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.

N Korea nuclear test 'threat to world peace'

North Korea has once again defied the international community by testing a nuclear weapon, its second such test within 3 years. The weapon was detonated some 10 km underground shortly after 23:00 GMT and triggered seismic readings of about 4.3 on the Richter scale.

The testing of the device, said to be equivalent to the 20 Kiloton bomb dropped on Nagasaki, Japan in 1945, has provoked widespread criticism and condemnation. China, who reacted with anger to North Korea’s October 2006 test [Wikipedia / tvnewswatch], have said it was “resolutely opposed” to the weapon’s test. US President Barack Obama described the test as a “Threat to international peace”.

“North Korea will not find respect through threats and illegal weapons,” Obama said in a statement on Monday. His comments were echoed by other world leaders who condemned the North Korean leadership. Britain’s Prime Minister Gordon Brown said the action would “undermine prospects for peace” on the Korean peninsula. Meanwhile the UK Foreign Secretary David Miliband called the test “Wrong, misguided and dangerous” and said it would leave N Korea even more isolated.

Closer to home, North Korea’s neighbours have been even more outspoken. Japan has called for “firm action” and asked that a UN Security Council meeting be convened as soon as practically possible. South Korea, which remains in a tense stand-off with its neighbour called the test an “intolerable provocation”. Meanwhile anger spilled onto the streets as news about the weapons test began to spread.

Stock markets were also rattled by the news, though sharp falls seen early in the morning in Seoul soon recovered.

It is not clear whether six party talks will resume given that North Korea continues to ignore world opinion. Despite warnings from the US and others the defiant regime launched a rocket in April. It was widely seen as a long-range missile test, despite Pyongyang’s insistence it was a launch of a satellite. Both China and Russia have called for a return to the negotiating table, but there will be increasing scepticism about North Korea’s intentions. Six party talks resumed shortly after the 2006 weapons test [tvnewswatch], but the situation has changed significantly since then with the country becoming ever more unstable and the health of the North Korean leader Kim Jong-Il raising further doubts
[BBC / CNN / Sky News / Wikipedia].

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%

WHO warns of swine flu pandemic

The World Health Organisation has described outbreaks of swine flu in Mexico and the US as a “Public Health Emergency” [WHO]. The virus has so far killed 69 people in Mexico and more than 1,200 have been infected. The virus believed to be a strain of H1N1 has also spread to California and Texas. Latest reports suggest 7 people in California have been infected and an unspecified number in Texas. A variant of H1N1 was responsible for the Spanish flu pandemic that killed some 50 million to 100 million people worldwide from 1918 to 1919.

In a press conference on Saturday authorities in the US say that up to 200 pupils had been absent from school following their recent return from Mexico. Some had reported slight flu-like symptoms and early signs suggest that eight of nine specimens tested show possible swine fever. More comprehensive tests by the Center for Disease Control in Atlanta are expected on Sunday.

None of the 200 children had required hospital treatment and many had fully recovered, Dr Thomas Frieden told reporters, but the school could remain closed out of "an abundance of caution".

In the UK the Health Protection Agency has said it is monitoring the situation carefully [BBC]. Travellers to affected areas are advised to consult doctor immediately if they show signs of flu-like symptoms, the HPA has said. There are suggestions that the virus has the ability of passing from person to person which significantly raises the threat of a global pandemic. However, no-one outside Mexico has yet died or been seriously ill.

And there were worrying signs tonight after it was reported that an air steward returning from Mexico had developed flu-like symptoms. The unnamed man had been travelling on flight BA 242 which landed at Heathrow and was taken to Northwick Park hospital in Harrow, north London. A spokesman for the hospital said the man had been placed in isolation and was responding well to treatment. Spokesman Jonathan Street refused to say what treatment the man was being offered though it is known that patients with human swine influenza H1N1 respond well to antiviral drugs such as oseltamavir (Tamiflu®) and zanamivir (Relenza®).

[BBC / Sky News / CNN / wikipedia]

Terrorism and protests threaten G20

More than 30,000 protesters took to London’s streets on Saturday ahead of the G20 Summit scheduled for next week. Numbers were far fewer than expected with many being put off by cold, wet and windy conditions. Those that did join the procession were vocal in their protest which took them past Parliament to a rally in Hyde Park.

Dozens of different groups were represented under the banner of “Put People First”. Environmental groups were joined by anti-capitalists and anarchists. There were also church groups and those opposed to nuclear proliferation. The mixed messages were reflected by the sea of differing placards suggesting that “capitalism isn’t working” to a call for “Jobs not Bombs”.
The protest was the top story on both the BBC and Sky News though coverage remained scant. Policing was low profile and there was no sign of violence which some media reports suggested might occur.

The picture may well change next week when hundreds of anti-capitalist protestors are expected to descend on the City. With calls to “storm the banks” and “eat the bankers” anarchists and other groups are expected to try and create widespread disruption. However, some anarchists have claimed that while they want to disrupt the G20 Summit and the workings of the City, it was not their intention to be violent. Daisy, 19, an anarchist behind some of the literature told the Guardian, "This is politics. We're using symbols of oppression in an artistic way. It doesn't make us terrorists."

But the police are treating the threats of violence far more seriously. City workers have been told to “dress down” and even to leave expensive cars at home [Daily Mail / City of London Police]. The Metropolitan Police are also well prepared. Plans have been drawn up, police overtime has been cancelled and 3,000 extra police have been drafted in from other forces. All this is costing the British tax payer an estimated £7 million [Guardian].

