Has swine flu been handled well?

The Health Protection Agency has been overseeing the launch of nine regional Flu Response Centres to deal with the swine flu pandemic.
Using mainly HPA staff, the centres have dealt with thousands of calls from health professionals and managed all aspects of containment, from swabbing to treatment and contact tracing.
The East Midlands Flu Response Centre is supported by HPA public health consultant, Dr Philip Monk, who detailed his experiences in a unique audio diary for Radio Four over a week, beginning with the region's first significant outbreak, among students at Nottingham University on 21 June.
His team works taking swabs, dispensing anti-virals and - most importantly in the early days - buying crucial time for the NHS to adapt plans drawn up for bird flu.
But by 25 June staff were finding it hard to cope.
Dr Monk said: "We haven't got enough phone lines, we've only got 15 incoming numbers and we're getting irate people because they've had to wait a long time to get through.
"And we're getting tired and getting stressed, so it's all getting a bit tetchy and a bit irritable and there's no let-up in this."
Could do better
Professor Nigel Lightfoot, chief advisor at the HPA and head of the Pandemic Influenza Programme, has admitted to the BBC that more could have been done to properly resource the nine local response centres.
He said: "In some areas our flu response centres worked well but in others perhaps we should have moved faster in the staff, the resources, that were put in there and that is one thing we would do differently - just put more staff in.
"Lessons are being collected from the operation of the flu response centres and will be implemented if we ever have to do it again."
The phone lines are manned 12 hours a day, seven days a week but Professor Lightfoot says problems have also occurred because so many people used lines intended for health care professionals.
He said HPA representatives should have been dispatched overseas as soon as the new strain of virus was identified.
"We probably should have sent more people earlier to Mexico, sent some people to the US, to learn what was happening and we will be sending someone to Australia because Australia is in the winter season so they're experiencing what we might experience come October."

Swine flu infanted mother birth a child

An infant girl delivered prematurely from her mother, who has the swine flu virus, has died, hospital officials said Monday.

Aubrey Opdyke was put into a medically induced coma to give the baby as much oxygen as possible.

Parker Christine Opdyke was delivered 14 weeks early by doctors at Wellington Regional Medical Center in Florida's Palm Beach County.
Her mother, Aubrey Opdyke, was placed into a medically induced coma June 3 to help give the baby as much oxygen as possible. But doctors delivered Parker on Saturday after her mother suffered a collapsed lung last week.

Aubrey Opdyke remains comatose and in critical condition in Wellington's intensive care unit.
"Despite heroic efforts on the part of physicians and nurses, we are sad to announce that baby Parker Christine Opdyke has expired," said a written statement from the hospital.
No other details were available Monday. Attempts by CNN to reach the family were unsuccessful.
Even under the best circumstances, delivering a child at 27 weeks is a very early birth, Dr. David Feld, a Palm Beach County obstetrician and gynecologist, told CNN affiliate WPEC.
"When you have an infectious case, I don't think you're going to see that lung maturity as quickly, and I think that is the issue," he said. But, he said, now that Aubrey Opdyke is no longer pregnant, she will be able to fight for her own life.
Palm Beach County has had 247 confirmed cases of the H1N1 virus, known as swine flu, but only one death. In late June, a 25-year-old pregnant woman died, but her baby survived.
Pregnant women have long been a prime concern of health care officials regarding the flu virus, but are of particular concern during this outbreak of swine flu. Pregnant women have always been advised to get a flu shot because they are at greater risk because of the weakened immune system resulting from their pregnancy. But the H1N1 epidemic has seen new complications and challenges.
"We have seen, with this virus, worse complications and severe infections in pregnant women," said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. "We're urging women who are pregnant who develop fever or respiratory symptoms to seek care promptly."

The CDC said it is vitally important for pregnant women to recognize the signs and symptoms, like fever and cough, to get to their doctor quickly and to begin taking antiviral medicines early on.
"I know that many pregnant women don't want to take anything while they're pregnant," said Schuchat. "This is a situation where you need to be more worried about your health and the baby's health."
The CDC also recommends that pregnant women get the H1N1 vaccine when it becomes available, in addition to an annual flu shot. "For people who are at high risk, like pregnant women, planning to receive both vaccines is probably the right way to go," Schuchat said.

