At least 17 people have died after contracting swine flu in Britain, while tens of thousands of people are thought to have been infected. Is swine flu getting more dangerous?
No. Laboratory testing around the world indicates the influenza A (H1N1) virus appears to be behaving in the same manner as it was three months ago. The virus is spreading quickly in this country and elsewhere, making it more likely that people will become ill — some of them requiring hospital treatment — especially in the hotspots of London and the West Midlands. The latest studies on animals, published in the journal Nature, suggests that the pandemic strain is more virulent than seasonal flu.
Is there any evidence of the virus mutating?
There have been reports of strains that show signs of resistance to Tamiflu (ostelamivir), the main anti-viral drug used to treat symptoms, in Denmark, Japan and Hong Kong. These are being considered as isolated cases and there is no evidence so far of a drug-resistant strain spreading widely in Britain or elsewhere.
Is it likely to mutate?
Yes. Flu viruses are constantly changing as the emergence of this new swine flu virus — itself a combination of human and animal strains — testifies. There are suggestions that older people may have some residual immunity to the virus as it is similar to H1N1 strains which have circulated in previous decades as seasonal flu.
There may be cause for concern if the virus “reassorts” to become widely unrecognised by the human immune system or resistant to medication, but such changes are more or less random and it is hard to know what form they will take.
It is reported that one in 200 people may die from swine flu. Is this number as scary as it looks?
This calculation is based on a model suggesting that 0.5 per cent of those who suffer from swine flu badly enough to seek medical help may die from it. It does not take into account the fact that the vast majority of cases will be milder infections. Individuals may stay at home for a few days without needing to see a doctor or may not have any symptoms at all after contracting the H1N1 virus.
Researchers from Imperial College London, who produced the figure, say that the one in 200 “case fatality rate” (CFR) is very similar to the estimated number of deaths for seasonal influenza every year. Their research, published in the British Medical Journal, also suggests that the actual CFR in Britain and Europe may be much lower — 0.14 per cent. Due to gaps in swine flu data collection, it is hard to predict how many people will ultimately become ill or die but a surge in cases is expected as the winter flu season approaches.
Why has Britain got the third highest number of confirmed cases in the world?
In the early stage of the outbreak — known as the containment phase — Britain and other countries attempted to confirm every suspected case of swine flu by taking swabs from people with symptoms and sending them off for laboratory confirmation. As of last week Britain had more than 9,700 of these laboratory-confirmed cases, putting it third behind the numbers confirmed in the United States and Mexico, where the H1N1 virus first emerged. But as the number of people reporting symptoms has grown, all three countries have stopped lab tests for all cases to lift pressure on resources. Instead, infection levels are now estimated on the basis of clinical diagnoses.
Britain appears to be the worst affected country in Europe, which may be explained in part by the high rates of travel to and from the US.
There have been calls for a better system of reporting . Is this necessary?
Not necessary, but desirable. There are several different methods of tracking the swine flu virus but officials are now relying mainly on the number of people complaining of “flu-like illness” to their GP.
This weekly data, compiled from a sample of about 100 GP surgeries across the country, is also used to track seasonal flu activity. It may overestimate the total number of people becoming ill if symptoms are not down to swine flu, or underestimate it, if people are not ill enough to contact their GP or treat themselves at home. The Health Protection Agency said last week that of an estimated 27,000 people complaining of flu-like illness in a seven-day period only about 28 per cent — about 8,000 — would actually be infected with the swine flu virus.
As laboratory confirmation has been discontinued for all but a small sample of cases, experts say it would be useful to have daily updates of the number of people being treated in hospital for flu. Alternatively, wider testing of anonymous blood samples from the general population could also indicate roughly what proportion of people have been exposed to the H1N1 virus.
When is the vaccine going to be ready?
Ministers suggest that the first batches of a vaccine against the H1N1 flu strain will start being delivered by manufacturers in early September. Following safety checks, they are likely to be in use by the end of that month. The Government expects 60 million doses — enough for at least half the population — to be available this year, with a total of 130 million doses on order.
Wednesday, July 15, 2009
NHS Direct: struggling with swine flu
Many people concerned about swine flu have turned to NHS Direct for help, but the telephone helpline which is supposed to take the pressure off doctors is now trying to take the pressure off itself.
