Published 23 June 2009, doi:10.1136/bmj.b2565
Cite this as: BMJ 2009;338:b2565

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UK swine flu cases near 3000, as GP leader says use of Tamiflu may need to be rethought

¹ London

The United Kingdom may need to rethink its strategy on use of the antiviral drug oseltamivir (Tamiflu) to treat swine flu, a BMA official has said, as the UK’s number of cases is rising faster than in most of the rest of the world.

The number of confirmed cases of A/H1N1 infection in the UK rose from 1752 on Thursday 18 June to 2773 on the following Monday (as the BMJ went to press), says the Health Protection Agency. This was the third biggest jump around the world, which now has 52 427 confirmed cases, the World Health Organization reported, including 231 deaths. In Mexico, where the first major outbreak occurred, no new cases were reported over the weekend.

GPs in the UK may now be starting to deal with the problem differently, said Peter Holden, the BMA’s lead on pandemic flu and a negotiator for the General Practitioners Committee.

"It is a major problem," Dr Holden said, "and it’s something we are addressing at the moment.

"The HPA [Health Protection Agency] is now operating at capacity, and GPs are still trying to run normal services and deal with this. The best way to describe it is that the weather forecast for the UK is good, but in certain places there are tropical thunderstorms.

"It’s becoming very labour intensive, and we feel quite strongly that this has got to be looked at. You don’t want to overreact, but just because a given alert level hasn’t been declared doesn’t mean that some practices are not absolutely swamped."

Dr Holden said the sheer number of possible cases meant a risk that GPs might start prescribing Tamiflu over the phone rather than sending someone to swab the patient and test them before prescribing the drug.

"That in itself has its own problems. That would be a very quick way of blowing your supplies of Tamiflu—and how do you know the person is telling the truth? It’s a very real risk.

"Professional logic would dictate that it is probably time for a review of our Tamiflu strategy. It might be that we shouldn’t issue it while the flu is mild. The whole purpose of putting people on Tamiflu was to reduce the hospitalisation rate, and that isn’t a big issue at the moment."

So far only one person in the UK has died from the virus: a 38 year old woman who died in Paisley earlier this month after giving birth prematurely (BMJ 2009;338:b2470, 16 Jun, doi:10.1136/bmj.b2470).

Scotland’s health secretary, Nicola Sturgeon, called on the Westminster government to pay the £100m (120m; $160m) cost of vaccinating everyone in Scotland against swine flu, when a vaccine becomes available.

Ms Sturgeon said, "The UK holds contingency funding for contingencies. If a flu pandemic is not a contingency, most people would struggle to think what is."

Offering to vaccinate everyone in Scotland was the best way to limit the damage caused by swine flu, she added.

However, Jim Murphy, the UK Scottish secretary (the UK government’s representative for Scotland), rejected the request, saying, "I disagree that Scotland should have additional money over and above anywhere else in the United Kingdom."

Cite this as: BMJ 2009;338:b2565

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