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Swine Flu Trending Again

The UK media has been full of swine flu (H1N1) again this week, it’s been trending, to borrow Twitter terminology, what with reports on the tragic deaths of a young girl and a family doctor, advice on virulence and research from Imperial College London that suggests we need better research into the disease. Widespread anecdotal evidence of the spread of H1N1 abounds too.

I should also point out that since coming back from WCSJ09 I’ve had a rather nasty cough, a bit of a sore throat and have felt quite lethargic…but that’s more likely to do with all the mixing in smoky Westminster pub outdoor areas and the talking loudly to be heard over speakers at social events (apologies Natasha, Ed).

Anyway, back to the swine flu. The number of people contacting their doctor because they think they have swine flu has jumped almost 50% to 40,000 a week, according to a BBC report. The actual number of diagnosed cases has risen sixfold in the last week in some parts of the UK, The Guardian said. The Royal College of General Practitioners has criticised the government’s overall handling of H1N1.

The case of the GP who died this week is intriguing from the semantic point of view. According to various outlets, no inquest will be held into the death of 64-year-old Dr Day, who died on Saturday in the Luton and Dunstable Hospital of “natural causes”.

That last phrase covers an awful lot of issues with a nice shiny gloss, it’s the official stance on a whole range of causes of death used on death certificates. But, it doesn’t actually tell is what Dr Day died of and police have criticised the media for reporting his death as a swine flu death. But, of course, it was swine flu that killed him, even if it induced cardiac arrest or some kind of toxic overload. In the absence of the infection would he have otherwise died of “natural causes”? The phrase “natural causes”, is apparently legalese and we should be avoiding it like…well, the plague…for the sake of epidemiology and long-term public records in the face of an emergent virus.

As to the cause of death of an apparently healthy six-year old girl, the post mortem is underway…

Meanwhile, despite declarations to the contrary, it seems that a swine flu vaccine is still months away, according to The Guardian, and is likely to not be ready for the so-called second wave predicted for the autumn.

Several weeks ago, a GP friend told me that word on the street was that one in three people would be infected in that second wave, that ratio was confirmed by BBC news coverage today; some sources say ultimately half of us will eventually be infected. Although the Telegraph reports that according to chief medical officer, Liam Donaldson, just one in eight workers will be forced to stay home because of H1N1.

The BBC’s report was made almost in the same breath as they reported the Imperial College research that says it’s almost impossible to tell who has and who hasn’t been infected and so impossible to determine a true mortality rate value for H1N1 (something I discussed here and elsewhere when information about the disease first emerged).

Now, if one in three are likely to be infected and the mortality rate is a conservative 2%…then that will be approximately half a million UK deaths. The mortality rate may be lower, but the second wave could be more virulent and some researchers, as I’ve reported previously, suggest that 6% might die, that’s three times as many deaths. Official guesstimates are saying 65,000, but they admit that the figure is essentially plucked from the air.

One other point of semantics that is rather irritating and could have been avoided with a simple word switch is regarding the usage of “pandemic”. The word has a strict definition in medical circles, referring simply to how far a disease has spread into the world population.

However, many media talk about “pandemic” as if it were synonymous with lethality or virulence and use it to differentiate between the H1N1 flu virus and so-called “seasonal” influenza, which incidentally kills half a million people each year. If only the WHO had chosen the term “emergent” influenza, then I think many of the misconceptions regarding their announcements on pandemic flu would have been avoided…too late now, of course.

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