H1N1 - BMA & GPs clash over opinions

British authorities have insisted that the risk to public health from the A/H1N1 virus, commonly referred to as Swine Flu, remains low despite the first death being reported on Sunday [14th June] [BBC]. But there are mounting fears in some medical circles that increasing numbers of cases may create problems for doctors and the NHS.

In the UK, 1,320 people have so far been identified as having contracted the virus including 59 cases confirmed on Monday.

The fatality is the first reported within Europe, but British health officials have stressed it is not an indication the virus was becoming more virulent. The victim, 38 year old Jacqueline Fleming, had suffered from pre-existing health conditions, authorities have said. She had also recently given birth prematurely but health officials said the baby had not contracted Swine Flu but had subsequently died from unrelated medical problems [BBC].

BMA warns of increasing problems

As the virus spreads across Britain, there are increasing concerns that General Practitioners (GP), also known as primary healthcare physicians or family doctors, may be subject to mounting pressures. The British Medical Association (BMA) has warned that some GPs may be forced to withdraw their services should the risks to themselves increase [BBC].

The medical body says that GPs may be at risk not only from the virus, but also from patients angry at what they might perceive as a lack of care.

If the numbers of patients suffering from A/H1N1 increase, hospitals may also be overwhelmed by admissions, the BMA says. This in turn would leave family doctors with a dilemma as to where to send other patients, who may suffer as a result. Such situations may result in a doctor being sued, something the BMA says it is extremely concerned about.

Effectively many family doctors are self-employed and have their own insurance. And this may not cover themselves or their family if they were to die or be sued by a patient, the BMA fears.

Dr Dean Marshall, from the BMA said that doctors “will be putting their lives on the line” and that it was important that they were “properly covered if anything goes wrong.”

GPs unconcerned

However, some GPs have been critical of the medical body. One GP, who preferred not to be named, told tvnewswatch, “I had not heard this report myself since I’ve been working today [Monday], but I’m surprised the BMA should be focused on such a narrow issue of self interest.”

“I don’t care for myself. I took a Hippocratic Oath to help people to best of my ability, so as regards insurance I am not concerned,” he said. “I think they’re missing the centre of the target,” he added. “The BMA should be more focused on what can be done to keep doctors well enough to treat their patients,” the GP said, expressing surprise that the BMA should raise such issues.

If a pandemic were to occur, he said he believed doctors and their teams would work together in what he described as the “Battle of Britain spirit”.

“No one was going to sue in those days,” he said. “Britain invented the queue and people know how to wait their turn,” he added. “I’ve been a doctor for 30 years, and I’m not cynical about how the vast majority of people can work together.”

As regards to publicity, he told tvnewswatch that his surgery had made the decision not to put up posters warning about the spread of Swine Flu. Such measures often had a negative effect, he said, and many people were suffering from “Swine Flu fatigue”. However information pamphlets were available.

Measures to protect staff and patients had been implemented, he stressed. “We do have gloves, masks and alcohol gel in stock as standard. But we have also ordered extra supplies,” the doctor added, “In addition we do take measures to reduce our own chances of getting the flu.”

If visiting patients suffering from flu-like symptoms, he said they might be asked to go to a different room and open the window before the doctor’s arrival. Even the issue of a prescription may be completed in a different room to reduce risks of contamination, he explained.

Strain on health service

The BMA has said the number of admissions to hospital will rise significantly if a pandemic takes hold, putting further strain on the National Health Service (NHS) as a whole.

For every 100 patients with flu symptoms up to four of them may require hospital admission, if there are beds available, the BMA says in a 61 page report issued to GPs.

Around 25 percent may require critical care with an average length of stay in hospital of up to ten days. The BMA also says that scientific models suggest that up to 2.5 percent of all flu victims may die.

In a recent statement, Director-General of the World Health Organisation Margaret Chan described the virus as “unstoppable”. There are also estimates that half of the UK population could contract the disease. Given the BMA’s estimate that 25 in every thousand affected could die, swine flu could account for around 750,000 deaths in Britain alone.

Already the effects of the disease have been felt with dozens of schools being periodically closed across the country as pupils contract the virus.

Meanwhile, the British government continues in its effort to stockpile flu treatments such as Roche’s Tamiflu, and Relenza, which is made by British pharmaceutical giant Glaxosmithkline.

Additionally, efforts are being made to prepare a vaccine, though it may be many months before it becomes available to the general public [BBC].

