Sneeze and Click service launched in England

Last week 100,000 people are estimated to have had swine flu in the UK. 840 are in hospital and 63 are in intensive care according to Chief Medical Officer Sir Liam Donaldson. The number of deaths has climbed to 26, while worldwide 700 are thought to have died.

GP consultation rates rose dramatically last week. The RCGP’s figures show that it doubled from 73.4 to 155.3 consultations per 100,000 people in England and Wales. They will be at epidemic levels when the rate goes above 200. The QSurveillance figure, based on the diagnostic codes used in GP practices, puts the consultation rate above this threshold at 221.4.

With consultation rates so high the launch of the national pandemic flu service in England yesterday might come as a relief to GPs. People worried they have flu can now call or logon and be issued with a special number that they can exchange for a course of antivirals if they meet the criteria. At 5pm yesterday the website was getting 2600 hits per second (9 million per hour) and the site crashed.

The advice line is staffed by trained but not clinically qualified staff, which seems to be the biggest criticism of it so far. Sarah Vine, in The Times, called the line on behalf of her husband:

Was the person I was calling on behalf of a child? No. Were they with me? Yes. Were they also in England. Er, yes. Asleep or awake? Awake. Could they talk without loss of breath? Yes. She checked again: it’s not a child? No. Are they making grunting noises? What, like the baby in Alice in Wonderland? No, not yet at any rate. Could the patient touch his chin to his chest. Yes.

As the questions progressed, it became clear that not only did the operator have no formal medical training, she wasn’t even familiar with basic health terminology. For example, she struggled to read out the word “Relenza”; When asking if the patient had any other metabolic conditions, the word “metabolic” seemed to baffle her, as did the names of various drugs; and the term “cystic fibrosis” eluded her completely. I really wasn’t expecting any detailed clinical knowledge, but surely basic literacy should be a requirement.

Tales of tongue-tied operators might make entertaining articles but if the flu service fails to take the strain off clinicians it might be for another, more unexpected reason: that they cannot provide the reassurance of a consultation. Most people know that swine flu is generally mild and that they are likely to get better in a few days. However, the daily stories of people dying from swine flu, vaccine shortages and delays in getting treatment mean that if symptoms do develop people worry. A GP told me the other day that most patients she speaks to seem to be seeking reassurance more than anything. The importance of communication, drummed into all medical students these days, is the most significant thing missing from the pandemic flu service. These methods can, arguably, weed out the seriously ill and diagnose flu, but they can’t listen to your worries and fears and provide advice and reassurance.

The launch of ‘sneeze and click’ has overshadowed an even bigger website launch yesterday: the BMJ Group’s pandemic flu site. You can find it at

Swine halts wine for Anglicans

Swine flu has found a new host: Holy Communion. The Archbishops of Canterbury and York have written to Bishops of the Church of England asking them not to use the chalice, or for the minister to do the dipping instead.

“… we recommend those presiding at Holy Communion suspend the administration of the chalice during this wave of pandemic flu.

“For those who still wish to offer in both kinds, we recommend the practice whereby the presiding minister, whose hands should have been washed with the appropriate alcohol based rub before handling the elements and the vessels, personally intincts all wafers before placing them in the hands of communicants.”

The Catholic Church are yet to follow suit, although the Bishop of Chelmsford has called for holy water to be banned from fonts and stoups. It’s not clear whether this will altar infection rates.

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