The swine flu paradox
The latest figures on H1N1 swine flu may get scant publicity, but they are worth investigating as they reveal an apparent contradiction which will become hugely important in the coming months.
The paradox is this: swine flu is a mild illness, yet intensive care units are under mounting pressure.
How to explain this? It is true, and worth repeating, that the vast majority of us who get swine flu will not be seriously ill.
Many will have extremely mild symptoms; others will feel lousy for a few days and be confined to bed, which still counts as a mild illness.
Rest and plenty of fluids will be all they require. Antivirals may help to reduce symptoms.
But a minority will get complications. While most of those will have underlying health problems (like asthma or heart disease), not all will - so it is impossible to predict who will be unlucky enough to need hospital treatment as a result of the virus.
Statistics released by the chief medical officer for England, Sir Liam Donaldson help illustrate the swine flu paradox.
This table shows that there were 751 patients in hospital in England with swine-flu-related illness as of yesterday, of whom 157 were in critical care. That means 20% of hospitalised swine flu patients require critical care.
That is both the highest number in intensive care since the outbreak began and the highest proportion of hospitalised patients. It means one in five people hospitalised with swine flu now require intensive care.
Sir Liam Donaldson said there was "an eerie similarity" with what happened in Australia during its recent winter, where 25% of hospital admissions for swine flu ended up in intensive care.
Another graph further illustrates the problem of predicting who will be struck down by swine flu.
This is a study of nearly 400 patients admitted to hospital in England with swine flu. Those who had existing health problems are coloured blue; those without are burgundy.
You can see that only 19% of the under-5s have existing conditions (the jargon term is comorbidity). Only 42% of those aged 5-15 who need hospital treatment have other health problems.
These figures should not alarm you. Remember that most people will get a mild illness (if I had a pound for every time I wrote that...).
It is simply worth pointing out that just because you are a healthy person with healthy children, it does not mean that swine flu cannot turn your life upside down.
On a positive note, most of those who end up in critical care will recover completely. But having seen patients on life support because of H1N1, I can assure you this is not a virus to dismiss out of hand.
Young children under five make up the group most likely to require hospital treatment and those most likely to have been entirely healthy before.
It's for this reason that it seems inevitable to me that the Department of Health will eventually offer swine flu immunisation to all children.
This will come after a recommendation from the JCVI (The Joint Committee on Vaccination and Immunisation). The United States is offering immunisation for everyone aged six months to 24 years, in addition to at-risk groups.
Sir Liam Donaldson confirmed today they would eventually extend the immunisation programme beyond at-risk groups and health workers. He said: "It will be expanded. It's just how we do it."
Expect an announcement expanding the programme to all infants and school age children before Christmas.
My hunch would be that the decision has probably already been made, but that health officials want to focus on getting the first wave of immunisation well under way before making any announcement.
Ian Dalton, national director for flu resilience, said all GPs in England should get their first box of 500 doses of H1N1 vaccine in the next three to four weeks.
That means many of those who have serious health conditions are likely to be waiting well into December for their jab.
Some, though, are getting letters (post strike permitting) inviting them to get a swine flu shot and may be wondering whether to have the jab. It's a personal choice. What people must ask themselves is why they wouldn't have it.
Is it because they think the virus will be mild for them (why take that chance?). Or because they worry about the safety of the vaccine? All medicines have potential side-effects, vaccines included.
The European Medicines Agency said more than one in 10 doses of Pandemrix (the jab being used for almost everyone in the UK) led to side-effects. These included headache, joint or muscle pain and sore arms.
Now look again at the numbers who are currently critically ill with swine flu, and then balance the risk of the disease against that of being immunised.
This graph shows that, of the deaths so far in England, 65% have been among people who would have qualified for the vaccine, among them several pregnant women.
The H1N1 virus is now a preventable illness, and it will be important to see in the coming months what effect immunisation has on death and hospitalisation.
Sir Liam revealed that posters condemning vaccination as a "weapon of mass destruction" were put up in a Birmingham hospital at the weekend.
He said it appeared to be the work of an anarchist group who also believed that 9/11 was the work of the US government.
A brief look at their website left me slightly unsure what they stand for except that government is bad, as are taxes.
The latest figures for flu reveal that the second wave continues a steady upward, but not explosive, trend.
There were an estimated 78,000 new cases of swine flu in the past week in England, up from 53,000 the week before.
In Scotland, there were around 20,000 cases and 65 people were in critical care as of yesterday.
