Patient Involvement Group
Church Street Practice, The Health Centre,
Mably Way, Grove, OX12 9BN

Pandemic Flu

Humans have an uneasy relationship with the flu virus. We are used to seasonal outbreaks or epidemics but thanks to a degree of immunity in the population and immunization programmes their scale and severity is limited.

However 2 or 3 times each century the flu virus adapts or exchanges genes with other flu viruses that infect animals to create a new ‘pandemic’ form of the virus to which we have little or no immunity. It can appear at any time of year, is a more severe illness and spreads rapidly around the world affecting hundreds of thousands of people.

The last pandemic was in 1968/9 ( Hong Kong flu) and the appearance of the H5N1 flu virus in birds (Bird or Avian flu), which has already demonstrated its ability to infect humans, has led some experts to believe we are on the brink of another.

Countries around the world, including the UK are developing their plans for dealing with a pandemic.

EM microscope picture of the H5N1 virus
that killed the first two people to contract ‘bird flu

‘---- its not a question of whether there will be another severe influenza pandemic but when’

‘--- the appearance of H5N1 (‘bird flu’) ----- signals the world has moved closer to the next pandemic’

World Health Organisation

What will it do?

A summary of the possible impact of pandemic flu in the UK makes uncomfortable reading but is a timely reminder we need robust national and local plans and that all of us should put some thought in to how we, as communities and individuals, should prepare.

• The scale and severity of illness will exceed that of even the most severe winter epidemics.
• Mortality in the UK is likely to exceed 50,000 deaths, possibly appreciably higher.
• Besides the elderly, excess mortality is also likely in younger adults and children.
• After a case occurs in Hong Kong , because it will take less than one month for the virus to reach the UK .
• Once cases begin to occur in the UK it will take only two to three weeks before activity is widespread and roughly a further three weeks (six weeks after initial cases in UK ) until activity peaks.
• It is possible that there will be more than one epidemic wave and, if a second wave occurs, it may be more severe than the first.
• Cumulative clinical and serological attack rates across all waves together may be in the order of 25% and 50% respectively. (25-50% of people in the UK are likely to contract the disease *)
• Increases in demand for health care services are likely to be very substantial in both primary care and hospital settings.

From: Provisional guidelines from the British Infection Society, British Thoracic Society, Health Protection Agency, in collaboration with the Department of Health 2006

It is likely the pandemic will come in several waves. The first wave will last 3-4 months and reach a peak at around weeks 6 to 8 at which time we could expect 5% of population to get flu. In our practice of approximately 12000 patients this equates to 240 new cases a week.

How many people will die from pandemic flu?

The number of people affected and the impact on the healthcare system will depend critically on the detailed properties of the pandemic flu virus and the proportion of the population who become ill (attack rates) could range from 10% to 50%. This range of scenarios gives mortality estimates ranging from 21,500 to 709,000 excess deaths in the UK.

What will the effect of pandemic flu be in the community?

Pandemic flu will impact on all services including health, police, fire, the military, fuel supply, food supply, food preparation, distribution and transport, prisons, education and business. All are likely to be affected by staff sickness, travel restrictions and other potentially restrictive countermeasures, and the knock-on effects of reduced transport, deliveries etc.

What are the symptoms of pandemic flu?

The incubation period (the time between catching the virus and the beginning of symptoms) is 1-4 days and the virus can be passed on to other people from the day before the illness to 5 days after it is over.

The symptoms of uncomplicated pandemic flu are:

Fever > 38C in adults, 38.5C in children

Fever of rapid onset begins to decline after day 3

Myalgia (muscle aches and pains)

Cough

Fatigue

The cough, weakness and fatigue can persist for up to 6 weeks more usually 2 weeks.

How to avoid catching or spreading pandemic flu

The virus is passed from person to person by breathing in air containing the virus produced when an infected person talks, coughs or sneezes. It can also be spread through hand/ face contact after touching a person or surface contaminated with the virus.

