Swine flu in Britain: The guessing game

As the pandemic spreads, the NHS and other public services are preparing for the worst-case scenario – but they have no real idea of how bad the situation might get. Nina Lakhani reports

Britain is this weekend caught in a terrifying guessing game as scientists and the Government try to work out just how bad the H1N1 virus will get. Eight weeks after the first case of swine flu reached Britain, amid calls for calm, this was the week when it all got serious.

Scores of schools have closed early for the summer holidays; the NHS is being swamped by new cases and children have started dying. The Government's Chief Medical Officer, Sir Liam Donaldson, told us that as many as 65,000 people could die from the H1N1 virus, but the truth is no one actually knows how the virus will mutate before it comes back for the second wave in the autumn. Until we understand what course it will take, everyone has to prepare for the worst-case scenario while trying not to panic.

Holidays

Reports emerged yesterday that a group of 52 British schoolchildren and teachers have been quarantined during a trip to China after four were taken to hospital with suspected swine flu.

Hundreds of thousands of families could face a miserable summer at home as a growing number of countries step up airport medical checks and stop suspected swine flu sufferers from entering the country. Five millions Britons have booked foreign holidays over the summer, but if the virus spreads as predicted, mass cancellations are possible.

Several countries, including China, India and Egypt, have introduced medical screening at airports for international passengers. Travellers with flu-like symptoms such as a high fever are being quarantined for up to seven days or turned back from these countries, warns the Foreign Office.

Pregnancy

Doctors and midwives are bracing themselves for a major rise in pregnancy complications as pregnant women and children under five emerged as the groups most vulnerable to H1N1.

Several clusters of serious illness among pregnant women and newborn babies in Australia last week have rung alarm bells, triggering new advice from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, which are urging pregnant women with flu symptoms to take paracetemol to treat the fever, together with the antiviral drug Reflenza.

Previous flu pandemics have resulted in an increase in first trimester miscarriages and children born with neural tube defects such as spina bifida. Reflenza is preferred over Tamiflu because it is inhaled and acts locally on the upper respiratory system, though neither drug has been clinically tested on pregnant women.

The risk of contracting any infection is higher among pregnant women, because pregnancy weakens the immune system. Doctors worry most about a high temperature because this can lead to premature delivery.

Dr Boon Lim from the Royal College of Obstetricians and Gynaecologists said: "We are trying to find ways to collate as much data as possible in order to assess the impact of H1N1 on pregnant women and their babies. We don't know yet whether this virus behaves differently in pregnant women but they seem to have a higher risk of becoming more seriously ill.

"Pregnant women should stay away from crowded places but otherwise go about their normal business; there is no evidence to suggest self-quarantine is necessary."

This advice follows the death of Ruptara Miah, 39, last Monday after she became seriously ill with H1NI while heavily pregnant. Mrs Mhia, originally from Bangladesh, did not regain consciousness after giving birth to her premature son.

Emergencies

Worried parents flooded accident and emergency departments after news of the death of Chloe Buckley, an apparently healthy six-year-old, triggered the first signs of panic last week. Hundreds of suspected swine flu cases were seen in A&E departments across the country as worried people struggled to get through to NHS Direct or get appointments at GP surgeries.

More patients, an increase in staff sickness because of H1N1 and the need to keep pregnant staff away from suspected flu cases meant pressure was starting to increase on doctors and nurses, according to the College of Emergency Medicine. Dr John Heyworth, president of the college, said: "We are in this transition phase, waiting for the community centres and government flu line to be set up, so it's understandable that A&E has become the default option for worried people. We need these community facilities to be in place by next week."

The NHS is likely to concentrate all its efforts on acute services at the expense of less urgent procedures. Maternity services could lose 50 per cent of the workforce as a result of sick leave and childcare issues. Community midwives could be put into labour wards and junior doctors drafted out on to general medical wards, The Independent on Sunday has been told. NHS Direct took 93,000 calls a day last week compared with 7,000 a day before the pandemic.

Science behind the statistics

At the moment, understandably, the Government is using estimates based on previous pandemics and better-known viruses to plan how many vaccines will be needed, what NHS services will have to be put on the back burner and to make sure that public services and businesses do not collapse. But an eminent statistician has criticised the Government and

the Chief Medical Officer for failing to prioritise data collection, which is essential if we are to check whether current forecasts for the disease, and our plans to deal with it, are accurate.

According to Professor Sheila Bird, senior scientist at the Medical Research Council's Biostatistics Unit, not enough information is being collected about people ill in hospital or about those who die – information necessary to verify the Government's estimates about infection rates.

A failure to collect basic data now could prove disastrous as health professionals will not have time to do so once the infection rate escalates, said Professor Bird. "We have the analytical tools but we need the basic data in order to carry out empirical checks," she added. "Otherwise we won't know whether the current estimates being made about infection rates and deaths are right or wrong. We have a very short window in which to get the reporting system right, before the peak, while there is still time to think."

Schools

Businesses will be hit hard if more schools are forced to close early for the summer. About 1,000 schools have already been affected by cases of swine flu, but most head teachers chose to stay open. The Government last week admitted that schools and nurseries may not be able to reopen in September if, as predicted, 30 per cent of the population develops flu. The effects of school closures on productivity has led some economists to predict a 5 per cent drop in GDP.

Vaccine safety

The IoS has learnt that the UK has signed an order that grants drug companies making the swine flu vaccine immunity from compensation claims by patients who suffer side effects. This highly unusual move comes after claims in yesterday's Independent that high-risks groups such as children are likely to receive the vaccine before the final clinical trail results are in.

A Department of Health spokeswoman said: "Our position is exactly the same as all countries using H1N1 vaccine. We accept liability, except for damages as a result of manufacturing defects."

The swine flu industry

Several private clinics have been swift to cash in, offering tests and antiviral drugs. For example, it costs £125 for a H1N1 test with the Nottingham-based company Medichecks. But the Department of Health said this kind of testing was "irrelevant and unnecessary" as those who needed treatment can get it for free on the NHS.

While health bosses have so far led efforts to manage the effects of the pandemic, a sense of urgency is growing elsewhere in public services. Local councillors will meet this Friday to iron out civil contingency plans for coping with large numbers of deaths.

Confused advice: 'The drugs made things worse'

Lauren Kaye, 32, is a company lawyer from north London

"I woke up feeling funny on Wednesday 8 July but put it down to the anaesthetic I'd had two days earlier for an operation on my wrist. I went to work, but my boss sent me home.

"Within a couple of hours I had a high fever. I was really scared. It felt as if I had two golf balls in my throat. I had a pounding headache and even blinking was an effort. I went to the out-of-hours GP clinic but, looking back, the doctor was quite useless. He sent me home with antibiotics and didn't even mention swine flu.

"The next morning I went to my normal GP practice and the doctor told me I had flu but said he wouldn't give me Tamiflu because he didn't know how it would react with the medication I take for Crohn's disease. My immune system doesn't work properly, so I'm a high-risk person – a few years ago I ended up in hospital for four weeks with a respiratory infection.

"I spent Thursday to Sunday sweating and shivering and felt really sick, until last Monday I saw a GP who was familiar with my medical history and prescribed me Tamiflu. But the drug made my flu symptoms worse, so the next day the GP told me to stop taking it and I felt much better within 24 hours. It was all very confused."