Swine flu and Tamiflu

Concerns have been raised that swine flu is becoming resistant to anti-viral drugs at the same time that ACT Health braces for a potential outbreak of the disease as children return from school holidays.
Federal Health Minister Nicola Roxon said there was isolated evidence that swine flu was becoming resistant to the anti-viral drug Tamiflu overseas.
''I do agree with doctors that we have to be careful not to over-prescribe this medication. It's why we're urging people, the vast majority who have mild symptoms, not to take Tamiflu unless they are in a vulnerable category and unless their doctor recommends that it's necessary,'' Ms Roxon said.
She warned swine flu would persist for months, and ACT Chief Health Officer Charles Guest said the end of holidays could lead to an outbreak of swine flu when children return to classrooms today.
''The return to school ... changes the groupings around and yes, it's possible that we might see a spike in cases ... On the other hand there is a lot of flu this week here and elsewhere,'' Dr Guest said.

Why You Should Still Be Worried: Swine flu

Swine flu is spreading faster than ever — so much so that the World Health Organization has decided to stop tracking cases.
In the U.S., the H1N1 virus has sickened tens of thousands and closed summer camps at a time when there should be little or no flu activity.
Even as the WHO and the U.S. Centers for Disease Control and Prevention continue to raise awareness of this potentially deadly disease, which appears to be killing both sick and healthy individuals, the topic has virtually disappeared from the headlines.
“Complacency is a major concern,” said Dr. Anne Schuchat, director for National Center for Immunization and Respiratory Diseases at the CDC.
“This virus is a new one, and on top of that, we really still don’t know how it’s going to behave,” Schuchat said during a media conference call Friday. “There are special efforts that have been undertaken by health agencies, but individuals also need to be ready, to be thinking ahead and have steps in place should a family member get sick or a workplace close down or a situation arise that requires working from home.”
Over the next six to 12 weeks, there are several concerns that national health officials are preparing for:
1. Figuring out how the virus will react and spread once students return to schools, especially inner city schools, which typically struggle with overcrowding issues.
2. Overseeing the completion of a vaccine and getting it to the individuals who need it most.
3. Determining how the virus will behave as it spreads and mutates.
Schools
School districts across the U.S. struggle every fall with outbreaks of typically non-flu respiratory viruses, which are easily spread through germs on surfaces and doorknobs, as well as passed from student to student through sneezing, coughing, and sharing drinks and food.
Seasonal influenza usually begins to spread through schools in the late fall and early winter, but this probably will not be the case with swine flu, which behaves differently than seasonal influenza – by oddly thriving in warm and humid conditions.
“This year we’re seeing the H1N1 virus circulating through summer camps and military units, so I’m expecting we may see an increase in cases once school starts, but we don’t definitely know that,” Schuchat said. “We are concerned that there will be challenges in the fall. It is the kind of thing we want to be ready for and not surprised by.”
Schuchat said national and state health officials are working closely together on updating their guidance for schools and similar institutions with regard to swine flu outbreaks.
“We still believe that the best place for kids is in schools, where they can be nourished receiving a healthy breakfast and lunch and learning,” she said. “But we also believe the best place for a sick kid is at home being cared for. So we’re working on putting strong plans in place on communication and preparedness on the local and state levels.”
Vaccine
Companies such as Baxter, GlaxoSmithKline and Novartis are working to ready a swine flu vaccine for October. Earlier this week, concerns were raised that the U.S. may not receive all the vaccine it needs because it only manufactures about 20 percent of its own supply. The other 80 percent is produced in foreign countries, which will also need ample supplies of the vaccine.
But Schuchat downplayed those concerns, saying the U.S. has contracts in place with manufacturers around the world that guarantee it will receive adequate vaccine.
But, will the vaccine be effective?
In a typical year, the seasonal flu vaccine is about 70 to 90 percent effective, depending on how closely the vaccine matches the strains circulating and on the population the vaccine is used in. In other words, a vaccine is not going to be as effective in a person with a compromised immune system or someone who is considered at high risk for the virus.
Scientists typically spend months researching the strains of seasonal flu virus that are circulating the globe in order to pick out the three strains that it puts into the annual vaccine.
Because swine flu is new and mutating – for example, in Argentina the virus appears to have mutated to where it can now easily spread from humans to pigs – scientists have their work cut out for them when it comes to determining what strains of the H1N1 swine flu virus to include in the vaccine.
“Unfortunately, right now, we do not know how effective it will be in different populations,” Schuchat said. “We will be looking back at how well it worked, taking into account whether it worked as well as expected, better than expected or worse than expected. Unfortunately, that’s something we’re not able to do until after the fact.”
Virus Behavior
World and U.S. health officials have already determined that swine flu behaves differently than seasonal flu in a number of ways. First, it’s able to spread in hot and humid weather, which is not usually the case for the seasonal flu virus.
Second, the infection appears to be more severe in young people and less severe in the elderly than the typical seasonal flu. Schuchat said in some countries, elderly people, usually at high-risk for influenza, appear to be immune to swine flu – possibly because of the similarities between swine flu and the 1918 flu pandemic, which some of the world’s elderly survived and may be resistant to.
“We are particularly concerned about pregnant women; we’re seeing fatalities and life-threatening illnesses that have occurred in pregnant women in the Southern Hemisphere,” Schuchat said. “We are expecting pregnant women to get a recommendation to get the H1N1 vaccine to reduce the risk of complications from influenza. We know many pregnant women don’t like to take any drugs, but this is one instance where you need to be much more concerned about your health than the baby’s health.”
“We’re in a very active stage of preparing for the [coming months],” she continued. “We’re working with the private sector. We want individuals and families to be preparing. Influenza in general is unpredictable, and we don’t know what to expect in the weeks and months ahead.”

