H1N1 – the science bit

Yesterday the number of deaths in the UK rose to seven. So far all of those who have died with H1N1 in the UK have had serious underlying health conditions and little information has been released about whether these people have died with H1N1 or because of it.

Meanwhile the UN Secretary-General Ban Ki-moon has said that $1 billion will be needed by the end of the year to fight swine flu, and Bolivia is considering closing its border with Argentina if the disease ‘expands’ (as it undoubtedly will).

Otherwise everything seems to have gone fairly quiet. No wonder, when there other big health stories around such as “Beer does not cause pot bellies” and “caffeine reverses dementia symptoms in mice“.

“What was being communicated is unclear”

Although news might be a bit thin on the ground, people with symptoms aren’t.  But are GPs coping? According to Pulse, a “survey claims 44% of GPs feel deluged with information but that much of what was being communicated is unclear.” Is that true? Certainly over the last week or so things have changed a lot and information is coming out from all over the place: the HPA, DoH, BMA, RCGP and PCTs. But is this information unclear? Take a look at the HPA website and you find the diagnostic criteria for H1N1, advice on testing and treatment and links to the Department of Health’s “swine flu clinical package” . The package contains community guidelines on who to refer to secondary care (both in adults and children) and hospital pathways. The RCGP homepage has been turned into a H1N1 microsite (although the links to the updates weren’t working when I checked yesterday). All of these appear, to me, to be giving a consistent message – but please correct me if I’m wrong.

Here comes the science bit…

Last Thursday, when the UK strategy on flu treatment changed, the Department of Health published a short document called “Swine flu: from containment to treatment – scientific issues”. It contains some interesting early information about hospitalisations in the UK and the reasoning behind high risk categories.

By 19 June, 48 patients had been hospitalised in the UK, which represented a rate of 2.5% of the laboratory confirmed cases identified by that time. If the additional 850 patients clinically diagnosed by that date were taken into account the rate would be 1.8%. About 40% of hospitalised patients had a comorbidity of the type recognised to increase risk from seasonal influenza, with asthma being the most common (4 patients). Other comorbidities included liver disease, chronic respiratory disease, recurrent chest infections, cardiac disease and diabetes.

It cites the NEJM and WHO.

According to a WHO report, 46% of 45 fatal cases in Mexico had underlying conditions including pregnancy, asthma, other lung diseases, diabetes, morbid obesity, conditions giving rise to immunosuppression, neurological disorders, and cardiovascular disease.

Other sources are a little less reliable.

A report (Sydney Morning Herald) states that “Most people who have been hospitalised have had existing conditions or complications.”

And other sources just aren’t given.

…children younger than 2 years have the greater risk for severe complications from seasonal flu. It appears that that this experience is being reflected with A(H1N1), with about 9% of US hospitalisations having been said to be in patients under the age of 2.

The Flu Pandemic Game

Have you played the Department of Health’s The Flu Pandemic Game yet?

All you need is between 3 and 8 people together, dice, some pens and the facilitator pack. You take it in turns to roll the dice and depending on what you roll you do or don’t get infected with flu. If you catch it you miss two goes but are then immune. Then there’s the chance cards.

At the end of rounds 1-14, the Facilitator reads out the Chance Card for that particular round. The Chance Cards introduce external events which affect the GP practice, such as fuel shortages or disruptions to supplies.

The idea is to encourage GP practices to think through difficult scenarios and brainstorm ideas on how they might deal with them. Sounds boring? Not at all – it even comes with a spooky health warning:


Some people may find it disturbing to play the Game using the details of their own organisation. The Game is a simulation and has no effect at all on subsequent events, but it can seem a little like fortune telling.

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