Policy shift expected
The Health Secretary Andy Burnham is giving a statement to the Commons later today at which I understand he'll signal a new phase in how H1N1 swine flu is dealt with.
I understand that a move to the so-called "treatment phase" will happen very soon. This will be a UK-wide policy and will unify the approach of the health service in tackling the disease.
At present, there is a flexible approach: GPs in hot-spot areas like London and the West Midlands have stopped swabbing every person who reports swine flu smptoms.
The changes are being made to relieve the pressure on health officials. Those who contact NHS Direct with uncomplicated symptoms will be told to stay at home while arrangements are made for them to get Tamiflu.
This has always been the case, but the need for testing has meant that many have seen either a GP or other health official to confirm the diagnosis.
People who have come into close contact with those infected will no longer be chased up and offered drugs.
This policy will soon be extended UK-wide. I don't have the precise timing, but am told it will be soon.
I should stress that this is NOT a sign that the virus is getting more virulent. It IS an admission that the spread of the virus can no longer be contained. Those who have symptoms will still be offered Tamiflu, although this might eventually be restricted to those most at risk - people with lung, circulation and immune disorders.
For more information on what the treatment phase involves, see a post from last week ("Radical use in antiviral use considered").
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At risk of sounding cynical, I personally can't help but wonder if better management of the situation in the earlier stages would have delayed the UK going to the 'treatment' phase.
We all heard stories of people being told by 'officials' from NHSDirect or wherever, to present to their local hospital's A&E although the patients were clearly very probably infected. And also of people whose infection had been confirmed being told to travel to XYZ pharmacy to obtain Tamiflu.
Hopefully, the 'flu planners' and other contingency coordinators within the NHS and other authorities will learn something from this experience and somewhat poor performance in terms of infection control.
What is that old adage from Teacher Training - 'prudent planning and proper preparation prevents a poor performance'? (Or seomthing like that).
Whilst the NHS and other government agencies are not renowned for their abilities to 'learn from their mistakes', I do hope the 'goofs' will be factored into future planning.
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I not sure you understand the magnitude of what you are saying, to contain this or any virus in the community any further would have ment the cessation of a good many human rights! In saying that however the early advice in some areas was very mixed and yes I agree that hopefully lessons will be learnt.
Also there is the thought that delaying the spread any longer would have far mor implications should the second wave (as is expected) concur with normal seasonal flu.
A lot of the problems experienced early on was that certain areas of public office (not the NHS it should be said) did not take the threat of pandemic influenza seriously, this was in contridiction it should be noted from central goverment even listing pandemic influenza as the UK's biggest threat in terms of both likelhood & impact on the national risk register.
Go figure!
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Having read the report on the website regarding the government's new strategy, I remain mystified as to why, given the (current) very mild illness that this new strain of flu seems to produce, we actually need to waste public money handing out Tamiflu willy-nilly. By all means give it to the vulnerable, but not to everyone that gets the flu.
Another matter, given how mild it is, just what is so wrong with people who want to get it now (whilst it's mild)and build up some resistance holding and taking parking in "swine flu parties". I know the HPA is dead against this sort of thing, but surely, for your average fit person it makes good sense.
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The expectation that we, as human beings, can solve all of nature's riddles is unrealistic. It is difficult to prepare for the unknown. The idea that we control nature rather than that we are a part of nature has also lead to reality checks. We have had one for finance, we are having one for the environment and the attempts to control the spread of H1N1. What will happen, will happen and there will be a response, the results can not be known at this time. What if........?
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Minsiters said the emergency response would now move to a new "treatment" phase across the UK as there may soon be 100,000 new cases a day.
To avoid 100,000 a day they should close all schools colleges ect early for the summer holidays (like now) and this measure will hopfully slow down the infection rates until a vaccine can be developed.
They are not closing the schools (in my opinion) because parents would have to take time off work to look after the children and this would hurt an already buggered economy. Well PM Brown stuff you, how dare you play god with our children.
Through the actions of your ministers alot more children will die.
the NHS is struggling to cope now nevermind in the autumn. The UK is "well placed" to deal with the pandemic, Bulls**t. can someone do the maths? 7000 confirmed cases since april and three deaths. How many proberble deaths from 100,000 per day?
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2. At 11:09am on 02 Jul 2009, chippermrd wrote:
"Go figure!"
