Sally Furniss
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Dialing for Diagnosis Helps U.K. ?Flu Friends? Spread Treatment
By Michelle Fay Cortez
July 24 (Bloomberg) -- Jessica Kennedy got a sore throat after going to Glastonbury, the iconic U.K. musical festival where 140,000 fans camped out to see Bruce Springsteen and Neil Young jam during the last week of June.
Then she started feeling disoriented. Three days after her first symptom, Kennedy was bedridden with a 103-degree fever.
?I was really out of it,? Kennedy, who works at the charity Water Aid, said in a telephone interview. ?I was slightly hallucinating.?
The 24-year-old Londoner was diagnosed with swine flu without ever seeing a doctor. She filled out an online checklist, and got an automatic call back from the local swine flu hotline. Since the number of cases in north London was so high, including in her home of Stoke Newington, the doctor said she probably had influenza and advised her to stay home.
The U.K., which yesterday reported 100,000 new flu cases in the last week, is stepping up its unprecedented approach to treatment with a nationwide dial-in service for people who suspect they have swine flu. Patients like Kennedy can call and talk to one of as many as 2,000 trained operators. The goal of the National Pandemic Flu Service is to ease the burden on the nation?s doctors and make it simpler to get antiviral drugs.
?The pandemic flu service is quite an innovative way to manage the demand without overwhelming our doctors and nurses in primary care centers with a gush of patients coming through,? said Ara Darzi, the U.K. health minister who stepped down this week. ?Our model is designed to treat patients in their own homes and their own communities, rather than overwhelm hospitals,? he said in an interview on July 20, his last day in office.
Speeding Treatment
The U.K. is focused on speeding treatment, after abandoning efforts to contain or mitigate the spread of the disease, which the World Health Organization has called ?unstoppable.? Initially the government tried to prevent the spread of the pandemic virus, known as H1N1, by testing people for the infection, quarantining patients, giving them and their close contacts Roche Holding AG?s Tamiflu and closing schools.
The new pandemic service ?opens up an alternative channel of access to the National Health Service through the telephone and Internet,? said Liam Donaldson, chief medical officer for England, at a press briefing in London yesterday. ?Call center operatives will follow medically prescribed algorithms.?
Some patients with suspected flu, such as pregnant women and children less than a year old, should see their doctors in person, Donaldson said.
100,000 Cases
The U.K. Health Protection Agency yesterday reported 100,000 new cases of swine flu in England last week, almost double the week before. Doctors reported 155 cases of flu-like illness per 100,000 people across England and Wales in the week ended July 19, the Royal College of General Practitioners said yesterday. That?s approaching the epidemic level of 200 cases per 100,000 seen in the U.K. winter of 1999-2000.
?In the last couple of weeks there has been a sharp increase in the number of cases of influenza, and a gradual spread across the country,? said Douglas Fleming, director of the Royal College of General Practitioners research and surveillance center, in a telephone interview. ?It was predominantly in school children and young adults, and now it?s spreading across the age ranges.?
The outbreak could lead to more than 65,000 deaths, the government estimated last week. The virus killed more than 700 worldwide since April, according to the WHO in Geneva.
Flu Friends
Doctors in hard-hit areas such as London have seen a six- fold increase in their workload, mainly in the form of calls from people worried about getting influenza, said Laurence Buckman, chairman of the British Medical Association?s general practitioners committee and a physician in the north London district of Finchley.
?It?s much more the people who are worried about flu, rather than the people with it,? Buckman said in a telephone interview. ?The phone calls are so many that you can?t deliver care for the people in the room.?
The program includes distribution centers where ?flu friends? can go to pick up a course of Tamiflu to fight the disease. The friends are supposed to slip the medication through a mail slot to reduce the risk of transmission. Given the mild infections and quick recovery most people have, quarantines haven?t been enforced.
The new service should make an enormous difference, if it holds up well, Buckman said. A similar initiative in Finchley was disbanded after the volume of calls overwhelmed the phone banks, he said.
