Showing posts with label swine flu. Show all posts
Showing posts with label swine flu. Show all posts

Tuesday, June 16, 2009

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.

Wednesday, April 29, 2009

WHO declares pandemic is imminent


The World Health Organisation has increased its swine flu threat level to Phase 5, which declares that a pandemic is imminent [WHO].

The WHO amounts to a call for action for governments around the world to actively prepare plans. In Britain the government laid out its plan during a parliamentary session and at an afternoon press conference.

Its health campaign launched on Thursday under the slogan of “Catch it, Bin it, Kill it”. The initiative came as Britain announced the number of people confirmed with the virus rose to five.

New cases

Prime Minister Gordon Brown made an announcement in the British parliament during Prime Minister’s Questions. One of those tested positive was identified as a 12 year old girl who had travelled on the same plane as the two currently being treated in Scotland. Two other adults were also identified as having contracted the virus, one a 22 year old man from south London and the other a 44 year old woman from Birmingham.

The girl from Torbay in Devon is being treated at home and many of her fellow pupils have been administered antiviral drugs. Paignton Community and Sports College, the school at the centre of the latest scare, has been shut for seven days and 230 students are being treated with Tamiflu. Fifty of them are being monitored closely after having come into close contact with the girl.

Although those infected show a direct connection with Mexico, there is no immediate sign of a human to human transmission in the UK, the government said today. But the government has said it is keeping a close eye on developments.

In a more positive note, 7 people who had been closely monitored after showing flu-like symptoms after coming into contact with the Scottish couple, the first in Britain to contract the virus, were today declared infection free.

Health plan

But the British government says it is not sitting by idly. In parliament on Wednesday, Prime Minister Gordon Brown said more anti-viral drugs, namely Tamilfu and Relenza, were being ordered to treat up to 80% of the UK population. In addition the Secretary of State for Health, Alan Johnson said the government had ordered 60 million surgical and respiratory face masks for health workers. These specialist masks were beneficial if used properly, changed frequently and disposed off correctly, Johnson said. However, he dismissed the usefulness of masks by the general public. “There is no convincing scientific evidence to show the effectiveness of wearing a mask,” Alan Johnson said on Wednesday. Chief Medical Officer Professor Liam Donaldson also said that masks were of little use. “Scientific advice is that they are of very little value because they get moist and the virus is so small it goes through the pores,” Donaldson said, whilst adding, “it adds to a false sense of security.”

Instead, government health advice to those showing symptoms is to use a tissue and to dispose of it before then washing hands, preferably with anti-bacterial soap.
Alan Johnson told reporters that the best line in defence was to keep people informed about issues such as hygiene.

On Thursday a special telephone helpline was opened to the public [0800 513 513] and adverts were launched on TV, radio and in print media. Alan Johnson said that leaflets giving advice would also be distributed to every home in Britain on Tuesday next week.

Planning for a pandemic

Even before the WHO raised the threat level, Britain’s Chief Medical Officer Liam Donaldson said, “We are planning for all eventualities and we need to understand more about this virus.”

There was a great deal more to learn, he said, both in the way it was transmitted and how long the virus took to take hold. “We don’t know the incubation period yet,” Donaldson added.

Speaking in parliament on Wednesday evening, Britain’s Secretary of State for Health reiterated the country was “well placed to deal with this infection”. In 1968 when Britain was hit by a similar medical emergency, there had been no national plan, Johnson said, but the government had learnt from history. “We can reduce its impact seen in pandemics of the last century,” Johnson said.

While the government is aiming to reassure the public, there is continued concern that the media is overhyping the issue. There is also concern that online discussion on services like Twitter is also adding to people’s worries [CNN]. During the Sky News paper review Kelvin Mackenzie, ex-editor of the Sun newspaper, said that people should “calm down” adding that more people die from seasonal flu. It is has to be said that seasonal flu in the UK kills up to 2,000 people every year and 36,000 die in the US. So far, around 150 have died from so called swine flu.

There issue over its name is raising some debate. The correct name is the H1N1 Influenza A virus, and not ‘swine flu’ as it has been dubbed. It has perhaps angered pig farmers and butchers the most. Russia and China have both banned imports of pork from Mexico, despite there being no link to eating the meat. Egypt has gone further with orders issued to kill the country’s 300,000 pigs.

[BBC / Sky News / CNN / wikipedia].

Monday, April 27, 2009

Concern increases over swine flu


Britain is the second country in Europe to announce an outbreak of swine flu. Two people who had returned to Britain from Mexico were admitted to Monklands Hospital in Airshire, Scotland during the weekend after they showed signs of flu. On Monday at around 18:30 the Scottish Deputy First Minister and Health announced that the two people had been tested positive for the H1N1 virus. She said that 7 of the 22 people who had come into contact with the patients had also developed symptoms. But she insisted Britain was doing everything it could. “The government is responding very quickly,” Health Secretary Nicola Sturgeon told the media today.

Slow information flow

But information has been slow in coming from official sources. While the Foreign & Commonwealth Office and Health Protection Agency websites had some information, much of it was brief. The National Health Service website gave no advice or information and not one press conference was organised throughout the entire weekend despite increasing concern raised in the media.

