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Swine flu – global disaster or just story of the week?

The national media is already showing signs of tiring of swine flu, but GPs may have to brace themselves for the long haul

By Richard Hoey

The national media is already showing signs of tiring of swine flu, but GPs may have to brace themselves for the long haul

‘The world was put on an unprecedented alert that a swine flu epidemic was imminent last night,' today's Daily Mail proclaims.

Except it does so on page 10, seven pages back from a story about a girl of two who is apparently cleverer than Carol Vordeman.

It's a neat illustration of the two sides of the swine flu story. It has the potential to develop into a global pandemic that could cost millions of lives - but its reality, so far, is a smattering of cases in the UK and elsewhere worldwide, and just one death outside of Mexico.

So one week after the original outbreak was announced, how bad is it looking? And how much should GPs read into the apparent differences in the deadliness of the illness in Mexico and elsewhere?

Associated Press is reporting that there have been 160 deaths in Mexico so far, and 2,498 suspected cases. If those figures were accurate, and it's an extremely big if, that would be a death rate of 6%.

A flu pandemic could apparently infect up to 40% of the UK population, so if we had a mortality anywhere near that, we would be heading for the worst-case scenario estimate of 750,000 or so deaths.

But few believe that's going to happen. Most of the 150 or so cases outside Mexico seem to have been fairly mild, the virus does not appear to be spreading like wildfire just yet and in Mexico there are even signs that new infections are already levelling off.

The most likely reason for the differences in death rate is the simplest – that there have been far more cases in Mexico than we know about. That would bring the mortality rate there down to a more manageable, although still alarming, level.

But there are a number of other hypotheses for why people who have swine flu outside Mexico generally seem to be bearing up better than those inside it.

1. Outside Mexico, cases have been reported pretty much exclusively by developed countries with good surveillance systems – and these also tend to have good access to antiviral treatment. So far, it does seem to be responding to antivirals.

2. The virus will be mutating all the time as it passes from human to human – and variants that cause milder illnesses may well spread faster than others that send patients rapidly to their bed, or indeed their grave. For just the same reason, truly scary Ebola tends to burn itself out after a 100 or so deaths, whereas the common cold gets everywhere. We're probably seeing the quick-spreading, milder versions of the virus so far, which is not to say that nastier versions may not come along later.

3. There may actually be biological reasons why the locals in Mexico have suffered worse than elsewhere – another virus circulating in the population, perhaps, or even differences in genetics or levels of immunity.

At the moment, nobody really knows.

But if in another week swine flu is back on the Daily Mail's front page, the chances are GPs really should batten down the hatches and prepare for a full-blown pandemic.

By Richard Hoey, Pulse deputy editor

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