Better Health For All

As widely predicted, swine flu appears to be plateauing and slipping from the headlines – for a while at any rate, helped largely by the school holidays. Time for some well-earned R&R all round.

What have we learned so far? What lessons to help us face a possible second, more virulent wave in the autumn?

I think perhaps the main lesson is that despite about five years of preparation, scenario planning and multi-agency live exercises, we didn’t expect the unexpected.

Whilst flu experts were anxiously monitoring poultry farmers in south east Asia and bird migration patterns across the globe, the pandemic surprised everybody by popping up in Mexico, from pigs.

For reasons still unclear the UK rapidly became the most affected country outside the Americas, with outbreaks centring largely on schools, fuelled by the number of young people returning from trips to America.

When WHO raised the level to 6, despite repeated reassurances that for most people the resulting illness is mild and recovery fairly rapid, a few high-profile deaths and a news-hungry press combined to whip up a huge surge of demand for diagnosis and antivirals that threatened to overwhelm the system. Primary care was swamped and the national flu line was not yet ready to take the load. It became more a pandemic of worried well than swine flu.

Then, with the policy of giving antivirals to anyone whether they were in a priority group or not, we had concerns about wasting them on people who didn’t need them or wouldn’t benefit from them, and worries about developing resistence or unnecessarily risking side-effects.

This gave the press another opportunity, this time highlighting the ‘confusion’ over the official advice for pregnant women  – actually caused more by statements from various professional bodies rather than the Department of Health. Nonetheless, the government got the blame.

And most recently the focus has shifted to whether the vaccine will be deployed in time and whether there are enough intensive care beds and ventilators to see us through a potential double whammy of swine flu plus seasonal flu this coming winter.

So, as we enter a strange lull, there’s lots to reflect on and learn, not just about managing the pandemic, but perhaps mostly about managing public expectations and the media. Thank goodness the virus was relatively mild.

And another lesson, for those who decide these things. Local public health teams and health protection units have been at the forefront of the fight against the pandemic and have thoroughly proved their worth. All the more reason therefore to beef up the public health workforce nationally, increase its capacity and capability, and develop its leadership.

As with the Stanley Royd salmonella outbreak 25 years ago which ushered in a new era for public health, it’s an ill wind that blows nobody any good.

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