Look at the red line and you can see that the curve is still upward, but way below July and the last epidemic of 1999/2000. But the flu season has barely begun.
More than 500,000 people are now thought to have had swine flu since the outbreak began. The number of deaths remains, thankfully, comparatively low. The latest death toll for the UK is 137.
This is part of the swine flu paradox, because we would expect several thousand deaths from seasonal flu every year, mostly in the frail elderly.
By contrast, the majority of deaths from swine flu are in people aged under 45. So although the total number of deaths is low, hospitals are gearing up for what could be their busiest winter in intensive care for a generation.
Useful resources:
• Detailed UK weekly epidemiology update
• Swine flu figures for Northern Ireland
• Swine flu figures for Scotland
• Swine flu figures for Wales
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Excellent post Fergus. Well written, and to the point. Its great to read positive news and on the whole that is positive. Instead of thousands of deaths we will get hundreds this winter. If that. Good news.
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Can anyone explain why the "Outbreak Map" hasn't been updated since 30th July, as it could show how the Southern Hemispere winters (Australsia & South America) influence the flu's development?.
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Laziness combined with less demand for swine flu news i guess.
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Great post, 100% fact and straight to the point, thank you.
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Another great post! So from now on let's focus on fact and the positive side of things!
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Gillie overall the situation is very positive anyway, you have to dig so deep to find some obscure foreign article to find anything negative. And even then it usually turns out to be garbage.
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Simple question: How many critical care beds do we have available in the country? What happens once they're full?
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Once again, all useful information which I find (partly) comforting. The situation could be an awful lot worse considering how things looked when this story first broke in the spring. However, other than the obvious methods we have no doubt all been following for months, there is little more any of us can do to prevent us becoming another person included within these weekly statistics. What in my view we should now be focusing on is ensuring that as many people are given the vaccine as possible, and as quickly as possible.
At present I have seen very few critisms of the vaccination programme, and there seems to be a kind of cosy consensus that everything that could be done, is being done. However, does anyone now remember when we were first told that the vaccine would be available in early September, then it was mid-September, then mid-October and now here we are nearly in November and only a tiny proportion of people will have had it. We were also told (and Gordon Brown recently repeated this) that the UK was (and is) at the front of the queue to get the vaccine. That is simply not the case anymore, even if it ever was - the US, China and Australia (for example) are now well ahead of the UK in their programmes, notwithstanding that Australia is no longer in winter flu season, and the US and China have much bigger populations and therefore a much greater adminstrative burden.
What worries me is the constant slippage in the timetable, which seems to pass almost without comment from those responsible. For example, last week we were told that from Monday 26 October, all GPs surgeries would get their first 500 doses within 3-4 weeks (quite why it takes that long I have no idea), and therefore most of those in the priority groups would have the vaccine by mid to late November. Now we are being told (according to Fergus' blog) that it will still be 3-4 weeks before all GPs have their deliveries, and it will now be mid-December before all those on the priority list are vaccinated. So a week of the initial GP vaccination programme has gone past with no substantial progress, indeed the process has effectively gone backwards. My guess is that within a week or so we will be told that it is now expected that priority patients will be vaccinated by the end of the year, and so on.
What we should be focusing on now is not how many unfortunate people have had the virus, but how many people can be prevented from getting it in future. Any person who contracts the virus from now on who dies (particularly if they are in a priority group and therefore eligible to receive the vaccine already) is someone who could have been saved had the vaccine been distributed more quickly. Fergus, any chance of an official blog as to why progress is slipping? The line that 'it just takes time to organise' is just not good enough - we all know that, but the organisation should have been in place weeks ago. For my part, I don't believe that the supply of only an initial 500 doses to each GP surgery is being held up by the production of the vaccine. I suspect that it is purely adminstrative, and in my view that simply is not good enough.
One other thing, people on here have been commenting about the lack of effect of the half-term holiday on the figures for those getting the disease. They should worry not, as I understand it the figures released every Thursday are for the previous week, ie those released yesterday are for the week up to 25 October (last Sunday). So half-term had no part to play in these latest figures. The fact that the increase has slowed is therefore a good sign, as next week's figures will be those for the half-term week.
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Great post Fergus thank you!
Thanks also for your yummy 'flu' soup recipe granny; I am going to make a big batch of it this weekend and freeze it. We usually use the carcass of our Sunday chicken and make something a little similar on a Sunday but I like the sound of yours more! I'll let you know how I get on!!