I partly agree with some of your comments, but I would remind you that there was a great deal of contingency planning in respect of the expected, 'overdue' pandemic, even before anyone mentioned the term swine flu.
And NHS Managers are not without blame - the loss of focus on infection control by NHSDirect Managers being just one example.
I also think that the interface between the HPA and the NHS in such a situation probably needs to be improved. And I'm sure there are other lessons to be learnt.
Some years ago, many expected that this sort of large-scale infection control would probably be required in response to a terrorist attack, or similar release of contaminant, involving a biological agent of some sort.
Perhaps we should be very thankful indeed that such a situation has not put to the test our abilities to contain and infection risk.
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5. At 1:32pm on 02 Jul 2009, vinnysmith1973 wrote:
"the NHS is struggling to cope now never mind in the autumn".
In reality, many infected people have already recovered, many without Tamiflu, vaccines, or interventions other than rest and 'over the counter' remedies. Whilst the number of reported confirmed cases is almost certainly considerably less than the real number of those who are or have been infected with this virus, we need to remember that as it is a reasonably 'mild' flu, many people did not require, or seek, medical intervention at all.
Now the problem really lies with the 'vulnerable'.
It seems that many older people may have a resistance to this flu due to previous flu outbreaks, so that reduces significantly the numbers on the vulnerable category.
However, identifying those with illnesses or conditions that put them at risk is not easy. 'Swine flu parties' could infect children who have other infections (undiscovered) or yet-to-be-diagnosed conditions and, therefore, put them at significant risk of harm.
For most people, the NHS's ability to respond will be somewhere between adequate to fine. In the main, the NHS will be givers of advice and, in some cases, givers of Tamiflu.
They NHS will also be treaters of those who are vulnerable and the greatest risk to this provision would seem to be the danger of the NHS experiencing high levels of absent staff due to them being infected themselves.
Now, there are a number of 'unknowns', such as:-
Will there or won't there be a vaccine and how quickly?
Will there be a significant number of cases of resistance to anti-virals?
Will the strain of flu mutate into something nastier?
Will other factors, (heatwave, floods, terrorist attacks, natural disasters, war or whatever) disrupt the ability of the NHS to deliver services?
Will there be a great surge of doctors and nurses off work with the flu all at the same time?
All of those are unknowns, but probably, when everything is taken into reasonable consideration - but no cast-iron guarantees - everything will be mostly o.k.
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Hey! I talked to someone today who had absolutely no idea that there was an unusual flu outbreak, let alone a pandemic. I watched this person's face look utterly bewildered when I mentioned flu.
The reaction was, why isn't it in the newspapers?
Some very overpaid thinkers have lost the plot, because by now, we should all know about this illness.
Not everyone goes on the Internet and not everyone reads the paper every day.
Information should be on public display and in simple, easy to understand language, preferably with annotated diagrams.
Post information in shopping malls, supermarkets, public loos, where it can't be missed.
Don't forget we are a multicultural society and many of our citizens have a very limited ability to read and understand English.
The flu info posted through doors was probably posted into the bin, because it looked like yet more junk mail.
Use a nice big international sign like a green cross or something, to get people's attention.
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I think its about 45% (i will seek more info on this % rate) of the deaths from h1n1 in the usa have been healthy people with no underlying health problems.
with the current infection to death rate about 0.4%(i think its currently about this) many people will die.
They have to try and slow the infection rate down.
please come and look at the posts on this site http://flutracker.rhizalabs.com/ there are many sorces of information from all over the world the above link is one of the better ones :)
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Am I the only one that finds it hard to believe that up to 100,000 people a DAY will be infected by late August? Surely the hotter weather should be slowing it down or killing it off altogether rather than it continuing to thrive? I could possibly believe that there will have been 100,000 cases overall by the end of August but 100k a DAY? That is pure fantasy! This is nothing more than scare mongering on a ridiculous scale. The government ought to be ashamed of themselves.
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9. At 2:10pm on 02 Jul 2009, vinnysmith1973 wrote:
'with the current infection to death rate about 0.4%(i think its currently about this) many people will die.'
Read the blog by Fergus below 'UK cases double in a week; US cases top 1m'. If thats the case then in the USA the death rate is around 0.03 - and that's only an estimation. More people have / have had this than the official figures are reporting.
There will still be people dying which is obviously a tragedy but not in the volumes you're hinting at.
