Time for concern, not panic
Update 0813, 17 July 2009: This post was updated overnight - it now includes a table and a different explanation of the technical language.
Journalists like numbers. But given a range, the tendency is to go for the extremes. It's just the way we are, I'm afraid.
So given several potential death tolls for the UK from H1N1 swine flu, you can be sure that the headline writers will go for the biggest.
The figure of 65,000 deaths was given in a briefing to reporters by the Chief Medical Officer for England, Sir Liam Donaldson. It's based on what are called "mortality planning assumptions" for the NHS. It's very important to remember that these are not predictions.
What does it mean? Well, the case fatality rate is the percentage of people who may die after getting swine flu (this is a different method of predicting fatalities than that used by Imperial College London - see my previous post, What are the chances of dying from swine flu?).
The clinical attack rate is the percentage of people likely to get swine flu in the population in the first wave - some time between now and the end of winter.
So let's assume, for planning purposes, that 0.1% (one in 1,000) of those who get swine flu, die from it. If 5% of the population get it (the clinical attack rate), that means there would be around 3,100 deaths based on a population of around 60 million. And the other columns give other potential attack rates.
Now, if we take a higher case fatality rate of 0.35% (3.5 people in every 1,000), we get a different set of figures, ending with a potential death toll of 65,000.
You can be sure that this is the one that the headline writers will pick and probably the figure that most people will remember.
The plain fact is that we simply don't know yet how many people will die - but the figure of 65,000 seems extraordinarily high given what's happening around the world and taking into account that number-crunching from Imperial College.
Extreme and unlikely it may be - but it's not impossible, and it was given out by the chief medical officer, so that makes it okay for headlines? Discuss.
While we are dealing with numbers, remember that seasonal flu kills - it's a virus which is much underestimated. The last epidemic, in the winter of 1999-2000, probably caused around 21,000 excess deaths, and in an average winter, flu may kill 6,000 people.
The real difference we note when comparing pandemic to seasonal flu is the groups targeted. The biggest group who die from seasonal winter flu is made up of the frail elderly. They are least likely to catch H1N1 swine flu - but if they do, they have a greater than average risk of complications.
For some, it's when they read about young adults dying with swine flu and children in hospital that they begin to get really worried. It is a time for concern, especially for those with underlying health conditions (for a list of these, see posts from 12 June and 26 June). It's also a time in which we should all take personal hygiene seriously: "catch it, bin it, kill it".
There will be some deaths among people who were previously entirely healthy. But we can get a different perspective if we compare that to other risks we run each day, like road accidents, which kill around 3,000 people each year, or around 4,000 deaths from accidents in the home [53Kb PDF].
The vast majority who get H1N1 swine flu will be fine - and many won't realise that they've had it.
A lot will feel lousy for a few days. A minority will have complications and some will die. That is the reality of infectious disease. We are better prepared than ever to fight this pandemic. Antivirals like Oseltamivir (currently best known as the brand name Tamiflu) are effective, and a vaccine is coming - though it will be touch-and-go whether most at-risk groups are immunised before the peak of the first wave of infection.
PS: The Department of Health website has published Swine Flu: UK Planning Assumptions [65Kb PDF] and the Health Protection Agency its Weekly pandemic flu update.
I'm 
© MMIX~RS~q~RS~~RS~z~RS~17~RS~)
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Assuming that the assumptions underlying the high projections are not arbitrary (why 30% as a worst case scenario?), given that the virus attacks kids (also more prone to infection due to behaviour) and given that we know that vaccines will possibly not be available until October, I am wondering why not put measures in place to slow the spread? Obviously the virus cannot be contained. But it is not rational to assume that the rate of spread will be the same with or without measures. If the spread rate can be reduced until a vaccine arrives lives could perhaps be saved and also very significant disruptions later on could be avoided, because I am wondering has anyone calculated the direct and indirect cost of a partial collapse of the health service?
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Another calm and reasoned piece. Lets hope it allays some of the panic.
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Educated best guesses-best and worst case scenarios. I think the government is right to give us both. They're covered, and anywhere in between to the low side will be seen as 'not so bad after all'. Personally I would prefer to know worst case and anything else is a bonus. That's just me.
Others will panic, and sadly, the media does need to be mindful of these sensitive souls, particularly in view of the extraordinary pressure on hospitals and GP's. The government is presenting its deliberations calmly. Is chasing a headline worthwhile when you think what panic and disruption it causes? What about all those people who are very poorly, need a doctor and can't get through because 1000's of people with colds think they've got SF?
Calmness is the order of the day-flu is flu, mild or severe, this one is only scary because of it's phenomenal transmission rate and numbers of young people affected, as you quite rightly state, Fergus. It's small wonder that parents are so worried. What we need is a good dose of old fashioned British pragmatism! Hopefully the flu line will help ease the pressure on the NHS.
I may have an underlying health condition, but I'm not in any hurry to get vaccinated! Rather see it properly tested first!
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Can we turn the numbers on their head and talk about them in context of the survivabilty rate per 1000 confirmed cases ?
There is a wealth of data out there regarding the actual live experiences of the onset of SF infection, what symtoms occurred, in what order, severity, timeline etc.
Lots of confirmed cases of SF infections have recovered, what was the experience like, has anybody asked them ?
Has nobody U-Tubed their SF infection yet ?
How did the survivers think that they had caught SF ?
An online Swine Flu Wiki thingy could provide an almost live tracking system of the virus and its characteristics.
Experience must be shared so that we can learn to mitigate the risks
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I have read about the symptoms for 'the flu' but many of them I have all the time - how do I then know if I have it and am infecting others. also what is the truth about how long the virus can be active on things such as door handles? I was not worried but am getting more concerned espeacially for 13 yr old son who is a healthy teen going out to a theme park on school trip today.
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With the flu outbreak its important to try to stay healthy, eat a good healthy diet,try to sleep well,try to reduce the amount of stress in your life. It may be useful to use multi-vitamin tablets. I also recommend taking high strength vitamin C tablets to boost the immune system. There is also a homeopathic medicine called Gelsemium which can be useful if you are sure that have flu.
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Congratulations on an excellent piece of writing; it is so unusual now to read / hear a reported giving facts especially on a scientific subject. This article should be used as an example to all BBC reporters to show them how to write facts backed up with data and avoiding sensationalism.
This piece has given me hope that one day we may start being trusted by reporters to come to our own conclusions after being given all the FACTS.
Thanks you Fergus, I will now become a regular reader of your writing.
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BobRocket and Shiver...
You have alerted me to some issues in our family that I had only mildly considered before. I checked up on the symptoms and they fit, except for the spots. We have also had the symptom from the other type with the result of zero platelets which resulted in hospitalisation. Luckily that has resolved itself and the child has not had a repeat of the problem.
symptoms:
Pain in joints as nearly identical to the throbbing pain of holding onto an electrified cattle fence (I Know because I had what I thought was a bout of pain coming on after mistakenly holding on to a live cattle fence to get past a deep puddle)
The pain builds up and lasts for about 8 hours, only relieved by asprin.(that was all that was available back then)
Acute abdominal pain which goes on for hours with all the other stuff. Even as an adult an attack of the pain can cause fainting.
Kidney issues that come on very rapidly and have to be treated.
Does mean the flu medication could be an issue or that the flu itself is going to be an issue? I need to know because I have other family members to consider.
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Sensibleoldgranny
I wonder if you would be so kind as to put the websites up again for me to see-I've not seen anything more than usual flu symptoms plus vomiting and diarrhea, and I am particularly interested in 'internal' effects of SF. Particularly so as my immune system and blood results suggest I have a bone marrow problem.
I must have missed these websites in my rush to read the comments. Thank you in advance.
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Great article. The most interesting part (for me) is that as panic rises, and more people present to healthcare centers, the death rate will decrease. I think that the problem with media reporting is that the very report itself sensationalizes the story. I cannot see any way to avoid this sensationalization other than by not reporting at all (which is what the media chooses to do in the case of traffic related death and injury, and accidents in the home).
One feature of swine flu is its propensity to attack young people - a bit like traffice-related death and injury! I suspect that when the pandemic finally subsides, there will still have been more people killed on the roads than by swine flu. Perhaps all reports about swine flu deaths should show comparisons over the same period with other, more "normal" premature deaths.
All death is painful for the bereaved, and premature death even more so. But the sad fact is that "familiarity breeds contempt", and so the old familiar and needless slaughter of young people by careless driving (90% of all "accidents" are actually caused by careless driving) is accepted as "part of life", whilst a handful of people dying of swine flu is the treated as "the end of the world as we know it".
There is no way to stop this frenzied reporting in a free society such ours. We are very lucky to have a prominent (dare I say world-leading) public service broadcaster such as the BBC who from time to time are still capable of balanced reporting like this.
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How can we contain the spread of the virus when we are all encouraged to buy our weekly shop in the same place as we treat the sick?
Pharmacies in supermarkets are encouraging the spread of disease - eventually a disease we can not contain will be spread enmass beacuse we have encouraged the sick to shop in the same place as we buy our daily bread.
Surely there is a potential for a serious disease to spread in these environments - diseases spread much more slowly when Pharmacists were in individual shops.
Our health is put at risk everyday - but putting the sick in with the food is asking for serious trouble - in my humble opinion.
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This comment may seem a bit bizarre, but I feel more needs to be said (in my view both here and by the authorities) about vaccines and vaccination programmes and how they work and why they are used and about the risks of side effects, bad reactions, and what steps would be built into such a programme to alleviate these.
Some might say that the answers are bloomin' obvious, but I think they probably aren't that obvious to everyone.
Some might say, yes fine, but let's wait until we're nearer having the programme up and running and when we're got some initial results to put more detail on it.
To that, I would humbly suggest, no - start the public education process now, even if it has some caveats and even if it is only in broad brush strokes.
It strikes me that many people won't have been involved in such a programme and will have forgotten about being vaccinated by GPs as children, or within a schools based programme.
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No mention anywhere of what hospitalisation rates are expected or how that capacity will be made available. Will this result in many people who need ventilation (or even just canulation) not being treated and thus pushing up the mortality rates?
What is the 30% for the 'attack rate' based on? Seems this virus is spreading extremely quickly and affecting all groups of the population so why the assumption that a normal flu rate of 30% will be the limit?
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Tigerjayj,
Bob and Shiver... talked about a particular illness that they have in their family, which I checked out on a google search, and realized the problem. It is something I have refused to allow to dominate my life but, after a very recent need for urgent medical treatment have decided to ask questions. I have never been diagnosed with the particular disease and neither have my family but the questions are still there. I am sure Bob and Shiver... will clarify as at this stage I am still asking the questions myself.
