlike the UK, has restricted antivirals to those at most risk of complications, so comparatively few doses of Tamiflu have been handed out.
The CDC can't say yet how many people are asymptomatic - that is, the number of people that have such mild illness they don't even realise they've had swine flu - but with a million plus Americans thought to have had swine flu, it must be a pretty sizeable number.
A minority can have a much tougher time, according to Dr Schuchat:
"It's important for everyone to be aware of the virus, and especially for those with underlying health conditions, asthma, diabetes, chronic lung disease, and pregnant women: these people need to be especially concerned if they develop a fever and respiratory illness."Some mention has been made of obesity being a risk factor.
Dr Schuhat said that those who were obese, and especially the morbidly obese (those with a Body Mass Index, or BMI, above 40) often have chronic lung disease, and that's why they were at risk of complications. Being obese on its own does not seem to be a risk factor.
To sum up: swine flu is here to stay. For the vast majority it is nothing to worry about. For a small minority, it can cause serious illness. It should neither be dismissed out of hand nor should it be a reason for panic.
Scientists must continue to monitor the virus to see whether it mutates or becomes more virulent or becomes resistant to antivirals; thankfully, there's no sign of those at present.
I'm 
© MMIX~RS~q~RS~~RS~z~RS~19~RS~)
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Oh look scaremongerers! More evidence to contradict the idiotic people who belive this is the second coming of the black death. Highest odds of dying is in older people, as ive said from the start and was put down constantly by other commenters, its obvious they havent had the amounts of cases as younger people, probably due to some type of resistance. but they will be more likely to die. Its a fact and i knew this and was saying it months ago, nobody belived me. No cytokine storms, contrary to people posting silly links to unrelated virology websites with horror stories from bird flu. You arent helping anyone like that, just go and panic in the corner.
Again as ive said since i started posting. Very mild influenza strain, very stable in its makeup, very contageous, very unlikely to become any kind of risk for the majority.
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Who mentioned the black death? Who is panicking? Who is scaremongering? The only thing that is going on here is discussion.
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This comment was removed because the moderators found it broke the House Rules.
Dear me! I know it's hot and humid, but chill a little Skyline!
People need to know the facts. Currently, ACCURATE and accessible info is what people want! Please also bear in mind that with the WHO wanting to track this so closely (an exciting opportunity if you are of that ilk of scientist, I expect), then it's important that honesty from governments and media alike is the key.
Certainly, this pandemic has not been classified on severity of illness, but rather on spread of transmission. Not to mention the fact that it's an excellent chance to test the preparedness of each country for pandemic management.
It's important also to remember that those sick and dying are people with feelings. Most people accept that they may catch this illness at some point, and those with small children or underlying medical conditions are bound to be concerned, if not frightened. It's extremely unkind to dismiss their fears out of hand, particularly when it does seem to be a lottery for access to prompt diagnosis and treatment.
There will always be 'worried well', regardless of the illness. These people will always think a touch of heartburn is a heart attack for example. Usually those who crave attention for whatever reason. There will be some who may fall foul of crying wolf-but I would imagine their GP's would rather spend 5 mins reassuring them than risk missing a diagnosis.
I'd be most interested to know why, when a vaste swathe of the world has reported some degree of infection, there some countries with none. Are they really flu free zones, or do they just lack access to medical facilities?
Let's just be a little more considerate please. Don't forget, this flu pandemic was identified in it's infancy because of its ability to spread at a time considered unseasonal. It may have been missed altogether if it had broken out during the normal flu seasons. Certainly the numbers would be far less accurately diagnosed. Noone knows what picture we will see in 6 months' time, nor how it may or may not mutate. We are lucky to have this many statistics already at such an early stage.
I can't access the map, because flash player won't work on my phone. Any chance of putting it on BBC iPlayer please?
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SkylineOnFire wrote:
What sickens me is the absolute negativity in these comments. Its packed with horrid people condemning the NHS, its apparently useless, all medical staff are now selfish..... Its just a shame we have a nation packed with idiotic brits who see life in a negative light.
Yes unfortunately those of us in the NHS are damned if we do and damned if we don't! Having been involved with this right from the start I can confidently state that there are a lot of people talking utter nonsense! The NHS is well placed to cope with this situation - it is probably going to get worse before it gets better but it is testament to the professionalism of staff in the NHS and HPA that we are not in a worse state already.
