Tom Nolan on how to kiss during a flu pandemic

The first cases of H1N1 infection resistant to oseltamivir (Tamiflu) spreading from person-to-person were found in Wales last week. The spread of the resistant strain occurred at the University Hospital of Wales in Cardiff and all five people affected have “severe underlying health conditions” according to officials.

Dr Roland Salmon, Director of the NPHS Communicable Disease Surveillance Centre, said: “The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.”

Is it significant that the first cases of a resistant strain of H1N1 spreading from person-to-person should happen in the UK? Probably not, but many will ask whether the greater use of anti-virals in the UK compared to other countries may be encouraging resistance in this country.

Pulse Oximetry Update

The previous blog highlighted Department of Health guidelines that instructed GPs to always measure pulse oximetry when assessing patients with flu, making a pulse oximeter an essential piece of kit for the first time.

I raised this issue with the RCGP flu team who mentioned the issue in their update to members:

“Recent DH clinical management guidelines for use during the H1N1 2009 influenza pandemic have recommended that the measurement of peripheral oxygen saturation by pulse oximetry is essential in making decisions to refer patients from primary care to hospital. The acquisition of oximeters by all practices will be beneficial both during and beyond the pandemic.”

Thanks to Pekka Valmari, a consultant paediatrician in Finland, for giving the following cautionary tale on this issue: “A GP once consulted me from a long distance by phone, asking if a small baby with very minor respiratory symptoms needed any further investigations. Having babies with RSV bronchiolitis on the ward at that time, I asked for her SpO2. It turned out to be 85-95%, so the infant was invited to paediatric hospital care. The first night after admission she became apnoeic with an SpO2 of 60%. Apnoeic spells can be the very first sign of bronchiolitis, especially in the youngest infants. In her case, specialist care was needed for over a week.

“As measuring SpO2 is a very simple and rapid procedure, I see no reason to keep trusting merely the (inexistent) doctor’s “Superman vision.”

How to kiss during a flu pandemic

Times have changed. Gone are the days when your only worry about going to the Christmas party was whose lips to avoid. Now you have to think about technique too. Debretts, the self-proclaimed authority on etiquette have issued advice on how to kiss at Christmas during the flu pandemic.

“Because of the spread of swine flu this year, people have started to think they might not jump under the mistletoe quite as readily this season. But it’s medically proven that a peck on the cheek is much more hygienic than a handshake. People carry billions more germs on their hands so ‘cheek-to-cheek’ kissing is a healthier greeting by far.”

Mistletoe auctioneer Nick Champion is worried that sales will suffer, according to the Daily Telegraph.
“The last thing we need is people worrying about kissing at Christmas and we’re really hoping that people aren’t going to be put off buying mistletoe because of some health scare.”

Tom Nolan is a GP trainee, London.