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#8 Sensibleoldgrannie
My son's HSP started with a few dark purple non-blanching spots (a week before Easter)and a stomach ache, and within 24 hrs his feet were hugely swollen and bruised, and he had "puddles" of blood all over (a couple of inches wide in some places). It took A&E and several specialists 6 hours to diagnose, which was scary. My son spent the first week unable to even stand, due to arthritis in all his joints, and the following week with stomach pain and severe vomiting. On the third week all the spots and joint pain came back. At no time did he ever have renal involvement, but he did have a terrible chest infection, which involved coughing up terrible amounts of fluid and lumps of mucus (sorry!)
The doc told us that children who have had HSP are often more susceptible to staph infections, but she didn't clarify for how long after the HSP. He had another blood test recently as our doc suspected that this time he has IPT (low red blood cell count) but it wsn't the case. Phew! However, I still have no idea whether, though his blood counts are fine, his immune system is over/under-reactive etc.
The thing to remember with HSP is that most children recover from it within at most 4-6 wks (or 3 in our case) and most don't have severe renal involvement (we are still regularly checking the urine for blood and protein and will do for at least 6 months).
If you have concerns, please do speak to a doc, but make sure it's a doc who really knows about HSP. Several of the docs we saw (at our local surgery) had never even heard of it (apparently 20 cases present per 100,000 children....that's why flu statistics don't mean as much to me any more, if you see what I mean)
Sorry everyone for going off topic. I couldn't figure out if there is a way to send a member a private message.
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Sensibleoldgrannie....
Sorry, I forgot to say:
you asked about whether the flu or the vaccination could involve more risk. I read (on a government health site) that HSP can be (amongst many other things, to be fair) brought on by vaccinations, as can many auto-immune issues. My son had a nasty reaction to some vaccinations when he was twelve weeks old and so hasn't had any vaccinations since then. In view of his auto-immune reaction (the HSP) I won't be having him vaccinated with the SF, but that is just me, and my child. In a way, I wish I trusted vaccinations more, as it would be great to have it done, know for a fact there are no risks, and know for a fact that we are all covered, but we can't know any of those things for certain. That's life!
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3100 deaths would be far, far too many, and it would be an appalling dereliction of duty were the government to stand by and allow this to happen. We should take advice from the authorities in Mexico City. Its difficult to know the situation there now, but it does seem that by some relatively simple measure in late April, the authorities there got on top of their outbreak. We should copy these measures at least.
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The 30% attack rate is unusual - normal seasonal flu does not infect that many people in a inter-pandemic year. The normal rate is usually a lot lower, around 5-10% at the upper limit. But even this, when taking into account that in a 'good' flu year, it takes the lives of around 8,500 people - over the whole year that averages at 23 deaths a day. Obviously they aren't as conveniently spread out evenly over the full year, so on average you could have 100 deaths in a single day during the flu season. It annoys me to see tabloid front pages slapping numbers of deaths from the last few days all over themselves. Even the BBC in the early days of this crisis practically had a rolling death ticker on Breakfast. They should have had a little 'gong' noise going off every time it racked up a new fatality. Even over the top of whatever was going on in the programme. Hmm...
What I'm getting at is, these figures aren't pumped out at us all the time, as the Chief Medical Officer has said, the epidemic in the '99-'00 flu season hardly raised a ripple in the press, besides nearly quadrupling the average death toll seen in a normal year. More people were building bunkers and stocking up on pineapple chunks for the Y2K Bug, which incidentally was pedalled out by the press as being the unavoidable end of the world.
They didn't seem to realise that a lot of people worked day and night to make sure that didn't come to pass, just in the same way now, lots of people are doing the same to mitigate the effects of this pandemic.
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The virus seems to behaving here in a very similuar way here to the US.
USA roughly 1 million plus infections, circa 220 fatalities. UK roughly 100,000 infected, 29 fatalities. Probably way more infections in both countries.
Mainly people with underlyingh health issues but some other fatalities.
This has been happening a month or two in front of the UK. New York was badly hit for example. I suspect London will have a very similar experience.
So whilst all of the recent headline news is worrying - it is not unsuprising?
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Shiver...
Thank you. It is better that these things are in the open as I am sure there are many people with 'underlying health problems' who want to know what to do next.
Luckily, although the person in my family lost all of his platelets for a few weeks, he was bouncing around and running around even in acute illness, which must of been a mystery to the hospital staff, and was a worry for the mum. As far as I am aware, there were no signs of spots, just very large bruises.
That illness, I hasten to say, happened a FEW YEARS AGO and has not happened since.
Here, I am just using my case as an example for consideration:
The problem arose a week after a 7 day bout of stomach upset and some vomiting from an undiagnosed bug.
I found that sports drinks were very good for keeping fluid levels up and providing energy, as recommended.
I don't think the illness was swine flu because there were no signs of a cough or cold and my body temperature was 35.5 at one point then raising to 36 degrees, the opposite of swine flu fever where the temperature climbs up to 39 degrees plus.
The problem of the kidneys started a week after the stomach upset and ended up needing urgent treatment with antibiotics. Initially I was told to go to the doctors when I described sudden, acute, lower abdominal pain. I had no visible symptoms of kidney problems. It was only after a urine test was done, as an afterthought, that the lab stick lit up like a christmas tree for everything on it. It took a full two weeks for things to return to normal and my blood pressure to return to normal.
Women are more prone to kidney infections because of the way they are designed and I do think this is a situation to watch out for if you get a really bad stomach upset with the flu or other bug that is in circulation at the moment. It was Sutara who actually inadvertently prompted me to go to the doctors, thanks Sutara.
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11. At 08:46am on 17 Jul 2009, KNIGHT-DE-TEMPLAR wrote:
"How can we contain the spread of the virus when we are all encouraged to buy our weekly shop in the same place as we treat the sick?"
I really don't want to sound sarcastic, but what exactly are you advocating? The requisitioning, by Government, of various buildings to be turned into 'isolation hospitals', as they did many years ago to deal with the TB infections?
The designation of swine-flu 'colonies' where infected people are marched off to at gun-point against their will? (A bit like the biblical leper colonies).
To keep things in proportion, we don't resort to such measures - for a whole number of reasons - for seasonal flu and this is really (at least on current information) a slight step up from that.
In reality, won't the supermarket / pharmacy /corner shop have various people in it, very probably infectious, buying their packs of blackcurrant Lemsip Max or whatever 'over-the-counter' remedies?
Is the bus, train or car that you make your next journey in guaranteed 100% germ-free? Is your office? Is the coffee-shop or greasy spoon caff? Did you just push a button on a pedestrian crossing? That might have been contaminated, you know, it's not likely anyone will have wiped that with a disinfectant wipe .... and on .... and on
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Fergus,
Well, 65,000 is a vast improvement on what was in some media only a couple of days ago, i.e. 150,000.
I also think these reduced numbers are very probably much nearer the mark, though I would, of course, be delighted to see them proved to be excessive estimates.
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Well said Sutara. As I and others have said endlessly on this blog take basic hygiene precautions. Catch it, bin it, kill it. If someone coughs or sneezes near you then put your own hand to your mouth in case they don't bother. Use handgels on a regular basis. And finally carry antibacterial wipes with you and use these to wipe down surfaces before you touch them.
By these basic precautions, not only are you safeguarding yourself but others around you as well. Common sense is what is needed here. We all have to shop, after all even if your shopping is delivered to your door who actually picked and packed it from the shop? We could go on being paranoid but then we would end up being locked in our homes for the next nine months.
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Just seen this in this BBC News article:
http://news.bbc.co.uk/1/hi/health/8155464.stm
Areas with highest weekly demand for GPs
Tower Hamlets - 759 flu consultations per 100,000
City and Hackney - 392
Islington - 306
Newham - 293
Luton - 272
Epidemic levels are classed as 200
Could anyone tell me where I can find information for all London boroughs? I would be especially interested in data for Wandsworth.
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Hi Fergus. Interesting blog as ever.
One thing that strikes me about this pandemic is the huge variation in mortality rates between countries. From your blog I understand that the crude case/fatality ratio in the U.K. is running at about 0.14%. In Argentina, from the Pan-American Health Organisation's figures (16/07/09), I make it just under 4.5%. Is this related to poor general health, or different swabbing regimes, or lower availability of anti-virals - or does it raise the prospect that a mutation is starting to occur in the southern hemisphere?
I am looking for reassurance, not trying to be alarmist!
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Getting back to a slightly different point,
Numbers mean nothing to the individual or to families except when they need help, they find everyone else also needing help.
How can we help ourselves self-diagnose the other 'pre existing conditions' so that we do not clog up doctors surgeries? The last place on the planet that people want to visit is the doctor's surgery unless for some urgent problem.
I would like to do my own testing if I could. Most people with a 'pre-existing' condition probably know more about their problem than their local GP because it is personal to them and many would have checked it out on the Internet.
Do pharmacies stock lab-sticks or some other system for checking urine for example? Is it possible to check your own blood pressure? Most of us know how to check our own temperature.
Diabetics can buy their own diagnostic kits. Women can check to see if they are pregnant.
It is all very well dragging out the repeated phrases of 'catch it, bin it, kill it', and other stock-in-hand phrases, but these are not panaceas for all ills. The population are still going to have to deal with non flu problems and will still need to have check ups and advice. Perhaps if there were more available self check systems the worried well might also leave the medical professionals to get on with flu containment.
I know the medical authorities probably think we might get it wrong but it is better than doing nothing.
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This is truly the BBC at its best and what it should be. Clear and honest reporting of the facts and a comment board not dominated by ill informed scaremongering but sober unsensational fact and useful discussion and information.
As there is no recommend button but I just had to post a recommendation.
And why? I have an chronically ill family member who has been scared witless by the rest of the media and irresponsible reporting. These reports and blog comments have helped over the last days to put the risks in some context and give them some peace of mind. I was concerned the stress alone would kill them, of course SF still may but at least they are aware it is a slim possibility again and not a certainty.
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17. At 09:55am on 17 Jul 2009, Ozymandias wrote:
"3100 deaths would be far, far too many, and it would be an appalling dereliction of duty were the government to stand by and allow this to happen".
I'm sorry but I really don't understand your remark.
If the UK had only 3,100 flu-attibutable deaths between now and the end of the year, then that would prove hands-down how incredibly well the healthcare agencies had performed.
You can NOT wave a magic wand and make the virus disappear, nor can you prevent it spreading, nor can you stop people contracting it. (I accept the general population can slow down the spread of it by good hygiene practices).
Once someone has the flu, you can't stop them having it. You can reduce the severity of their symptoms and, with anti-virals probably slightly shorten the episode for them.
What you can do is target the most vulnerable, and be very alert to those whose condition becomes serious quickly, so that the small percentage who need significant medical intervention, e.g. hospitalisation, stabilisation of their breathing, antibiotic treatment, steroid treatment, etc., etc., and all the way through to intensive care, can receive those.
Even all those interventions - and let's be quite clear, there will be significant numbers of people whose lives will be saved by such medical interventions - can NOT stop all the potential deaths from this, or any other flu virus.
