Hugh Pennington

'H1N1: now entering the recrimination phase,' a recent 'Editor's Choice' in theBritish Medical Journal was headlined. The piece began: 'If influenza was a rock band how would it rate its latest release, H1N1? Not too well, I suspect, despite the greatest prepublicity since – well, its previous release.' A nice summary. People have died – but in far fewer numbers than even the most optimistic official estimates predicted. Absenteeism has not stopped the trains or planes or threatened food supplies. The second wave came, but the virus had not mutated. We have been lucky, so far. The virus has been no nastier than seasonal flu, and the usual target for lethal infections, the elderly, have been largely spared, probably because of immunity conferred by H1N1 infections suffered by them 60 and more years ago.

Charles Haddon-Cave's Nimrod Review: An Independent Review into the Broader Issues Surrounding the Loss of the RAF Nimrod MR2 Aircraft XV230 in Afghanistan in 2006 was laid before Parliament and published by the Stationery Office on 28 October. Two days later it was out of print. The Review was not a Public Inquiry with statutory powers. It sat in Ministry of Defence premises. Some staff were seconded from the ministry. But its conclusions, and its naming of the incompetent, leave no doubts about its independence. The accident to XV230 was avoidable. My report identifies manifold shortcomings in the UK airworthiness and in-service support regime, and reveals matters which are as surprising as they are disturbing.

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 first death caused by swine flu virus outside the Americas occurred in Scotland on Sunday. The announcement generated more media interest than the declaration three days before by the World Health Organisation that the spread of the virus had moved into pandemic mode. But the declaration was expected and generated less fear than anticipated. The public can see that in Britain the virus is doing well – which is all that was needed to meet the pandemic criterion of sustained community spread in a region outside the Americas – and the message that the virus is mild is also well established, tempering the notion that the word 'pandemic' carries lethal overtones. But this means that a death requires explanation. There is no such thing as a naturally avirulent influenza virus. Even the mildest ones that infect humans can kill. They do it routinely every winter.

The spread of the novel influenza A(H1N1) virus through North America is nearly complete. Only three continental US jurisdictions (Wyoming, West Virginia and Alaska) and three Canadian provinces or territories (Newfoundland, Nunavut and the Northwest Territories) haven't reported cases. Its progress elsewhere is still slow, however. Japan (163 cases), Spain (103), the UK (102) and Panama (54) lead; vigorous containment is still the order of the day in the UK. But unless the North American epidemic slows soon, the continued export of the virus – in the coughs and sneezes of infected travellers returning home (particularly to the southern hemisphere, which is just entering its flu season) – has a good chance of defeating all best-laid plans. And it is doing well in Japan.