Come swine with me

My plans for a H1N1 themed dinner party “come swine with me” are in tatters after Dr Jarvis, chairman of the British Medical Association’s public health committee, yesterday declared swine flu parties not to be a good idea. Apparently it will threaten to undo all the good work that’s been done to contain the outbreak.

If we get to the point where containment is not possible we will not be able to monitor cases as closely or get anti-virals out as quickly. Will we consider it a mild virus then?

The response so far has been superb. We have contained better than we expected and that has given us time. We are getting closer to a vaccine and we want that to continue.

Going out to try to get the virus will just aid its spread.

What a shame, the spread that I had planned for my soirée would have been wonderful. For the greater good, though, I will postpone.

Apocalypse Not? Don’t speak too soon.

The public perception – and that of most doctors too – seems to be that H1N1 is a very mild illness. The mortality rate is lower than feared and probably lower (or at least no higher) than seasonal flu. Another factor in this perception must also be the media’s reporting of the illness.  After back to back coverage of the story for day after day in the spring, swine flu didn’t really live up to the hype. So now we’re seeing swine flu parties (above) and stories like the one in Wired magazine last week titled “Apocalypse Not: Behind the Swine Flu Hysteria“.

At the height of the swine flu pandemic this spring, when the US Centers for Disease Control and Prevention was recommending that schools with cases of H1N1 be closed for 14 days and Mexico was still on lockdown, the epidemiology community already suspected the world wasn’t ending.”
It goes on to explain what case fatality rates and replication rates (“R-zero”) mean.

H1N1 had an RØ of about 1.3, high enough to spread the virus but low enough that a strong isolation program could break its back. Its case fatality rate was a wussy 1.9 percent in Mexico and 0.1 percent worldwide. By comparison, the 1918 Spanish flu had an RØ of 2.7 and a case fatality rate of up to 5 percent, making it far more deadly.

A case fatality rate of 1.9%? Doesn’t sound too wussy to me! There are lots of very nicely drawn graphs and maps comparing H1N1 to 1918 and the fictional flu in Stephen King’s The Stand, and they’re all nice and reassuring. But isn’t it too early to write off swine flu like this?
So are we all being a bit too relaxed about swine flu at the moment? In Case of Emergency, a blog about public health preparedness, certainly thinks so:

I’ve heard, from extremely intelligent people, that this is nothing to be worried about; it’s nothing like in 1918. Tens of millions of people died then, and we’ve only seen, what a couple of hundred deaths? Why get all worked up over that?

They… extrapolate what we’re seeing now as the recipe for how this flu will act from start to finish. I worry that this type of thinking will only get worse as this wave recedes and flu cases stop occurring in the States. In the three twentieth century pandemics, the initial wave was by far the most mild.

Is he right? Only time will tell.

Flu doctors needed – don’t all rush at once.

Every GP practice has been asked to identify a lead doctor for the flu pandemic. If no-one wants the job (and who would?), how do you decide who gets lumped with it? Do you draw lots? Look at who’s most qualified? Or avoid the problem altogether and not appoint anyone? This is the question examined by Daniel Sokol in the BMJ. The dilemma, he says, is like that facing the first mate of the William Brown that sunk in 1841.

The doomed ship sank with 31 passengers. The remaining passengers scrambled onto lifeboats. In one of the lifeboats, the 41 escapees were so heavy that the first mate feared that the boat would sink. He instructed his eight crewmen to “go to work, or we shall all perish.” Sixteen passengers were thrown overboard.

So who are you throwing overboard?

Tom Nolan is the clinical community editor of doc2doc, the BMJ’s professional networking community. Do you have any news or stories that you’d like to share one this blog? Write them in the comments below or email