This is happening in the real world, not in some internet-game based "virtual" world with made-up rules.
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I just wanted to say I'm finding this guy (BMJ Blogs) very reassuring:
http://blogs.bmj.com/bmj/category/tom-nolan/
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There are simple measures such as taken by the Mexican authorities in late April, which the government could take to at least slow down the spread of this disease until the vaccine is ready. The failure to restrict international travel in April and May is already in my view a dereliction.
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celticbedouin, I don't know about Argentina but in Mexico (and especially Mexico City) the fact that air pollution and high altitude causes so many people - about 70% of the population - to have underlying breathing problems before swine flu was a big factor in why it hit them so hard, and it may be that Argentina also has high pollution. There is an article about it on here somewhere. I wonder if in the UK we will see more difficulties for those living in air polluted areas than in areas that aren't. Asthma rates tend to be higher is such locations, for example. It may be old-fashioned but perhaps the 'sea air' cure had something in it.
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Gordon Brown announced yesterday, that the Government has ordered 60 million doses of the H1N1 flu vaccine, enough to vaccinate everyone in the UK. What he has neglected to mention is what would happen to the UK's vaccine supply if the H1N1 strain mutates and becomes more severe than it currently is.
The UK has no vaccine manufacturing facility within the country and is solely dependent on supplies manufactured in Europe by GlaxoSmithKline PLC and Baxter International Inc., whose production plants are in Germany, Austria and the Czech Republic. These three countries have a combined population of over 100 million.
If the H1N1 virus becomes more virulent before the UK's delivery of vaccine has been produced and delivered, it is not conceivable that the political establishment in these production countries would allow vaccine to be exported to other countries before first inoculating their own populations; if they did there would be total anarchy. Just like any contract I have ever seen I am sure that the vaccine producers have a get out clause which will allow them to divert pre ordered doses to their own population.
A recent news item stated that the production process of producing the vaccine has proved to be not as successful as was hoped, adding even more pressure to the supply chain. In past years these manufactures have had serious difficulty in producing enough vaccine to support the regular Global flu season, so what are the chances that they will be able to produce sufficient quantities of the regular flu season vaccine and enough H1N1 vaccine to inoculate the world's population. The production of flu vaccine requires a lead time of about six months before the season begins; assuming the production of the H1N1 vaccine was started within a month of the Mexico outbreak in May the first vaccine would not be available until November.
We have been told that we will receive our first vaccine doses at the end of August, and the first sector of the population to receive it will be members of essential services, Doctors, nurses, police, fire, government etc. From this fact we are looking at around 5million doses, if we extrapolate these figures for just the European Union which has a population of 1/2 a billion people it would require a minimum of 35 million doses off the top just to keep essential services running. If we add the 100 million doses the three countries that produce the vaccine, will need to protect their own population we are looking at 135 million doses required before the public see one dose for themselves. This figure does not even take into account the 300 million doses ordered by the USA
The point is we are not being told the truth, the numbers just don't add up. We as a population are being fed this Pandemic in bite sized sound bites. The effect to the Worlds already weak economy will be catastrophic. Our only hope is that the N1H1 virus becomes no more virulent than it already is, because the alternative is something I don't even want to consider.
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Latest figures show 29 fatalities from 55,000 cases.
So mortality rate appears to be around 0.6 per 1000 cases deemed serious enough to warrant seeking medical attention.
The rate for all cases will be much lower (but it is not known by how much).
This means that the worst case survival rate for for cases serious enough to warrant seeking medical attention is 999.4 per 1000, that looks a little better doesn't it
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When the risk factors are taken into consideration, I wonder how much poverty will be an issue? I fear that when the pandemic has died down and we look at the group with the highest complications/mortality rate we will see once again that it is those who live in poor, overcrowded housing with a low-quality diet.
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I am all for calming panic, but I am implacably opposed to pretending that we are in this size of pandemic through pure serendipity. The history of the UK spread of this virus is being skilfully rewritten by spin doctors, but none of them seem able to answer the following very simple questions:
1. Why given an average level of Mexico visits does the UK have by far the fastest spread of Swine flu?
2. Why were only DIRECT contacts of Mexico visitors screened at the earliest stages?
3. Why did Britain lead the move to change the WHO definition of pandemic shortly after it started?
4. Why did the Government claim the existence of a non-existent national helpline?
5. Why did it ignore the advice of leading Californian epidemiologists that their containment startegy was (quote) 'like trying to maintain the integrity of a submarine with a kitchen door-screen'?
These are facts, not conspiracy theory. Mr Walsh continues to act as a public information officer for this incompetent MfH regime, but he would serve the public better by folowing up the endless stream of evidence pointing at abject bureaucratic and political failure.
'Now is not the time for a post-mortem' we are told. With the current Establishment, it never IS time for a post-mortem.
Those who were www.notbornyesterday.org already know this
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32. At 1:40pm on 17 Jul 2009, anglophile8 wrote:
"If the H1N1 virus becomes more virulent before the UK's delivery of vaccine has been produced and delivered, it is not conceivable that the political establishment in these production countries would allow vaccine to be exported to other countries before first inoculating their own populations; if they did there would be total anarchy."
Total anarchy, eh? That's a bit dramatic, isn't it?
Well the H1N1 virus stands a good chance of becoming more virulent, or less virulent, or staying about the same but in changing some other way. 'Cos that is what flu viruses do.
In my view, unless the flu pandemic in some way drastically alters and become SO big and serious an issue that all sorts of emergency, contingency legislation is brought into force, then global companies will continue to honour their contractual agreements with governments, if for no other reason, due to the legal and commercial consequences.
The rest of your piece goes on to make various assumptions that other governments / countries have made the same political decisions as the UK government about resourcing a mass vaccination programme. Did you check those out? I say that because I'm a long way from certain that many other governments have done that.
I could add cynically, 'but then perhaps they're not expecting a General Election early next year', but I guess I'd better behave myself.
Whatever, the simple fact is that mass vaccination is a good and appropriate strategy for dealing with the reality we have. No, it's not a 'one-size-fits-all' panacea. It won't be an answer for some, but for most it will be fine.
Yes, there is a small possibility that plans for mass vaccination might just go 'belly-up', either nationally, or in some areas, for one reason or another and, yes, that probably would mean more illnesses and deaths, particularly in future years.
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I'm sorry everyone, the mortality rate is very, very low and therefore utterly irrelevant until such time as the N1H1 mutates - if indeed it does.
My point here - still awaiting moderation - is WHY do we have the highest incidence and the fastest spread rate in the world?
Because those in charge made a catastrophically wrong assumption about CONTACT monitoring in the first few weeks.
I too dislike panicky sensationalism. I also dislike lazy journalists who don't investigate incompetence any more.
Those reading www.notbornyesterday.org already know this.
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30. At 1:23pm on 17 Jul 2009, Ozymandias wrote:
"The failure to restrict international travel in April and May is already in my view a dereliction."
I totally disagree. Just look at how it spread in the early stages. Stopping international travel would not have changed things very much but would have had a humungous effect on the economy adn the day to day activities of the UK population.
An airliner having an infectious person on it is probably the scenario you are thinking of, but sneezed over air freight would be just as probable.
For sure, there is the possibility for the Government to do all sorts of things, but the people of the UK do expect it to make MEASURED responses and interventions to such events. Stopping air transport, trains and shipping would have been really 'over the top' and probably more damaging than the flu virus.
If you did such a thing, how long do you think it would be before you had huge queues at substantilly sold-out supermarkets, civil disorder, e,g, looting and possbibly even official food rationing?
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http://www.thisislondon.co.uk/standard/article-23720886-details/Tower+Hamlets+is+worst-hit+area+with+400+new+cases+every+day/article.do
Here you can find infection rates in all London boroughs from last week.
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I spoke to my GP yesterday about an unrelated matter, and as I have young children he talked to me about swine flu. He said that locally he is seeing it in children, probably because adults aren't needing medical help and he suspects a degree of immunity. There is a high temperature but a quick recovery time. He recommends that if you suspect you have had swine flu but have not had a confirmed diagnosis that you still take up the vaccine. He agrees that it might be best to get it now in case it mutates later, but equally agrees that there is no sign that it will mutate. He said that compared to seasonal flu this is milder and, as viruses go, 'benign'. This bears out what a medic friend of my husband says about it being milder than common flu.
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nbyesterday,
There are huge numbers of environmental factors which make infections more or less likely to spread within different geographical areas.
For example, two of the suspected reasons for the more rapid spread in certain part of England are density of population and air quality. There are probably dozens more.
Comparing Country A to Country B, unless you somehow miraculously know all these medical, social and economic variables and how them impact upon the virus, really isn't that useful an exercise.
One of the reasons why some people are using the USA in such comparisons is because it is a very big sample and therefore, probably, these variables average out to some degree.
But even then, such comparisons are indicative only.
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#38 Sutara
Stopping international travel may have been impractical. However I rather suspect that issuing advice that any children who had been to the USA or Mexico on holiday should have taken a week off school on their return might actually have slowed the spread of the disease down considerably without any significant damage to the economy.
Even now I would guess that the spread of the disease could be slowed by closing schools early for the Summer holidays (many have already finished term). Also the situation in Mexico did seem to improve as a result of requesting that everyone stayed at home over an extended national holiday. Was that coincidence? Or did it actually help, and could we do the same here?
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What a sorry state we have allowed this country to get in to regarding health and our attitude to it. We are all now wasting out time trying to avoid the useless situation in the UK with the swine flu. In reality it should never have gotten this bad in the first place. I understand we al get flu and this is no different but lets look at the facts.
Nothing appeared to be done early on to educate people in how to avoid it and to be clean, all we heard was news and hype. Now because of this lack of effort we have more cases than we should. I have returned from a business trip to Hong Kong where the public information on how to better manage flu is posted everywhere. In suspected cases where they thermal screen you at imigration and from your own reports they quarantine people for up to 2 weeks who are suspectd to have swine flu. This contained it and stopped the huge spread we have seen here. Perfect! Nobody dies.
Why cant it be pushed home to people that they should:
1. Cover the mouth when sneezing.
2. If using a tissue then throw it away in a proper bin ASAP and not leave it in a pocket or anywhere the germs from it can be left. The virus can sit on a surface and survive for up to 24 hours I believe.
3. If you have the flu, stay at home and drink lots of fluids, just as you would with regular flu. Dont spread it around by being with others.
4. Wash your hands regularly and always after a sneeze.
In Hong Kong they wear a surgical mask as a precaution from catching the virus which is airbourne. They also wear a mask if they are sick to prevent it from transmitting to others.
These simple rules reduces the spread dramatically. We should be doing something to make sure everyone knows. After all prevention is better than no cure...
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CuriousAddition
Dead on cue!
Tower Hamlets is a good example of what I was just trying to explain, with a very high ethnic population coming from, mainly, Bangladesh and that part of the world.
