October 29 2009

As the mass vaccination campaign slowly gets going the need for it becomes ever more clear. Whilst the rate of increase in case numbers is slower than it was earlier in the year, the numbers grow steadily larger. The past week saw approx 53,000 new cases. Of concern are the 99 patients admitted to critical care because of Flu, and the disproportionate rise in deaths amongst pregnant women. Even from here one can see that vaccionation in pregnancy is going to be a hot issue this autumn. There is an inbuilt reluctance to advise pregnabt women to have medication of any sort. There is no such thing as a drug or treatment that has been proved to be safe for use in pregnancy. There never will be one either, for the simple reason that it is impossible to get such proof. To do this a trial would need to be set up where thousands of pregnant women were given drug x to see how much it harmed them or their unborn children. Realistically outside of a Nazi style concentration camp this sort of research is not going to happen. What we can say with certainty is that there are more Swine Flu deaths amongst pregnant women than would be expected from the numbers of cases. Lots more deaths. So what do we do here then ? Whilst the data is very limited some pregnant women have been vaccinated in various countries. Some because they were not aware they were pregnant at the time of the vaccination, or because a decision was made that this was the appropriate course of action for that women. So far no data has emerged to suggest that vaccination has caused a problem, but it is very early. This vaccine has not been around for long, it will be another year at least before there will be full data on a meaningful number of women and their pregnancies. Obviously pregnancy lasts 9 months so there is a limit as to how much it is possible to "hurry up" the results.

October 24 2009

This week the UK vaccination programme finally got under way. The most at risk in hospital and as many hospital staff as possible were the very first to be vaccinated. Starting next week ( October 26th), vaccina will be distributed to GP practices.

Vaccinating up to two thousand patients is obviously no small undertaking, and will take time. So not everyone will get vaccinated in the first week. All GP practices have been issued with guidelines on prioritising patient groups so that those getting called in the first week are those at greatest risk, not those who shout the loudest. Past experience tells us that this may not be well received by the small number of patients who are used to getting what they want, when they want it. That small group of patients who are not used to being told No! The Department of Health has been quite specific about who is, and who is not high priority, so that is the way that it will be done.

The first to be done will of course be the "Usual Suspects" those who know perfectly well who they are, and who fall into one of the groups who are at the highest risk of very serious illness or serious complications should they be unfortunate enough to actually catch Swine Flu. AT RISK GROUPS.

October 17 2009

Finally, at long last we are actually going to get our hands on the long awaited vaccine. Next week, on October 24th to be precise, the first supplies will be released to acute hospital trusts for the most at risk patients and key medical staff.

October 12 2009

Just as last week, there continue to be encouraging signs with swine flu. The much predicted second wave has begun. However with 18,000 cases last week (up from 14,000 the previous week) the increase in cases in England and Wales is much slower than officials had dared hope. In Scotland, cases actually fell, but remain very high in Northern Ireland. Once again there have been deaths, with four more patients losing the fight against the flu. This brings the total for the whole UK to 90 deaths from swine-flu since the first UK cases in April. The proportion of those dying who were previously fit and healthy has remained quite steady at around 20% . There ere 290 people in hospital because of Influenza of whom 47 are in intensive care units. (Figures from DOH press release for the week to October 9th.)

The Chief Medical Officer, Sir Liam Donaldson said:

"We are well into the second wave of pandemic flu but it is proving so far to be a slow burn. There is a possibility it might peak and at a lower level than we thought. This would be incredibly positive because it would mean we could roll out the vaccine. It would mean we might be able to avert a subsequent very big peak. But on the other side of the coin we have a worrying number of people going into hospital and intensive care. It isn't a killer virus but it can kill."

Why is flu rising slowly? Sir Liam said:

"There is a bit of herd immunity out there because of the earlier peak in July, especially among school children but it's too early to say whether it will continue to be a slow burn. We are still early in the flu season."

There are also encouraging signs from the United States where cases seem to have peaked sooner than expected and at a lower level.

Despite these encouraging signs it is important that we do not become complacent. There may be several peaks over the next few years, these may become bigger and the virus may become more virulent. At this stage there is simply no way of knowing.

 

 

October 12 2009

Just as last week, there continue to be encouraging signs with swine flu. The much predicted second wave has begun. However with 18,000 cases last week (up from 14,000 the previous week) the increase in cases in England and Wales is much slower than officials had dared hope. In Scotland, cases actually fell, but remain very high in Northern Ireland. Once again there have been deaths, with four more patients losing the fight against the flu. This brings the total for the whole UK to 90 deaths from swine-flu since the first UK cases in April. The proportion of those dying who were previously fit and healthy has remained quite steady at around 20% . There ere 290 people in hospital because of Influenza of whom 47 are in intensive care units. (Figures from DOH press release for the week to October 9th.)