The service, set up in 1997, has long been a target for criticism from doctors who have attacked what they see as its over-cautiousness.
Designed to take the strain off frontline staff, some claim it has increased workloads in the past by referring the perfectly healthy to out-of-hour doctors or A&E.
But many value its reassurance and advice and have turned to it in droves since swine flu was first reported. On Tuesday it received more than 9,000 calls relating to the virus - the highest yet.
There have been reports of lengthy waits to speak to an advisor - if you get through. Others have simply heard a recorded message.
One of the problems is that hundreds of fundamentally well people are still calling the service with their questions about swine flu, despite there being another telephone number for this purpose.
Many others have little wrong with them and are offered advice about home care.
NHS Direct itself is now urging people to use other channels for information, notably the website's symptom checker.
But the swine flu expert at the British Medical Association - the doctors's union - said the service was still not effectively triaging, and that too many were being referred to their GPs.
"NHS Direct has a place in the ordinary run of things but it is not tooled up for this job and it is struggling with the volume of calls," says Dr Peter Holden.
"As a working GP dealing with possible cases of swine flu NHS Direct has made no difference to my work load and has even made it harder, as I am getting a lot of referrals late in the day."
Not now
Those with children under five are specifically advised not to use the symptom checker on the NHS Direct website and contact the service directly.
Amanda McGregor, a mother of a one-year-old, said she decided to ring NHS Direct for advice and reassurance about her son's high temperature.
"My husband and I couldn't believe it when we got an answerphone saying they could not take calls because they had such a high volume of people ringing about swine flu. A voice message said information was available online."
"We ended up phoning our after hours GP service and were told to bring our toddler in. We were then transferred to accident and emergency and prescribed Tamiflu."
A fever is the most important symptom of swine flu - that is a temperature of 38C (100.4F) or above
There is reportedly little standard seasonal flu at the moment, so the chances are that if you have the above you do indeed have swine flu, experts say.
"Basically go out and buy a thermometer. If you have a temperature and two of the other symptoms you have flu, and should get treatment. If you're well enough to go to work, you don't," says Dr Holden.
Differentiating
On Tuesday NHS Direct received nearly 9,700 swine flu related calls and its chief executive said it was now encouraging people to use other means of obtaining information.
But Nick Chapman, chief executive of NHS Direct, stressed it was not simply referring callers straight on to GPs as some have claimed, and was sorting out the mildly ill from potential cases of swine flu.
"I am extremely aware of the current pressures facing all parts of the NHS, including GPs, and want to reassure people that NHS Direct is doing all it can to help relieve this pressure. We are dealing with a significantly increased number of calls about swine flu, yesterday alone nurses spoke to over 9,500 people who were worried they had swine flu.
"For half of these people we were able to give advice on how they could treat themselves at home, without advising them to contact their GP for further assessment.
"We are prioritising urgent calls so that people most in need are assessed as quickly as possible and urgent calls are being dealt with in less than 20 minutes. If a call back is required for a non-urgent call we will tell callers how long they have to wait when they speak to someone."
The service, set up in 1997, has long been a target for criticism from doctors who have attacked what they see as its over-cautiousness.
Designed to take the strain off frontline staff, some claim it has increased workloads in the past by referring the perfectly healthy to out-of-hour doctors or A&E.
But many value its reassurance and advice and have turned to it in droves since swine flu was first reported. On Tuesday it received more than 9,000 calls relating to the virus - the highest yet.
There have been reports of lengthy waits to speak to an advisor - if you get through. Others have simply heard a recorded message.
One of the problems is that hundreds of fundamentally well people are still calling the service with their questions about swine flu, despite there being another telephone number for this purpose.
Many others have little wrong with them and are offered advice about home care.
NHS Direct itself is now urging people to use other channels for information, notably the website's symptom checker.
But the swine flu expert at the British Medical Association - the doctors's union - said the service was still not effectively triaging, and that too many were being referred to their GPs.
"NHS Direct has a place in the ordinary run of things but it is not tooled up for this job and it is struggling with the volume of calls," says Dr Peter Holden.
