Archive for the 'swine flu' Category

If the world ends

This is the way the swine flu ends, not with a bang but a whimper

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Handshake drugs

Interesting article in the BMJ on the conflict of interest involved in the WHO pandemic recommendations regarding the swine flu pandemic of last year – remember that. I’m surprised we’re here at all to remember it given the hype.
The WHO were the official body that declared the “pandemic” and as a result kick started and guided the way we responded.
Most notably this brought an unheard of (though 10 year old) drug to world wide media attention.
It seems a bad idea that the NGO making the guidelines should be based on the science rather than the money but it seems that there is a lot of doubt as to the transparency of the process that WHO undertook and it is clear that many involved had financial ties to those making the drugs that were later recommended and more importantly stock piled (at big cost/profit) in colossal numbers by governments.
These drugs aren’t like penicillin for pneumonia. Even the most optimistic science doesn’t claim it’s gonna save lives. For a disease that gets better by itself in 99% of people then giving out these drugs in the drinking water will benefit only the people making them.
Interestingly the actual declaration of the pandemic triggered previously negotiated contracts on vaccine manufacture. There has been a suggestion that WHO not only changed the definition of pandemic but also that there was some influence on the actual declaration.
However given the way that drugs are developed it’s hard to form an expert committee to come up with guidelines without having a conflict of interest.
Having said all that, one of these days we’ll get a flu as contagious as swine flu (that spread over the globe) and lethal as bird flu (that had a 40% mortality) and we’ll be properly buggered. I think I’d have a different take on oseltamavir if the disease behaved different.
NB – Mark Crislip has a an interesting retort to the reporting on the reporting by the BMJ here.

Sounds of summer

Some of you come here for bitchy posts about medicine and the NHS. To be perfectly honest we’ve had a pretty decent summer. Everyone buggers off to Spain and the Balaerics for two weeks and get sick in other countries or fall over and break their arm in Portstewart and end up in other hospitals apart from mine.

People don’t come to this part of the world for their hols. They used to come in huge numbers for a bit of a riot around Drumcree but we seem to have moved on some what.

Swine flu has had a bit of an impact. We have lost our paediatric area to become a swine flu isolation area where we have to wander around dressed up like someone from the moon landings just to take a history from a very well looking patient.

Despite huge amounts of coverage telling people NOT to turn up at A&E or their GP but to ring first, people still keep turning up. We shout at them mainly when they do. Tis the caring profession.

Despite seeing a good 10-15 patients with flu and my own family getting it I’m still going strong. Be it chance or the rigorous immune system that goes with working in A&E I’m still fighting fit. I’m all for getting it to be honest. The idea of a week or two of enforced isolation with nothing but some paracetamol, some DVDs and shelf of books fills me with great enthusiasm. In my fantasy I’ve blanked out all the flu-symptoms that come with having flu. I’ll keep the fingers crossed for some fevers and arthralgias.

There have been times in the past few weeks where there haven’t been any patients in the department waiting to be seen. People have been seen promptly and thoroughly, often getting the time, dignity and grace that they deserve. Without the doubt the whole place and system runs so much more smoothly and better at times like these.

So how do you measure quality of care? How do you measure it genuinely and honestly? And do we really want to pay for it?

IMG_3126

But it’s hardly all work. I was at U2 being blown away by the sheer scale and audacity of the thing. Feeling slightly bad that I’d prefer to be leaning on the railings at the sound desk in somewhere like Vicar St or the Empire.

I have seen U2 in Croke. That was box ticked. If I see Bruce then I’m not sure what else there is to live for so I’ll put that off for a while.

I saw Potter at a 1030am matinee. I liked it. Though it’s been about 3 or 4 years since i last read the book so I’d forgotten half of it. Despite running to three hours it felt very, very rushed. Too many disparate parts that seemed to have no discernible link.

I had a ride on the train from Sligo to Dublin and found some theses throughout the train:

IMG_0390

I’m not sure Translink are quite with the program yet.

I’ve been working my way through Subverting Global Myths, with my black biro underlining virtually everything and scribbling little comments of approval in the margins. There’s sections with titles like “rediscovering Christian integrity” that get me all excited. There will be more quotes no doubt. If the gospel is not socially, politically and relationally radical then I want none of it.

I had some time on call in work and learned that when trying to put an IV in a child that’s fitting then it’s generally best to use the half of the child that’s not fitting.

I made a kick ass roast dinner for a stack of people and we ascended to new levels of interpersonal communication by requesting songs off spotify by texting knoker sitting by the computer in the corner.

I became intimately acquainted with the inside of a 2002 VW polo and realised that if the car stereo isn’t working then it’s cheaper to but a 15 pence fuse that a 70 quid new stereo. Every day’s a school day I suppose.

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.


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November 2017
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