Helen Macdonald on Panorama Special; swine flu

Helen MacdonaldThe BBC trailed it as everything you need to know about swine flu. The title probably raised my expectations too high.

A street poll near the start of the programme showed that the public were a bit confused about who was at the most risk of swine flu, so it seemed the programme had some scope to educate viewers; and it did feel a bit like a government broadcast, or a school education film. Three presenters travelled the world to “expose the myths and the dangers of swine flu,” interviewing “swine flu survivors and the relatives of its young victims”.

The take home message was that the vast majority of cases are mild and a mere inconvenience; it is not as serious as the last three pandemics of 1918, 1957, and 1968 (unless it combines with another virus); and we will all get it over the next few years.

The visual effects were more memorable than much of the content, opening with holiday programme style shots of Brighton’s idyllic food market and Australian beaches. Later there were futuristic lab shots, and a few minutes tracking the journey of a flu jab from egg to vial around a vaccine factory.

What will the public remember?

It felt like the programme’s creators had tried to broadcast something balanced.

Experts’ advice was interspersed with personal experiences of swine flu, and I was left wondering what viewers will remember more; the slightly dull and reassuring facts spoken by bland-faced experts, or the emotive interviews with a handful of patients and relatives for whom swine flu has caused devastation.

The programme was split into sections, each underpinned by largely reassuring messages. I was less sure about the slightly gross slow motion sneeze, pulsating virus image and squelching noise, which signalled the end of a section.

What might doctors remember?

“The disease isn’t a killer. But it can kill people.” (Sir Liam Donaldson, Chief Medical Officer on death and swine flu.) That is what I’ll remember – a handy catchphrase for A&E, a post-take ward or a GP surgery? Australian paediatrician Professor Booy made a similar point. He said most people would have a mild illness “but we cannot predict, we just don’t have a blood test, we just do not know how to tell you, whether you are going to be the severe one.”

What they covered (or didn’t)

Much of the programme concentrated on the science and planning for swine flu, perhaps missing a chance for clearer practical pointers. I found the sections on GPs and diagnosis, call centres and tamiflu advice, quite confusing.

I wouldn’t have known what to watch out for (particularly worrying symptoms of other serious differential diagnoses), when to call the helpline; when to call the doctor; and who should take antivirals. There was talk of “vulnerable groups” and risks and benefits of tamiflu, but it was only the researcher discussing the side effects of tamiflu in children that produced a clear statement about numbers need to harm (vomiting) with tamiflu. 

Some snippets of information addressed common misconceptions – that the virus is not caught from swine and that masks are helpful for the public.

The programme travelled to Australia to explore what the UK could learn from that country as it emerges from its flu season (similar in content to a recent BMJ feature). Despite having a population one third of the size of the UK’s they have had twice as many deaths. The spotlight fell on intensive care and Australian doctors described seeing young, healthy people seriously ill.

Difficult questions about the UK intensive care services’ ability to cope fell to a slightly hesitant Liam Donaldson, who offered calming words on plans to double capacity, and get more staff, although he was not very precise about a timeline.

The programme touched on extra-corporeal membrane oxygenation (ECMO) for severe respiratory problems in intensive care. They included the story of the pregnant Scottish women, Sharon Pentleton, who was flown to Sweden because the only UK centre was full. There were two ECMO issues. Firstly, how good is ECMO? Anecdotal advice from Australian experts, and some new research published in the Lancet, seemed to tip the programme in favour of the treatment. The second questions is how much of it can the UK provide? Currently there are 20 machines in the UK, compared with a similar number in Sydney alone (population 4 million).

Finally they reported on vaccine plans and its safety. The program drew on a personal account of a terrible experience; the story of an American, Sandy Barnes, who was paralysed by Guillain-Barre syndrome in 1976, following being vaccinated against swine flu. In the US, 40 million people got the jab and there were 400 cases of Guillain-Barre syndrome, although the link between the two is not well understood. The message for viewers was that huge trials are required to test for rare side effects, and there isn’t time to do them. 

Sir Liam Donaldson offered some reassurance that the 2009 swine flu vaccine was just a minor modification to the existing H5N1 vaccination, which has been well tested – so they do not expect problems.

Whether people will take it seemed unclear. In Australia the programme featured one of the first families in the world to be vaccinated. But footage with pregnant UK mums revealed that none of them would have the vaccine. Evidence already exists suggesting health workers may not have the vaccine. Given the possible poor uptake and suggestions that one shot of the vaccine could provide immunity, has the UK ordered too much vaccine?