Now, the fact is that different ethnic cultures have different cultural attitudes to illness and treatment. So that also is a factor - sometimes only clarified by sociologists well after the event - that can make meaningful comparisons between geographical areas very difficult.
What I'm saying is that health, and ill-health, has a social construct.
How it works for you in your particular ethnic, religious, whatever culture may be quite different to how that works for others from other groups.
Then again, Tower Hamlets has something like 3.5 thousand people per square mile in it and also has some very serious air quality issues due to the major roads going through it and the vast amount of commuter traffic going to and from London through it.
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To conclude my contribution to this part of the debate.
The flu will kill a percentage of the population. That percentage is still unsure but has been set out as worse case, best case outcomes.
1) It will not be the flu that kills some of the population, the deaths will be attributed to 'natural causes' but those victims of natural causes may have started off by having the flu.
2) Some of the deaths will be from 'ordinary' seasonal flu.
3) Some of the deaths will be from H1NI.
4) Some of the deaths will be from H1NI followed by ordinary seasonal flu, or the other way around.
5) Some of the deaths will be from a mixture of H1N1, seasonal flu and natural causes.
6) some of the deaths will be from the 'natural cause' of pneumonia
Logically, if the seasonal flu jab is given then it eliminates problem 2 and reduces the risk of problem 4
If the pneumonia jab is given then it will eliminate the risk of problem 6 and reduces the risk of problem 1
If children are up to date with their regular vaccines it will reduce problem 1 and problem 5
If people are more empowered to help themselves by simple diagnostic systems, manageable home remedies, rapid
diagnosis of high risk groups, rapid response to acute symptoms, it may help reduce the risk of problem 1 and problem 2 and problem 3 and problem 4 and problem 5 and problem 6
If the H1H1 flu vaccine becomes available it should remove problem 3 and reduce the others.
If people catch the disease and recover at a managed rate then it may reduce some of congestion in the public health system and reduce all problems.
If there is a careful screening at airports and other portals into this country, it may reduce the risk of as yet unknown problems.
If some of you brainy people out there can improve on this please do, as this is just how an old grannie makes sense of it all.
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#31 angelscomeinthrees:
Another part of it could be attributed to the living conditions. To the best of my knowledge, Mexico City and Buenos Aires (where a significant number of the Argentine casualties has been located, 69 out of 139 in my slightly outdated source) have fairly large areas with people living in severe poverty. I imagine that it's entirely possible, though I lack conclusive data, for a lot of deaths to come from that area of town. It doesn't, however, explain the casualties in the Santa Fe area, but I'm thinking (and very much hoping!) that the 25 % CFR I interpret from the data (my Spanish is virtually non-existent) is partially due to not testing. Likewise, I hope the same for Buenos Aires.
See http://www.msal.gov.ar/htm/site/default.asp for more information. Click on 'Situacion De Influenza' for a .pdf file (which is why I don't link it here) with the data I refer to on the second page.
#32 anglophile8:
The capacity is, indeed, not enough. WHO itself states that whilst they could, theoretically, make 4.9 billion doses of vaccine per year, or per two flu seasons, but that's only so if all production is aimed towards a vaccine and if the manufacturer utilises 'dose-sparing', which the WHO defines as 'using a smaller quantity of active principle' (which I take to be the use of adjuvants -- something not everyone is entirely happy with...) The WHO notes that 'at least 1 to 2 billion doses per year' is a more conservative possibility. Seeing as current estimations state that 2 jabs will be needed (with a possibility for 3 in children), it's likely that a shortage will arise.
Given these numbers, it'll be a full year before the US, Canada and Europe alone will have been vaccinated.
See http://www.who.int/csr/disease/swineflu/frequently_asked_questions/vaccine_preparedness/production_availability/en/index.html for the WHO parts I refer to.
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A lot of sense is now being posted on this blog which is good news. I went to my local supermarket today and they had completely sold out of ibuprofen, aspirin and cold and flu treatments! I asked customer services how hand gels and wipes were selling and they said as normal! Come on everyone - prevention is better for us all!
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I was in Boots' branch in Waterloo station and all hand gels and hand wipes were gone!
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But these gels and wipes are surely only anti-bacterial. I have ordered some anti-viral and anti-bacterial gel from HiBi, but they are taking their time delivering it.
Am I wrong to assume that anti-bacterial gels won't help with the swine flu? I would genuinely like to know the answer to this.
Thanks
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Alcohol based hand gels DO kill cold and flu germs so, yes, they are still useful in reducing your chances of catching such illnesses.
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In this day and age, surely a concerted effort to instil a greater degree of cleanliness should be carried out. Why not an advert on all TV channels after each programme throughout the day, why not a front page spread on 1 day in all newspapers, surely something could be posted on the web.
People need to up their game regards cleanliness and the need to avoid spreading germs of any kind. Those who remember HIV coming onto the scene will probably recall the saturation coverage, it does not seem to be the same this time.
Yes, in this multicultural land, with many visitors, you wont crack the problem but at least it would surely contribute a positive step to overcoming this issue
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Thank you Curious Addition.
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Regarding the national flu pandemic service, don't you find the whole idea of this is very concerning. Given the mass numbers of people who have bought counterfeit tamiflu on the internet do you not think that individuals/parents in the know will contact the service eloquently describing symptoms of flu in order to get their supply of the drug 'just in case'? You could find stocks rapidly depleted with none left for the poor, sick and dying, individuals who really need it. I assume there will be no checks or regulation.
Hospital consultant
Manchester
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42. At 2:56pm on 17 Jul 2009, random_thought wrote:
#38 Sutara
"Stopping international travel may have been impractical."
It would not have been impractical - it could have been done quite easily by the police, armed forces and sea port and airport authorities within a few minutes of the order being given.
It was unnecesary and unhelpful and would not have been a measured response to the situation at the time.
Please don't underestimate the things that the Government can legally do if certain emergency situations arose that demanded serious actions. The powers are quite extensive and some of them can be put in place directly by the Order of the relevant Secretary of State, some others would need parliamentary approval.
If it were necessary and was an appropriate and measured response to the situation then TV and radio networks (and ISP networks) could be shut down, transport limited to 'authorised' journeys only, ports and airports closed, curfews put in place, property and other resources commandeered and all of that done under martial law, etc., etc.
But you would need one hell of a justification for such actions and we do still live in a democracy(ish) and MPs and civil servants are accountable (to some degree, at any rate).
Can you imagine the outrage (both within the Uk and elsewhere) if international travel had been stopped for an event that is basically no greater a medical issue than the flu we get every winter, year in and year out?
Now if you were talking a major toxic contamination, or a highly contagious fatal disease, then perhaps you would put some such measures in place, at least in the local, or regional area to the incident.
I mean there are much bigger medical emergencies that a county could have to deal with than this flu.
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The 30% figure is based on the estimate of the population effected from the 1918 pandemic. Given that the world is a lot more mobile and the virus is novel to our immune system, 30% is not an unrealistic figure at all.
Side note: While people naturally tend to focus on the case fatality rate, the more worrisome is the hospitalization rate. Since the virus is going through the under-65 population, the health care system will very quickly become overwhelmed. There will not be enough beds & ventilators for all the cases. In 1918 they used "influenza wards" which were nothing more than tents, cots, and sheets for walls.
That's not meant to be a scare factor. The point is this--while the case fatality rate is somewhat low right now, it's because you have full access to health care. When the system is overwhelmed and there are not enough resources at hand, you're essentially living in the year 1918. The virus does NOT have to mutate for the case fatality rate to shoot up. The "second wave" will occur when hospitals can not properly handle all its cases.
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agmneuro
Interesting comment.
I'd be even more interested in what checks and balances against such abuse of this temporary system might be put in place whilst not hampering effective infection control safeguards.
I also would admit that I do think perhaps the public perceived need for, and usefulness of, anti-virals versus 'over the counter' remedies, may have been talked up a bit excessively.
But then again, I suppose there is a significant public expectation that the healthcare profession just must have a 'fix' for every possible problem.
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Come on, we can flatten whole countries over 3100 deaths apparantly. Closing all sea ports and airports seems pretty measured to me.
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55. At 4:22pm on 17 Jul 2009, Grumble69 wrote:
"The "second wave" will occur when hospitals can not properly handle all its cases."
Which eloquently explains the significance of a vaccination programme.
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agmneuro
Oh and I suppose "the doctor gave me anti-virals" sounds a lot sexier than "I rubbed Vicks on my chest".
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agmneuro
I understand that each of us will have a uniquely allocated number and will only be able to order tamiflu over the internet or by phone once. This is to prevent people from stockpiling. My big concern is that so many people will hit the internet site when it goes live that it may crash! We don't have a great history with the nhs and computer systems after all!
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Grumble69,
The issue of hospital spaces extends further than H1N1 flu victims. There is still ordinary flu to contend with during the winter months. People cannot put other illnesses on hold either. If one is going to play the numbers game it has to be extended further to potential outcomes from other illnesses during a time of pandemic. There will be finite resources in all aspects of care which will force health leaders to make choices or take innovative steps to cope with health care. What will our leaders do, make choices or be innovative and create new ways of doing things. My vote would be with a health leader who is creative and innovative, who creates new ways of doing things, who joins up the dots and who can show the world that Britain still has the potential to lead the world in health care.
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Ozymandias
If you were to take such extreme action as to close all airports and sea ports, then how would you keep the UK population supplied with medications, vaccines, petrol & diesel, heating oil, food, etc., etc?
Just look at your fruit and veg aisle in your supermarket and note how much of the produce has been flown in to the UK, for starters.
You would so badly hinder the operation of dealing with the flu virus, it would be counter-productive plus it would cause a whole raft of other problems.
We've seen recently how quickly road fuel becomes a problem if a refinery shuts down for a few days for industrial action. Can you imagine the consequences and sequels to your proposal?
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sensibleoldgrannie,
That's a very good point. Most people will not even get the swine flu. But there are innumerable other reasons that can bring a person to the ER. They will be understaffed and have an increased caseload. So while the 65K may be directly attributed to the influenza, it underestimates the number that will die from other conditions due to the health care system being overly stressed.
I'm hoping that the health policy experts have an innovative plan in the works to minimize our losses. I'm also hoping that the vaccine becomes widely available in a timely fashion (and the cure is not worse than the disease). But to be honest, this looks like it's going to be a real mess. I don't even want to think about what kind of toll it will wrack in countries like India.
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Worst case would be 30,000,000 get swine flu this year and 29,940,000 survive. Seems a little better that way around!
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Yet another very well written article,I have been following this flu blog for quite some time and everytime i read it it makes me smile at the thought that not all reporters are talking a load of rubbish. Fergus i think you bring more calm to the readers of this blog in one post than the government will ever bring to people. Personally i was quite worried about the flu outbreak being as since about 4 years ago i have been getting more affected by flu every time and i used to read a lot on skynews at the begining of the outbreak and that didnt help me at all! and then i read this and my whole outlook on the situation has changed. my main concern at the moment is not myself, but for
A) those with the significant health issues
and B) the poorer countries that will not have access to the health care we do whilst there is no available vaccine.