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CuriousAddition, #10
Am I the only one that finds it hard to believe that up to 100,000 people a DAY will be infected by late August?
No, I was bewildered by that figure too. Be interested to know how it compares with typical flu epidemics in the winter.
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Re. Post 10. I have to agree - these sort of projected figures just aren't borne out by what is happening elsewhere: Mexico has had swine flu longer than the rest of the world and their (albeit official) total of cases to date is still well below ten thousand!
So much for the "don't panic" approach - what on earth is Andy Burnham thinking about?!
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Curious,
From what I can gather, H1N1 loves this hot dry weather, but not the ultraviolet light. As far as I am aware, H1N1 is not so clever in humid, wet conditions (The bug obviously didn't come from Britain). Maybe its little spiky bits get soggy in wet conditions. Maybe I am completely wrong, time will tell.
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I am quite amazed that people seem to think that there has been bad planning for this flu pandemic! I'll come clean - I have been involved in a lot of the mitigation phase and the amount of planning and work that has been going on has been amazing. To be honest if there wasn't the effort then this phase we are entering now would have happened an awful lot quicker. All of this has not been seen by people yet many feel that because they have the expert knowledge to comment.
As to the numbers that is based on replication figures which I don't know off by heart but remember reading that infection rates will double every 10 days or so. That is probably where that comes from. Not scaremongering but looking at potential figures - again if this didn't happen people would complain. Damned if you do and damned if you don't
As to post number 8 - if you throw the leaflet in the bin, don't watch the TV adverts and haven't looked at TV or even seen a newspaper there is not much else you could do to reach these people.
And as for swine flu parties - this disease is a killer - it has killed healthy people in the states - why on earth would you want to go and expose yourself to that unnecessarily? Honestly sometimes I wonder....
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I live in Handsworth, the centre of swine flu capital. My grandchildren are at a local school, which had escaped till last week. At no time did the authorities give proper guidance to teachers and heads, the whole epedemic seems to be planned from a book, taking a chapter in turn, but no overall co-ordination.
However, the population are equally to blame. We have seen affected children on the buses, shopping with their parents, visiting religious establishments and playing with all and sundry in the street.
Until many death take place, nobody will take this disease seriously, and the first to be blamed will be the authorities, not the parents who let their kids on the streets to spread it to everyone.
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TroyTempest99, do you personally feel that 100,000 new cases a day by late August is a particularly likely thing to happen or would you say its more likely to be a great deal less than that? I just can't see how it could get that severe especially at this time of year!
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CuriousAddition wrote:
"TroyTempest99, do you personally feel that 100,000 new cases a day by late August is a particularly likely thing to happen or would you say its more likely to be a great deal less than that?"
To be honest I have no idea - I haven't seen the projections myself so don't know what they have been worked out using. It is probably one of those situations where this has been modelled and a worst case scenario could be this. I must confess to being a little surprised when I heard this - but if it has been modelled there will be some theory behind it!
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Based on their statement that new cases will double each week (seems fare enough based on the figures I have seen).
New Cases:
7 days up to 02/07/09 = 4000 per BBC website
to 09/07/09 = 8,000 new cases (wait and see)
to 16/07/09 = 16,000 new cases
to 23/07/09 = 32,000
to 30/07/09 = 64,000
to 06/08/09 = 132,000.
Based on that, 100,000 cases per week by start of August is well possible, based on Govt assumption that new cases will double each week
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have a look at the comments here -
http://news.bbc.co.uk/1/hi/health/8131149.stm
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Interestingly a lot of comments in the link from the poster above suggest that people don't have swine flu but are getting jumpy if people are coughing and sneezing around them! Not good in the hay fever season! The process is dynamic - this is an ever changing situation. It changed today. That doesn't mean we don't have plans - every single change I was involved in came from the flu plan we had.
I can see from the figures above how we could get to 100,000 per day by August - I am just a little sceptical that it would grow that fast but that is the general model for planning.
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check these comments out. scroll down the page to find the comments
http://www.nhs.uk/conditions/pandemic-flu/Pages/Introduction.asp
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Ironic really that people are commenting about a lack of information on a website that gives them all the information they need. Looking at the comments there, shows there were several who obviously did not have swine flu yet despite reassurance were still complaining about the system breaking down. And on a website telling them the facts. Frankly we can only do so much - there is a bit of a situation going on and if peoples swabs (read the page linked to above) aren't picked up immediately they are taken it doesn't mean the whole system is broken!
