Tom Nolan: assessing the swine flu pandemic

GPs, politicians, journalists, and practice managers met for the Pandemic Summit at the Royal College of General Practitioners (RCGP) last Thursday to share their experiences on surviving the swine flu pandemic. Speakers included representatives from the Department of Health, ECDC (European Centre for Disease Prevention and Control), and the RCGP. Fergus Walsh, the BBC’s health correspondent and Tony Jewell, the Chief Medical Officer for Wales also took to the stage.

Amongst the talks was a look back at the National Pandemic Flu Service (sneeze and click). The numbers are huge:

2.73 million assessments
1.81 million unique reference numbers (i.e. individual patients with swine flu symptoms) for antivirals
1.16 million antivirals were collected
7000 people used the cold and flu symptom checker each day
At its peak, it had 175,000 users in one day
10,000,000 unique users prior to the end of November

Sneeze and click had anticipated receiving over 150 complaints per day – a prime example of the first principle of the pandemic in action: plan for the worst, hope for the best. In the end they only received 77 formal complaints, and only 30 of those were clinical. They even received 39 compliments.

Plans for the next version of the website were revealed: it will be translated into six languages, and GPs and healthcare professionals will be able to be issued with antivirals without going through the algorithm.

“We had to make it up”

The biggest admission of the day was the declaration from Professor Lindsay Davies, National Director of Pandemic Influenza Preparedness at the Department of Health, that despite all the planning that had apparently gone on over the year, the containment phase of the outbreak hadn’t been planned at all: “We had to make it up. It was genuinely thinking on the hoof”.
Despite that, Professor Davies still agrees in principle with the need for a containment phase, but in future would want to do it in a “more measured and less tiring” way.

A missed opportunity

This was a tale of two summits: the one that should have happened, and the one that did. The summit that took place was a series of polite presentations from various organisations responsible for tackling the pandemic. But the summit that many attendees had wanted was a series of debates between the front line workers (GPs, practice managers, and nurses) and those at the top. All were present but for some reason only 50 minutes out of a six and a half hour day were set aside for discussion. The frustration in those who did manage to get a question in was evident.

“I would like an opportunity for GPs to be listened to, which is not happening,” said one GP.

Others wanted to discuss the efficacy of Tamiflu, the inadequacy of out-of-hours services, performance of ‘middle managers’ and information overload. Ultimately there was insufficient time for these issues to be discussed in detail, so an ideal opportunity for those in charge of protecting the public from another pandemic to learn from the experiences of those on the front line was lost.

Tom Nolan is a trainee GP in London.