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Good grief Sutara, were talking about something between 3000 and 65000 dead, and you are worried about whether you can get fresh mangos in Tesco?
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58. Sutara:
"The "second wave" will occur when hospitals can not properly handle all its cases."
Which eloquently explains the significance of a vaccination programme.
-------------
What any good would the vaccination be as the second wave will be a "mutated" virus? I mean, of course, other than the benefit of the pharmaceutical companies.
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I am an employer and I have a member of staff with a compromised immune system.
Where can I get advice on what to do?
Should I insist the member of staff stays at home, offer the option, or take some other course? My instinct is to be cautious but other staff don't know this member of staff has an issue and I don't want to make them feel ostracised or the subject of speculation.
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#68 511simmo
simple things done well
Call all of your staff together, tell them that it is in everyones interest to take simple hygiene precations during this outbreak to minimise disruption to the business and their jobs.
Make gels, wipes and tissues available to all staff at all times, ensure that they use them (peer pressure, make them self policing)
Pay sick pay from day 1, make sure that whilst you appreciate the efforts of staff who come to work when they are a bit under the weather, at the current time it is better if they stay at home but keep coleagues informed.
Your special member of staff knows better than you how to manage their condition, ask them what works for them.
Above all, treat All of your staff fairly, they will appreciate it and repay it in spades
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In fact all employers should pay full sick pay from day 1, the sheer numbers of contagious people suffering all sorts of things at work at any one time is shocking.
It is time that employers realised that Lizzie who is a good worker and has a flawless attendance record is in reality a modern day Typhiod Mary, forced to come to work because she can't afford the time off and bringing all sorts of minor ailments to work, she infects co-workers who do take time off. The result is a loss to the business (and co-workers) greater than just giving Lizzie a sick day off twice per year.
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66. At 7:38pm on 17 Jul 2009, Ozymandias wrote:
"Good grief Sutara, were talking about something between 3000 and 65000 dead, and you are worried about whether you can get fresh mangos in Tesco?"
YOU were the one suggesting closing air and seaports, not me!!
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511simmo, I agree with BobRocket, the one good thing that should come out of this should be an end to the culture whereby sick people pop a pill and go to work, thereby infecting goodness knows how many, including those with medical conditions. If I were your employee I woudl like to be given the option of staying at home, but I think you may have to tread carefully with regrad to any possible discrimination. I would also add that you need to be tolerant of parents who may need time off to look after their children, both from the point of view of not hurrying their kids back to school before they are well and also to ensure they are not infectious when they go back to work.
I do think that the health service is doing all it can but I think it is undeniable that had schools closed early we would not be seeing the outbreaks that we are, and that the reason they were kept open is so that parents could keep on going to work. The Autumn term, when the flu outbreak is likely to pick up again after the holidays, is the longest of the year and with the shortest breaks; anyone with young children knows how exhausted and bug-ridden they are by half term, let alone Christmas. We have already had a letter from the CC telling us we must send our children into schools where there are outbreaks unless they are ill. I hope that common sense will take over and schools closed for longer in order for the spread to be limited, and for children to have the time and space to recover. I would like to see the schools finish at the beginning of December anyway, it goes completely against nature to push children (or anyone) hard in the Winter months.
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67. At 8:17pm on 17 Jul 2009, echofloripa wrote:
"What any good would the vaccination be as the second wave will be a "mutated" virus?"
You meant MIGHT be a mutated virus, didn't you?
Yes, you're right that is a possibility, but not a certainty.
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People seem to believe that if they can get hold of antivirals and take them for five days then they are 'covered'. This is incorrect. A couple of days later they may come in contact with the virus and go down with it. Antivirals should not be taken 'just in case'.
People should, however, spend a few pounds on an accurate thermometer for home use in order to aid diagnosis. The system risks being logjammed by the worried well. It will be mild for most and some will barely notice that they have had it.
The media have done the public and medical services a disservice by focussing only on the worst case scenario. The likelihood is significantly lower and it is just prudent to plan for the worst. I think that many people will simply have been ignorant to the fact that seasonal flu kills a few thousand people each year.
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Re post 71: Yes Sutara I am, I am advocating that we should have closed air and sea ports to keep this virus out, and that the prospect of empty fruit and veg aisles in supermarkets, raised by you in post 62, is not exactly a big deal. We can live off what we grow, we did for 6 years in WWII remember.
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angelscomeinthrees wrote: "I hope that common sense will take over and schools closed for longer in order for the spread to be limited"
Yes but you would then have to ensure that you isolated the children and didn't let them come into contact with anyone else! The virus is out in the community so closing schools early won't have any effect. Why select schools - you may as well close shopping centres (as children hang out there and so could catch flu) or anywhere that groups of young people hang out. I had a look at some figures this morning and they showed that the largest number of people in our area who were "diagnosed" with swine flu were in the 30 -40 age range. As these people are in the age range where a high proportion are parents, using your logic we shouldn't really be sending the kids home to them as they are at higher risk! (Obviously I know that you need to send kids home to their parents but I am using this as an example to show how pointless it would be to close schools!)
A lot of work went on in the mitigation stage to prevent the disease taking hold - but we are beyond that now. Closing schools is pointless - if you are ill don't go in. If you're not - it's fine.
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RE:#21 Sutara
My opinion that Pharmacies in Supermarkets could pose a potential risk to our health is I believe not suggesting the return of the Isolation hospitals you mention.
I believe Pharmacies are places you attend to fill your prescription for whatever condition, illness or other you alone may be suffering from.
My concern is that when you are contagious - regardless of whether it is Flu, a Common cold, TB, Ebola, H5N1 (Bird Flu) or some other contagion, we the public have no choice but to buy food and in doing so expose ourselves to diseases which in the past would have been limited to Pharmacies on the high street - with limited spread.
The easiest way to spread a disease is to infect large numbers all at once - Supermarkets are by their very nature a confined space where hundreds are crowded together - raising the potential for a more serious disease to be spread - putting the vulnerable (Young/Old/Sick) at risk of catching disease and suffering life threatening complications.
Inevitably we are all at risk from everday life - I am not suggesting we all go around in bubbles - or wear face masks. But I am pointing out a very real risk that is evident regarding the locating of Pharmacies in Supermarkets with the potential of infecting hundreds of innocent people in a short period of time - thus increasing the spread of any disease.
It is a sad fact that because the majority resist travelling from shop to shop buying everyday goods we are now limited to Food warehouses/supermarkets for convenience. Let us hope that the convenience doesn't turn out to be lavatorial- or labrotorial...
I have read your posts that appear on nearly all Flu related blogs on the BBC website - may I suggest that you are most versed in the advise you give.
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Troy, it's well known that schools are hotbeds for bugs. As I understand it the outbreak in Birmingham revolved initially around a particular school; siblings at other schools then got infected and spread the virus out into the community. If you have spent any time in a crowded classroom, particularly of primary aged children, you will know how much close contact they have - it's very different from a shopping mall or supermarket, or even a youth club (and remember primary children don't have the same social behaviour as secondary ones). At primary level there will be drinking bottles clustered together, few toilets and, in my experience, overcrowding. And young children do struggle with the hygiene thing, and they aren't always taught it in the first place. Slightly different topic but I've never yet worked out why my daughter's class always smells of poo.
I agree that it is too late to stop the spread now, and I also agree that it would have got out into the community eventually. But I do believe its effects will be mitigated by closing schools throughout the winter and giving children a long break, whether they have the virus or not.
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# 75 Ozymandias
"Get a grip, person". This virus was holidaying here long before it was recognised as a possible pandemic agent in its home town.
If it had turned out to be a very nasty one then the airports/ports/shopping malls etc. would have closed themselves due to loss of customers through fear of infection by a very deadly agent.
We don't need some mad overreaction, if you want to lock yourself in a closed sterile environment for some unspecified period then go ahead, build your own private prison, just don't include me.
Sensible, sustainable precautions against infection against all manner of horrible lurgies that we are faced with each day is what I will be doing.
I will make sure that I will wash my hands regularly, cough/sneeze into a tissue, maintain personal space where possible, get lots of fresh air etc.
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BobRocket I agree, but sadly the precautions you wish to take for yoruself are impossible in schools. This week, my daughter's class was so crowded she had to sit on the floor for some lessons, so no personal space; and when I reminded her to wash her hands after playtime, she told me that they aren't allowed to, but have to get straight back to work. They are allowed to wash hands if they sneeze, but frequent handwashing is the most effective way of prevention and the daily timetable is so manic that there isn't time for a class of thirty to wash their hands as much as they should. And if it is sprinkling with rain you can forget any ideas of fresh air at playtime - too risky as they might slip - so they play in the same crowded space as they work. Windows are shut and very often the blinds are drawn so there isn't even any natural light.
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At the start of May, there was masses of info available on the Internet regarding SF in the workplace. Most responsible employers would have systems in place to ensure minimal disruption should there be an outbreak in their workplace. My only issue with the info was that it should have been collected in one place, not spread over different websites.
Alcohol gels for personal and general use may seem expensive, but better surely, than losing a significant part of your workforce over a protracted time. Home working is a viable alternative for many posts and linking with similar companies to outsource other posts is a good idea too. Again, most companies should have such a 'disaster plan' already in place.
Read packets carefully to find wipes and other cleaning products which are effective against H1N1 - there are several products now, especially among large suppliers of office cleaning goods. In May, I found several standard household cleaning products with this ability-many of which we all have under the kitchen sink already!
Regarding sick pay-it's a damned if you do/don't scenario-I've worked under both approaches-without a doubt, sick pay is drastically abused and current employment law makes it very difficult to monitor without involving additional costs of occupational health services. I have yet to find a half way house on this one.
If the virus mutates, would a vaccination against the original form protect against its mutation? Is the manner of vaccine production indicative of efficacy? There have been suggestoons that the slower grown batches will be more effective. How exactly has SF caused people to die? What predisposes an underlying condition to react badly to SF and cause death?
These are my questions at the moment, but I don't think they will be answered anytime soon!
Sensibleoldgranny-thank you for your answer earlier-the condition of which you speak sounds very painful and dangerous-I hope all those with this condition keep well.
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If you think youself or your children are at serious risk from either being infected with SF or indeed of infecting others because they already have symptomless SF then by all means keep them off school.
I personally don't think the risks associated with SF are any greater than all the other risks that my 3 primary age boys go through each day.
My boys like going to school, if they weren't in school learning something they would be out playing with the local kids anyway and both me and my employer would be losing out.