The Health Protection Agency [HPA] gave out general advice to travellers returning from affected areas saying they should contact their doctor if they showed signs of influenza. In addition they give general advice about hygiene.

The HPA said that it was important to cover the nose and mouth when coughing or sneezing, and use a tissue wherever possible. Maintaining good basic hygiene such as washing hands frequently with soap and water to reduce the spread of the virus is also encouraged.

The Foreign and Commonwealth Office [FCO] website said that visitors to Mexico should be “aware of the outbreak of influenza”. The FCO advised travellers to “avoid large crowds, shaking hands, kissing people as a greeting, or using the subway” and said people should maintain “a distance of at least six feet from other persons”.

Other agencies had not updated information on their websites nor could many be contacted through their press office. The BAA media centre was shut and there was no response from other agency departments on Sunday.

On Sunday passengers at Gatwick airport reported that they had been asked to fill in a questionnaire upon their arrival from Mexico. But today many said they had not been stopped nor advised.

Even some doctors have said they have received little or no advice.

Media overkill

Front pages of many of Monday’s newspapers in Britain carried sensationalist headlines, and it was not just confined to the tabloids. Suggestions that up to a million could die and that up to nine million could contract the virus.

“Is Swine Flu already here?” the Mail asked, while the Daily Express shouted the headline, “Killer Pig Flu Fear in Britain”. Howard Kurtz one media analyst at the Washington Post says the media was over-egging the story. “The sheer volume of coverage creates the impression that the story is bigger than it really is,” he said on CNN’s Backstory.

“There is no great competing news story at present” he said, thus leaving the door wide open for such sensationalist reporting. The 24 hour news cycle was particularly to blame, Kurtz said, since the story was often repeated over and over again.
“In this business we have the ability to spread fear whether we mean it or not,” he said.

Conflicting advice

While there has been general advice pertaining to general hygiene and the use of a handkerchief of tissue, there is conflicting advice on whether masks are effective. Britain’s health minister questioned the effectiveness of the use of masks while a CNN reporter stationed in Mexico said that part of his kit included N95 masks which he said “seem to be the best to stop the virus entering our lungs”.

There has been little or no information about the use or distribution of Tamiflu and other anti viral drugs in the UK, though the government says it has enough treatment for half the population of Britain according to Health Secretary Alan Johnson.

Sir Liam Donaldson, Britain’s chief medical officer, said today that it could not be ruled out that a pandemic could hit the country and the World Health Organisation raised its level of threat to phase 4, though it stops short of referring to the spread as being a global pandemic.

Threat uncertain

In Mexico where more than 100 have died many streets are empty. A sell out football match was played in an empty stadium. Public buildings have been closed and some fear that the public transport system could be next.

If a pandemic were to occur, scenes like these may be repeated elsewhere

The number of countries so far affected is increasing, but so far no deaths have been reported. The number is changing almost hourly but by late Monday night there were 75 confirmed cases worldwide. There are confirmed cases in the US, Canada, Spain and the UK. Meanwhile there are several suspected cases in France, Israel and New Zealand.

One health and safety expert in New Zealand told tvnewswatch that the risk of a pandemic was worrying.

Speaking on the phone from Auckland, Dave Feickert said, “It sounds like a very serious pandemic and they (the authorities) are going to have to get on to it very quickly. The World Health Organisation (WHO) has acted quickly, too.”

Although Feickert has worked in preventive methods with other types of flu, such as Avian flu, he stressed that the nature of the recent outbreak had still to be determined.

“I was doing some work on how to alter farming methods so that chicken flu could be prevented from passing to pigs and then leaping the species barrier to people,” he said, “However, the epidemiologists and flu scientists are not certain what this new strain is exactly.”

As for New Zealand, he said that the country was very well prepared. “We are very well organised for this kind of thing because New Zealand is a small open country, heavily dependent on its agricultural trade and incoming tourists,” he said.

Nonetheless he was still concerned. “I’m going to be travelling soon and I always think about the risks of contracting something when flying because of the recirculation of air,” Feickert said.

Stocks affected by pandemic threat

The risks posed by air travel have already prompted some authorities to implement new procedures. In Japan and Chile, thermo-graphic cameras have been installed to monitor the body temperature of incoming passengers.

The perceived global threat is already affecting stock markets. Mexican stocks were down 4% and their currency fell 3%. But it was stocks relating to travel and tourism that were particularly hard hit. The situation wasn’t helped by comments from EU Health Commissioner Androulla Vassiliou who said, "Personally, I'd try to avoid non-essential travel to the areas which are reported to be in the center (of the crisis)."

Airline stocks Lufthansa and British Airways fell 9.25% and 7.75% respectively and travel agent Thomas Cook dropped 4.42%.

There was some positive news though. Pharmaceutical stocks soared in the wake of the bad news spreading around the globe. Makers of Tamiflu and Relenza both saw their stocks rise. Roche was up 3.5%, Glaxosmithkline rose 6.11% and Astrazeneca lifted 3.01%