Swine flu – how frightened should you be?

Ryan Jeffries, who works in the NHS reports on how the service is coping.

By the end of August the total of swine flu deaths in Britain reached 59. Each of those deaths is, of course, a tragedy for the individuals and their families and friends. However, the numbers of deaths falls far short of the figures predicted at the start of the spread of the swine flu pandemic from Mexico earlier this year. And in virtually all cases the individual was already suffering from serious medical conditions. There has been no repeat of the 1919 flu epidemic in which millions died – the majority of them young and previously healthy.

Does that mean the seriousness of the threat has been exaggerated? Or does it mean that the response of the NHS and government in Britain has helped keep the numbers of dead to a figure barely beyond the usual numbers who die each year as a result of flu? And what has been the impact on the NHS, on staff and patients, of the response to the predicted pandemic? What effect will vaccination have? These questions are related and have a bearing on what effects we can expect the flu virus to have in the autumn and winter.

G.P.s bore the brunt of dealing with cases of swine flu in the initial stages before the launch of the National Flu Pandemic Service (NFPS) on 23^rd July. Contrary to some newspaper reports the NFPS is not run by 16 year olds but involves skilled professionals, some of whom are working as volunteers or have been rostered by their employers for a number of sessions.

The NFPS has certainly reduced the pressure on G.P.s (and Accident & Emergency Services) by allowing anyone concerned they may have swine flu to contact the NFPS either on-line or by phone. This has helped reduce the potential spread of the disease by encouraging people to stay at home rather than visiting often crowded GP surgeries. The setting up of Antiviral Collection Points where a ‘flu friend’, who does not have swine flu, can collect Tamiflu has also helped reduce the spread of the illness.

However, the NFPS has also obscured the real level of swine flu. Diagnosis is made essentially on what someone using the service says and only a small number of those reporting swine flu are swabbed. This has helped reduce pressure on pathology laboratories but cannot give an accurate figure for those who have been infected with H1N1.

Form filling

One of the main effects so far on hospital based staff has been an increase in the amount of form filling. Every day (Monday to Friday) I have to submit an electronic report of how many patients have swine flu, how many of them are new cases, how many are recovering from swine flu, how many staff are off sick with swine flu, how many off work because they are caring for dependents with swine flu etc. In addition we have to submit a daily report on how many beds we have available.

This is clearly in preparation for a more serious outbreak in the autumn and winter. Past experience has shown that if there were to be even a small increase in the number of cases of flu above the normal level patients with even vaguely psychiatric symptoms would be moved from general hospitals into the psychiatric services, where patients would be moved around to accommodate the sudden influx.

Where inpatients have been suspected of having swine flu they have been swabbed. Until they are given the all clear then restrictions on visiting, staff movements and admissions are put in place. Staff who are off sick with swine flu must stay away from work for at least a week. So far very few staff have been absent from work with swine flu – despite newspaper predictions of on-line or telephone diagnosis of swine flu via the NFPS providing an excuse for workers to take an extra week’s holiday.

There has also been an increase in training for staff, much of it quite sensibly electronic based. An east London Trust developed a swine flu –e-learning package which has been used quite widely throughout London. In my trust all staff had to complete the training, however minimal their contact with patients. There has been a marked increase in issues of infection control, which will obviously be of benefit whether or not there is a further rise in cases of swine flu.

Useful planning

Everyone has also had to complete a skills survey, which asks staff to provide information on a wide variety of skills – not solely medical but, for example, whether or not they can drive. Again this is very useful planning for any large scale increase in cases of swine flu in the autumn and winter.

Extra personal protective equipment for staff has been made available to wards, though Tamiflu only seems to have been supplied where there have been identified cases of swine flu. Where it is available it is to be treated in the same way as a controlled drug, with detailed records being kept of amounts received and amounts administered.

At the moment there is no vaccination programme since the newly developed vaccines have not yet been licensed by the European Medicines Agency. This is expected to happen in September or early October. In the initial stages vaccination will be prioritised for those deemed most at risk (the very young, the elderly and those with pre-existing serious medical conditions), pregnant women (subject to licensing conditions on trimesters) and household contacts of people with comprised immune systems. In addition front line NHS staff will be offered vaccination.

This still leaves a large part of the population who won’t be able to access vaccination, at least in the early stages. The vaccine will only protect against the H1N1 strain of flu, not seasonal flu. There is always an element of guesswork in deciding which strain of flu will appear in any given year: fortunately so far this has not caused any major problems. However, any mutation in the H1N1 strain or an unexpected strain of seasonal flu could have devastating consequences.

At the moment the NHS appears to be making sensible plans for an increase in swine flu in the autumn. Hospitals are better equipped to cope than they were and staff are better trained in how to restrict the spread of flu and are more aware of infection control measures. The vaccination programme, once it is active, will be a significant step to reducing the impact of swine flu. There is generally less need for alarm than when the first cases were being reported from Mexico.

None of which, of course, means that a devastating flu pandemic on the scale of 1919 will not happen at some time in the future.