Tom Nolan’s flu blog

The media’s interest in H1N1 may have declined, but the number of cases appears to be on the increase, and not just in the southern hemisphere where we’re told to look to. The World Health Organisation’s latest map of H1N1 cases gives an interesting if simplistic snapshot of the most affected areas globally. Countries with the most cases are painted a rusty red, meaning Spain with its 539 cases and the US with over 20,000 share the same colour, but you get the idea.

In the UK the number of confirmed cases has jumped from 1752 to 2773 in a week.  In the West Midlands there were a further 89 cases confirmed only yesterday. There is a lot of talk about services being stretched and confusion amongst doctors. However, the picture seems to be mixed, as described by this meteorological metaphor from Peter Holden, the BMA’s lead on pandemic flu:

The best way to describe it is that the weather forecast for the UK is good, but in certain places there are tropical thunderstorms.

So where does this leave GPs who are struggling to cope with flu and their normal workload? Isn’t it just a case of following a protocol? Londonwide LMC (Local Medical Committees) boss Dr Michelle Drage confirms that it’s not quite that easy in a memo to London GPs.

Clinicians should use their clinical judgement in assessing the severity of symptoms and the vulnerability of patients; and, where necessary, prescribe antivirals.

The first step on the HPA and NHS London algorithm (if it’s not already burnt into your memory) is “does the patient have a history of fever (>38) over the last seven days?”

Commonsense is needed here [says Dr Drage]. Please read the Algorithm to mean a properly taken fever >38. If the temperature has not been taken properly, consider getting the patient to take it properly at home, and report the reading to the surgery at the next session if above 38. Obviously this won’t apply if the patient is otherwise significantly unwell.

But for how much longer will the current algorithms be sustainable? Peter Holden again:

The whole purpose of putting people on Tamiflu was to reduce the hospitalisation rate, and that isn’t a big issue at the moment.

So should we be saving Tamiflu for only the most severe or high risk cases? And what about post-exposure prophylaxis? Are the current HPA guidelines on this looking rather generous?

The vaccines are coming! Or do you have other plans?

The race to find a vaccine might have a new leader if you believe the CEO of Protein Sciences Corporation:

We turned out our first batch of doses — about 100,000 — against (A)H1N1 flu last week and we’re continuing to manufacture it.

This vaccine is apparently made with the help of caterpillars and they reckon they could make 50 million within six months. It doesn’t sound like they’ve tested it yet, according to this article,  but let’s not get bogged down in details.

Have you got a secret stash of tamiflu somewhere at home? You’re probably not the only one, but will you come out and admit to it? Here’s what one doctor in Australia thinks of it all:

We must set an example and be brave. Next thing we’ll be hoarding carrots to stave off night blindness. I have encouraged my butcher to continue selling pork sausages and roast pork and crackling after an initial slump in sales. I set an example by now asking him for sliced swine from his swine slicer (instead of ham). Don’t talk the talk; roast the pork.

But not everyone will be so brave. Many will resort to online pharmacies who are willing to give you some Tamiflu at the right price. They work out at about £10 a pill from this supplier.

What’s your experience? What questions do you have?

I’ll be blogging daily here, attempting to keep up to date with the latest news and views on H1N1. More importantly though, I’d like to hear your experiences of the pandemic. If you have any questions too, I’ll try to put them to the right people and find answers for you. Leave your comments below or email me at

Tom Nolan is the clinical community editor of doc2doc, the BMJ’s professional networking community.