Global threat

The World Health Organisation last week declared a global pandemic of level 6, for some an indication of the seriousness of the situation.

At least 75 countries around the world are now affected, and some have implemented more stringent health controls. Apart from Mexico, where the virus appeared to originate, Britain, the United States, Canada, Chile and Australia have shown the highest numbers of affected individuals [Map].

However, it is not clear whether the high numbers are more down to a better system of health checks and identification. While some countries have implemented health checks at airports and even quarantine procedures for some visitors, international travel has so far been unrestricted.

Domestically, various governments have launched health campaigns to advise the public on the risks. In Britain, leaflets have been delivered to every household giving information on how the virus is spread and advising how best to protect oneself from it. There has also been a large publicity campaign launched on television and radio in an attempt to persuade people to be more careful when they sneeze.

The main advice to the public is to “catch it, bin it, kill it”, by using a tissue, disposing of it quickly and by washing hands regularly.

While there is an obvious concern from the risks of A/H1N1, so far the virus has not shown itself to be as deadly a threat as some have feared.

An estimated 12,000 people, mainly in the older age group, die every year from seasonal flu in the UK, according to the BMA. In the U.S. tens of thousands die annually from seasonal flu. But so far the entire global death rate from A/H1N1 remains well below 1,000, with the WHO confirming only 146 deaths.

Many of those affected by A/H1N1 are in a much younger age group, and some are otherwise healthy individuals. The greatest fear amongst medical experts is the virus could mutate and become ever more deadly.

In the past, pandemics have killed more than a million around the world. Between 1918 and 1919, the so-called Spanish Flu was responsible for an estimated 20 to 40 million deaths. And in more recent history the Asian Flu in 1957 and the Hong Kong Flu of 1968 killed up to 4 million between them.

G20 officer may face manslaughter charges

A police officer has been interviewed under caution after a post-mortem showed a protester he allegedly assaulted subsequently died from an abdominal haemorrhage. An earlier post-mortem showed Ian Tomlinson had died of a heart attack shortly after being struck by an unnamed officer as he tried to make his way home during the G20 protests. But Dr Nat Cary, who conducted the second post-mortem, rejected the findings and said there had been internal bleeding.

Ian Tomlinson was not taking part in the protests of April 1st and merely trying to get home after a day of working as a newspaper seller outside Monument station.

There have been accusations that police may have been ordered to use excessive force during the G20 protests. But former commander specialist operations at Scotland Yard Roy Ramm insisted that no orders would have been given to use violence. “Every police officer is responsible for his or her actions,” he told Sky News.

Although he welcomed an investigation he said the police had a difficult job to do as they faced “80 or 90 different groups” with differing agendas. Policing such protests “was almost impossible.”

Ian Tomlinson's stepson has called for answers. “First we were told there was no contact. Then there was a heart attack. Now we’re told he died of internal bleeding following an assault,” Paul King said, “We want the truth” [Guardian / BBC / Sky News]. Tonight on Channel Four News former London mayor Ken Livingstone said the case raised many worries. "It gets murkier by the minute," he said.

Ian Tomlinson’s death has already raised concerns as to policing methods employed during the G20 protests. The possibility that a Metropolitan Police officer might be charged with manslaughter will heighten those concerns. It has already emerged that the Independent Police Complaints Commission has received more than 145 complaints [BBC]. At least 70 are connected to assault. The Metropolitan Police may well be facing further charges.

IPCC to investigate G20 protest death

The Metropolitan Police will be once again attempting to defend their actions and an apparent tissue of lies after footage released tonight showed police officers pushing a man to the floor who later died of a heart attack. Ian Tomlinson had been returning from work as a newspaper vendor outside Monument station on the day of the G20 protests when he was violently pushed to the floor. Protesters at the scene attended to the man and he walked away dazed. He collapsed moments later and died of a heart attack despite a swift response from police paramedics.

Various reports emerged from the police that evening. In the Gold control room there were suggestions the man had been a vagrant or homeless, and that he had been drinking. It was also widely circulated that Mr Tomlinson had taken part in the protests.

His death was breaking news at around 10 pm on Wednesday night on both Sky News and the BBC. Both channels quoted the Metropolitan Police saying that a man had died after “collapsing in the street”. Police later said they had at no point made contact with the man. Though some of the officers may not have known the man pushed to the ground was to be the man who died.

Pictures published later however brought forward many witnesses after they recognised the man in the picture and have reported the earlier incident to the IPCC [Independent Police Complaints Commission].

