As the headlines descend into hyperbole, Dr Mark Porter advises on how to avoid H1N1, and what to do if you think you may have it

When the Health Secretary, Andy Burnham stood up in Parliament at the beginning of the month and announced that there could be as many as 100,000 new cases of swine flu a day by the end of August there was an audible intake of breath. Just over a fortnight later and that gloomy prediction is looking increasingly realistic — the latest estimates suggest that we might have breached the 10,000 new cases a day threshold in the early part of last week, the death toll is mounting, and hundreds of people have been admitted to hospital.

Now for the good news: the influenza A (H1N1) virus causes a milder illness than expected. Like all flu viruses it can and will kill some people, but for the vast majority of people who catch it, it will mean little more than a few days in bed and a week or two off work, school or college.

The latest government predictions may be worrying, but predictions of anywhere between 19,000 and 65,000 deaths this winter suggest that swine flu is only marginally more virulent than some of the more aggressive seasonal strains. The 1989-1990 flu epidemic, for instance, is thought to have been responsible for as many as 30,000 deaths in the UK.

These predictions are little more than educated guesses, which is why the authorities are erring on the side of caution — it is their job to plan around a worst-case scenario. But while good planning can help to minimise the impact of the virus, widespread panic is only going to make the situation worse. There is very little that individuals, families or employers can do to protect themselves from the infection other than remaining calm and following the latest guidance.

Who is most at risk?

• Children aged under 5 and adults aged over 65.
• Pregnant women.
• Anyone with continuing lung disease, including asthma.
• People with heart, kidney or liver disease.
• People with diabetes, cystic fibrosis, sickle cell disease, or neurological conditions such as cerebral palsy, stroke, multiple sclerosis or muscular dystrophy.
• Anyone with a weakened immune system due to disease or treatment (including chemotherapy and steroids).

How likely am I to get swine flu?

The worst-case scenario on which the authorities are basing their plans is that as many as one in ten of the UK population will catch the virus by the end of August, and that one in three will catch it this winter — meaning that two out of three will not. Children aged under 14 seem particularly susceptible to developing swine flu, and it is more of a threat to the youngest ones.

How dangerous is it?

Assuming that the virus does not mutate to become more virulent (and it hasn’t so far), it is thought that one in seven cases will develop some form of complication (typically a chest infection) and that 1 in 50 will require a stay in hospital.

The fatality rate is expected to be at least 1 in 1,000 (similar to normal seasonal flu) with some predictions putting it as high as 1 in 200. The 1918 pandemic had a fatality rate of at least 1 in 40.

What are the symptoms?

Seek advice if you have a high temperature (38C or more) and two or more of the following symptoms:

A cough A runny nose Limb or joint pain Headache Vomiting Diarrhoea Until the National Pandemic Flu Service is in place (look out for announcements later in the week), there is no one-stop shop for confirming the diagnosis and accessing treatment and you have a number of options (see next question).

What do I do if I think I may have caught it?

You should stay at home to avoid spreading the infection and follow the advice in the box overleaf. If you need Tamiflu or Relenza, arrange for a friend, relative or neighbour to collect it from the pharmacy or nearest distribution point to which you have been directed.

Different parts of the country have different provisions to cater for people who don’t have a “flu friend”. NHS Gloucestershire, for example, has an agreement with the Red Cross, which is now providing a 24-hour collection and delivery service for people who have no other way of obtaining their drugs. There is no prescription charge.

Time is important. The sooner you start treatment the better, particularly if you are in one of the high-risk groups. Ideally, antivirals should be started within 48 hours of the onset of symptoms. The symptoms for swine flu are no different from those of any other flu. They tend to come on rapidly (within hours), unlike other viral coughs and colds that tend to develop over a day or two.

You can use the symptom checker at www.nhs.uk and follow the advice given. Call NHS Direct on 0845 4647 if you live in England or Wales, 0845 4242424 (NHS 24) in Scotland, and 0800 0514142 in Northern Ireland. Or try the swine flu information line on 0800 1 513 513 from anywhere in the UK If you are still concerned, or directed to do so by the sources above, your next step is to contact your GP. DO NOT go to your surgery, pharmacy or to A&E.

What should I do if I am in contact with someone who has swine flu?

Carry on as normal unless you develop symptoms. Contacts of people with swine flu are no longer routinely being given antivirals, although it may still be considered for people in the high-risk groups (see box overleaf).

How can I protect myself?

There is no need to change your daily routine. Masks are a waste of time and your best defence is good personal hygiene and steering clear of anyone who is unwell. The spread is mainly airborne, via the virus-laden droplets produced by coughing and sneezing — which is why it is vital that everyone coughs and sneezes into tissues before throwing them away — but it can also survive on hard surfaces for many hours. So wash your hands after travelling into work on the bus or train and, if you are in a public place, wash them regularly throughout the day or use an antiseptic handwash or wipe.

Should I buy Tamiflu?

No. There is enough Tamiflu stockpiled to treat everyone in the country and it is vital that these supplies are available for those who need them. It won’t help if they are stockpiled in the bathroom cabinets of the two-thirds of the population who are unlikely to get swine flu this year.

If you need an antiviral, you will be supplied with some within a matter of a few hours. Do not try to buy your own supply over the internet — you will almost certainly end up with counterfeit drugs that won’t do you any good, and could do you a lot of harm.

When is the vaccine going to be available?

The UK is in line to be one of the first countries to start vaccination, and the programme is likely to begin in September. There are two vaccines in the pipeline, and both are in the final stages of testing, although there is currently some controversy about whether this process should be fast-tracked to get supplies out sooner. Shortcuts in safety testing are acceptable if a swine flu pandemic poses a significant threat, but not if it is no worse than a normal seasonal outbreak.

Whatever the final release date, key personnel and the most vulnerable are likely to be the first in line for the vaccine, with the rest of the population being immunised as quickly as NHS resources and supplies allow. If you have already had swine flu, you will have natural immunity to further infection, but you are still likely to be offered vaccination.

Will I be all right once I have started Tamiflu?

Tamiflu (a tablet that is taken twice daily for five days), and the other anti-viral, Relenza (inhaled twice daily for five days), work by making it difficult for the flu virus to spread and reproduce.

It has three potential benefits: to shorten the duration of the illness, to reduce the rate of complications such as pneumonia, and to reduce the risk of passing the infection on to someone else.

Antivirals remain the best weapon we have, but neither drug will fully protect you from complications, so contact your GP if you are concerned. A persistent fever, a worsening cough and shortness of breath are signs that you may need additional treatment.

What if I am pregnant?

Pregnant women, particularly those in the latter stages, are at higher risk from swine flu and should take antivirals. Neither Tamiflu nor Relenza has been specifically tested in pregnancy, but there has been no evidence of any harm to the developing babies of several hundred pregnant women who have taken it — a finding backed by animal studies. Relenza is the drug of choice in pregnancy as it is inhaled and gives lower concentrations in the blood, so less reaches the baby.

Source: Times Online UK

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