The Chief Medical Officer, Sir Liam Donaldson said:

"We are well into the second wave of pandemic flu but it is proving so far to be a slow burn. There is a possibility it might peak and at a lower level than we thought. This would be incredibly positive because it would mean we could roll out the vaccine. It would mean we might be able to avert a subsequent very big peak. But on the other side of the coin we have a worrying number of people going into hospital and intensive care. It isn't a killer virus but it can kill."

Why is flu rising slowly? Sir Liam said:

"There is a bit of herd immunity out there because of the earlier peak in July, especially among school children but it's too early to say whether it will continue to be a slow burn. We are still early in the flu season, although there are also encouraging signs from the United States where cases seem to have peaked sooner than expected and at a lower level."

Despite these encouraging signs it is important that we do not become complacent. There may be several peaks over the next few years, these may become bigger and the virus may become more virulent. At this stage there is simply no way of knowing.

 

2nd October 2009

Figures announced today show that the number of new cases is increasing as expected.Up to 14,000 cases last week from 9,000 the week before. For all practical purposes this confirms that the second wave of cases is well and truely with us. One slight glimmer of better news is that the rate of increase continues to be a little slower than might have been expected. In the first wave the numbers of cases were doubling in less than a week giving very rapid growth in numbers. It is much too early to read much into this, and it may well be that next week it will go from fourteen to over twenty eight thousand in less than the week. We will just have to wait and see.Despite all promises it is now October and still we do not have the vaccine in GP practices, we are sitting waiting to start vaccinating hundreds of people, if the press is to be believed the NHS has taken delivery of over 5 million doses SO WHERE IS IT !!

Sadly however, there have been two further deaths in the last week, bringing the UK total to 84 so far. Of these 84, 16 or 19% have been in previously totally fit healthy people.

September 15th

As we head into Autumn and the "Flu season" here in Europe, in Australia they are leaving their excuse of a winter behind as Spring gets going. As well as the Australian seasons being the wrong way around, of course so is their "Flu season" that they are just emerging from. They have had quite a time of it. Read comments on the season from Prof Dwyer, a virologist and Flu expert in Sydney.

September 14th

Whilst the case numbers remain very low, the Government continues to prepare for the expected second wave of Flu. The latest announcement is that there is to be a doubling of the number of intensive care beds available in the UK. Considering the investment in equipment and training involved this is a major undertaking. Bearing in mind the fact that our Government is not renowned for over providing for the NHS. To make such a large commitment they must have very good information that it will be needed. This will only be a short term measure, the biggest thing that has to be done to free up intensive care beds, is to stop planned operations. Most ICU beds are used for post operative care after cardiac and other major surgery so non emergency operations would have to be cancelled.The plan ius that this would just be for a few weeks over the peak of flu cases.

As we gear up to start dishing out the new H1N1 vaccine in the near future, trials are showing that the vaccine is not only safe and effective, but gives a better than expected response to a single dose. This raises the possibility that a single dose may be sufficient, not the expected two doses.

September 8th

Again there has been another big drop in the number of new cases this week. With just over 4,000 new cases confirmed in the past week, things are a long way from the 100,000 plus of just a few weeks ago. Sadly however, we have not seen the end of it by a long way. As I am sure everybody knows by now a second, much larger wave of infections is expected in the next few weeks as the school term kicks off and the children (or "super-spreaders" as they are technically called) start swapping their bugs around.

So far there has been no sign of a mutated strain with any greater virulence, so perhaps we may just be lucky and escape with nothing more than the mild Flu currently around. However it is much too early to be speculating about that.

There is good news on the vaccine front. It seems that the vaccine should be fully tested, passed as safe and available in the quantities needed by the end of September. Hopefully this time the deadline will stand. Follow the links on the left for more information about who gets it, when, where and how. We are expecting a "lively debate" over who gets it first, and who will take priority. No doubt there will be much grandstanding with every known pressure group making the case for why their members should be at the front of the queue. This will all be nicely in time for the major political party conferences, perhaps it might liven them up a bit ! ( couldn't make them any worse!) The point that will no doubt be widely missed is that with the best will and resourses in the world, it will still take a long time to give 60 million injections, if half the population is to have two shots each. Quite how this is to be done we hear little about.

 

August 18th

Once again this week the number of new cases continues to decline. It would seem that without doubt the peak of this first wave has passed. The general opinion is that we should now get a break of a few weeks until the schools are back and the kids resume their normal bug-swapping activities. What happens then is the great unknown!

There seems to be a general assumption that at some point the mild Flu causing virus that we have at the moment, will swap a few bits of DNA with some other passing bug, and mutate into some fearsome "SuperFlu" that will be lethal and resistant to all known treatments.

