Published 30 June 2009, doi:10.1136/bmj.b2670
Cite this as: BMJ 2009;338:b2670

News

Two more people in UK die from swine flu, as swabbing policy ends in "hot spot" areas

¹ London

Two more people have died in the United Kingdom after contracting the A/H1N1 virus, while some GPs in so called hot spot areas are now handling the virus in a different way from how they did at the start of the epidemic.

A young schoolgirl in Birmingham and a 73 year old man in Paisley have died. Officials said they had tested positive for the virus, but it has not yet been confirmed whether the virus was the main cause of their death.

The man, who has not yet been named, died at the Royal Alexandra Hospital, the same hospital where the first flu victim, 38 year old Jacqueline Fleming, died in June.

The girl, 6 year old Sameerah Ahmad, died at the Birmingham Children’s Hospital. In both cases the patients had serious underlying health problems.

As the BMJ went to press on Tuesday 30 June the confirmed number of cases worldwide was 70 893, the World Health Organization reported, including 311 deaths.

The UK has 5937 confirmed cases, the Health Protection Agency said. This figure rose by 1604 between Friday and Monday.

At the end of last week the agency altered its guidance to GPs in "hot spot" areas where the virus is widespread, effectively ending the policy of swabbing people with a potential case for laboratory testing and relying instead on doctors’ own clinical diagnosis and judgment. All primary care trusts in London and the primary care trusts for Heart of Birmingham, Birmingham East and North, South Birmingham, Sandwell, Berkshire East, West Hertfordshire, and Luton are now deemed to have widespread community transmission of the virus.

An agency spokesperson said: "Nationally our policy has not changed, but in areas where it’s considered there are high levels of community transmission, or what you could call hot spots, we have changed our policy.

"This only applies to some areas, mostly London and some parts of the West Midlands, where GPs are not giving out antivirals to everyone [who has been in contact with someone infected] and not testing for potential new cases, because that is not deemed to be an effective way of containing the virus.

"We issue guidance, and all GPs have their own discretion when following it as well, so there are variations in different areas."

In hot spot areas the agency says that treatment with antiviral drugs can be offered to people with clinically diagnosed swine flu but that there is no need to swab these people unless this is specially advised (for instance if they are part of a targeted surveillance scheme).

It is not necessary, however, to give antivirals to contacts (people in contact with those who have been confirmed as being infected with the virus) unless there is thought to be a special clinical indication (for instance, for people in a care home), and doctors should advise patients to isolate themselves until they are free of symptoms and should not swab contacts.

Some hospitals are also adapting their response to the virus by creating swine flu assessment areas.

The Heart of England NHS Foundation Trust’s three hospitals have set up an assessment area for people who are worried about the symptoms of swine flu to help ease pressure on its accident and emergency departments, which have seen a 25% rise in the number of visitors in recent weeks.

Meanwhile Liam Donaldson, England’s chief medical officer, said last week that the epidemic could develop at a much faster pace in the autumn. At a press briefing he said that tens of thousands of new cases could emerge every week by the autumn.

"We could be in one of two situations," he said. "One situation is that this is a virus that is spreading more gradually than might have otherwise been the case.

"Or it could be that we are in the situation of the previous pandemics that we know about in the 20th century in this country, when during the summer months we saw a steady climb in cases rather than an explosive outbreak, and we would see an explosive outbreak in the autumn or winter. That’s still the scenario we believe we are in."

In the United States, where 127 people have died from A/H1N1, Robert Derzon, the first director of the federal agency that manages Medicare and Medicaid, has died from the infection, aged 78.

Mr Derzon, who had previously been deputy commissioner of New York city’s Department of Hospitals, was a longstanding proponent of universal healthcare coverage.

Cite this as: BMJ 2009;338:b2670

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The updated HPA guidance can be seen at www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1245914987796.

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