Nigel 
July 23rd,2009
Is this getting into your nightmares?
There’s an ambulance guy (Emergency Medical Technician) in London called Brian Kellett who blogs about his work. The site is called Random Acts of Reality:Trying to kill as few people as possible. He uses the pen name Tom Reynolds.
Here is an excerpt from one of his recent posts:
An example of one of our ‘clients’–she called four ambulances over four days as her child has Swine ‘flu,which isn’t ‘getting any better’,despite being told that it can take over a week to feel better. Needless to say the child involved is fine if a bit generally unwell –certainly nothing that requires hospital treatment. Multiply this by the number of people across London and you can see one more reason why the number of calls is raised.
The information which makes it onto TV and the papers about the swine flu pandemic has not been reassuring,and has often left me confused. This suggests the reporters may themselves be confused,but have to produce something by their deadline.
Just how dangerous is swine flu?
I’ve been reading up on this and thinking about what I’ve read. There are several factors to take into account when answering this question,and even if this is done properly the answer will depend on exactly what you think the question means.
A simpler example:is swine flu more dangerous than normal seasonal flu? Answer:yes and no,it depends what you mean by dangerous.
Here are the factors as I see them,together with what solid numbers I’ve been able to find:
How fast is it spreading?
In the week up to 14 July (I think – dates are vague) there were 55,000 new cases in England.
The following week there were 100,000 new cases.
This is out of a population of 61,000,000.
Let’s express that differently. Last week 1 person in 600 went down with swine flu in England. It’s unclear whether this rate will stabilise or increase,but if you’ve watched the drama series Survivors then relax because there is no comparison.
How many people will catch it?
The current estimate is that at most one person in three will catch it. That’s about 18 million in England. Okay so that’s a lot,but they won’t all be ill at once.
How many of the people who catch it will die?
In order to plan for a range of problems the government has assumed this flu will be similar in effect to normal seasonal flu. This gives a death rate of between 1 and 3.5 people per 1000 of those who catch it. This suggests somewhere between 18,000 and 64,000 fatalities.
Let’s put this figure in perspective:each year deaths in England from various other causes are typically about:
- 800 from violence
- 2,000 in a heat wave (eg 2003)
- 3,000 in road accidents
- 8,000 from alcohol related problems
- 80,000 from smoking
Almost everyone who catches swine flu will experience only mild symptoms – although mild flu symptoms tend to mean an unpleasant week in bed.
How does this compare with normal flu?
Flu peaks every winter in the northern hemisphere. In England about 10 – 15% of people catch that seasonal flu each year. Swine flu is currently predicted to only hit about three times as many people.
What type of person catches it most easily?
Swine flu is unusual in that children under 14 appear the most likely to catch it. Once having caught it they are at slightly greater risk than a healthy adult because their immune systems are not fully developed,but it is other groups of people for whom flu is far more likely to be dangerous.
What type of person is most at risk of dying from it?
- People of ‘advanced age’,which loosely means over 65
- People who already have some kind of heart or breathing problem. For instance I have chronic bronchitis and mild asthma,so fall into this group. In the past I’ve found flu merely unpleasant,and inhalers have dealt with extra breathing problems just fine.
- Women who are pregnant (pregnancy drains the immune system a bit)
- People living in ‘closed communities’ such as prisons,universities and schools. It is quite possible swine flu will ease off later in August and then peak again soon after schools start their new term. That’s why some are suggesting schools not reopen,but that might just delay the process until they did finally open.
Other than killing some people,what other problems will it cause?
A major concern is demands put on the health service. The number of people seeking medical advice is well above normal this week,but still well below peak rates during the 1968 pandemic (see graph below). This will rise,putting a lot of pressure on hospitals and family doctors (GPs). If a significant proportion of doctors and nurses are also off work with swine flu the problem will be worse. Intensive care units will be particularly under pressure,and some patients in need of intensive care may receive it in other parts of a hospital.
Basically the moral is simple:if you don’t absolutely have to see a doctor during the pandemic then don’t – they’ve got enough urgent stuff on their hands. It also means if you think you have the flu,stay at home and recover. There’s plenty of guidance on the web. If you absolutely must consult a doctor do so by phone so you don’t spread flu unnecessarily.
Weekly flu consultations in UK now (23 July 2009) compared with 1968
There may be some reduction in various services. However we’re not expecting a third of the population to be off work with flu at the same time – it lasts about a week,and cases will be spread out over many months. If there aren’t quite as many buses as usual,or your local supermarket seems understaffed,just bear with it. The government is putting plans into place to ensure the most important services are adequately staffed. If the checkout queues are longer we’ll survive,but if your house catches fire you’ll want the fire service there promptly.
Frankly a major problem this time round is the level of uninformed panic. We are going through a normal process. It happened in 1968-1970 when I was at University,and to be honest I don’t remember even being aware of it. Everything in my life carried on as normal. Perhaps these days bad news reaches us too quickly from too many poorly informed sources. Ah well,swings and roundabouts.
Why are figures about flu and flu-related deaths so unreliable?
Cholera is a notifiable disease. Once diagnosed it must be reported to the appropriate national agency – in UK the Health Protection Agency. Cholera is relatively easy to diagnose (partly because it often kills within 1 – 18 hours) and in cases of doubt specimens are sent for analysis. This means our records about cholera in this country are pretty reliable.
Flu is a very different case. People often think they have flu when all they have is a very bad cold. Most cases are not reported to medics. When it comes to death caused by flu there are two problems. Firstly it may not be clear whether flu was the cause,or just helped existing problems finish someone off. Also doctors are often overworked and may not spend too long thinking through the relative merits of different ways to fill in the cause of death section on the relevant form. They do not send samples off for analysis to check whether the infection was flu or a cold.
Mind you,it isn’t as bad as some years ago when we had an ‘own clothes day’ for charity at my school and one of my students wore a t-shirt saying:
- 80,000 deaths a year from smoking
- 8,000 deaths a year from alcohol
- 3,000 deaths a year on the roads
- 0 deaths from using cannabis
- go figure
His statistics were in line with what had been recorded,but merely because at that time deaths from cannabis use had to be classified in other way. There was no cheap,reliable way to test a corpse for recent cannabis use. The death would be attributed to something like a road accident or smoking.
But
I’ve taken a lot of trouble to make this post as accurate as possible,but there will probably be some errors. If you spot any please let me know so I can amend the article and credit you for the info. Cheers.
Useful links for more UK info
On the National Health Service swine flu page you’ll find a link to the latest briefing notes:http://www.nhs.uk/news/2009/04April/Pages/Swineflulatest.aspx
The Health Protection Agency has some helpful stuff too:www.hpa.org.uk/swineflu/
The graph shown above is taken from the Pandemic Influenza Weekly Situation Report,Sir Liam Donaldson,Chief Medical Officer,23 July 2009. I am assuming since this was publicly distributed including to the media that permission is granted to reproduce it. It would be odd if not. The full report is on the NHS site (link above).