Resistance to treatment is sadly not all that unlikely. It is well known how quickly a strain of bacteria can develop resistance to a new antibiotic. Viruses and ant-virals will have the same problems, though probably quicker.

why do bugs become resistant?

Should I take Tamiflu if I get Swine-Flu now?

August 7th

Without wanting to be premature, the signs are hopeful that this wave of the UK Epidemic may have reached its peak and be declining. Last week saw a slower than expected rate of increase of new cases. In the past week there has been a reduction in the number of new cases. Also much to everyones relief there has been some let-up in the numbers of people queuing for hours at hospital A&E departments. There never was any possible need for this, especially after the Pandemic web and phone hotline was up and running. However when did lack of serious illness ever deter the good old British public from spending a weekend queuing in A&E ?

In some areas specialhospital "Flu Teams" have been stood down for the time being. Whilst obviously it is good to see fewer people becoming ill and less pressure on NHS resources, this will only be a temporary let-up. The current Pandemic of H1N1 "Swine-Flu" can be expected to behave in the same way as all other large epidemics or Pandemics of an infectious disease.

A large epidemic or Pandemic does not come in one huge great uncontrollable wave of infection knocking down everyone in its path. It will come as a series of waves. Ultimately a high proportion of the non-immune population will catch the disease, but not all at the same time. The final number of cases can only be guessed at, and will depend on many things, especially how infectious the disease turns out to be, and the severity of the disease it causes. With a relatively mild illness like Influenza the overwhelming majority of people who catch it will get fully better in a week or two irrespective of any vaccines, anti-viral drugs or even Doctors. Yes believe it of not over 98% of people will survive a Flu outbreak even if there are no Doctors at all !! So apart from at the very beginning of a new pandemic, there are rapidly increasing numbers of people who have had the disease and got better. They are then immune so can not catch it again meaning that as the number of ill people grows, so does the number of recovered people. After the first wave of unfection, there will always be more people who are recovered and immune that those actually getting ill. So the world does not come to a total stand-still whilst we all have Flu.

On the other hand, occasionally an infectious disease is not only very infectious but also very fatal. With almost everyone who catches the disease dying from it, the prospect is very different. This is what happened in Europe when the Black Death first appeared in Medieval times. In 14th century England, if you caught the Black Death then you died from it within 2-3 days, virtually nobody survived it, so there was never the group of people whe had recovered and were immune. So there was noboby who coulkd tend to the sick and dying, without facing infection and almost certain death themselves.

Effective treatments and medical knowledge were virtually non-existant in those times, but one thing they did know was that the best way to survive was to get as far away from infected people as possible. Dying from something as ghastly as The Black Death, with nothing to relieve the excruciating pain, and nobody to even fetch you a drink of water, must have been a dreadful way to die. One can well imagine why it was regarded as God's punishment for their simfulness. With between a third and a half of the entire population dead within 2 years, the world did not just grind to a halt, but stayed halted for a long time. It was over 150 years before the population of Britain got back to anywhere near to the pre Black Death level.

One interesting little foot-note of no relevance whatever, is that it did not take long for people to cotton on to the fact that Priests, Monks and true believers were dying like flies like the rest of the population. Even these uneducated people could work out that if God was not sparing his own, then either the Church must be as corrupt as the rest of them, or God was not as all powerful as the Priests told them. In England and some other European countries the Catholic Church never really recovered from this demonstration of how fallible it was.

This realisation of how ineffective the Catholic Church seemed to be was one of the many sparks that set off the Reformation, and in England the usurping of the Catholic Church's position by a new way of worshiping God. The Protestant way.

 

August 1st

What if you get it twice?

Well another week has passed, with another big rise in numbers of Flu cases, but with only one further death in the UK. Also the past week has been the first for some time, where the increase in new cases is less than the increase that would be predicted if the virus was spreading totally un-checked through a totally non-immune population. Coupled with only one further death, this is an encouraging sign. However little can really be said about one week's figures. If it is the same again in the next week then possibly this wave of infection has passed its peak. This is not to say we are seeing the back of it.

No such luck I am afraid. What tends to happen is that when a new Bug like our friendly Pig-Flu arrives in the spring or summer, there is an initial wave of infection that may reach a fair sized peak but dies down in a matter of weeks. Flu viruses despite the havoc they wreak are not very tough, and in slightly warmer weather, the virus can only survive for a very short time outside of a human body. As soon as it starts to get dry it dies. This weather effect is why there is a typical "Flu season" through the colder wetter months of the year. Clearly this varies from country to country and whether it is North or South Hemisphere. You may have seen that there is a lot of Flu in the not very big population of Australia. Now is the middle of Winter there, so this is their main Flu Season peak of infection. By contrast in UK, despite the wet Summer, the transmission of Flu from person to person is greatly impeded. Between the weather effect, clobbering it with Tamiflu transmission between children at school stopping in the holidays and some degree of immunity in some older people, it may be nearly at or possibly even past the peak of this wave of infection.