Widespread Disease
?If this means that people who are ill can get to see me, that will be better,? Buckman said. ?This is meant to help people who have concerns, who have such obvious flu that they don?t need a doctor or nurse to get access to Tamiflu, or if they want reassurance that they don?t need the drug.?
European health authorities are stepping up their surveillance of swine flu rates in the U.K. It is the only area with widespread disease and high intensity levels in the 53 countries in the WHO?s European Region.
England reported the highest infection rates seen in the past eight years, even though the influenza season is traditionally finished in July. The country accounted for 65 percent of all confirmed cases in the region, according to a report from the WHO?s office for Europe. The next highest rates came in Spain, accounting for 8 percent of cases, and Israel, with 6 percent of cases, the report found.
While the surge in cases is worrisome, the number of people dying from the disease is still somewhat low, officials said. The number of swine flu deaths was 26, the government said yesterday, the same as it reported last week.
Mild Illness
?You have to remember that swine flu is a mild illness for most people,? Buckman said. ?Quite a number have few or no symptoms, who are barely ill. During the early phases, I swabbed a few people who were positive who had no symptoms at all.?
The aggressive approach may boost the number of people who are diagnosed with swine flu, even though they have a different condition, Darzi said. Others may be erroneously told they are free of the infection, he said.
?I have no doubt there will be some false positives and some false negatives,? he said. ?You have to remember everything we do has risks and benefits. I think the benefits outweigh the risks here.?
Kennedy, who says she had ?proper flu,? fully recovered from her illness while staying home and resting.
?I?d like to hope that I will have some natural immunity,? said Kennedy. ?I?ve heard that the flu changes so fast that it doesn?t always work that way. I?ll probably get it again.?
To contact the reporter on this story: Michelle Fay Cortez in London at mcortez@bloomberg.net
Last Updated: July 24, 2009 03:44 EDT
http://www.bloomberg.com/apps/news?pid=20601085&sid=avzSEi_iRFzI
By Michelle Fay Cortez
July 24 (Bloomberg) -- Jessica Kennedy got a sore throat after going to Glastonbury, the iconic U.K. musical festival where 140,000 fans camped out to see Bruce Springsteen and Neil Young jam during the last week of June.
Then she started feeling disoriented. Three days after her first symptom, Kennedy was bedridden with a 103-degree fever.
?I was really out of it,? Kennedy, who works at the charity Water Aid, said in a telephone interview. ?I was slightly hallucinating.?
The 24-year-old Londoner was diagnosed with swine flu without ever seeing a doctor. She filled out an online checklist, and got an automatic call back from the local swine flu hotline. Since the number of cases in north London was so high, including in her home of Stoke Newington, the doctor said she probably had influenza and advised her to stay home.
The U.K., which yesterday reported 100,000 new flu cases in the last week, is stepping up its unprecedented approach to treatment with a nationwide dial-in service for people who suspect they have swine flu. Patients like Kennedy can call and talk to one of as many as 2,000 trained operators. The goal of the National Pandemic Flu Service is to ease the burden on the nation?s doctors and make it simpler to get antiviral drugs.
?The pandemic flu service is quite an innovative way to manage the demand without overwhelming our doctors and nurses in primary care centers with a gush of patients coming through,? said Ara Darzi, the U.K. health minister who stepped down this week. ?Our model is designed to treat patients in their own homes and their own communities, rather than overwhelm hospitals,? he said in an interview on July 20, his last day in office.
Speeding Treatment
The U.K. is focused on speeding treatment, after abandoning efforts to contain or mitigate the spread of the disease, which the World Health Organization has called ?unstoppable.? Initially the government tried to prevent the spread of the pandemic virus, known as H1N1, by testing people for the infection, quarantining patients, giving them and their close contacts Roche Holding AG?s Tamiflu and closing schools.
