Partners in swine

Yesterday I attended the Department of Health briefing on swine flu where the suave new secretary of state for health, Andy Burnham, and his partner in swine, Sir Liam Donaldson, gave an update. Cases have doubled in the last week and at the current rate could hit 100,000 per day. The big news, though, is that the whole of the UK had entered the “treatment phase” of the flu pandemic plan. This means that all routine screening will cease and doctors will be able to treat the flu empirically. Giving prophylaxis to flu contacts will also end.

What is the reasoning behind this decision? Why move to the treatment phase in parts of the country where only one or two cases are being confirmed each day (such as Northern Ireland and the North East)? If there’s no evidence of widespread community spread in these areas isn’t it still worth persevering with containment?

We have always been clear that, at some point, we will need to take the decision to move from containment to treatment across the UK. We have drawn on advice from leading scientists and health experts to inform our decision…” (from the DoH guide published yesterday)

But what did the scientists say?

Does everyone really need Tamiflu?

The UK appears to be the only country in the world offering antivirals to all swine flu sufferers. Apparently, the Scientific Advisory Group of Experts (SAGE) have advised the DoH that the current evidence points to a targeted use of antivirals to at-risk groups as opposed to widespread treatment, but say the evidence is ‘finely balanced’. So why not restrict treatment to those at risk? Burnham explained that as there are still question marks over who is actually at risk of developing complications of H1N1 infection it is “sensible to continue in this way until evidence of these risks is clearer”. He also said that the UK is the “only country in the world able to offer antivirals to everyone rather than those at risk”. So there.

Anyone with symptoms is encouraged to use the symptom checker ( or call the Swine Flu Information Line or NHS Direct. If this shows that their symptoms are of swine flu, they should then call their GP who will make a telephone diagnosis. According to the DoH advice the GP will then prescribe you Tamiflu.

If Swine Flu is confirmed, the GP will give the patient an authorisation voucher which their Flu Friend can then take to the designated local collection centre to pick up antivirals.

It was interesting, then, to read the RCGP’s email to GPs following today’s announcement. Rather than dishing antivirals out to everyone, they urge GPs to use a little more discretion:

As antiviral medication carries the risk of side effects, some individuals [who are not in one of the high risk groups] may prefer to put up with the symptoms and stay at home. For others who are unsure about the appropriateness of medication, we urge them to discuss the issue with their GP. It remains a matter of clinical discretion as to whether antivirals should be prescribed in individual cases.

Coming soon: online vouchers

The “National Pandemic Flu Service” is close to being launched. It sounds very high-tech: online and over the phone diagnostics with authorisation vouchers that you (or your flu friend) can print off and take down to the local antiviral collection point. The aim is to take some of the burden off GPs. I do think it needs a catchier name though. How about “sneeze and click”?

Quote of the day

The cavalry have come out of their barracks and are well over the hill.

Sir Liam Donaldson describing the current situation.

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