BBC BLOGS - Fergus's Medical Files

Archives for August 2009

The current situation and the next peak

Fergus Walsh | 12:51 UK time, Friday, 21 August 2009


Don't be fooled into thinking that H1N1 swine flu has disappeared completely, even if it is attracting less media interest. The virus is still at large in the UK. On the morning of 19 August, there were 263 people in hospital in England with the virus, 30 of them in intensive care. That is exceptional for the time of year.

Having said that, there is much less swine flu about.

Sir Liam Donaldson's weekly briefing to journalists is extremely helpful and has allowed us to track the progress of the virus in England and Wales. Here are a few of the main points:

• estimated number of cases of swine flu in England in the past week: 11,000 (possible range: 6,000-25,000)
• weekly GP consultation rate for influenza-like illness in England and Wales in the week ending 16 August: 21.1 per 100,000 people
• weekly consultation rate has fallen by 37% from last week to this week
• deaths related to swine flu in England now 54 with five in Scotland, giving a UK total of 59

Now for some graphs.

Influenza-like illness: Weekly GP consultation rate England & Wales, week ending 16 August

Above you can see the weekly consultation rate for influenza-type illness. The red line (the current rate) continues to show a sharp decline. The other lines show activity from flu in previous years.

Underlying conditions information for fully-investigated deaths

The pie chart above needs careful reading. For the small number of people who have died, it shows what their health had previously been.

As you can see, 52% had severe underlying medical conditions, and 21% had been previously healthy. The rest had some kind of health problem, mild or moderate.

Remember, though, that the percentages are based on very small numbers. The 21% figure suggests that, so far, 11 entirely-healthy people have died in England after contracting swine flu.

What everyone wants to know is when the next peak will come. Two graphs presented by Sir Liam illustrate how difficult this is to predict:

1957-58 Pandemic

This shows the path of the 1957-58 pandemic in the UK. You can see that the peak happened in the first autumn, just after pupils had returned to school. That could be what happens next month.

1968-70 Pandemic

This shows the 1968-70 pandemic. By contrast, there was a small peak at the end of the first winter, but a far larger peak in the following flu season, a full 18 months after the first case in the UK. So perhaps that could happen this time as well.

Clearly, it would be better if the second scenario happened this time, as it will enable immunisation of at-risk groups to be completed.

Update 1534: Finally, some interesting guidance from the World Health Organization on antiviral use. It says that otherwise-healthy people who get infected and have uncomplicated illness do not need oseltamivir (often sold as Tamiflu) and zanamivir (Relenza). The difficulty, of course, is that in order to be effective, antivirals need to be taken soon after the onset of symptoms - usually well before people know whether they have are going to get complications.

The UK government's policy is to make antivirals available to anyone who is suspected of having H1N1 swine flu.

The WHO guidance will add to the debate about whether antivirals should be so freely available.

A Department of Health spokesman has said:

"We believe a safety-first approach of offering antivirals, when required, to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects."

Vaccination, antivirals and some respite

Fergus Walsh | 12:04 UK time, Thursday, 20 August 2009


After several weeks' absence, I was delighted to see that the discussion has continued at Fergus On Flu. I haven't read all your comments yet, but I am really pleased that the blog has become established as a forum for discussion on an issue that now appears only sporadically in the media.

Swine flu virus multiplication from an animation sequence by the Novartis pharmaceutical companyI had a very good break - and encountered no H1N1 swine flu - and then filmed some news stories, so I have not been on holiday all this time! Many thanks for your kind wishes and for continuing the conversation.

A few issues which emerged while I've been away:

• First, vaccination policy on H1N1 swine flu. The decision to immunise those with existing medical problems, pregnant women and healthcare workers this autumn was no surprise and had been widely predicted. Holding back from a wider immunisation campaign at this stage is interesting. Limiting the vaccine to at-risk groups will still create a huge logistical problem for the health service which will also be immunising the elderly and the vulnerable this autumn. I anticipate some public confusion about who is eligible for what.

• Another interesting development concerned the study about antivirals and children. This questioned the policy of giving Tamiflu or Relenza to otherwise healthy children who catch the H1N1 virus. The research suggested that the side-effects outweighed the benefits, but was based on seasonal flu, not on H1N1 swine flu. It seems to me that the research raises important issues, but is not a definitive study or the final word on whether antivirals should be available to all.

• Finally, as many had hoped, the incidence of flu has dropped sharply in August. This gives the NHS - and us all - some respite. The question now is: when will cases start to rise? I suggest looking to Scotland, where children are heading back to school well before those in England and Wales (see also BBC Northern Ireland's Flu meeting ahead of school start). If Scotland experiences a sudden increase in cases in the coming few weeks, then a similar surge can be expected elsewhere in the UK.

BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.