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How not to manage an influenza outbreak? Let me count the ways.

Central Government has been congratulating itself on a swine flu pandemic so far excellently managed.

Central Government has been congratulating itself on a swine flu pandemic so far excellently managed.

‘We are the best prepared country in the Western World to manage this process', they say, and as the first wave of infection dies down; ‘we can afford to pat ourselves on the back'.

"Didn't they do well!" as a famous comedian once said.

I'm sorry to rain on their parade, but the Jobbing Doctor doesn't think they have done terribly well.

The areas that they haven't done well: the attendant publicity was not well managed. The constant drip-drip-drip of statistics in relation to numbers of cases and the very small numbers of fatalities enabled media outlets to keep the story on the front pages. This engendered a rising sense of panic amongst my patients.

Worse still was the role of the Chief Medical Officer, Professor Liam Donaldson, whose media appearances (and wasn't he always available) were not helpful. He didn't understand that appropriate scientific speculation would always be interpreted as the worst case scenario. So a range of possible fatalities gets translated in the ferrel press as "65,000 people could die of swine ‘flu' says Chief Medical Officer". Not helpful.

General Practice has not had any help at all for coping with the additional strain. That's fine, as we never asked for help: as a front-line service we are used to dealing with the ebb and flow of demand. Insisting on swabbing the patients (a process we abandoned after 2 days) was a pointless exercise. What does it achieve?

We were not helped by the avalanche of documents channeled through the Primary Care Trusts with the ‘algorithm of the week'. My e-mail inbox was clogged with communications from self-important minor functionaries who have finally found something useful to do. I had given up on my NHS e-mail address when I started getting 40-50 e-mails a day, and this doubled the number.

The National Flu pandemic line was the final piece in the central command-and-control jigsaw. This and the on-line version have been a bad decision in Jobbing Doctor's view. The problem is that most of the people who have been diagnosed with swine flu don't actually have swine flu. They have colds, and ear infections and kidney infections and nothing much. Some might have seasonal flu, and some might actually have swine flu. The people who were manning the hotline had no experience at all, and were working from a computer programme. All pretty unsatisfactory.

Then there is Tamiflu. Government had stockpiled 30 million doses of this stuff, and many people have commented that it was almost past its sell-by date, so you can imagine someone in the Department of Health saying - "we've got this stuff, it will soon be worthless, lets design a programme to use it so we can be seen to be doing something".

Tamiflu has not impressed me much. I have never ever prescribed it for any type of ‘flu', and the data on it seems pretty weak. We also have the mindset developing in the population that if you have ‘flu', then you must have Tamiflu. This will undoubtedly impact on our daily management of colds and flu, with increasing demands for expensive and pretty ineffective medication.

So the early self-congratulation from the Department of Health is premature. I would hope that more sensible people would have a long hard look at how it has actually been at the work-face.

Could do better.

The Jobbing Doctor The Jobbing Doctor

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