Pandemic Flu: Here at Last?

By Jennifer Cole, Head of Emergency Management

As the UK is told to expect cases of swine flu following the outbreak in Mexico over the weekend, health services and emergency planners around the country will be waiting to see if this becomes the global influenza pandemic the world has feared.

If it is, it will be the greatest test the twenty-first century has so far thrown at UK emergency planners and responders. Dealing with the emergency lies not only in the ability of the health service to diagnose cases, administer vaccines and prescribe drugs, but in how calmly - or not - the public reacts. Panic could be the catalyst that makes or breaks our country's ability to respond to a threat that sits at the very top of the National Risk Register, above flooding and well above the threat from terrorism.

Anticipating the Pandemic

The outbreak has not been unexpected. Global influenza pandemics have occurred throughout history, caused by new strains of the disease to which humans have little immunity. Though their exact timing is irregular, they appear at the relatively steady rate of three in every one hundred years; the twentieth century saw its share in 1918-19, 1957 and 1968. Forty years since the last outbreak, we are, quite simply, about due for another.

What we are seeing in Mexico, the US and Canada may be the beginnings of this, but it is not all bad news. The very fact that a global outbreak is considered overdue means that from a health perspective we are better prepared for one now than we have ever been. The ability to control and monitor outbreaks has improved vastly.

The World Health Organisation ensures that countries work together to pool knowledge and resources, and to share information on suspected outbreaks as soon as possible. The UK, along with France, is considered to be one of the best prepared countries in the world. The UK Government has stockpiled millions of doses of the Tamiflu anti-viral drug, which can be used preventatively as well as to treat symptoms. There is already £500 million of flu medication at the ready and John McCracken, chief executive of the Health Protection Agency Emergency, has told the BBC that he considers this to be enough. Responders are well briefed and emergency plans have been well exercised.

In short, we - or rather the health system - should be able to cope. But to manage an outbreak effectively, the health professionals will need the general public to remain calm and collected so that the system is not strained any more than is necessary. Key to ensuring this is the messages that are passed to the public and the way in which those messages are disseminated by the Government and by the media.

Placing the Pandemic in Perspective

Most important of all, there should be a focus on putting the threat into context. Influenza pandemics do not wipe out populations but unfounded fears that they might, combined with a real or perceived poor response by the authorities, could discredit and even destabilise a government. After all, the authorities should be able to cope: while the worst-case estimates put the number of deaths from a new pandemic at around 750,000 in the UK, this is approximately one in eighty of the population. More realistic figures sit around one in 200-300, similar to the death rate seen in UK during the 1918-19 outbreak. Under normal conditions, just over 500,000 deaths are currently registered in England and Wales each year.

It is equally important to remember that as a population we are healthier, and our health system much more advanced, than when the flu pandemics of the twentieth century hit. The 1921 census shows us that more than 300-400,000 people per year routinely died of respiratory infections at that time, for instance, compared to around 100,000 today. Spanish flu - history's worst health crisis since the Bubonic Plague - did not even double the usual death figures for respiratory disease alone.

The influenza emerging from Mexico is a sub-strain of the H1N1 virus - the same one responsible for Spanish flu - with which science has a lot of experience, rather than the less familiar H5N1 'bird flu' strain that has long been the favourite to trigger the next pandemic. This gives scientists a head start in developing the vaccines and drugs that will be needed to combat a widespread outbreak. In fact, it may well be that all we need are the Tamiflu anti-viral drugs that have been stockpiled by governments around the world to 'hold the fort' while a more effective treatment is developed may.

A Resilient Healthcare System

It is also important to remember that, at the time of writing, all recorded deaths from the current outbreak had occurred in Mexico, a developing country where the socio-economic demographic and access to health care is very different from the UK. In the US, where healthcare is more advanced, all treated cases are recovering.

Of course, the most serious challenge comes not from the number of deaths a flu pandemic will cause, but from the additional numbers of the living who require treatment and hospital care before they recover. Here also, we will need to guard against panic. Not everyone will catch the disease. As much as seventy five per cent of the population will be naturally immune. Not everyone will catch it at the same time. Hospitals and doctor's surgeries, affected by sick leave as much as everyone else, will be stretched, but as long as the public remains calm and patient, they will be able to cope.

With the assistance of NHS helplines, many will be able to self-diagnose and have their drugs collected family and friends or delivered to their door, rather than venturing out to doctors' surgeries, infecting others as they go. The vast majority of those who catch the disease will not need hospital treatment; the public will need to be aware not only of how to recognise symptoms, but also of how to recognise the point at which those symptoms need treatment that only professionals can give.

This brings us back to the critical factor: communication. In the next few weeks, the role of the media will be more important than ever and language must be chosen carefully. Infection control experts may be 'scrambling' to respond, as the BBC website reports, but the etymology is that of a crack fighter squadron scrambling to engage an enemy, not a panicked crowd scrambling to escape. Emergency plans for dealing with a flu pandemic are robust, extensive and regularly exercised. We are as ready as we possibly can be.

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The views expressed above are the author's own, and do not necessarily reflect those of RUSI.