"As a working GP dealing with possible cases of swine flu NHS Direct has made no difference to my work load and has even made it harder, as I am getting a lot of referrals late in the day."
Not now
Those with children under five are specifically advised not to use the symptom checker on the NHS Direct website and contact the service directly.
Amanda McGregor, a mother of a one-year-old, said she decided to ring NHS Direct for advice and reassurance about her son's high temperature.
"My husband and I couldn't believe it when we got an answerphone saying they could not take calls because they had such a high volume of people ringing about swine flu. A voice message said information was available online."
"We ended up phoning our after hours GP service and were told to bring our toddler in. We were then transferred to accident and emergency and prescribed Tamiflu."
A fever is the most important symptom of swine flu - that is a temperature of 38C (100.4F) or above
There is reportedly little standard seasonal flu at the moment, so the chances are that if you have the above you do indeed have swine flu, experts say.
"Basically go out and buy a thermometer. If you have a temperature and two of the other symptoms you have flu, and should get treatment. If you're well enough to go to work, you don't," says Dr Holden.
Differentiating
On Tuesday NHS Direct received nearly 9,700 swine flu related calls and its chief executive said it was now encouraging people to use other means of obtaining information.
But Nick Chapman, chief executive of NHS Direct, stressed it was not simply referring callers straight on to GPs as some have claimed, and was sorting out the mildly ill from potential cases of swine flu.
"I am extremely aware of the current pressures facing all parts of the NHS, including GPs, and want to reassure people that NHS Direct is doing all it can to help relieve this pressure. We are dealing with a significantly increased number of calls about swine flu, yesterday alone nurses spoke to over 9,500 people who were worried they had swine flu.
"For half of these people we were able to give advice on how they could treat themselves at home, without advising them to contact their GP for further assessment.
"We are prioritising urgent calls so that people most in need are assessed as quickly as possible and urgent calls are being dealt with in less than 20 minutes. If a call back is required for a non-urgent call we will tell callers how long they have to wait when they speak to someone."
Mass swine flu vaccination ‘could cost up to £10m’ in Wales
PLANS to vaccinate everyone in Wales against swine flu could cost up to £10m, it has been estimated.
The Welsh Conservatives have said frontline budgets must not be cut to meet the costs of the massive vaccination programme.
And it emerged last night that the Welsh Assembly Government has not yet had a reply from the Treasury about who will foot the bill for dealing with the swine flu pandemic.
Wales has ordered six million doses of the swine flu vaccine, which should be available in weeks.
It is sufficient for everyone to receive the necessary two doses, three weeks apart.
It is expected that those at greatest risk of suffering a serious illness and frontline emergency workers will be offered a vaccine first.
Experts believe that up to a million people in Wales – one in three – could become ill with swine flu over the next 18 months.
Tory Andrew RT Davies, the Shadow Health Minister, said: “With an estimated six million anti-viral treatments heading to Wales, we are looking at a cost of around £8m to £10m.
“While I fully appreciate how important these vaccinations are, I would like an assurance that frontline budgets will not be raided in order to fund the programme and that reserve funding will instead be used.”
Experts hope that the swine flu vaccine could help limit the spread of the virus – it could prevent one in six cases of illness – and reduce the impact on the health service and the Welsh economy.
Westminster Health Secretary Andy Burnham said last night: “We have made very good plans in this country for this eventuality, for being in this situation, and Britain is at the front of the queue in the world for vaccine. We could not be in a better position.
“So as soon as stocks are made, the very first vaccines will come to this country. We expect to get the first next month.”
An Assembly Government spokesman said: “We have not yet had a response from the Treasury on the First Minister’s letter on who will pay for dealing with swine flu.
“The Department of Health is leading with the procurement of the vaccine for the UK. Wales will receive its proportion.
“Due to commercial confidentiality, it would be inappropriate to comment on the cost of the vaccine.”
Predictions about the cost of a mass vaccination programme came as it emerged a Bedfordshire GP who had swine flu died from natural causes.
A blood clot to Dr Michael Day’s lungs was the major factor in his death. The 64-year-old died on Saturday in the Luton and Dunstable Hospital.
The results of a post-mortem examination into the death of six-year-old Chloe Buckley, from West Drayton, are still pending.