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#81 Tigerjayj wrote:
'Regarding sick pay-it's a damned if you do/don't scenario'
Any employee who wilfully misuses the sickpay scheme is also stealing the pens, surfing facebook during working hours and any number of other activities that are considered to be gross misconduct that are subject to summary dismissal.
Not paying sick pay from day 1 means that contagious employees are forced to put their co-workers and the business at unnecessary risk.
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KNIGHT-DE-TEMPLAR.
I don't see pharmacies as being a place of significantly heightened risk in terms of spreading infections compared to residential and nursing homes, hospital wards and a fair number of other environments that I can think of.
If you feel that a particular pharmacy arrangement in a particular supermarket in some way endangers public health through its customers proximity to food within the shop, then I would suggest that you take that issue up with the relevant local authority's environmental health service.
Focussing on the flu contamination thing remember the old saying that coughs and sneezes spread diseases - but you have to be in range of the droplets of saliva to breath them in / ingest them, or to have contact with surfaces which have been contaminated by them.
Mostly the pharmacy sections are set away from the main stores, at least in the ones I know. Or at minimum well away from unwrapped produce, e.g. loose fruit and veg.
Anyhow, I'm not truly convinced the risk from the number of contagious people walking around in the average supermarket anyhow, or indeed in many other public places, would be significantly different to that in the pharmacy.
I would have thought if people are going to go to the pharmacy when they feel grotty, they're pretty likely to also do a bit of shopping somewhere whilst they are out, e.g. "I feel awful but I must go out and get this prescription dispensed and while I'm out I must also get some bread and milk and ...."
Your supposition might just be right, but it would take some serious work to prove that it was and until there was such proof, it would be no more than supposition.
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Ozymandias
And what are you going to do for fuel? Ports are shut - no oil tankers showing up at the refineries.
And what are you going to do for all the imported pharmaceuticals and vaccines? No, you can't airfreight them in from Europe or the USA, the airports are shut.
How will the butcher / baker / fishmonger get their food distributed without diesel and petrol?
How will the critically ill get to hospital? Horse-drawn ambulance perhaps?
How will the doctors and nurses get there? The buses aren't running because there's no fuel.
And on ... and on.
Just think out the consequences and sequels for yourself and it is surely pretty obvious why the Government chose not to go down that route.
I think you underestimate how dependent the U.K. is on importing many day to day essentials.
Plus there would have been many other consequences commercially, economically, politically and in many other ways too.
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BobRocket, at the moment I agree with you, my kids love school and are better off there, although they are ready for the holidays. But I think in the Winter it may look very different and I may decide to keep them at home - last winter I did so for the last two days' before the Christmas holidays when a third of my daughter's class were off with norovirus and I didn't fancy getting that for Christmas! The fact is that the Winter term is too long and the children pushed too hard.
But, I've seen first hand that the kinds of precautions that we wish to take for ourselves as adults barely happen in schools. And if infection rates in schools shoot up, then so will rates in the wider community, which will ineviatbly affect the vulnerable - younger children may have a mum who is pregnant, for starters.
shiveringpeaprincess, I hesitate to recommend anything complementary for fear of seeming a bit flakey, but in case you weren't aware tea tree and ravensara essential oils have a reputation for being antiviral - as well as vapourising them, you can put a drop on the collar of a shirt. You do have to be careful with people with asthma and pregnant women, and ravensara is best for younger children (but not young babies) , but generally most people can use these oils safely in this way. A friend of mine was a paediatric nurse in New Zealand and they used aromatherapy oils to stop infection.
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What we have got is a novel flu pandemic, of a similar severity to average seasonal flu, but with a higher rate of infectivity. Every year we cope with the usual round of flu and get over it as we have always done. The present flu only really creates more of a problem because the population do not have immunity to it and so infects more people than usual. This novel flu appears to take a longer time to get over because our bodies are not used to fighting it. This blog has tested and developed arguments about what to do, over several weeks, since the beginning of the outbreak. All of our suggestions are here and archived at the bottom of the page. If you like a particular line of argument, just highlight the name and you will get all of that persons comments for that particular debate. You can access all of the debate questions in a similar fashion. To Join in the debate is easy, but don't expect a good reception from us if you only post junk. We have been allowed to put our concerns out there in the public domain, without censorship and sometimes with a certain amount of risk, as the worries sometimes seem far-fetched. However, all serious concerns have been worked through thoroughly. Everyone is welcome and I have noticed more and more people are beginning to join in. There have been very few put-downs and theses have been removed thankfully. Just putting you in the picture if you are new to this blog. I am just welcoming you as an ordinary member of this blog and I hope we as a community answer some of your questions. What you say counts, and someone out there in blogland is looking at these blogs and taking notes, your contribution may help our country.
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To take your mind off doom and gloom, have you noticed how near we are to 22 July and the total solar eclipse?
I noticed someone on the blog had put a doom and gloom prophesy on 09/09/2009. It must have been a disappointment for him/her back in 1999 and now he/she is hoping for some action this year. I shall be making a birthday cake and buying a present for my daughter's birthday the following day. The 22nd July is my brothers birthday, so no doom and gloom there either. The kids all break up for the holidays and hopefully, I can go and do a spot of granny time with my grandchildren.
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So our great British press are going into overdrive.
The vaccines will have additives that can cause side effects
The companies producing the vaccines will renege on their contracts so that the vaccines are given instead to the country where they are produced.
We are all going to be prevented from travelling abroad.
There may well be truths in all 3 but please stop sensationalising.
Regards bannning travelling abroad,is that not far too late ?
If that is adopted,do we close London,inc Heathrow, Gatwick, Stansted which seems to be the biggest hotspot?
How many Europeans have been in this country and returned home potentially contagious ? So to ban Brits from going abroad WHEN SEEMINGLY PERFECTLY WELL AT THE TIME OF TRAVEL appears to have double standards written all over it. Tell me a country that has not been infected and they have the right to ban anyone from any infected country.
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There again, those in charge do seem to make the Keystone Cops look competent
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im really worried cos i got sore throat and im dizzy im 34 weeks preagnat have i got it
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Diamond, don't panic! the most important thing is do you have a temperature? If yes seek medical help now as it can cause premature labour if it goes too high - I had flu at 30 wks and that was the biggest risk. Ring the delivery suite where yoru baby is due to be delivered and speak to the duty midwife who will advise you what to do. Take paracetamol and keep up your fluids. If you don't have a temperature then still ring for advice. I only needed to be in hospital for a few days', and my baby was born on time, fit and well. Good luck!
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sensibleoldgrannie, I'm feeling pretty chilled too - looking forward to a lazy first week of the holidays. I will have to look for the info on the solar eclipse - my eldest gets the Sky at Night mag so there must be somethng in there about it. Do you know what I do when it all gets a bit much? (not just over sf, but anything.) I go outside and look at the sky, or look at it from a window if I must. Especially clouds. Somehow the timelessness of it puts everything in perspective.
Have a great weekend!
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This comment was removed because the moderators found it broke the House Rules.
If you want to know how and what the NHS will and won't do in a full blown Influenza pandemic please read;
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_098769
Kindest regards
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chippermrd,
I just don't think that directing the public to this 127 page, technical guidance to professionals - some of which may well have been revised and amended by more recent orders and guidance - is something that would really help many of them.
The guidance is for GPs, GP practice managers, public health officials, PCT and SHA senior officers, hospital managers and the like.
Yes, fine, it is rightly in 'the public domain' as the civil servants who wrote it are, rightly, accountable, but it isn't truly the sort of reading I'd recommend to the public.
Furthermore, such Departmental guidance could (and would) be amended quickly by official DOH circulars if changed circumstances demanded it.
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In his piece about swine flu Fergus says of journalists that:Journalists like numbers. But given a range, the tendency is to go for the extremes. It's just the way we are, I'm afraid.
Why is it acceptable for journalists to deliberately upset people as much as possible?
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I'm looking for specifics, now that we have moved into 'treatment' phase.
I can't find answers to my previous questions and now I have a couple more-
the symptoms specified seem to be those of seasonal flu with the added twist of upset stomachs. My quiet, remote corner of the SE coast has now got many cases of SF. The local weekly paper cites some sufferers as having temperature first, then upset stomach, then cough, sore throat and sneezing. Do the symptoms always appear in the same order all the time? Are certain symptoms age specific? (ie-do children get symptoms in one order, adults in another?) some reports include the stomach aspect, others do not. Whilst there are reports of very mild symptoms in some, do these people have all of them?
Concerning possible mutation-if someone has had the original version, will they get the mutated version? Will the vaccine protect against a mutation? I only ask because a new seasonal vaccine is produced every year.
How is the research progressing on the interaction between underlying conditions and SF? What about info regarding exactly what SF does to be responsible for someone dying? If a person contracts SF, develops a complication (eg Pneumonia), and then dies, is SF the cause, or Pneumonia?
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I still think home testing kits would be a good idea-especially now that the NHS is under such a strain. Surely it would be a sensible thing to mass produce and get on the shelf? I have read that swab kits in hospitals could give a result in 4 hours. I'd much rather have some of these in the house than waste a doctor's time! I'm sure a lot of others would too.
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Tigerjayj
Alcohol gels and wipes are effective, but then again so is good ol' soap and warm water. (Important to remember to wash ALL the hand, e.g. the back, the bits between the fingers, the wrist, etc.)
The virus may or may not mutate, but the vaccine might still be able to be effective. As with many of the issues, the devil is in the detail and we don't know for sure yet, one way or the other.
I'm not sure if I would use the phrase "predisposes an underlying condition to react badly", it is probably more a case of if a person has certain underlying health issues, these may cause the person's health not to be robust enough to cope with a viral respiratory disease such as flu on top of their other problems.
Fighting a flu virus can put a significant strain on your body.
Certainly, if a person's underlying health issue is some form of immuno-deficiency, for example, you can easily see how s/he might struggle to combat the attack.
Equally, anyone with existing respiratory weakness/vulnerability is clearly going to have more problems.
Also, a very small number of those infected seem to have experienced a much more severe episode of flu and, as far as I know, no-one has quite worked out just why as yet.
The symptoms can vary, and indeed some people are contracting the disease without perceivable symptoms. Probably the key one is about the fever / increased temperature. Does this piece by Fergus assist?
http://news.bbc.co.uk/1/hi/health/8151249.stm
'Cause of death' is not just a medical issue, it can also a legal one.
Now the cause written on an individual death certificate by a medical practitioner may be presumptive. In the example you gave, the pneumonia is surely a consequence of the repiratory infection, so in effect either might be cited.
Let me try to put that another way. If I get a bacterial chest infection, which causes me to have serious difficulties breathing (broncospasm) and as a result of that (and lack of access to broncdilators), I die. Did I die from the infection or suppressed respiraton? The answer is I died from both ... or either.
What gets put onto my death certificate by the medic? Well, now, that's a good question.