Swine-Flu Vaccination UK plans

The medical establishment in Britain, the nation hardest hit by swine flu outside North America, is scrambling to roll out a large-scale vaccination program in an effort to protect its population against a virus that threatens to spread rapidly here in coming weeks.
The state-run health system is deciding whether to hire private contractors to help doctors carry out the massive vaccination job, said Peter Holden, a general practitioner who represents the British Medical Association in pandemic-flu planning with the government. Doctors would rather handle the shots themselves, he said, but as phone calls and office visits related to swine flu have jumped, they are concerned the extra work will overwhelm them unless they suspend some other routine care.

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A postman delivers a leaflets giving information about swine flu to a home in Scotland. The leaflets were delivered to every household in the U.K.

In his own practice in the Peak District in central England, Dr. Holden is making plans for each doctor or nurse to vaccinate between 30 and 40 people an hour. "There'll be no chitchat. It will be, 'Are you allergic to anything? Bang, in, out,'" he said.
It isn't yet clear how many doses will be needed per person, but many flu experts believe it will be two.
Since the spring, 17 Britons have died after being infected with the H1N1 virus that is causing the swine-flu pandemic, according to U.K. officials. The U.K. recently recorded its first swine-flu death in an otherwise healthy patient, an event that set off further concern, even as other deaths, including that of a 6-year-old girl last week, have gained attention.
As of July 6, the U.K. had 7,447 confirmed cases, ranking the country fourth in the world, behind the U.S., Mexico and Canada, according to the World Health Organization's most recent figures. World-wide, 429 people have died from swine flu and 94,512 have been infected, according to the WHO.

swine flu deaths in London

Four more people in London have died after contracting swine flu, including a baby less than six months old.

The other casualties are a 70-year-old man, a 39-year-old woman and another adult. All of the victims had underlying health problems.
Three other possible swine flu deaths are also being investigated.
NHS London said the latest fatalities, which happened in the past two weeks, bring the total number of swine flu-related deaths in the capital to 10.
The baby died at Royal Free Hospital last week.
Dr Simon Tanner, regional director of public health at NHS London, said: "We would like to extend our deepest sympathies to each of the families affected at this very difficult time.
"It is also important that these deaths be kept in perspective.
"All four had underlying health conditions and these upsetting cases should be kept in context with the many people who have had swine flu and recovered just a few days after experiencing a mild illness."
Andy Wapling, head of emergency preparedness at NHS London, said: "We would like to reassure people that NHS London is well-prepared - all NHS organisations have plans which have been practised and checked regularly.
"NHS London has put in place recently audited plans on how to prepare for flu pandemic and ensure that anyone who needs help will receive it."
Twenty-nine people have now died in the UK after contracting swine flu and the number of new cases hit 55,000 last week.
The NHS has seen a surge in calls and consultations.
Ministers in England have responded by promising the National Flu Service will go live at the end of next week to relieve pressure on hospitals and GPs.
The government has also warned that deaths from swine flu this winter could be between 19,000 and 65,000 in the UK.