Wales continues to lag about a month behind England and Scotland, where there have been 16 deaths linked to the swine flu virus.
Official figures last night estimated that 585 people have flu-like symptoms in Wales. There are still low levels in all regions of Wales, but the virus is “increasing”.
Public health officials have urged parents not to send their children to school if they have any flu-like symptoms, even though the end of the school year is imminent.
The Welsh Conservatives have said frontline budgets must not be cut to meet the costs of the massive vaccination programme.
And it emerged last night that the Welsh Assembly Government has not yet had a reply from the Treasury about who will foot the bill for dealing with the swine flu pandemic.
Wales has ordered six million doses of the swine flu vaccine, which should be available in weeks.
It is sufficient for everyone to receive the necessary two doses, three weeks apart.
It is expected that those at greatest risk of suffering a serious illness and frontline emergency workers will be offered a vaccine first.
Experts believe that up to a million people in Wales – one in three – could become ill with swine flu over the next 18 months.
Tory Andrew RT Davies, the Shadow Health Minister, said: “With an estimated six million anti-viral treatments heading to Wales, we are looking at a cost of around £8m to £10m.
“While I fully appreciate how important these vaccinations are, I would like an assurance that frontline budgets will not be raided in order to fund the programme and that reserve funding will instead be used.”
Experts hope that the swine flu vaccine could help limit the spread of the virus – it could prevent one in six cases of illness – and reduce the impact on the health service and the Welsh economy.
Westminster Health Secretary Andy Burnham said last night: “We have made very good plans in this country for this eventuality, for being in this situation, and Britain is at the front of the queue in the world for vaccine. We could not be in a better position.
“So as soon as stocks are made, the very first vaccines will come to this country. We expect to get the first next month.”
An Assembly Government spokesman said: “We have not yet had a response from the Treasury on the First Minister’s letter on who will pay for dealing with swine flu.
“The Department of Health is leading with the procurement of the vaccine for the UK. Wales will receive its proportion.
“Due to commercial confidentiality, it would be inappropriate to comment on the cost of the vaccine.”
Predictions about the cost of a mass vaccination programme came as it emerged a Bedfordshire GP who had swine flu died from natural causes.
A blood clot to Dr Michael Day’s lungs was the major factor in his death. The 64-year-old died on Saturday in the Luton and Dunstable Hospital.
The results of a post-mortem examination into the death of six-year-old Chloe Buckley, from West Drayton, are still pending.
Wales continues to lag about a month behind England and Scotland, where there have been 16 deaths linked to the swine flu virus.
Official figures last night estimated that 585 people have flu-like symptoms in Wales. There are still low levels in all regions of Wales, but the virus is “increasing”.
Public health officials have urged parents not to send their children to school if they have any flu-like symptoms, even though the end of the school year is imminent.
Swine flu: Google shuts office
Google’s India headquarters based in Hyderabad has shut down one of its offices for two days after one of the employees was confirmed to be suffering from the H1N1 flu virus.
After the employee tested positive, the search engine sent at least 100 employees to the Government General and Chest Hospital at Erragadda to undergo tests. Officials at the hospital said at least half a dozen employees were detected with swine flu symptoms and have been quarantined.
The employee, who had gone to Houston on a training assignment and returned to the city on July 5, passed through the screening at the Rajiv Gandhi International Airport.
“It appears that he was carrying the virus, which manifested itself only after he joined duty at the Hyderabad office. Others probably contracted infection from him,” Dr K Subhakar, coordinator, H1N1 Influenza nodal centre coordinator set up in Hyderabad, said.
After the employee tested positive, the search engine sent at least 100 employees to the Government General and Chest Hospital at Erragadda to undergo tests. Officials at the hospital said at least half a dozen employees were detected with swine flu symptoms and have been quarantined.
The employee, who had gone to Houston on a training assignment and returned to the city on July 5, passed through the screening at the Rajiv Gandhi International Airport.
“It appears that he was carrying the virus, which manifested itself only after he joined duty at the Hyderabad office. Others probably contracted infection from him,” Dr K Subhakar, coordinator, H1N1 Influenza nodal centre coordinator set up in Hyderabad, said.
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