My experience at the front line of swine flu pandemic planning

27 Apr 09

"The bottom line is, until an effective vaccine is developed, there’s little than can be done to stop it spreading."

But underpinning all the HPA’s work was a constant fear of the big one – pandemic flu. And sitting next to the pandemic flu team on a daily basis, reading contingency plans and participating in exercises, I was given almost by osmosis a pretty clear idea of how a flu pandemic might develop.

None of this is any big secret – you can read it all in much more detail in the pandemic flu national framework, or the joint RCGP-BMA pandemic flu guidance for GPs – and much is widely known. But as journalists around the country scramble for the facts, it’s worth remembering a few key points:

1. Interventions can be limited. Closing the borders doesn’t work – the Government’s modelling suggests even a travel ban that is 99.9% effective would only delay the arrival of a pandemic by two months at the most. Modelling in the national framework also suggests that widespread public use of face masks, cordons sanitaires to isolate affected communities and even a blanket ban on large public gatherings are all likely to be relatively ineffective.

Targeted use of antivirals and stringent infection control and hygiene measures are likely to be more useful - but the bottom line is, until an effective vaccine is developed, there’s little than can be done to stop it spreading.

2. Pandemics last a long time. While each one is different, the best modelling suggests that it will reach the UK between 4-8 weeks after it begins in the country of origin. Once in the UK, ‘it is likely to spread to all major population centres within one to two weeks, with its peak possibly only 50 days from initial entry.’ There may also be subsequent pandemic waves – the 1918 pandemic lasted 18 months. Should we flee to the hills, I used to be asked at the HPA. Not unless you’re willing to stay there indefinitely, we replied…

3. There will be massive disruption. Leaving aside the number of excess deaths – projected at anything from 55,000 to 750,000, depending on the nature of the virus – up to 50% of the workforce may require time off at some stage and the already-reeling economy will be hit hard. And for GPs, maintaining routine care for patients not suffering from flu will be a key challenge, as the pandemic threatens to swamp the health service.

4. Which leads to the final point – at the end of the day, it will be GPs who will be at the sharp end of any pandemic. In the current, pre-pandemic phase, the Health Protection Agency is rightly taking a lead role (my overworked former colleagues were co-ordinating every media query today, with bodies such as the NHS Direct seemingly unwilling to speak out of turn). But if flu spreads widely, it will be down to PCTs and GPs. Even though patients will be encouraged to self-care and access antivirals by phone, the RCGP estimates the average 6,000-patient practice can expect around 186 cases in the peak week of the pandemic.

We’re getting ahead of ourselves, of course. It may well be that no pandemic develops, that swine flu disappears into obscurity as quickly as it emerged.

But if – or when – a pandemic does emerge, GPs will be very much on the frontline.