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Does my daughter have swine flu?

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It’s been a tough month for my 12-year-old; she dislocated an elbow on an activity trip, was involved in a car accident, and then, last Friday, went down with suspected swine flu.

And suspected it will remain as it developed a day after the policy of testing all possible cases was dropped. Like thousands of others, we are left wondering whether she has swine flu or just a run-of-the-mill fluey bug. No great problem for us, but later this summer there will be plenty of people cancelling their summer holidays and trying to claim on their travel insurance on the basis of suspected cases.

But although I have no intention of throwing a swine flu party, I’m not exactly distraught that it has hit the household early - before services become overwhelmed.

My experience was that the system is still working, but things could get dicey very quickly. Personalised care is likely to go out of the window for the majority of people. The emphasis will be on handing out Tamiflu and dealing with more complex cases.

So far, NHS Direct have been useless. After a long wait just to get into the phone system, I chose the swine flu option on their menu and talked to a call handler. She said a nurse would call me back but the waiting time for calls was 10 hours. I went to bed expecting a call at 5am on Saturday. I am still waiting.

My local out-of-hours service, which I rang after giving up on NHS Direct, was pretty efficient, getting a doctor on the line to me quickly, seeking Health Protection Agency advice, and arranging for Tamiflu to be dispensed at a community hospital.

The nurse who dispensed it said some people were being asked to travel nearly 20 miles to collect it. The clinic had given out four or five doses already that morning, yet had no extra staff to take on the time-consuming task of handing out the drug and giving additional information. That’s bearable when they have a handful of people a day, but would overwhelm them when numbers grow 10-fold.

Detailed information on swine flu is hard to find on NHS sites, and the availability of such information will become even more important as services get swamped and people can’t get through on the phone.

My daughter did not have a significant temperature, but did have all the other symptoms and had been in close contact with someone who lived in a swine flu hotspot and who had displayed similar symptoms. But finding information which allowed us to assess her individual risk was hard, and the online NHS Direct ‘swine flu symptom checker’ kept sticking on me. 

There are mixed messages going out to the public. I was told that the rest of the family, despite being close contacts of a suspected case, could go about their business as usual, unless they displayed symptoms themselves.

Picking up the Tamiflu, however, I was ushered to an unused part of the waiting room and sat in splendid isolation.

A quick search of the internet shows lots of reputable sites suggesting swine flu can be infectious before symptoms show, including the US Centers for Disease Control and Prevention. I’ve no idea which advice is right, but we are past the point where people will take something as gospel because the NHS tells them it is true.  

Plenty of people will find it hard to move from the images of white-suited and masked men entering houses to take swabs and families being effectively isolated and treated with Tamiflu, to the idea that close contacts can go to work, school, social events and the supermarket and need no treatment.

One minute schools with a single case were being closed and hundreds of children being offered Tamiflu: the next they were told to stay open, without antivirals, until a shortage of staff means they can no longer function - or parents vote with their feet.

The shift from containment to treatment may be justifiable on pragmatic grounds, but public understanding of the reasons for it will be limited, and will lag behind changes in practice.  

Alison Moore is a freelance health reporter

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