Simple precautions can greatly reduce the risk of catching or spreading it:

• Cover your nose and mouth when coughing or sneezing, using a tissue when possible;
• Dispose of dirty tissues promptly and carefully – bag and bin them;
• Avoid non-essential travel and large crowds whenever possible;
• Maintain good basic hygiene, for example washing your hands frequently with soap and water to reduce the spread of the virus from your hands to your face, or to other people;
• Clean hard surfaces (e.g. kitchen worktops, door handles) frequently, using a normal cleaning product;
• Making sure your children follow this advice.

What to do if you catch pandemic flu

Most otherwise fit people will be able to manage flu symptoms without prescription drugs. Uncomplicated cases should be managed at home. Appointments at the surgery and visits increase the risk of spreading the virus.

• Stay at home and rest;
• Take medicines such as aspirin, ibuprofen or paracetamol to relieve the symptoms (following the instructions with the medicines). Please note: Children under 16 must not be given aspirin or ready made flu remedies containing aspirin;
• Drink plenty of fluids;
• Contact your doctor if your condition worsens. (Advice on symptoms and signs to watch for will be publicised when a pandemic starts.)

What about anti viral drugs (Tamiflu)?

The H5N1 virus may be susceptible to some antiviral drugs and the Government has purchased enough courses of oseltamivir (Tamiflu) to treat 25% of the population. Not everyone will need the drug and it is not clear how effective it will be.

At best Tamiflu is not expected to prevent flu or cure it but may shorten the length of time it takes to recover from it and reduce the risk of complications. It is only likely to be effective if used within 2 days of the onset of symptoms. Guidance about who should have it will depend on the characteristics of any new flu virus.

What about vaccination?

Until the next virus to cause pandemic flu appears and its properties are known it will not be possible to produce a vaccine with any certainty of protecting people from the infection. It is unlikely a vaccine will be available before the first wave of infection is over.

The UK will need approximately 120 million doses to be available as soon as possible and the Government is working with industry to ensure an effective vaccine is available as early in a pandemic as possible.

The Department of Health is stockpiling 3.3 million doses of H5N1 (the bird flu virus) vaccines which may be used in frontline healthcare workers if there was a close enough match between the vaccine strain and the emerging pandemic strain.

Who is at special risk?

We cannot know which groups of people will be susceptible to the pandemic virus until it emerges. However, from experience of previous pandemics we know that it is not necessarily the young and the elderly.

Those with established chronic disease for example; chronic lung and heart disease are likely to require special precautions.

What are the local plans for dealing with pandemic flu?

A flu pandemic is likely to pose challenges to the health and social care system on an unprecedented scale. National and local plans for dealing with the effects are well under way.

Locally we expect to have to stop all non-essential work in the practice. This would include chronic disease clinics and non-essential services for example diabetic heart and blood pressure and asthma follow up.

Appointments at the surgery and home visits will be limited to those that are essential. In their place will be increased access to telephone advice through the surgery, NHS Direct and a National Flu Pandemic phone line will be available.

Strict infection control measures will be in place in the surgeries and will include stripping out soft furnishings from waiting areas and consulting rooms supplies of tissues and masks for patients with facilities for safe disposal. The practices will work together closely and at the peak of a pandemic work will be divided into flu and non-flu emergency services.

What can I do to prepare?

Advice will be available nationally when a Pandemic flu strain emerges and its properties are known but there are some simple things that you can do now.

1. Make sure you have a working thermometer. Knowing your temperature is an important indicator of whether you have flu and a way of monitoring its progress.
2. Keep a supply of paracetamol and/or ibuprofen. These medications help to reduce temperature and ease the aches and pains of flu.
3. Think about how you would manage if you or those around you had flu especially those who might need extra support during the illness. Who might be able to collect medication? Who could ensure they have an adequate diet and fluid intake? Who would look after their personal care needs? Who would contact medical services if they are not making a good recovery?

-- and finally

There will be another pandemic and whilst we cannot know the scale and severity we are in a better position now than at any other time in our long and fraught association with the flu virus to respond effectively. It will be a testing time and require planning co-ordination and co-operation from all of us to limit its impact.

For further information the following links may be helpful:

http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1303

http://www.dh.gov.uk/en/PandemicFlu/index.htm

http://194.74.226.162/infections/topics_az/influenza/pandemic/fluplan.htm

Dr Mark Drury
October 2007