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Ian Dalton's swine flu update - latest evidence is positive, but we must stay vigilant

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In his weekly update for HSJ and Nursing Times, national director for NHS flu resilience Ian Dalton discusses the latest developments in UK swine flu preparations

What should NHS staff be focusing their efforts on?

We have always been clear that our response to the current pandemic will be informed by the best scientific advice. On 22 October the Cabinet Office and the Department of Health published new guidance to support pandemic planners based on the latest science and understanding of the swine flu virus. As well as our own experience, the UK can now benefit from the southern hemisphere’s experience of winter, and the impact of a pandemic as well as annual winter pressures. 

The evidence suggests that the pandemic may peak at a lower rate than we originally thought.  Therefore, the reasonable worst-case clinical attack rate from 1 October to mid-May 2010 has now been revised down from 30 per cent to 12 per cent for adults. For children, the reasonable worst-case clinical attack rate has been revised down from 50 per cent to 30 per cent. The reasonable worst-case number of deaths is now assumed to be 1,000. The worst-case sickness absence rate (resulting from swine flu but not other causes) in the peak weeks of the pandemic is reduced from 12 per cent to 5 per cent. The guidance can be found on the DH website.

We should welcome this latest planning guidance but must do so cautiously.  That we may expect significantly fewer deaths from swine flu than the scientists originally feared can only be good news. 

The next steps

However, we must not underestimate the threat that swine flu still poses. The number of cases, although not yet at the levels seen during the first peak, are rising rapidly and we have seen a 96 per cent increase in cases in the last week. The numbers of people currently being admitted to hospital with flu is rising and in the last week alone has increased by almost 40 per cent. The number of patients in critical care is currently higher than at any point during the first wave, and four times the level of four weeks ago. One in five patients is now in critical care compared with an average of about one in 10 during the first wave. These figures are worrying and atypical for this time of year.  They serve as a warning that we need to continue to ensure that our flu resilience is as strong as it possibly can be.

We know that we must plan for the possibility of swine flu and seasonal flu peaks in sequence, which could mean a period of sustained, increased demand for some months, and it is important that the NHS remains prepared for this possibility.

This means that despite the good news in this latest guidance, the NHS may be facing its toughest winter for many years. The NHS has improved its preparedness for winter pressures dramatically in recent years and this experience stands us in good stead.  But it has not before had to deal with increased levels of flu sustained over five months from November to March as well as seasonal winter pressures including RSV, norovirus and the potential for poor weather. 

It is vital, therefore that we work hard to maintain services for all patients in the face of significant, sustained pressure across large parts of the NHS. 

Vaccination continues to be a crucial part of our resilience strategy and it is good news that the programme has now started. Vaccinating those at greatest risk will help manage demand on NHS services when it’s needed most. It could potentially reduce the hospitalisation figure by about 20 per cent and reduce the number of deaths by about 30 per cent if there is a high level of uptake. High take up rates among frontline NHS and social care staff vaccination are equally important. Early vaccination offers our staff, their patients, colleagues and families protection from the virus. It will help ensure that those working with the most vulnerable patients cannot transmit the infection and that teams working in areas of greatest demands are as robust as possible.  Vaccine is now being delivered to the NHS and we anticipate that vaccination programmes will continue to begin immediately on receipt of deliveries. 

This winter, more than ever, we need a whole system approach to managing winter and pandemic flu pressures across each regional health economy, and across the NHS and social care, but I have no reason to doubt the ability of the NHS to be able to respond quickly and flexibly or to be able to mobilise rapidly mutual aid arrangements if required by the demands of the situation we may face.

Progress to date

Further details on the current increase in numbers of flu like illnesses, GP consultation rates, hospitalisations and deaths can be found on the HPA website.

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