Swine flu has been spreading in Britain for three months. The virus has got about quite well, although the great majority of infections have been mild. Until two weeks ago reassurance about our preparedness for a pandemic was the order of the day. But the media tone changed with the reporting of the deaths of six-year old Chloe Buckley and Dr Michael Day. Chloe was said to have been infected with the virus but didn’t have the ‘underlying health conditions’ usually present in fatal cases, and Day was the first healthcare worker to have a lethal infection.
Coincidentally, the tenor of official public pronouncements altered too. The chief medical officer for England mentioned the possibility of 65,000 deaths. On television he was quick to qualify: that figure was a worst-case scenario, necessary for planning, not a prediction. But the number, not the caveat, got the publicity. There was also a change in the way that case statistics were announced, with a shift from laboratory confirmation to estimates based on GP consultation rates and clinical diagnoses. The overnight five-fold increase in ‘cases’ was inevitable. Lab tests tend to underestimate, and consultation rates increase because of the media coverage.
The media have been interested in rows about inconsistent advice to the pregnant after the death of Ruptara Miah on 13 July. The National Childbirth Trust advised postponing pregnancy during the pandemic, but was attacked by the Royal College of General Practitioners for pessimism. The NCT retracted the advice, blaming the Department of Health. The NHS Choices website recommends that pregnant women should avoid non-essential journeys and crowds. The Department of Health website was silent about these things.
Is the metropolitan media momentum soundly based? Its whiffs of panic are not restricted to journalists. It is a reasonable guess that cases and deaths in London and its surrounds are a powerful driver (a flu death in pregnancy in Scotland in mid-June had much less impact). The big question is whether the pandemic in England will continue to gather strength. If it is correct that school closures will seriously dampen down the spread of the virus (in 1957 the virus came to Britain in the summer but didn’t take off until the start of the autumn term in September), the peak has probably passed. And the swine flu epidemic in the UK is running about six weeks behind the US, where virus activity started to calm down about a month ago. Putting the pandemic into perspective helps. In the last decade in Britain the number of flu deaths every year has been a hundred times greater than in the 2009 pandemic to date.
The current UK Pandemic Plan is sound in parts, being responsible for good stocks of tamiflu, and is correct in expressing caution about school closures as a practical control measure. It doesn’t spell it out, but the problem is not whether to close, but when to reopen. After all, the H3N2 virus that caused the 1968 pandemic is still circulating and has been killing people every winter for the last 40 years.
But a bad effect of the plan has come from its worst-case philosophy – its expectation that an optimistic outcome in a pandemic would be 48,000 deaths in the first wave of cases. In my view this has infected opinion-formers with undue pessimism about current events, created a policy favouring the use of emergency vaccines – appropriate for a 1918 virus but questionable for swine flu – and provided proof of the correctness of the Thomas theorem: ‘If men define situations as real, they are real in their consequences.’