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SKYLINE, how on earth did people get your e-mail address? Can't you put a filter on your e-mails to get rid of the spam? I thought your comments were interesting, don't be disheartened by negative comments and don't react rudely, just be polite and defend your viewpoint without making a meal of it. I had an extremely unpleasant response to one of my inputs, but I responded politely and the remark has been removed by someone else. If you have something important to say, that is backed up by reliable research, say it.
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I have just looked for my hospital medical card and found that it is hopelessly out of date, with a previous address, former name and a different doctor's surgery. It would be wise for everyone to check their cards and get them up to date if necessary.
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'Brits out Europeans in'.
Thats is happening already and is why viruses manage to cover the globe so easily.
Making racist and extremly rude remarks because some people have different views is not the way to go. I have been reading these posts since they started and have found much more valuble information here, from many different comments, than on 'official' websites. If these pages become a battleground rather than an exchange of information, they will be removed and then there will be no helpful articles to absorb.
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While the continuing rise in cases is of concern, I feel some sense of perspective should be remembered. There have now been about 1,000 confirmed cases in London alone. London has a population of about 8 million or so. 1% of that is 80,000 while 0.1% is 8,000. Now, if I've got my sums right, I believe 0.1% of London's population can also be referred to as 1 in 1,000. I'm sure there have been lots of undetected cases so the real figure is probably about 4,000 so far in the capital so far or 1 in 5,000. Not exactly an epidemic is it? We may well get up to 8,000 cases in the capital within a matter of weeks but I seriously doubt it will get to 80,000 before the autumn. In fact, I don't see us even managing HALF of that. And let's not forget: Just because there could be as many as 4,000 people in London who have contracted the illness so far does not mean that there are 4,000 people with it right now. Many will have recovered by now. Keep that in mind once the London figures go into 5 figures, which is something that is still a month away at least.
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These latest figures posted by Fergus are very reassuring. I agree that if the figures of infected people are much higher than official ones, then that means that mortality rates must be very low indeed. HOWEVER, there is one factor here that has not been considered; and that is that a couple of weeks ago it was reported that people being admitted to UK hospitals with respiratory illness are NOT being routinely tested for swine flu. I don't know how many people in the UK are being hospitalised and dying with respiratory illnesses, but if they are not being tested for swine flu, and if (as is likely) some of these people do have swine flu; then the hospitalisation / mortality rates may be HIGHER than those recorded. This is cut'n'pasted from the article I found:
"The extent of swine flu infection in the UK is being underestimated because hospitals are failing to test patients with respiratory illnesses for the virus, according to one of the worlds leading experts on the disease.
Professor Neil Ferguson, an epidemiologist at Imperial College London, who advises the Government and the World Health Organisation, has said he is almost certain serious cases of the virus are being missed due to lax hospital surveillance.
Speaking at The Times Cheltenham Science Festival, he said that there was anecdotal evidence of significant numbers of cases of severe respiratory illness in London, which should be checked in case they were caused by swine flu.
Professor Ferguson added that surveillance strategies need to be implemented immediately as the virus appears to be spreading quickly.
One thing I am concerned about is that surveillance of severe disease is almost non-existent, Professor Ferguson said. If you go into hospital and have severe respiratory disease, you will not be tested for H1N1.
Anecdotally, I am hearing reports of a quite significant number of severe cases of respiratory illness in London. We need to be testing them.
We need hospital-based surveillance, but while its being thought about its not been brought in yet.
Were not assessing respiratory patients for H1N1, and that is going to be important over the coming weeks.
According to Ferguson, the UK needs to rethink its approach to tackling the illness and follow the example of the US, where hospitals have stopped focusing on individual case surveillance and are instead focusing on testing healthy young adults hospitalised with respiratory disease."
This article is dated 8th June; perhaps this situation has now changed and respiratory patients are now being tested for swine flu? Does anybody know?
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Well, well, well, ask the right questions and look what comes up. RESPIRATORY DISTRESS CAUSED BY SWINE FLU is the key thing to investigate.
How long would it take to for each health authority to test their respiratory diseased patients for swine flue and get results?
Didn't some guy in Southampton develop a swine flu tester that can be done in about 15minutes with results. Even if the results are not 100% accurate, they could used to make a prediction of flu trends. Select the patients to be tested, do the test, record the results on lline to a National data base and get the results circulated by the end of next week.