Also thanks for the tip on coughing. I have had lots of bad, painful coughs in the past (even pulled muscles coughing!) so I will try your method if I get a nasty one.
On the subject of coughs I found the Olbas oil vaporiser (costs aprox £6) really useful when my daughter was very congested a few weeks ago (she said it felt like the mucus was stuck to the back of her nose and she couldn't blow it out or swallow it -yuck!). It is powered by a battery and gives off vapours all night. This meant she could get a good night’s sleep;I also believe it may have helped her avoid a secondary infection as it didn't allow the mucus to 'stick' to her throat or chest. I think someone (Angel?) suggested damp towels on radiators with essential oils on them; maybe Olbas oil on a damp towel would work in this way too. We also used the age old remedy of steam inhalation which really cleared her nose and airways. If it was SF we gave it such a hard time it had no chance to linger as my daughter was constantly blowing her nose!! Not even sure she had SF, as it wasn’t confirmed, but maybe my musings will help someone else! Hope the moderator allows the brand name through if not I am sure you can find something similar in the local chemists or use the towel method.
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In response to ALAYTON81's excellent post- I couldn't agree more. So far, the practice I belong to has absolutely no information on when they will get deliveries of their first allowance of vaccine. And as someone with a rather personal interest (I'm an asthmatic), I'm on the anxiously-awaiting the vaccine list. Frankly I find it astounding that the chain of communication from the local surgeries to the patients is basically non-existent.
My contraction of the virus is entirely preventable- if only I could get the vaccine. As an aside, I visited the US recently, and around 10% of my colleagues that I met had already received the H1N1 vaccine (and interestingly, none of them had received the seasonal vaccine).
I think a future blog on the seeming inability to get the vaccine out to patients would be a most worthy one.
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Snork41, I should also declare a personal interest being a Type 1 diabetic.
The key to getting large administrative tasks done in the quickest time possible is to try to ensure that you use up as much time as possible actually doing things that take the process forward in parallel, rather than waiting for someone else to complete their part of the process. At present, the GPs don't know when they will get their vaccines, so they can't contact patients to invite them to be vaccinated. They appear to have to wait until the day the vaccine happens to be delivered to their surgery, and only then can they contact patients. In other words, from the GPs point of view at present, the process is totally stalled.
Call me cynical if you wish, but the really sad thing is that I doubt anyone will be surprised that the UK is not able to facilitate a proper administrative process to deliver the vaccine efficiently. This will inevitably cost lives, which is particularly frusrating when in my view the scientists who produce the vaccine and the regulators who test and license it have acted with as much haste as possible without compromising safety.
Anyway, sorry to be negative, we should all remember that it is still quite hard statistically to catch this virus (this week, only 78,000 people out of 65 million, so around 1 in every 1,000) and for the majority of people who do catch it - including those of us with underlying health conditions - it is merely a mild illness.
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Thanks to alayton81 and snork41. I promise to pursue this. There are 11,000 GP practices in the UK. Each one will get an initial box of 500 doses within the next three to four weeks. That makes 5.5 million doses. The government has five million doses of Pandemrix in stock already.
Even allowing for doses going to front line health workers, there is plenty of vaccine there to distribute. But the Department of Health says it is going as quickly as possible and these need to be sent out under temperature control. And it is dependent on the manufacturers regarding subsequent deliveries.
Now we come to the tough part. There will undoubtedly be deaths and hospitalisations among vaccine-eligible people in the weeks ahead. To date, such tragic events have been unavoidable. But what about in, say, a month's time? Their families and GPs may well be unhappy about the length of time that the distribution is taking.
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Fergus, thanks so much for this. I would be grateful for any 'official' information you are able to provide. Just one further thing - in your subsequent blog about WHO analysis of the safety of the vaccine, you say that there "at least 14 countries" where hundreds of thousands of people have been vaccinated. If that is right, then that demonstrates just how far the UK has fallen in terms of being at the front of the queue for this vaccine. It is that sort of information which is really going to make people start to question if, as you say, in a month's time people on the priority list are still being admitted to hospital or worse. Anyway, thanks again for your great work on this subject and I look forward to reading more in the coming days and weeks.