Even if this is the case, it will sadly not just go away now. The numbers may drop to quite low levels and somewhat drop out of sight as the Media fill the Silly-Season with the usual stories. However when schools and Universities back and we get into colder late October / November weather, then we will find out what this bug can really do. That is when we will get the real epidemic. Everybody worked themselves up into a frenzy over 100,000 cases. When we are counting in millions in a few months time we will see how well prepared the NHS and Government really are.

The one thing that will really make a difference is whether or not a safe and effective vaccine can be made available in sufficient quantity before the main part of the epidemic hits us.

July 28th

The National Flu Pandemic Service is now up and running . Whilst there were teething problems with exceptional demand on the first day, it is now running smoothly. It is a phone service of Web-site that allows people who are concerned they may have Swine Flu to check to see if they have the relevant symptoms as well as a fever. Treatment is made immediately available for those who need it. See The National Flu Pandemic Service for further information on how it works and what happens.

Sadly the Welsh Assembly has decided that Wales should not join the full service and only symptom checking & diagnosis is available for those who give an address in Wales. Not that the web-site or phone service can possibly know where you live. For more information on why is it not possible to get the treatment in Wales.

 

July 21st

Things are continuing as expected from last week. The Government has confirmed that the Flu assessment Lines will be up and running by the end of the week.

July 17th

The last few weeks has seen a big increase in numbers of known cases in the UK and unfortunately there have been a number of deaths. It is not clear if any of the deaths have been amongst people without any other serious health problems, in most cases there did seem to be other health problems that had to some extent weakened the patients and made them more prone to the serious complications, in other cases the actual cause of death has not yet been confirmed.

From the way that the Media are reporting the pandemic one could be forgiven for thinking that there has been a huge unexpected rise in Flu cases and many unforeseen deaths. Fortunately this is not the case. Over the past week there has been a doubling in the number of cases. This sounds dreadful but is exactly what was predicted. This is how epidemics behave. It is a text book example of how a new virus spreads in a non-immune population. I can tell you now that there will be another doubling next week and the week after or sooner. Sadly some newspapers and broadcasters will be trumpeting this as the Sky falling in, and another example of Government mishandling of the situation. To be fair to the Government, spread of a totally new virus is not something that they or anyone else could ever have done anything about. The situation is obviously serious, but not perhaps the end of the world quite yet.

It is not numbers of cases in any particular time that matters. It is the severity of the illness that is important. We have to accept the fact that most of us are going to catch this at some point irrespective of what we do about it. Until there is an effective vaccine there is nothing that can prevent someone catching the Flu if they come into contact. So we have to concentrate on treating those who have it, and keeping a careful watch to ensure that those developing serious complications can be treated appropriately, in or out of hospital.

The other very important thing is that Doctors and medical staff have to be available to treat the more seriously ill and look out for the complications. If GP's and Hospitals are swamped with crowds of people with minor symptoms and low risk of complications, they are not going to be able to give the seriously ill the care that they need. The Department of Health is adamant that medical staff should devote their time to the seriously ill whilst those with more minor symptoms will be given anti-viral drugs and advice on home treatment without the attention of their GP.

To facilitate this a special National Flu Pandemic Service help line and web-site will be available by the end of next week. All callers to Gp practices, Out of hours services or NHS direct, who are calling regarding Flu like symptoms, will be directed to the assessment line. They will then be taken through an assessment process over the phone and the the assessor they speak to will decide if there are symptoms strongly suggestive of Flu. If the patient does have Flu a course of anti-virals will be arranged. Where symptoms do not match up to those of Flu, patients will be advised about home treatment and asked to ring back if it deteriorates. Those with more serious sounding problems will be advised to contact their GP who at this stage will not pass them on the the Assessment line.

Why do I just speak to someone on the phone not see a Doctor ? Click HERE

June 29th.

The current H1 N1 Swine Flu Pandemic has now been running for nearly 3 Months. It all started with an un seasonal wave of what were initially thought to be flu-related deaths in Mexico in early April. This rapidly became a global scare story as cases were identified far and wide across the world. Fortunately many of the Mexican deaths turned out to be from other causes, and what was identified as a new H1 N1 Influenza strain seemed to lose some of its punch as it propagated around the world.

Sadly there have been deaths, some here in the UK, but as a proportion of the hundreds of thousands of cases that there have now been worldwide, death or even serious illness has been much less common than looked likely. By some happy fluke of a mutating virus our first Global Pandemic in 40 years is with an unusually mild flu strain. That is not to say that you don't get unwell if you catch it, you do, as with any flu. However, bad as it feels at the time, really dying of flu, is a bit more extreme than just feeling like you are going to !!