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Half million deaths from flu!

Scary isn’t it? Everywhere you look there are tales about killer flu. Get your Tamiflu now! It’s your only hope! We’re doomed!

Some of the journalism I have seen on the subject has been truly horrific, even from reputable sources such as the BBC – though perhaps the media shouldn’t be singled out for our opprobrium when the government can be seen to be egging them on at every opportunity!

One headline you probably haven’t seen is the ‘half a million deaths’ one posted above… but it’s actually true. Not in respect of swine flu of course… but plain old seasonal flu that comes round every winter and kills off thousands of old people in the UK annually. The figures from the Centre for Disease Prevention and Control in the USA state that probably 250,000-500,000 people die from the flu every year around the world. By contrast the figure for worldwide confirmed swine flu deaths from the start of the outbreak is…. wait for it… 700! (Source.) Not quite so scary when taken in context is it?

But Swine flu is much more dangerous isn’t it? Well…. that might turn out to be true – but not based on what we know so far.  The rate of deaths per confirmed case serious enough to need medical attention is currently estimated to be about 0.5% – very similar to the case fatality rate of seasonal flu as reported (here.) Don’t take this to mean that there will be 1 death for every 200 people with swine flu however… there would be many thousands of cases of mild infection that wouldn’t even be reported to medical services and so wouldn’t be included in the figures. The actual death rate will in reality be much lower than 0.5%.

So it might not be that dangerous… and if we do get it Tamiflu will save us anyway wont it?

Erm… no.  This is the most shocking aspect of this whole mess in my opinion. Tamiflu has been around since 1999.  But up till now has not exactly covered itself in glory.  The limited research that exists suggests that it’s effect on flu is to reduce its duration by three quarters of a day to one full day at best.  It may reduce the chance of developing pneumonia in flu patients… but it has never been established exactly how good it would be at preventing death in affected individuals.  Figures (based on incomplete evidence) suggest that you would need to treat 1800-3200 patients to save just one life – though some doctors think you would have to treat many many more times those numbers to do so.  As is so often the case in medicine we just don’t have all the facts…. but my gut feeling (for what it’s worth) is that Tamiflu probably isn’t all that much use. An interesting debate is linked here – though it isn’t geared towards the layperson you may find it interesting.  That’s not to say that Tamiflu doesn’t have a role. In vulnerable patients it might just make the difference between life and death… but that’s not how it is being used under current UK policy.

But are there any downsides to using it? Well there are some side effects – nausea and vomiting being the most common, and some people wonder if there may be serious psychiatric reactions in a very few cases (link.) Of more concern is the fact that widespread use of this drug (which is after all the best antiviral we have got) will most probably lead to widespread anti-viral resistance within a short period of time.  Basically – if you give it to a whole load of people with mild symptoms who would have got better anyway… by the time someone really sick comes along they might not have much of a chance because the drug has started to become useless!

So – what should you do?

Well – you could start with this video… quite a nice FAQ from the BBC website that goes through the basics.

You could read this BBC blog which gives a pretty reasoned outlook on how the flu is going (unlike some parts of the BBC!)

You could use the online symptom checker at NHS direct or phone NHS 24  on 08454242424.  Both of these routes can help tell you if you are in one of the at risk groups who needs to consider using Tamiflu / seeing a doctor for your symptoms – or if you could just deal with it yourself with paracetamol and fluids like a normal cold.

If you are not in a high risk group and you do have the flu you need to make a decision about whether you would want to take Tamiflu or not. We would be happy to discuss this decision over the phone and give advice. Please don’t book an appointment or turn up at the surgery – one thing we can ALL do is to try and prevent the bug spreading as much as possible by keeping our infections to ourselves. being careful who we meet up with if we feel unwell and taking basic hygiene measures seriously (like washing our hands frequently.)

Unfortunately people will die from this virus – just as people die from viruses every year.  Some of them will be children, and some will be healthy adults who you would have expected to pull through.  Tamiflu isn’t going to change that basic fact – and telling the public that it is some sort of wonder drug that will somehow make you safe from harm is disingenuous to say the least. 

The best thing to have by your side heading into a pandemic situation is a fair bit of luck.  Luck in not catching it, or luck in having a mild illness when you do.  The next best thing would be to have good life support if you became seriously unwell – so the intensive care departments in big city hospitals will be an important factor in saving lives for the worst affected amongst us.  Tamiflu has its place as well, but some common sense is needed in analysing exactly what it can do for us – both as an individual and as a society.

Thankfully however. the odds are in our favour…. the vast majority of people who catch swine flu will be unwell for a few days and then get on with the rest of their lives. We don’t need to live in fear of this bug, despite of what the newspapers say!