Swine flu: too early to say mild?

The number of laboratory confirmed cases of swine flu in England has shot up by nearly fifty percent since last Friday. 1604 new cases were confirmed between 27-29th June, bringing the total number to 4968.
The third UK death was confirmed – a 9 year old girl with underlying health problems who was being treated at Birmingham Children’s Hospital.
Meanwhile, BBC News last night reported the first case of swine flu resistant to Tamiflu:

Roche Holding AG confirmed a patient with H1N1 influenza in Denmark showed resistance to the antiviral drug. David Reddy, company executive, said it was not unexpected given that common seasonal flu could do the same.

When is a prescription not a prescription?
The FP10 – or regular GP prescription to the man on the street – has been the focus of much discussion and frustration over the last week or two. The problem is simple: you shouldn’t really use an FP10 for Tamiflu because prescribing Tamiflu isn’t done on a normal NHS prescription – it’s a “patient specific direction” and gets sent somewhere else after the pharmacist has finished with it. Doctors still want to use FP10s so they can easily keep an electronic record of the prescription. The cunning plan to get around this is to write “convenient stationery” on the script. They must also write the name of the “flu friend” who will collect the tablets on the patient’s behalf.  The GP (or more likely, the GP’s receptionist) then faxes the prescription over to the pharmacy and posts the original to the Medicines Management team. A lot of paperwork just for some Tamiflu!
The situation is even worse in some hospitals. One hospital doctor I spoke to described how before prescribing tamiflu someone has to call a flu line to notify them of a new case. With dozens of new cases every day they’re having to send patients with milder symptoms back to their GPs for their Tamiflu prescription.

The real winners
All the fuss over Tamiflu prescriptions is surely making many doctors pull their hair out. Couple that with what appears at the moment, in the vast majority of cases to be a mild infection you can be forgiven for wondering whether it’s really worth it. One GP in London told me:

My feeling is that the main beneficiaries of this policy are the drug company that makes Tamiflu, who must be dancing with glee at the business.  The other aspect is that I suspect Tamiflu or similar drugs will now be considered necessary for all sorts of flu in the future – plenty of future business too.

If the word swine were removed from all of this then GPs would just be doing what they always used to do – give advice about staying at home, drinking plenty of fluids and so on. The current flu seems to be no worse (and possibly even a bit better) than seasonal flu.

What’s your experience of treating H1N1 been like? Do you have any news or stories that you’d like to share on this blog? Write them in the comments below or email tnolan@bmjgroup.com

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