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Early lessons from the swine flu pandemic

By Steve Nowottny

With the swine flu outbreak now officially all but over, PulseToday editor By Steve Nowottny looks at what we've learnt from the pandemic that hardly was

If the flu pandemic has taught us one thing, it's to expect the unexpected, so never say never. There's always the chance we could be caught off-guard by a surprise third wave. But yesterday the Chief Medical Officer Sir Liam Donaldson confirmed what GPs on the ground already knew - that with new cases of swine flu having fallen to their lowest level yet, the current outbreak is ‘virtually concluded'.

Over the coming weeks and months swine flu and the NHS's response to it will be subject to intense scientific scrutiny. (As I write, an invitation to an international swine flu conference in March with more than 20 breakout sessions has just popped into my inbox.) But it's not too early to draw a few preliminary conclusions – conclusions which might help shape our response to a future pandemic:

1/ Global spread is inevitable and rapid. When I blogged immediately after the swine flu story broke, I warned that ‘the best modelling suggests that it will reach the UK between 4-8 weeks after it begins in the country of origin.' While it's hard to pinpoint exactly when H1N1 first originated in Mexico, if anything, swine flu spread even quicker.

2/ The modelling got it wrong. Consistently wrong, in fact. First we were told that it could be very bad, avian flu bad, and it wasn't. Then the prediction was that it would die down as soon as early summer hit – in fact, GPs at practices across the country were at full stretch when the first wave peaked in mid-July. Then Sir Liam infamously admitted that DH modelling predicted as many as 65,000 people in the UK could die this winter – a prediction which was soon rapidly revised.

3/ Diagnosis by call centre leaves a lot to be desired. With the benefit of hindsight, of course, it's easy to forget the almost audible sigh of relief at practices up and down the country when the National Pandemic Flu Service first swung into action, just as the first wave was reaching its peak. But doubts soon set in, with Pulse revealing in September more than a third of practices had had patients suffer complications after being misdiagnosed, and reports of patients dying from meningitis. Lurid tales in the Daily Mail of call centre workers diagnosing patients while high on cannabis or drunk on vodka didn't do much to inspire confidence either.

4/ Pandemic response can take on a life and momentum of its own. Once the Government had set its pandemic response plans – geared perhaps too specifically towards avian flu – in motion, everything which followed became almost inevitable. Was such widespread Tamiflu necessary? Possibly not – but the stockpiles were there. Would the Government choose again to conduct such an ambitious mass vaccination programme? Possibly not – but at the time the decision was taken, it certainly seemed the sensible course of action.

5/ Finally, we got lucky. With the benefit of hindsight, much will be written about how the threat of pandemic flu was overplayed – and certainly hundreds of millions has been spent on dealing with a limited threat at the time that the NHS could ill-afford it. But ultimately the limited nature of the threat has been due to the nature of the virus itself rather than any public health intervention, and it's easy to forget how close some GP services came to toppling over.

Certainly for out-of-hours GPs in hotspot areas such as Birmingham and Tower Hamlets, swine flu won't be remembered as a damp squib. More of a lucky escape.

By Steve Nowottny


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