Yesterday the Guardian ran a story in which they suggested that Ian Tomlinson had been assaulted. Photographer Anna Branthwaite told the paper, "I can remember seeing Ian Tomlinson. He was rushed from behind by a riot officer with a helmet and shield two or three minutes before he collapsed." Branthwaite, an experienced press photographer, has made a statement to the IPCC as have several others. A female protester, who did not want to be named but has given her testimony to the IPCC, said she saw a man she later recognised as Tomlinson being pushed aggressively from behind by officers. "I saw a man violently propelled forward, as though he'd been flung by the arm, and fall forward on his head. He hit the top front area of his head on the pavement. I noticed his fall particularly because it struck me as a horrifically forceful push by a policeman and an especially hard fall; it made me wince."

On BBC Radio 4’ PM programme Tomlinson’s son Paul King called for witnesses to come forward so the family could learn the truth behind his fathers death. He said the family was “devastated” by Ian’s death and described him as a “lovely father”. The Guardian article and radio report has now brought further eyewitness reports and video evidence which not only refute police claims but may bring possible charges if the IPCC find that the apparent assault on Mr Tomlinson resulted in his subsequent heart attack [Sky News / BBC / Guardian]

Italy quake draws little media coverage

Although the story is the top headline, coverage is scant

Unlike previous earthquake tragedies, the Italian earthquake has failed to draw the usual saturation coverage from news channels. Although the news broke in the early hours of Monday, pictures were slow to role in. In Britain several domestic stories also took up much airtime which also pushed the Italian earthquake back on the news agenda. For much of the day CNN continued with regularly scheduled programming with Living Golf and World Sport remaining in place. Other news channels also brought scant coverage of events happening in Italy. Although al-Jazeera, Press TV, France 24 and Russia Today all covered the story, none gave it more than a few minutes airtime.

The 6.3 earthquake struck at 03:32 local time [01:32 GMT] at a depth of only 10 km. Striking in a rural area it has hampered rescue efforts. The tremors also hit towns and villages with extremely old buildings and hardly any remained unscathed. Initially more than 50,000 people were said to have been made homeless in the town of L’Aquila, which means eagle in Italian. But by Tuesday morning the town’s mayor revised this figure down to 10,000. However this still accounts for at least 1 in 7 of the population.

The death toll rose however. First reports indicated a relatively low death toll of some 50 individuals. As night fell the figure had risen to 91. Official figures released on Tuesday morning put the death toll at 179. But many people remain trapped in rubble and rescue efforts are continuing despite there being relatively little coverage of events on the ground.

The effort to dig injured people from the rubble of the ancient town has been difficult. Several aftershocks as large as 4.9 on the Richter scale have shaken the region making the search extremely dangerous. The weather has so far remained clear, but with temperatures falling to as low as 3 degrees Celsius at night, it is imperative to reach those trapped as quickly as possible. Day time temperatures are a little more tolerable reaching about 16 degrees, but Wednesday may bring rain which will add to the problems faced in the rescue effort.

At least 1,500 people have been injured and rescuers have pulled some 100 people alive from the rubble. Authorities say at least 34 people are still missing, but it is not clear whether all the rural areas have been searched. The BBC, which have given the most extensive news coverage, visited the deserted village of Onna where hardly a single property has remained unscathed. The thousands made homeless by this disaster face an uncertain future. New homes will almost certainly have to be built. Even those still standing remain structurally unsafe. As to who will pay for the reconstruction, is also an unknown quantity [BBC / Sky News / CNN].

Reality TV star Jade Goody dies

Jade Goody pictured last October

The reality television star Jade Goody has died at her Essex home after a long battle with cancer. The 27 year old who came to fame after appearing on Big Brother, a reality TV show on Channel 4, passed away at 03:55 according to her mother Jakkiey Budden who spoke to reporters early this morning. Jade courted much controversy especially after she made disparaging and perceived racist comments toward Shilpa Shetty, an Indian actress who appeared alongside her in Big Brother. She also revelled in the publicity surrounding her and refused to push the press away even as she became critically ill. The media circus will continue to follow the story until Jade is buried. Her funeral will be held near to he family home. It remains to be seen whether Jack Tweed, her newly wed husband will be able to attend. He is due to be sentenced for assault this week, the second such offence for which he’s been convicted. Last year he was jailed for assault a teenager with a golf club and is currently out on licence. Jade Goody departure leaves him a widower and her two young sons without a mother [BBC / Sky News].