Further testing using other techniques could be done to confirm results at a later date.
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This is probably stepping outside the box but here goes.
Has there been an increase in cases of chronic illnesses, disorders that have suddenly become worse.
Does novel virus H1N1 always behave like conventional flu?
Have there been cases of diarrhoea and vomiting that has lead on to acute abdominal pain, urine infection and kidney infection but without traditional flu symptoms?
A virus that caused diarrhoea and vomiting is also attacking the digestive system and if there is already a weakness, surely the virus will concentrate on attacking that part because it is easier.
Have some patients presented with very low temperatures and blood pressure and sudden unexplained illness?
Have diabetic symptoms become more pronounced with this flu?
THIS IS PURE SPECULATION but I am wondering about this after repeated reports of, 'underlying health conditions.'
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" RESPIRATORY DISTRESS CAUSED BY SWINE FLU is the key thing to investigate. "
Well yes - seeing as influenza is a respiratory condition! However you need to consider that there are a variety of conditions that can cause respiratory distress. These have distinct symptoms and you can rule in or out the condition by observing those clinical symptoms. There are very valid reasons for not testing all your respiratory patients. I'm not sure if you think there is some sort of conspiracy going on here (these things tend to bring out the conspiracy theorists so apologies if you are not). Having been involved in the early stages of this pandemic I can assure you that a high proportion of people who were thought to have swine flu were found not to have on testing. It is more likely that we think we have cases which are subsequently rejected rather than the other way around.
Believe me there are people who know what they are doing and if the patients are presenting with symptoms that are suggestive of swine flu then they will be tested.
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Further to #13 "a high proportion of people who were thought to have swine flu were found not to have on testing"
As someone who is also involved in monitering swine flu I can also add that a lot of cases of suspected swine flu have in fact been other things, common cold being one. How do we know. Because many labs have the ability to test for a wide range of pathogens. In my experience if an in patient is suspected of having any viral respiratory infection and their doctors have the foresight to send a sample to the lab then it WILL get tested for swine flu as well as a host of other viruses.
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Thanks lab and troy, I guess you know the situation better than anyone. As for conspiracy theories troy, you must have been watching too much X Files and Outer Limits (good anagram in here, FLU) they bang on about conspiracy theories. We don't all think conspiracy theory even if it looks like the case at first glance. I just have a conceptual art fascination of maps, germs, ICT, new media and the dissemination of information. It is strange how we use similar terminology for all these areas.
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So, it seems to be getting clearer by the day that although Swine Flu affects younger people disproportionately (as a result of a lack of historically acquired immunity that older people will more likely have) the bug itself causes symptoms that are no worse than normal 'seasonal' flu. And, it seems that the mortality rate is lower than seasonal flu too.
So, considering that we're not all running around like headless chickens each winter terrified of 'normal' flu there's no reason to be more concerned about this one.
Ultimately, Swine Flu appears to be less of a risk to life and health than normal flu, and if you've had any type of flu previously you aren't particularly likely to be struck down dead by this one if you're in a reasonable state of health and, indeed, you'll possibly not even have such a bad attack this time either, according to empirical evidence so far.
Conclusion: It's just another bug that's doing the rounds. Now, can everyone please get back to concentrating on the real problems in the world?!
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Troy Tempest
I would like to have the faith you have in our health professionals, but I am not alone in having suffered poor treatment/wrong diagnosis at the hands of the NHS. Sadly, myself and many others are weary and skeptical as the clinical ideal falls short in practice. I have had personal experience of death caused by lack of action in a doctor, and if routine testing of respiratorily distressed patients on presentation was simply a case of a swab, then I'm sure many would be reassured. Many diagnoses depend on listening carefully to a patient, and this seems to happen more rarely these days. Good medical practise is unfortunately patchy, and hence quality of care sadly becomes a lottery. The reasons for this may be legion, but the results are the same.
I'm afraid I remain a skeptic through bitter experience. Yet despite previously having lung infections from both Chicken Pox and flu (and an autoimmune condition), should I develop flu symptoms I won't be running off to casualty. Bed, paracetamol and fluids is my treatment of choice, contacting the doc only if I have difficulty breathing like before. The onset was lightning fast and quite obviously not right it was clear that something was very wrong.
