Swine flu forecast

Yesterday was a busy day for swine flu in the UK. First we learnt that 65,000 people could die from it in the UK if the government’s worst case scenario predictions come true. That’s three times more than the excess deaths during the 1999/2000 winter flu season and double the number in the two previous global pandemics in 1957-8 and 1968-9.

We also learnt the latest hospitalisation and mortality figures. On July 14th there were 652 patients hospitalised with suspected influenza in England. The overall hospitalisation rate is 1.3 per 100,000, with children under 5 having the highest rate at 4.5 per 100,000. A total of 28 people have died in England and Scotland with laboratory confirmed H1N1 infection.

In North America things are looking a little more hopeful.  Influenza activity in the United States has decreased, whilst Canada saw a decrease in infection rates for the third week running, although hospitalisations jumped 25% this week.

The RCGP and DoH cross swords

If you go to the NHS Direct website to look for advice on swine flu you’ll probably come away thinking that if you have the flu you’ll be given tamiflu.

“If swine flu is confirmed, ask a healthy friend or relative to visit your GP to pick up a document entitling you to antiviral medication.”

But many GPs aren’t likely to be so obliging. The Royal College of General Practitioners has issued subtly different advice, as pointed out in yesterday’s Guardian.

…advice circulated by the Royal College makes it clear that even if a diagnosis is confirmed, clinical discretion means it may not be necessary to prescribe anti-viral drugs to an infected, healthy patient. Doctors, the college insisted, should exercise clinical discretion in their decision on whether or not to give the drugs.

The advice given to GPs treating those diagnosed with swine flu who are not in a vulnerable medical category is to “consider authorisation of antivirals bearing in mind whether the patient has a strong preference for active treatment.”

The chairman of the RCGP, Professor Steve Field, had this to say:

“The last time [the advice] was changed was to give more discretion to GPs for dealing with those outside the at risk groups and partly to send the message to patients that they don’t all need Tamiflu.”

Are we seeing a clash of consultation styles here? On the one hand you have the DoH with its paternalistic approach (you have swine flu, take this and get better), on the other you have the RCGP attempting a more modern approach: explain the benefits and harms of treatment, offer the patient advice and let them make a final decision. But which is more appropriate in this situation?

Cherie on the message boards

It looks like Cherie Blair is fighting swine flu. My mum used to tell me that the best cure for flu is sympathy, so I’m sure Cherie will feel much better after she reads some of these messages left for her on the news websites. Birdmaniw in The Sun says “I feel sorry for the swine flu,” while Laura37 is annoyed at the preferential treatment she’s supposed to have had. “See she got tested and given antiviral drug. I rang doctors yesterday about my 12 year old and all I got told was rest, fluids, and paracetamol. Wouldn’t even test him to see if it was swine flu”. Finally, Cyber Man in the Times can’t help making it political: “This would never have happened under the Tories.”

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