While the H12N1 Swine Flu continues to spread in the UK the government continues floundering in it’s response. There appears to be complete confusion on the issue of Tamiflu, the antiviral drug used to “treat the flu.”  Chief Medical Officer Sir Liam Donaldson appears ready to distribute vouchers to anyone off the Internet or otherwise, just days after giving doctors permission to not prescribe Tamiflu if their phone rings too much.

Because patients must be treated with 48 hours after the onset of symptoms there is limited usefulness for the drug. It also does not cure the flu, it only shortens the duration by 1-2 days. While some projections are that widespread distribution of Tamiflu to the general population would save millions of lives, the reality is no one knows if Tamiflu would be effective at all  with this type of distribution. It is more likely to create widespread resistance and render Tamiflu a useless drug.  Tamiflu is a tremendous asset for a pandemic but it should be reserved for susceptible populations and specific situations and remain under the control of doctors, not the government. Isolation and preventative measures are our front line defense against the pandemic, not handing out Tamiflu to everyone.

A case in point is the Air Force Academy outbreak of Swine Flu. It is early and Tamiflu could be administered to the entire population since they live in close quarters and could be sequestered short term in the contained environment of the Academy. Or they could be more conservative and administer Tamiflu to anyone with a history of respiratory or immune problems making them a higher risk for serious complications, and restrict the campus short term. Letting everyone in Colorado Springs have a free voucher for Tamiflu would be irresponsible.

Tamiflu is not a panacea and using it as one will probably render it useless for the people who need it most. Lets hope the UK does not create a resitant strain of flu via massive distribution of vouchers.

UK new Health Secretary Andy Burnham predicted the H1N1 swine flu could be infecting 100,000 people daily by August with 40 deaths per day. With about 7000 cases currently and reportedly doubling daily, one has to wonder where these projections come from. With the current mortality rate and experience in the U.S. these projections seem inflated to say the least.

More troubling is Mr. Burnham’s statement that Doctors will be given the authority to not prescribe Tamiflu if they are overwhelmed with calls. Mr Burnham is engaging in the act of practicing medicine at this point. It should not be under his purvey to make such a declaration. That is a decision that should be left to the doctors and makes no sense, given that the UK reportedly has ample supplies of Tamiflu. Just because the phone is ringing has no bearing on evidence based medicine decision making.

Hopefully, health care reform in the U.S. when not lead to government meddling in patient care decision making of this nature. If your family doctor can’t decide whether your symptoms and history indicate the need for an  antiviral drug  they should take up another line of work. If they are not allowed freedom  in prescribing we may as well stay home and order whatever sounds good off the Internet. This is also someone who is very proud of the 18 week wait cycle. Eighteen weeks waiting for referrals for testing and treatment is not a model to emulate.  Health care reform can do better than this.

I

Table. U.S. Human Cases of H1N1 Flu Infection
Web page updated June 12, 2009,
11:00 AM ET (Updated each Friday)
Data reported to CDC by June 11, 2009, 3:00 PM ET

States and Territories*	Confirmed and Probable Cases	Deaths
States
Alabama	123 cases	0 deaths
Alaska	11cases	0 deaths
Arkansas	13cases	0 deaths
Arizona	597 cases	5 deaths
California	1094 cases	6 deaths
Colorado	75 cases	0 deaths
Connecticut	637 cases	1 death
Delaware	187 cases	0 deaths
Florida	417 cases	0 deaths
Georgia	39 cases	0 deaths
Hawaii	198 cases	0 deaths
Idaho	29 cases	0 deaths
Illinois	1983 cases	5
Indiana	201 cases	0 deaths
Iowa	92 cases	0 deaths
Kansas	97	0 deaths
Kentucky	106	0 deaths
Louisiana	134 cases	0 deaths
Maine	33	0 deaths
Maryland	139	0 deaths
Massachusetts	1078	0 deaths
Michigan	419 cases	1 death
Minnesota	153	0 deaths
Mississippi	59 cases	0 deaths
Missouri	46 cases	1 death
Montana	27 cases	0 deaths
Nebraska	71 cases	0 deaths
Nevada	162 cases	0 deaths
New Hampshire	92 cases	0 deaths
New Jersey	348 cases	0 deaths
New Mexico	155 cases	0 deaths
New York	1160	13 deaths
North Carolina	61 cases	0 deaths
North Dakota	31 cases	0 deaths
Ohio	53 cases	0 deaths
Oklahoma	93 cases	0 deaths
Oregon	189 cases	1 death
Pennsylvania	626 cases	2 deaths
Rhode Island	62 cases	0 deaths
South Carolina	60	0 deaths
South Dakota	14 cases	1 death
Tennessee	110 cases	0 deaths
Texas	2049 cases	3 deaths
Utah	688 cases	2 deaths
Vermont	32 cases	0 deaths
Virginia	90 cases	1 death
Washington	584 cases	2 deaths
Washington, D.C.	33 cases	0 deaths
West Virginia	40 cases	0 deaths
Wisconsin	3008 cases	1 death
Wyoming	50 cases	0 deaths
Territories
Puerto Rico	7 case	0 deaths
TOTAL*(52)	17,855 cases	45 deaths

A mite over reaction from Prime Minister Kevin Rudd of Australia? The 14th confirmed case of H1N1 Swine Flu has him in a call to arms to fight the Pandemic. Every Year in Australia:

• Lightening kills 5-10 people per year and injures about 100.
• Over 1000 people are killed in motor vehicle accidents
• Over 200 People are killed walking down the street by cars
• About 30 bicyclists are killed in accidents
• Tobacco related deaths exceed 20,000
• Fatalities from heat are over 20
• Boating Deaths Are 40-50
• Sharks attack 60-70 people

Be Wise and Use Precautions but so far this appears to be an overreaction.

H1N1 Flu (Swine Flu) has possibly spread in a community based transmission from person to person in Japan with over 100 cases now. Since this is different from infections resulting from travel to the U.S or Mexico it may result in elevating the status to a  world pandemic. The H1N1 Flu is still considered mild in severity, even if it becomes labeled a pandemic.

Swine Flu May Be Human Error

U.S. Human Cases of H1N1 Flu Infection

U.S. Human Cases of H1N1 Flu Infection
(As of May 7, 2009, 11:00 AM ET)

States	Laboratory confirmed cases	Deaths
Alabama	4
Arizona	48
California	106
Colorado	17
Connecticut	4
Delaware	38
Florida	5
Georgia	3
Hawaii	3
Idaho	1
Illinois	204
Indiana	15
Iowa	5
Kansas	7
Kentucky*	2
Louisiana	7
Maine	4
Maryland	4
Massachusetts	71
Michigan	9
Minnesota	1
Missouri	4
Nebraska	4
Nevada	5
New Hampshire	2
New Jersey	7
New Mexico	8
New York	98
North Carolina	7
Ohio	5
Oklahoma	1
Oregon	15
Pennsylvania	2
Rhode Island	2
South Carolina	17
Tennessee	2
Texas	91	2
Utah	8
Virginia	11
Washington	23
Wisconsin	26
TOTAL (41)	896 cases	2 deaths
International Human Cases of Swine Flu Infection See: World Health Organization *Case is resident of KY but currently hospitalized in GA. NOTE: Because of daily reporting deadlines, the state totals reported by CDC may not always be consistent with those reported by state health departments. If there is a discrepancy between these two counts, data from the state health departments should be used as the most accurate numbe