Friday, 12 June 2009

Swine Flu

I've been reading some of the posts to the BBC about Swine Flu. The predictability is awesome, mostly along the lines that this is a media hype.
I looked at the figures from CDC in the USA. As of today just over 13,000 cases and 27 people have died, in other words about 1 death in 500 cases. At the moment in the UK, as I understand it, we are still trying to contain Swine Flu. That means each time there is a case then all the possible contacts are traced, and given antiviral drugs. Classes or whole schools are closed, people sent home from work, whatever it takes to try and stop each case giving it to lots more people. So far this has kept the numbers down to 800 cases.
It also means that all these cases are going into hospital as needed and no doubt getting the best possible treatment. It also helps that it's summer, a time when Flu viruses don't usually spread in the UK.
If the numbers increase faster then it won't be possible to contain it because there will be just too many contacts to trace, and not enough health workers to do it.
You might think contact tracing is easy, but for Flu it is made more difficult because the incubation period is short, and new cases are often infectious before they have symptoms. Even if everyone is being very responsible (how likely is that?) and not going out when they have symptoms, they may still give it to lots of others before they know that they have it. Plus of course there will be very mild cases who don't even realise that they have flu, and they can still spread it.
Make a list of everyone that you met three days ago and then see if you can find them all in the next two days, and see if you can find all the people that they met in two more days, and all the people that they met in two more. You get the idea?
Once it gets out of hand, in other words when it is spreading faster than the health workers can keep up with it then we will move to the next stage of the strategy. I think what is supposed to happen then is that if you think you have symptoms then there will be a number to phone in order to collect your antiviral pills. You'll probably have to send someone to collect them and while they are there they might as well get some for themselves because they will catch it off you when they bring you the pills. If you don't start taking the pills within about a day of symptoms starting then they don't work as well, so make sure you have your pill collecting volunteer handy.
If we are lucky, and sunshine still works then we might well contain it until next autumn, let's hope so. Once it gets out of hand then probably 20% of the population will get it, possibly more, which is about 10,000,000 cases and if 1 in 500 die then that's 20,000 deaths. Of course if it gets to that, then probably they won't all be treated as well, and those who are already ill may find it harder to avoid because there will be so much more virus circulating, so we might have more than 20,000 deaths.
On average there are just under 10,000 deaths from all causes each week in the UK; so a mild flu outbreak which adds 20,000 deaths over a 10 week period will increase deaths by about 2000 per week, a 20% increase. At that rate the funeral service should cope and we won't have bodies in freezer vans waiting to be cremated or burried or need to have funeral pyres like the foot and mouth outbreak. It wouldn't take much more than that to cause a problem, the funeral market is pretty stable so there is not a lot of competition and over capacity. If the virus got a bit more lethal and particularly if it killed younger people who were not about to die anyway, then queues to be burried will develop, and once they get behind then they will get more and more behind over the period of the epidemic. Well I suppose we could cremate people two at a time or have church services in the middle of then night (so long as the preacher doesn't have flu).
So, to sum up, for all those cynics saying it's all media hype, I suggest that they get out there and catch it as quick as they can. If they are right, and it's mild then they will soon be immune, and able to collect pills for everyone else, and if they are unlucky and die, at least they won't have to queue for a funeral.

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