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I totally agree with Tigerjayj's suggestion about home wab tesing. Only a month ago two of my children had high temps, tummy upsets and runny noses. Was it swine flu? Who knows, because even as recently as that my GP wasn't testing unless we'd been to Mexico or the US, or had a known contact. I did try pointing out that we knew people who'd been to London and Birmingham but to no avail. Within a week the criteria had changed to clinical diagnosis only. I really wish I knew for sure if they'd had sf, and I'm still quite cross with the GP (not my usual one) - it is now spreading here and possibly my kids have been instrumental in that - we were even told to send my daughter in to school with a temperature because she was well in herself!
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Last night I went into London for a meal at a restaurant with a party friends and I observed the following:
1. The tube was packed and there were several people looking unwell, with apparent high colours indicated potentially raised temperatures and some coughing.
2. Everyone had to use the tube handrails (a hard surface on which viruses can last quite a long time.) (and there was no evidence of gloves being used or of face masks by those with coughs.)
3. On arriving at the Restaurant there was an opportunity to wash ones hands - the older members of my party did so but one older teenager did not.
4. The restaurant did not offer any specific anti-infection advice or equipment (hand gels etc.) Nor did they make it clear that communally handles and surfaces such as those used for ingress and egress to and from the restaurant and its toilets were regularly disinfected.
5. Some of the food served required the use of the diners' hands.
These experiences convince me that the way that the British carry on is highly likely to cause the infection to spread and to spread rapidly.
I would recommend that all restaurants offer specific hand cleansing advice and assurances over disinfection procedures within the premises. This will, when and if the rates of infection rise, be a considerable marketing advantage to the businesses and also cost very little. I recall that for many years restaurants overseas have offered warm disinfected towels on arrival fro diners to ensure that the infection risk is minimised and because this type of strategy is not being offered in the UK I can well see that we are the dirty, and infected man, of Europe.
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"Male_of_kent: What a sorry state we have allowed this country to get in to ....nothing appeared to be done early on to educate people in how to avoid it and to be clean, all we heard was news and hype"
I'm no advocate for this government, but did you not notice the information pack that came through your letterbox over 2 months ago?
This is unknown territory for all of us, and I think we're going to cope remarkably well.
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The home testing debate:
Don't you think having to post home test kits to every paranoid parent in the country would put even more strain on the nhs? Surely the current policy is far more sensible, ie. tamiflu for all those with even slight symptoms.
Available next week without appointment over the phone or at http://www.nhsdirect.nhs.uk/
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Regarding reported symptoms, surely the upset stomachs are a side-effect of taking Tamiflu rather than the virus itself? That's the sort of symptom you see with gastroenteritis not flu. Although I guess its largely children who are experiencing this particular symptom.
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http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Symptoms.aspx
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#102 John_from_Hendon
I don't think you normally catch flu through ingestion. According to the US CDC advice
"The flu usually spreads from person to person in respiratory droplets when people who are infected cough or sneeze. People occasionally may become infected by touching something with influenza virus on it and then touching their mouth, nose or eyes."
So it seems that the primary reason for washing your hands is to protect yourself against subsequently touching your eyes, nose or mouth rather than through touching your food. (Hmm - I suppose the food does actually come in contact with your mouth and throat. Anyone know if that is considered a realistic means of infection too? And if so would drinking alcohol with the meal prevent it?)
Anyway, it sounds like the coughing and sneezing on the tube, buses etc is much more likely to be a problem. I wonder if the current distribution of the disease is related to areas of high public transport use?
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Thank you chip..
Now we have the battle plan lets get on with what WE are going to do instead of moaning about what someone else or the government has done or is going to do.
1) In hospital or even at the doctors, the main most simple diagnostic devices are, temperature, blood pressure, urine test, bowel regularity, fluid intake and output. We work a bit like cars and those with cars have to do regular checks. We don't moan to the government if our car is poorly maintained.
2) Self testing is an empowering and sensible thing to do when health services are going to become overwhelmed with us lot.
3) Self testing kits are not readily available in pharmacies and are overpriced. Boots the say their thermometers are selling rapidly. Get bulk items sorted out to reduce the cost.
4) I bought some urine dip sticks yesterday and the cost was £16 for 25 sticks, ouch! By having the sticks it will save me bothering the surgery nurse and save x amount of time for the surgery nurse to deal with someone else. Admittedly I know exactly how to use them as I was trained as a SRN nurse.
5) I am not sure how someone could do their own blood pressure, if that is their issue, any ideas?
6) Why bother with flu testing kits as we know the flu is embedded in the community now.
7) Flu testing MUST MUST be done in hospital, for those showing atypical symptoms or exaggerated symptoms.
8) As there are finite respiratory resources available, how about adapting and improvising other less expensive options, it does not matter if the system looks clumsy and unsophisticated so long as it does the job.
9) As far as I can make out, correct me if I am wrong, this virus attacks and replicates in epithelial tissues and if so, has the potential to replicate in epithelial tissues anywhere in the body????????
10) We cannot rely on the government to do everything for us. The government is a body employing people like us to represent the population in deciding how money and resources are allocated. The government has to rely on what we pay as taxes. If there is less money in the pot then less money can be spent. The NAMES could be given a shopping list of what is urgently needed, perhaps they could assist in a time of crisis. Certain businesses are still flush, ask them for a bit more help, give them a title or something, or a few gold stars and stickers.
11) Everyone could start by adjusting their diet slightly to build up resistance to germs. There are stacks of ideas on this blog about that.
12) If you know a pregnant mum with small kids, offer to do their shopping.
13) Step on bus companies who do not make the effort to provide a reliable bus service, giving them a fine doesn't seem to work as they still continue with a poor service in some areas. I think there is something fundamentally wrong and immoral to have a bus service which picks and choses when to cancel buses without any notification. I have seen the elderly shivering with cold and obviously at risk from hypothermia, because a bus has been cancelled and there are no alternative options available. If the bus companies cannot provide workers due to flu then PUT IN PLACE CIVIL CONTINGENCY PLANS. If you don't believe me, go on the bus for a couple of days and see for yourself.
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With regards to the people who have so far sadly died, the use of language is vitally important here for me so lets be specific.
Did they die OF swine flu or WITH swine flu?
'Underlying Complications' is a very loose term and I think both the medical profession and the media need to be a little more specific.
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#98 Tigerjayj
"The local weekly paper cites some sufferers as having temperature first, then upset stomach, then cough, sore throat and sneezing. Do the symptoms always appear in the same order all the time?".
I've always understood that with flu you typically start with a sudden high fever (with aches and fatigue) and then other symptoms like sore throat, sneezing, cough etc may only show up a couple of days later. That's certainly what happened with my wife when she went dowm with seasonal flu back in December.
If you wait until the other symptoms show up before getting diagnosed then it's probably too late for Tamiflu to have any effect and you've probably been infecting people for a couple of days already. So given where we are with this epidemic (55000 cases per week), I would have thought if you get a sudden high fever (over 38C), even without other symptoms, it's probably best to assume your got swine flu.
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What an extraordinarily sensible assessment of this epidemic - as a doctor all I can say is that if more journalists wrote like this, the public would be far better informed than they presently are.
It appears that this epidemic is probably not the 'big one' that everyone fears and it is a pity that the Chief Medical Officer wasn't able to handle it better. However, there is a very real long-term concern that the appearance of a real killer virus is only a matter of time if we continue keep pigs and poultry in such high densities in this age of international travel. Unless we do something about the situation, we are running a big risk purely in order to keep eating cheap meat.
Much as I love pork and chicken, I would rather turn vegetarian than play Russian roulette with the 'flu virus. It is such a daft situation, given that there is an obvious cure.
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105. At 10:42am on 19 Jul 2009, CuriousAddition wrote:
"Regarding reported symptoms, surely the upset stomachs are a side-effect of taking Tamiflu rather than the virus itself? That's the sort of symptom you see with gastroenteritis not flu."
I just wanted to throw up an idea here.
The symptoms that YOU get when infected by this strain of flu will probably depend a lot more on YOUR body's response to it than the virus that has infected it.
(Oh and other factors like YOUR diet, YOUR general state of health, YOUR underlying health problems, YOUR immune system, YOUR history of previous infections).
Lots and lots has been said about symptoms, by the BBC, NHSChoices and lots of others - and its easy to find on the internet and in other places too.
But the variable factor isn't the virus, it's YOU.
That is why for most people it is a mild flu episode, for some even unperceived, but for others there are varying degrees of severity of infection and outcomes.
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I don't suggest the NHS should post a testing kit-merely that they should be available at pharmacies so those who wish to help themselves can purchase them. A theoretical strategy which could, if NHS or government led, would achieve 3 things-
1. People would feel they were being proactive, had more control and would therefore be less inclined to panic.
2. If purchasing a kit supplied to shops by the government, this would offset costs of producing them and possibly contribute a small sum towards funding the extra resources needed.
3. The worried well would not need to clog up the phone lines leaving these clearer for those who really need to use them-not just for SF, but other serious conditions. (I had a brain haemorrhage 3 years ago and the NHS Direct phone line saved my life by calling an ambulance while I was on the phone to them-I'd hate to think someone would die because they can't get through quick enough).
Also, noone would hesitate to call an ambulance or their GP if they or their loved ones were suffering breathing difficulties.
I am sure that most people are doing their best to boost their immune systems eating extra fresh veg, orange juice, taking vitamins etc. I also see many people using hand gel and washing children's hands with them. There are hand gels specifically for children too. My concern is that these things all add to weekly budget costs, and since food prices have increased so much, I'm worried that many people will find it financially difficult-maybe food vouchers or free prescriptions could help here? However, I would imagine that schools have a really difficult time logistically with this-a 15 minute playtime will disappear with the need to supervise every child washing their hands-the only alternative would be losing lesson time. It must be a nightmare to manage.
Thank you Sutara and Sensibleoldgranny-very helpful at satisying my curious mind-the devil really is in the detail, but a rapid soaring temp seems to be the first symptom. As with any flu virus, this is the first indicator, with other symptoms developing over the next 12-24 hours. Perhaps the advice we are given should be if you have a sudden high temperature, wait and see what other symptoms you develop, then make a phone call? The exception obviously being babies, expectant mothers and the elderly. I remember a couple of occasions when my children had soaring temperatures which then either went away or developed into Chicken Pox or a tummy bug. In fact, my son never had proper flu, and my daughter only once in her 21 years. This virus seems to spread as quickly as Norovirus does, particularly among children. I'm sure hygiene and large groups together are the reasons this happens.
With SF it is NOT inevitable that everyone will get it, only inevitable that some will. This is surely the same with anything? I didn't get Chicken Pox when my brother, cousins and friends did, despite a concerted effort on my mother's part! I got it when I nursed my children through it. We should therefore be carrying on with our lives as normally as possible, be diligent about hygiene, and quietly alert for a sudden, unexpected fever. Even at the worst, we have a 50% chance of NOT catching it.
