07 Jul

Swine Flu Update 17

Published by MacDoctor on July 7th, 2009
11 Comments »

In a nice ironic twist, the MacDoctor is typing this swine flu update while off work with the flu. It could be swine flu, of course, but I haven’t had the urge to roll in mud, yet…

John Key has just announced that the government will buy lots of experimental vaccine to offer to their front-line staff. I confess to a modicum of skepticism here, as I recall that the same thing happened in the last swine flu epidemic. That vaccine, you might recall, did more damage than the virus, causing a number of cases of ascending motor paralysis. Admittedly, the vaccine manufacturing processes of today are far superior to the processes of 1975. But I think I am going to want to see some hard evidence that this vaccine is safe before I allow my practice nurse to approach me with a sharp object.

Of course, by December, the vast majority of frontline health care workers will have been exposed to Swine Flu and have developed natural immunity, so I suspect this is just the government wishing to be seen to be “doing something”. It all reminds me of the futile waste of money that was the MeNZB vaccine. Too little too late and at great expense. Frankly, the government would be better off using those doses on people with severe lung disease who have not yet been infected by the flu. At least they may gain some benefit – assuming it is demonstrably safe.

Now that there have been a few fatalities from the disease in this country, everyone is taking this epidemic far more seriously. The practice in which I am working has experienced a 20% increase in the past week, almost all of them upper respiratory illnesses (colds and flu). Some people seem quite put out that we are no longer swabbing every influenza-like illness nor are we dishing out Tamiflu. The Ministry of Health has requested that we do not give out scripts for Tamiflu for colds, mild flu or overseas travel. I have much sympathy with that request as the drug is not without side effects – many, of which, mimic flu. That’s right, Tamiflu can make your flu seem worse! There is also 100% resistance of seasonal flus to Tamiflu. For this reason, we are only providing it to people with flu-like illnesses AND risk factors (pregnancy, severe asthma, emphysema or heart disease) or to people who have severe respiratory symptoms.

Currently the background level of flu in the community is more than double last year’s (although this is within the normal range for levels of flu at this time of year). This probably indicates that a significant proportion of community flu is actually swine flu. Having had a couple of proper flus before, I can tell you that, if what I have is Swine Flu, it is fairly mild as flus go. I can still think (slightly) and type.

This is good news. If Swine flu is a short-acting, fairly mild flu in most people, few will need to access our strained health services, except for the unfortunates who get the severe disease. This means that our hospitals may actually cope with the disease. The other good news is that the current mortality of 4 cases per thousand is probably greatly exaggerated, as most confirmed cases have been swabbed because they have significant disease. In other words there is probably a large pool of people with very mild swine flu, who have not been confirmed.

If there is a much larger pool of mild cases in the community then the large number of confirmed cases in my side bar may, in fact, be far smaller than the actual number of cases. Should there be five times the number of actual cases, the mortality then becomes only twice the mortality of standard flu. Ten times the number and we are down to ordinary flu. Thus, large amounts of extra flu in our community, without a large increase in mortality, is a very good sign.

Unless, of course, you actually have the stupid disease. Now where did I put the paracetamol…?

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