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After being a daily lurker since May I would just like to say a huge thanks to some of the bloggers who have genuinely kept me sane these last six months. I've always been a 'worrier' as my mam would say. I seem to live my life in fear of the phone ringing or a knock at the door to say something has happened to a loved one. I seemed to get worse after having my little girl five years ago and was at the stage where I didn't read the papers or watch the news as I would drive myself insane with worry. This changed at the end of April when I stumbled across the sf story. I didn't sleep for a week, spending all night googling and checking news updates. By mid may I was an emotional wreck and was prescribed anti-depressants. I felt 100% sure my little girl was going to be taken from me or me from her. Her fifth birthday wan on may 9th and I remember praying to god that she could please just have one more birthday. This blog was a life saver. I stopped reading the papers and watching the news after being scared to death by the misleading, irresponsible headlines. I still felt the compulsion to find out what the latest sf news was several times a day but used this blog to do that. Skyline I really can't thank you enough. You have been my voice of reason and stopped me from completely losing all sense of perspective. Angelscomeinthrees, tinkerbellbobby, tigerjay, universalmum, you have all made me realise I'm not alone. I honestly felt I was stark raving mad as none of my friends, family or gp could remotely understand what I was going through. You have all have helped me through such a difficult terrible time without even knowing it.
I still have the odd wobble over sf but feel it is not taking over my life anymore.
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"Each one will get an initial box of 500 doses within the next three to four weeks. That makes 5.5 million doses. The government has five million doses of Pandemrix in stock already."
This seems to be the crux of our concerns about the delay. If the govenment has (basically) all the doses ready, why on earth does it take 3-4 weeks to ship it out? Is there just one person in an office filling in address labels by hand?
We'd be most grateful if you can pursue this, Fergus.
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Worriedgeordiegirl - what a brave post. It was like reading about myself, but had never been as brave as you to say it. I never worried either until I had my children, they are the most precious things in the world and it takes every piece of energy not to worry about them or think catastrophically day to day. I know now what all this means and never realised I wasnt the only one either. Most of the thoughts are internal and anyone who knows me would never know what was really going on. Thank you for your post, there will be a lot of other people out there who feel the same too. Theres a v good website called nomorepanic.com, worth a look. Nice to see some other parents on here and its not all science. (although the science bit helps. lol )
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Tinkerbellbobby - Thanks so much for the website. Must admit don't feel very brave, it's easy to say when you're anonymous!
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Worriedgeordiegirl well done so well done for writing so clearly about the feelings that you have had and now you know you are not alone in them and those are exactly the ones I have had and am still trying like you also tinkerbell not to expend so much energy allowing those horrible worries to blot my daily life. It is in knowing we have so much love for our children and they are such amazing special people who share our lives that we can get so much joy and we must not let anything ruin that. I think perhaps our worries are symptomatic of the times we live in; there seems to be so much more to worry about these days (and then add in a potentially nasty illness like sf), and I often find myself thinking back to the times when I worried so much less, never seemed to have a care in the world. Was it me or was the world safer? Actually, I had an awful couple of years between about 1979 and 1982 when I really thought there could be a nuclear war, and that terrified me for a while.
On a more detached note thankyou ALAYTON81 and snork41 for posting so clearly about the administrative mess we are now in over the vaccine. I agree completely.
And finally for tonight, thankyou lurkingmum for the recommendations on Olbas and reminding me of angel's wet cloths on radiators with essential oils. Makes absolute sense.
LOL to all, and I'm off to get some down time. I almost didn't read anything tonight as I'm feeling a bit saturated with it all, and would like to have several days if possible when sf didn't even cross my consciousness but I doubt it will go away for very long. I'll check in again over the weekend.
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Fergus - absolutely brilliant post! Very helpful having those extra resource links at the end! Kind of a 'Swine Flu Blog Supermarket'! More of the same please!
I would especially like to thank you for responding to our concerns on here - this is not he first time you have done so, and it is really comforting to know that you do read the stuff that we write. Our voice in the wilderness - you're a star!
Thank you so much.
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I must say I'm still worried that all the government and press are still claiming that all GPs will be sending letters to eligible patients when this is not necessarily true - I know for a fact that my practice is NOT going to be doing this (either that or the receptionist has lied to me at least three times).
I very much doubt they are the only practice to be doing this, so why is everybody being told to wait for a letter that in many cases will never arrive, not only because of an appallingly timed postal strive, but because it was never sent. People who need the vaccine, want the vaccine, and are eligible for the vaccine, but "don't want to make a fuss" (and there are plenty of them) won't get it. And some of them will get very ill. Hopefully none of them will die.
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Superb blogpost! I've been trying to get similar information out to my Canadian and American friends. I will be suggesting they follow your blog--thanks again!
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