I wonder how many people like me have such a genuine dislike of visiting doctors and hospitals that they never get above the radar? There's no way of knowing. Looking at ratios of infected to population won't make sense either, until the winter months-peculiarly this virus is spreading in our summer months. I wonder if previous flu pandemics in the winter months began like this but were not noticed? I also wonder how many people are not diagnosed in other countries where emergency free health care is not available or not as good as elsewhere? In this countries, most people payfor their health care, and rarely visit a GP unless it is an emergency.
The symtoms of this are supposedly moderate (now a second death in Scotland) yet we are, as is said often, not yet in our seasonal flu cycle. Noone knows for certain if this flu will/will not mutate, so understandably speculation abounds.
Troy Tempest, I would love to think that hospital treatment is as good as you say across the country, but the voice of bitter experience tells me otherwise!
Whatever happens, some will be right and some wrong. It's always the case!
Personally I prefer to know as much as I can, and therefore be able to make an informed decision. One other thought occurs to me-if Tamiflu is most effective when prescribed early on with this virus, what's the point of waiting a week or more for test results?
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Great reporting - this is the kind of factual information people need.
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The impact is not as imporant as the pattern of spread. Although mild, this flu could become one of continuing for some period of time. What we have seen is that it spreads and builds in a population. When the more serious strain arrives it doesn't look like we can do anything but wait it out. It really is about budgetary priorities and public health is low on the list. Like with the plague, those who can afford to leave the towns and cities will do so to escape infection and those who remain will die in large numbers. Medicine will save more this time. Such is the way of the world.
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3. At 10:27pm on 26 Jun 2009, SkylineOnFire wrote:
"Scaremongering panic driven lies".
O.K., let's get something straight here.
Every person who reads and posts here will have varying degrees of understanding of the 'techinical' issues of virus mutation, perhaps even of barrier nursing, pharmacology or of contingency planning. (and many other aspects that might impinge upon the spread, diagnosis and treatment of this flu strain.
But each and every one of them DOES have the potential to be:
1) infected with this flu variant (unless they have some natural resistance to it and if that is the case, the individual probably doesn't know they have such a resistance)
2) to be concerned about the possible prognosis both for themselves and for those near and dear to them
3) infectious, at some point in time, to other people
4) inconvenienced by the social consequences of the spread of the virus - however minor or dramtic these may turn out to be.
5) trusting and confident, to varying degrees, in those 'in authority', the medical profession, the NHS (as an organisation) and the ability of all of these to deliver services and patient outcomes.
Note, I said potential.
All of those things may or may not be the case for any specific individual.
Having said that, SkylineOnFire, I don't think your comment is appropriate.
In the final analysis, each person will handle this matter, within the context of their professional or personal lives, according to his/her understanding, awareness and abilities.
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Well all I can do is state what is happening as I see it. The one thing I will say is that TigerJayj you have completely the right attitude with wanting to be informed and then making the decision yourself. It's not a criticism of doctors but the partnership approach to treatment is generally the best way to go. The only caveat to that is that you need to get information from reputable sources and not from blogs or forums! In terms of flu as I said before, there has been a lot of effort put in to mitigating this disease and it could have been significantly worse a lot sooner had this not happened.
I wouldn't say that swine flu is "just another bug doing the rounds" - to say that misses the point. I see we have three deaths now being linked to (but not necessarily caused by) swine flu. I'm sure the families of those people don't perceive it as just another bug doing the rounds.
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Yet another factor is whether the newly discovered resistance to Tamiflu proves to be a total red herring, or a significant issue, in terms of managing the spread and the treatment of the virus.
http://news.bbc.co.uk/1/hi/health/8124987.stm
NO - Don't Panic! Just note for future reference and watch and wait to see if it does become an issue in the UK, and if it does what degree of issue.
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I was sorry to hear the news of yet another victim of this H1N1 and I feel saddened for the parents and relatives.
I didn't think that the anti-virals were 100% effective. Doesn't the drug have to be taken right at the beginning of viral replication, within the first few hours of infection? It seem like shutting the door after the horse has bolted to give this specialist type of drug later. Correct me if I am wrong, does some of the anti-viral stockpile go out of its use-by-date in 2010? If there is evidence of virus resistance to the antivirals, what is the next plan?
