Archive for July 3rd, 2009

It’s the end of the world as we know it

Not that I plan to turn the blog into a “swine flu is going to the end the world as we know it” blog, but some it is really quite interesting to watch it evolve.

We have changed from containment to treatment. A few days after the rest of the UK, seeing as we were a bit lower on the numbers. Which basically means that if you get flu, then it’s most likely the swine variety and we don’t test you, or we either give you the tamiflu, (which no one knows works or not by the way), and you get better or we tell you to get a box of kleenex and sit in the house for a week and you get better anyway. Or in rare cases, you actually get sick and wind up in hospital, or even rarer – you die. Which understandably what everyone is worrying about.

Currently there are mortality rates about the world quoted from anywhere in the region of 1.5% to 3%. I consider that pretty high. But remember that it overestimates the death rate cause that only counts the numbers who attend medical services and get tested. Lots of people are at home with the kleenex getting better all on their own.

We had a big meeting about in work. Lots of people in a room trying to come up with some way to plan responses. Some of whom were more useful and contributory than others. If I hear anyone else talk about “blue sky thinking” then I’ll explode.

It is reassuring to know that we have actually thought about this and if the whole thing becomes like outbreak then we do have a plan in place.

Someone managed to project figures of 400/day attending our emergency department. At the minute we see 300 on a busy day, so imagine over doubling our numbers at the drop of a hat.

Via the BMJ blogs and the NEJM I found an article (not yet published) going over some of the historical perspective of influenza outbreaks and how something like this comes about.

Regarding the reemergecne of a 1950 strain in 1977

This finding suggested that the 1977 outbreak strain had been preserved
since 1950. The reemergence was probably an accidental release from a laboratory source in the setting of waning population immunity to H1 and
N1 antigens

Sacry eh?

In a different outbreak in an american military base in 1976, there was the ideal opportunity to study th epidemiology in controlled circumstances.

[Incidentally military bases and recruits have been huge contributors in infectious disease, with studies in them revelaing links of strep to rheumatic fever and huge amounts about the bugs that cause meningitis. However it means that the applicability of the science may not hold true. In other words penicillin may not stop you getting rheumatic fever unless you’re young, male, with a tendency to violence and a shaved head…]

In this case they decided to vaccinate a large proportion of the population. To the tune of 40 million. Yes that’s right – 40 million people.

To quote

The emergence of swine influenza at Fort Dix led to the implementation of a mass vaccination program, which resulted in 40 million civilian vaccinations and 532 cases of the Guillain-Barré syndrome (a rare side effect of influenza
vaccination), including 32 deaths

We killed 32 people (and gave a horrible experience to 500 others) with our vaccines. Was it worth it?

The simple question to ask if the UK were to consider a vaccination program (using purely theoretical figures – new vaccines may not cause GBS at all) is – is a 32/40,000,000 death rate acceptable in the light of a x/40,000,000 death rate from swine flu?

Too many variables in the equation as yet.

What might be more reaistic is what will be the outcome of giving vast numbers of people tamiflu. This could be one of the largest trials of efficacy and side-effect profiles in the history of therapeutics. If there are nasty side effects of tamiflu that either weren’t known about or even sweeped under the rug (have we learned the lessons from thalidomide) then they’re gonna come out be assured.


July 2009
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