The new pandemic service ?opens up an alternative channel of access to the National Health Service through the telephone and Internet,? said Liam Donaldson, chief medical officer for England, at a press briefing in London yesterday. ?Call center operatives will follow medically prescribed algorithms.?
Some patients with suspected flu, such as pregnant women and children less than a year old, should see their doctors in person, Donaldson said.
100,000 Cases
The U.K. Health Protection Agency yesterday reported 100,000 new cases of swine flu in England last week, almost double the week before. Doctors reported 155 cases of flu-like illness per 100,000 people across England and Wales in the week ended July 19, the Royal College of General Practitioners said yesterday. That?s approaching the epidemic level of 200 cases per 100,000 seen in the U.K. winter of 1999-2000.
?In the last couple of weeks there has been a sharp increase in the number of cases of influenza, and a gradual spread across the country,? said Douglas Fleming, director of the Royal College of General Practitioners research and surveillance center, in a telephone interview. ?It was predominantly in school children and young adults, and now it?s spreading across the age ranges.?
The outbreak could lead to more than 65,000 deaths, the government estimated last week. The virus killed more than 700 worldwide since April, according to the WHO in Geneva.
Flu Friends
Doctors in hard-hit areas such as London have seen a six- fold increase in their workload, mainly in the form of calls from people worried about getting influenza, said Laurence Buckman, chairman of the British Medical Association?s general practitioners committee and a physician in the north London district of Finchley.
?It?s much more the people who are worried about flu, rather than the people with it,? Buckman said in a telephone interview. ?The phone calls are so many that you can?t deliver care for the people in the room.?
The program includes distribution centers where ?flu friends? can go to pick up a course of Tamiflu to fight the disease. The friends are supposed to slip the medication through a mail slot to reduce the risk of transmission. Given the mild infections and quick recovery most people have, quarantines haven?t been enforced.
The new service should make an enormous difference, if it holds up well, Buckman said. A similar initiative in Finchley was disbanded after the volume of calls overwhelmed the phone banks, he said.
Widespread Disease
?If this means that people who are ill can get to see me, that will be better,? Buckman said. ?This is meant to help people who have concerns, who have such obvious flu that they don?t need a doctor or nurse to get access to Tamiflu, or if they want reassurance that they don?t need the drug.?
European health authorities are stepping up their surveillance of swine flu rates in the U.K. It is the only area with widespread disease and high intensity levels in the 53 countries in the WHO?s European Region.
England reported the highest infection rates seen in the past eight years, even though the influenza season is traditionally finished in July. The country accounted for 65 percent of all confirmed cases in the region, according to a report from the WHO?s office for Europe. The next highest rates came in Spain, accounting for 8 percent of cases, and Israel, with 6 percent of cases, the report found.
While the surge in cases is worrisome, the number of people dying from the disease is still somewhat low, officials said. The number of swine flu deaths was 26, the government said yesterday, the same as it reported last week.
Mild Illness
?You have to remember that swine flu is a mild illness for most people,? Buckman said. ?Quite a number have few or no symptoms, who are barely ill. During the early phases, I swabbed a few people who were positive who had no symptoms at all.?
The aggressive approach may boost the number of people who are diagnosed with swine flu, even though they have a different condition, Darzi said. Others may be erroneously told they are free of the infection, he said.
?I have no doubt there will be some false positives and some false negatives,? he said. ?You have to remember everything we do has risks and benefits. I think the benefits outweigh the risks here.?
Kennedy, who says she had ?proper flu,? fully recovered from her illness while staying home and resting.
?I?d like to hope that I will have some natural immunity,? said Kennedy. ?I?ve heard that the flu changes so fast that it doesn?t always work that way. I?ll probably get it again.?
To contact the reporter on this story: Michelle Fay Cortez in London at mcortez@bloomberg.net
Last Updated: July 24, 2009 03:44 EDT
http://www.bloomberg.com/apps/news?pid=20601085&sid=avzSEi_iRFzI