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My understanding of how flu viruses keep changing is from a simplified explanation from a virology blog and my own understanding from real life.
As humans, we produce offspring by using the genes from a male and a female and combining them to create a unique new human, who has a mixture of the genes from the father and the mother. The genes from the male pair up and match with the genes from the female. These pairs of genes swap bits of information. Once the genes have done all of the mixing, they then start the business of dividing and creating a human being.
We would find it impossible to mate and produce offspring from an animal (not that we would want to) because we are from a different species and our genes can't pair up and match.
Viruses from the same species, for example, subtype A, can effectively 'mate' and create reassortants in our unsuspecting cells. These reassortants have the genetic information of flue A1 and flue A2. When these new mixes 'mate' they can produce further reassortments. The virus genes use a similar mechanism to our genes, by swapping bits of information.
Like humans, each mixture can create either a naughty or nice offspring. Our only hope is that the viruses prefer to mix harmless offspring. Please feel free to correct me if I am wrong, I won't be offended.
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There seems to be no advice for pregnant women, for example teachers working in a school where swine flu has been confirmed. Should they continue to teach putting themselves and their unborn child at risk?
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If it were me, I would check my contract and see when I could officially take maternity leave. Also, I would talk to my anti-natal advisor and my doctor. These are the people who are OFFICIALLY monitoring your progress and who can put it in writing if they feel you need to take maternity leave early.
If you are advised by medical professionals to take early maternity leave, do it.
Teaching can be very stressful, and you are working in an environment where there is a continuous breeding ground for all types of bugs. In the meantime, take as much rest as you can, and be extra careful with your diet.
Take GREAT CARE OF PERSONAL HYGENE:
hand washing; alcohol gel
only use your own cup, keep it away from others
take your own lunch to school, well wrapped and labeled in the fridge to keep it cool
don't take risks because you are in a hurry, it is not worth it.
If you are using a keyboard wipe it first with a disinfectant wipe
try to maintain a 1 meter social distance
keep your room well ventilated; send sick children of to medical room immediately
don't stay late to catch up with trivial jobs, get someone else to do them, in school time ( merits. housepoints)
Remember, any paperwork, bookwork that you take home is a surface for H1N1 to hitch a lift to your house.
If you think that every hard surface in the school environment has the capacity to harbour this virus for hours, possibly a day and cleaners are only human and can only do a certain amount on their shift.
soft surfaces harbour the bug for 6 hours
If people think you are becoming cranky, ignore them, it is your life and your baby.
This is were child protection is a godsend, don't touch the children and don't let them touch you.
The staff-room and the class rest room are the places where you are likely to slip up in a moment of relaxation, this is where you are most likely to ingest harmful bugs because these are areas with less rigorous cleaning.
I would wash my hair every evening when I got home, to decontaminate it from a day in bug land.
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I think the number of cases is way above the official figures and I'm basing this on my 28 year old daughter's experience in Hackney,London. She reported her flu like symptoms and said she had been in contact with someone who had also reported it. The agency doctor promised to come within 2 hours but it was more than 24 hours later and then didn't seem at all sure what to do. He gave her a prescription for Tamiflu but it has proved to be almost impossible to find a chemist that stocks it (and you need a friend to go looking for it!). She had a swab but again the doctor didn't know what to do with it and took it away, only to bring it back later, saying it needed a courier to collect it. That was a week ago and she still hasn't had any confirmation and is now feeling better. So should she have alerted all her friends (especially teachers in schools) or not have bothered? Public information is so bad and confusing now.If the authorities are now talking about ' outbreak management ' in the large cities they should tell the public and lower expectations on what individual suspects should expect from their doctors. It's clear that swabbing is no longer happening and a more casual approach is taken. Hardly the full alert readiness we were told about by the government.This experience is very different to those earlier cases which we saw on the TV. It would be better to be honest than have this mixture of absolute fear shown by some people and acceptance in others.
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2 simple questions for you Fergus..
These underlying health conditions that 75% of people who have died have, what are they? and how many people in the UK suffer from them.
Asthma, for one is a "serious underlying condition", 5 million suffer from that. Diabetes is another. In some cases pregnancy(!) has been counted as such.
Why is there no information coming out in the UK on the media regarding these "underlying conditions"? The US seems to be streets ahead in these respects, publishing specific advice for pregnant women, asthmatics ,etc.
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