Interesting watching Andy Burnham on the news tonight stating, quite clearly, that we COULD see 100,000 by august. Not we will, not it is guaranteed, just we COULD. Sort of puts it in a bit of perspective.
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Re. Post 19.: If we are talking of peak figures then 100,000 cases a week - albeit still very substantial - is rather a lot less than 100,000 per DAY!
Mexico hasn't reported anything like these figures and the last I heard the virus seemed to be fading out in Mexico City.
I'd also like to know if/when swine flu hits really big, how long do experts expect it to be around for? I mean, will it be long gone say a year from now or will cases continue (albeit presumably much less so) for a very prolonged period of time?
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I think 100,000 per day is probably fairly typical for the annual seasonal flu epidemic (10% of the population catch it every year - in the UK that's mostly over a 6-week peak period - and that comes out at around 100,1000 per day). So why should this be any different?
It is interesting that here in the UK at least there is no sign of the rate of infection slowing down over the summer. Has the infection rate really slowed down in Mexico/US? Or have they just stopped reporting it. Over here we have stopped swabbing patients now in Birmingham, London etc - so the growth in infections will be severely under-reported, and it still seems to be growing exponentially. I expect the same is true in the US, Mexico etc. My guess would be a peak towards the end of August.
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IF we do see anything like what's being predicted then, by the time the first doses of vaccine are available in the UK, then would there be any point in anyone who has had the virus to receive the jab? I just think it might be too little, too late if the situation really did get as severe as has been suggested.
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There have always been wild discrepancies in reported numbers between countries, and the main WHO site moved away from daily counts some time ago (daft really, when the virus is considered to be still in it's infancy!). How do we really know what are accurate figures? It's interesting to note that of the highest figures reported, at least 4 countries have, imho, a well developed, accessible medical system. Personally, I wonder if this is a major factor, or if it's simply countries who have a high amount of mobility among their populations (both abroad and at home), which is the deciding factor? It could even be down to density of population-my curiosity is aroused on a purely academic level!
The numbers reported by WHO had seem stable at an average daily increase of approx 1500, and yet they reported the UK cases as being nearly that all on their own yesterday-judging by that huge jump, it would appear that 100,000 cases a day is not as far fetched as it seems. I suspect the jump may be purely due to diagnosis on symptoms rather than swab tests. It does concern me however that certain areas will suffer from lack of doctors, nurses and drugs. All figures can only talk in 'average' terms, not specifics, so will deprived areas really have the medical resources available as are being described? Optimism says yes, reality check says no!
My daughter saw an old acquaintance today who is recovering from Swine Flu. He had apparently only just released from quarantine and headed immediately to the local supermarket. Neither he nor his family were offered Tamiflu, and the young man concerned (aged 26) was clearly very poorly still-grey toned skin, sweating while still shivering-hardly mild symptoms! Didn't seem as though he should have been out and about to me, yet was released from quarantine. Hardly good management.
Regarding the lack of posters etc-there have been plenty around to download and print since the beginning of Mayl. As my staff were concerned I printed several, put them up, issued alcohol hand gel to everyone and bought anti viral tissues and wipes for handles, telephones keyboards etc. I'm sure we will get it in our homes/workplaces eventually, but there was an initial push at the start to make sure basic simple info was available to everyone. Now details are sparse as the media/government are not keen on national/area specifics.
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re:24,
sorry i forgot to continue on
to 06/08/09 = 132,000 per week
to 13/08/09 = 264,000 per week
to 20/08/09 = 528,000 per week
to 27/08/09 = 1,056,000 per week
1,056,000 / 7 = 150,857 per DAY by the end of August.
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I had flu like symptoms last week (very high temperature for three days, aching joints, vomiting etc), so I called NHS direct. They said that there was a possibility it was swine flu so they would send a swab kit. I asked if I should stay away from work, they said that no I could go back to work if I felt well enough.
How does this help with stopping the spread of the virus?
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Considering children who are at high risk such as asthmatics and diabetics etc... Why have schools not been closed in an endeavor to slow down the spread of swine flu to these vulnerable children thereby giving time for the vaccine to become available? Some might say the risk is not that high but if it avoids one death, is that not good enough reason? It is not long before they break up for school holidays, so why take the risk?
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