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#107. random_thought wrote:
"Anyway, it sounds like the coughing and sneezing on the tube, buses etc is much more likely to be a problem. I wonder if the current distribution of the disease is related to areas of high public transport use?"
Judging by the clammy surfaces on the hand grips on the tube and the unprotected coughing from the tightly packed crowds of people I saw last night I would guess that that transport is a particularly risky place, but we will never know.
I was particularly disappointed that restaurants are not taking advantage of the marketing opportunity to stress their particular hygienic procedures. My experience overseas is that they work far harder at hygiene. The reason I thought it would be sensible to stress that patrons should wash their hands on arrival is that they will have generally come from places like the tube or buses.
Also I suspect that picking up a gastroenteritis bug would weaken your ability to fight off the flu and thus could be seen as 'an underlying health issue' - the norovirus, for example, has some similar symptoms to the flu and can be very unpleasant indeed.
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I bought a home blood pressure thingy from my chemist last year and a blood sugar testing kit because my husband's family have a history of heart disease and my daughter is hypoglycaemic. This has helped us all manage our health better at home, and saved bothering our overworked GP. It helps put my husband's and daughter's minds at rest too as they are both probe to panic at the slightest thing! Just as well one of us is calm I think!
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To: At 7:57pm on 18 Jul 2009, chippermrd wrote:
"If you want to know how and what the NHS will and won't do in a full blown Influenza pandemic please read;
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_098769"
Thank you for this post. I've read it from beginning to end and it makes interesting and informative reading. It's important to read the appendices and not just the 'blurb'.
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PS - Thank you Fergus for a really interesting and informative series of blogs. Award yourself a gold star!!!
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A sensible piece well done BBC
quite unlike the British newspapers with their hysteria which makes so many people afraid...why has there not been the same hysteria in the USA when faced with the same issues...the British press is the worst in the world
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John_from_Hendon / random_thought
As with any contagious disease the risk of transmission and cross-infection usually increases with the density of population.
It doesn't really matter whether it's a crowded tube, bus, train, library, coffee-shop, pub or whatever. You're just more likely to pick up the infection from one encounter or another, because you are having a higher number of encounters with infectious people or contaminated surfaces.
It's a bit like the notion that underwriters use for car insurance.
Leaving aside theft risk, one of the main reasons motor insurance is so much more expensive in, say, London postal areas when compared to, say, the remote Scottish Highlands, is that there are, quite simply, more other cars around for you to have an accident with. (And probability dictates that about half of them will be the underwriter's customer's fault and about half the other side's fault).
It's a bit like that with population density and contagious diseases, but many other factors can also affect the rate of spread too, e.g. poverty indices - especially if that means that lot's of people are living within restricted spaces.
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With regards to home testing, if I knew I had had sf I would behave in a different way to if I wasn't sure. For example, I would be more relaxed about nursing a friend who had it, or looking after her kids. And I probably wouldn't be reading this blog!
I think it is worth bearing in mind that so much of the information that we have, such as leaflets from the government and also those prepared for the government agencies themselves, were produced a couple of years'or so ago when everyone was assuming bird flu was going to cause the next pandemic. For example, the school gave out leaflets from the county council only a week after the outbreak began in Mexico when very little was known about swine flu, and it was written for a scenario that was far worse than even the worse case guesses for sf. I also think that we had procedures in place that were triggered by the word 'pandemic' that again were intended for bird flu.
As for basic hygeine, my kids and I always wash our hands when we get in from anywhere, and before meals, and if we are eating out I get out the hand gel at least, if not take them to wash their hands. I do this all this all the year round, every year. It makes no sense not to. Norovirus can be a killer, not just flu. Let's hope that the habits people are getting into now stick and more unneccesary illness will be prevented in the future.
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Ozymandias wrote: Re post 71: Yes Sutara I am, I am advocating that we should have closed air and sea ports to keep this virus out, and that the prospect of empty fruit and veg aisles in supermarkets, raised by you in post 62, is not exactly a big deal. We can live off what we grow, we did for 6 years in WWII remember
The population of UK today is about 60m
Back in Wartime the population was about 45m and of those, most adult males were overseas fighting, so the resident population was about half what it is today
We survived because most people had gardens and they were dug up to home-grow produce
Today most people do not have gardens and even if they did, with both partners now working who would 'till the soil'?
The women worked their Gardens or Allotments back then and of the younger women not in the Forces, many worked on the Farms as Land-girls
Also, extremely stringent rationing was implemented and I mean extremely stringent, today's children would wonder what had hit them, although they might be fitter for it!
I don't think we could possibly be be self-sustaining today, not without much Govt regulation and even stricter rationing than we endured in WW2
I don't know of any Country that closed its Air and Sea Ports on account of the Swine Flu
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#119. Sutara wrote:
"As with any contagious disease the risk of transmission and cross-infection usually increases with the density of population."
But individuals can, do and should, take whatever steps they can to avoid infection themselves, shouldn't they?
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#112. At 12:24pm on 19 Jul 2009, Sutara wrote:
'#105. At 10:42am on 19 Jul 2009, CuriousAddition wrote:
"Regarding reported symptoms, surely the upset stomachs are a side-effect of taking Tamiflu rather than the virus itself? That's the sort of symptom you see with gastroenteritis not flu."
I just wanted to throw up an idea here.'
I agree that symptoms, severity and timescale as well as more longterm effects are personal to the individual sufferer but patterns will emerge.
What is important is to catch the data 'real-time', we need people filling in on-line symptom reports on their symptoms as they progress so that self-diagnosis for others becomes easy, suspect symptoms and false SF symptoms become apparent quickly.
Treatment strategies could be compared, side effects noted.
The wealth of data could also survey the currently healthy as to what precationary measures they are taking.
I have some hosting space available if someone wants to write a web application,
an open repository of peoples disease/illness experiences would be a useful resource for sufferers of any condition fom pandemic flu to lupus.
On-line anonymous self-reporting of all aspects of the disease/illness process would move us ahead of the pandemic spread curve allowing pro-active rather than re-active strategies.
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Conspiracy theorists :-
supposing I could develop a virus with a high transmissability rate such as H1N1 but without symptoms, which could transfer immunity to serious contagious diseases such as smallpox, rabies, hepetitus or herpes, wouldn't that be grounds for research, slights over funding, running off and releasing unknown agents into the atmosphere to hold the world to ransom for not recognising genius (vaccine co's in hot pursuit) ... I feel a movie coming on.
Get a grip. If you have, or know someone who has symptoms that they may suspect is swine flu then report it, take basic precautions and pro-active action by reporting your symptoms.
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Excellent piece again Fergus for pregnant women. Too much scare-mongering going on-most expectant women are sensitive because of their hormones-those responsible for their care should be far more careful about what and how they say things.
I notice comments in various places that UK holiday makers going abroad are being scanned on arrival like in Beijing cos we're high risk. Fair enough, but the same is happening at our UK airports with Virgin and BA. Surely this should have been done sooner? Those poor children in Beijing must be scared stiff to be marched off to quarantine and not allowed visitors-I can fully understand the reasons, but this is a foreign country. What must their parents be going through? Not only that, will they have to fly home on their own as they are not being allowed to leave hospital until they are well?
The Foreign Office advice has always been that you shouldn't travel if you feel ill, and apparently cabin crews all have protocols for radioing ahead should someone fall ill with SF on a flight. What happens though, if the sick person is a child from a family group? Will insurance companies refund the whole cost of an entire group cancelling, or just the sick person?
Screening this side must surely be better than being quarantined in a foreign country. Biggest problem I see with that-even longer queues and even more people squashed in confined spaces! Dear me, double security AND health screening-we'll soon have to check in a day early!
What about women in my age group-menopausal and prone to hot flushes? That could be a tricky one too as they could show a raised temperature if a hot flush occurred just as they were being scanned.
Lots of difficult permutations I think, but is all of this airport screening really necessary as SF has spread virtually the world over? I could understand it if there was no SF in a country, but what's the point if there is?
Hopefully we'll all have either had SF or been vaccinated by Christmas, and all of this circus will be over!
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@ GillieBollie, Whistling_Neil et al,
Whilst I'd agree with you that there is scaremngering and inconsistent reporting in the press, I am also concerned that there is a tendancy to extrapolta eforward from statistics to prove a position, when the reality of the situation is that such statistics will tell us nothing about what will happen if the flu mutates into a far more virulent strain. What we do know is that the flu will mutate. What we don't know, is the pathology of the new strain: whether it will turn current trends on their head, as the "Spanish Flu" of 1918 did.
So whilst I agree there is a need for common sense, to placate people with little knowledge of how this will play out is to risk attentuating the debate on matters such as policy of anti-virals and vaccinations.
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dver-2009
I agree with your comments. All I've been trying to suggest is that the media need to be more balanced in their reporting. For example, newspaper headlines stating 65,000 will die from swine flu is scaremonegering. The actual estimates were anything from 3,100 to 65,000.
The flu may mutate into something more virulant which is why it's important for people to start basic hygienic practices now to help later this year.
What we need is good practical information which is what generally I think Fergus is supllying in his blogs.
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Where do these statistics come from? At the moment people are not routinely being tested, so many people who think they have the swine flu could just be suffering from other viruses. Surely a high temperature and cold like symptoms /sickness etc , could be so many other things. If people get the tamiflu for something that isn't the swine flu what happens when they really get the swine flu. Maybe we are just making a bit too much of a drama of the whole thing.
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@ GillieBollie
I understand your point re reporting. My point is that the estimates themselves are worthless. The figure could be 1 million: we just don't know.
Therefore I question whether Fergus's reporting - which is factual and carefully prepared - achieves anything when it is based on the first generations of the flu. A better discussion on the stats would be to put them into perspective: the Spanish Flu starting off targeting young and old, but in mutating to a new virulent strain, developed symptoms that started targeting healthy people between 18-40, because it invoked an extreme immune response (cytokene storm) which meant the stronger your immune system, the more likely you were to die.
Sure, there were other factors - young troops living for prolonged periods in close proximity; lower medical response capability to secondary infections - but the point is that if you tried to extrapolate forward from, the first wave, you would have got it terribly wrong. Your antiviral and vaccination policies would have been wrong.
Discuss.
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Sutara wrwote:
"You meant MIGHT be a mutated virus, didn't you?
Yes, you're right that is a possibility, but not a certainty"
If it's not, there is no need for a dadly vaccine if the virus kills less than the normal flu....
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Just read that the number of new infections seems to be easing for now. I hope that is the case but of course Autumn will bring it's own potential worsening.
One thing that I think is important in light of this announcement is that schools being closed seems to have had a MAJOR effect on things. They have only been shut a couple of weeks and it seems to be slowing things down.
I really hope the Government takes note of this and has the courage to keep schools closed in the Autumn or to close them en mass if things start to spiral upwards again after children go back as it seems that this is perhaps one of the more effective things that can be done to try to gain some control of the situation.
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