Most of the concern in the build up to the G20 surrounds the potentially violent protests. There has been little or no discussion as to a potential terrorist attack. According to the Home Secretary Jacqui Smith, there is no specific terrorist threat aimed at disrupting the G20 Summit. However, the terror threat remains “severe” and she has conceded that the Summit would be a prime target for terrorists. Large scale demonstrations would act as perfect cover for a terrorist intending to launch a much talked about Chemical, Biological, Radiological or Nuclear attack. Such an incident would also create a logistical nightmare for the authorities and security services [BBC / Sky News / CNN].

UK terror threat growing, govt says

"The threat of a serious terrorist attack on Britain has grown"

British Home Secretary has put forward plans to train workers in hotels, airports and supermarkets as part of its ongoing anti-terrorism strategy. During a debate in parliament on Wednesday, Jacqui Smith thanked the hard work already done by the security services in helping to keep Britain safe, “We’ve disrupted more than a dozen terrorist plots in the UK” Jacqui Smith, British Home Secretary, told MPs as she laid out plans to increase the annual anti-terrorism budget to more than £3.5 Billion by 2011. She said the key strategy in fighting terrorism was to Pursue, Prevent, Protect & Prepare. But she insisted that while the government was making every effort to thwart the terrorists, the UK government was “against torture and extra-ordinary rendition”.

Chris Grayling, the Shadow Home Secretary, was supportive of the general effort to battle terrorism but was critical of the implementation of the government’s initiative. He said that anti-terror training of shopping centre staff as part of Project Argus amounted to a 3 hour seminar including a coffee break. The Conservative MP said that some stores he his office had contacted knew nothing about plan except for reports in papers [BBC].

Jacqui Smith was defensive of the project and insisted that 700 programs had been carried out and more than 30,000 individuals had been trained.

She also came under fire for failing to compensate those injured in terrorist attacks abroad. Ian McCartney, a Labour MP, talked of some 200 British citizens who had been killed abroad and more than 150 maimed. Asking why there was no specific compensation for such victims, Jacqui Smith said she understood his impassioned statement and added, “I will talk to colleagues about that”.

The risk from terrorism exists not only abroad, but much is exported back to Britain. Sky News today reported that some 20 extremists had returned to the UK after being trained in Pakistan. Sky said that many more radicalised individuals, possibly hundreds, could be following them. It has prompted US authorities to carry out surveillance on British Muslims living in the UK [Sky News].

The types of attacks that might be perpetrated was mainly focused on CBRNE, Chemical, Biological, Radiological, Nuclear & Explosive [BBC / Sky News / CNN]. But former Home Secretary David Blunkett raised the risk of a potential cyber-attack. He said that such attacks, seen recently in places like Estonia, could even threaten lives as well as the financial stability of Britain. Jacqui Smith said that the cyber-security was a concern and that there was “work going on in government”.

“We must ensure we are safe in the virtual world as we are in the real world” the Home Secretary added.

Some MPs were concerned as to how the terrorist initiatives were affecting the lives of ordinary people. While Liberal Democrat MP Chris Huhne applauded efforts to thwart terrorism, he asked why citizens were being continually intimidated by police for otherwise law-abiding activities.

Kerry McCarthy, Labour Bristol East, also criticised the arbitrary use of such powers. Smith insisted that “guidance was given to police”. But there is growing anger amongst some members of the public who are seeing their rights eroded. A trainspotter was recently banned from Macclesfield station in Cheshire after Virgin Trains deemed him a security risk [BBC]. Natioanl Express have also put plans in place to ban trainspotters from its East Coast line, again citing security concerns. One disgruntled man told a London paper, "Trainspotters may be seen as a bit odd but we are friends of the railways. We don't smash it up, steal cables or blow ourselves to bits - so why are they picking on us?" [This is London].

The irony is that many such individual may serve as the front line in surveillance. Trainspotters may well be able to give authorities first hand information of suspicious behaviour on the rail network.

The threat comes not only from Pakistan’s training camps but also from terrorist websites. Stewart Jackson, a Conservative MP, questioned the Home Secretary why not one terror website had been shut down despite pledges to do so. Powers outlined in the 2006 anti-terrorism act aimed to shut down such sites. However the Daily Telegraph revealed this week that the government had failed to make any headway in this effort. It remains to be seen what effects the news proposals announced by the government will have in pursuing and preventing those intent on perpetrating such acts.

Bomb threat at Paris store

An explosive device has been discovered in a Paris department store. Reports initially stated that 5 devices were found and that explosives experts had defused them. However within the hour Sky News were reporting that the “sticks of dynamite” had no detonators attached. The incident was further downplayed when CNN reported shortly before 12:00 GMT [13:00 CET] that only one device without detonator had been found.

A little known group calling itself the Afghan Revolutionary Front said they were responsible for planting the device at the Printemps Haussmann. Two days ago another warning was phoned through to police but no action was taken, according to CNN’s Jim Bittermann. The group are reported to have called for French troops to pull out of Afghanistan.

France has 1,900 troops deployed in the country and earlier this year President Sarkozy announced he was to increase numbers by up to 1,000. France has lost 23 troops during the 7 year war. Although the device was not viable, it is a clear signal from terror groups to countries involved in the Afghan campaign. The fear is, the next device may come without a warning, maiming and killing in its wake [BBC].