{"id":758,"date":"2009-07-17T12:46:37","date_gmt":"2009-07-17T11:46:37","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=758"},"modified":"2009-07-23T12:21:33","modified_gmt":"2009-07-23T11:21:33","slug":"tom-nolan-swine-flu-forecast","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2009\/07\/17\/tom-nolan-swine-flu-forecast\/","title":{"rendered":"Swine flu forecast"},"content":{"rendered":"

\"\"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\u2019s worst case scenario predictions come true. That\u2019s 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.<\/p>\n

We also learnt the latest hospitalisation and mortality figures. On July 14th there were 652 patients hospitalised with suspected influenza <\/a>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.<\/p>\n

In North America things are looking a little more hopeful.\u00a0 Influenza activity in the United States<\/a> has decreased, whilst Canada saw a decrease<\/a> in infection rates for the third week running, although hospitalisations jumped 25% this week.<\/p>\n

The RCGP and DoH cross swords<\/strong><\/p>\n

If you go to the NHS Direct website to look for advice on swine flu you\u2019ll probably come away thinking that if you have the flu you\u2019ll be given tamiflu.<\/p>\n

“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.”<\/p><\/blockquote>\n

But many GPs aren\u2019t likely to be so obliging. The Royal College of General Practitioners has issued subtly different advice, as pointed out in yesterday\u2019s Guardian<\/a>.<\/p>\n

\u2026advice 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.<\/p><\/blockquote>\n

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.”<\/p><\/blockquote>\n

The chairman of the RCGP, Professor Steve Field, had this to say:<\/p>\n

“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.”<\/p><\/blockquote>\n

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?<\/p>\n

Cherie on the message boards
\n<\/strong>
\nIt looks like Cherie Blair <\/a>is fighting swine flu. My mum used to tell me that the best cure for flu is sympathy, so I\u2019m sure Cherie will feel much better after she reads some of these messages left for her on the news websites. Birdmaniw<\/a> in The Sun says \u201cI feel sorry for the swine flu,\u201d while Laura37<\/a> is annoyed at the preferential treatment she\u2019s supposed to have had. \u201cSee 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\u201d. Finally, Cyber Man<\/a> in the Times\u00a0can\u2019t help making it political: \u201cThis would never have happened under the Tories.\u201d<\/p>\n

Tom Nolan<\/strong> is the clinical community editor of doc2doc, the BMJ\u2019s professional networking community.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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\u2019s worst case scenario […]<\/p>\n

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