H1N1: now entering the recrimination phaseBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c225 (Published 14 January 2010) Cite this as: BMJ 2010;340:c225
All rapid responses
H1N1 First Wave Audit (May-August 2009)
Dr Richard Steven (FY2)
Salford Royal NHS Foundation Trust
With response to this article in particular and the many
articles in general that have been written on the subject
I thought I would respond with a small audit that I
carried out. The results may be of interest and the points
raised may create some further discussion.
The emergence of H1N1 influenza (‘Swine flu’) became widely known
early in 2009 after initial reports from Mexico . H1N1 is an Influenza
A virus which is a negative stranded RNA virus. The virus is made up of
around ten proteins, two of which are responsible for the attachment and
release of the virus from cells; these are Haemaglutinin and Neuraminidase
. It is the Haemaglutinin and Neurminidase that are responsible for the
coding of the virus, hence H1N1. The initial wide spread publicity seems
to have been due to the speed at which the virus traversed the world.
Within around one month of the first cases been publicised the virus had
spread to a majority of the states of the USA and cases had been confirmed
in forty-six countries worldwide .
The aim of this audit was to observe suitability of admission for
those patients with suspected swine ‘flu. The gold standard is that there
should be no unnecessary admissions for people with presumed swine ‘flu.
A ward at Salford Royal NHS Foundation Trust Hospital which had been
designated to receive patients admitted with suspected H1N1 influenza was
used for data collection. An isolation bay had set up within this ward and
staff had been given training on how to deal with patients with suspected
swine ‘flu, including mask fitting. I, as the Foundation Year One doctor
on the ward, designed a proforma for patients admitted with suspected
swine ‘flu. Data collected included; age, sex, reason for admission,
temperature on admission, treatment received, complications, swab result
and length of stay. Only seven patients with suspected swine ‘flu were
admitted to the designated ward during the first 4 months of the outbreak
in the United Kingdom (up to and including August 2009). I, as the junior
doctor on the receiving ward had no input into which patients were
admitted. A required admission was one that was deemed unavoidable; either
due to the patient requiring active treatment with intravenous fluids or
antibiotics or due to other circumstances that made outpatient management
Table 1; Reason for admission and if admission was required.
Number Swab positive? Admission
reason Required admission?
1 No Acute on
2 No Pneumonia Yes
3 No Pneumonia Yes
4 No Infective
of asthma Yes
5 No Pneumonia Yes
6 No Pneumonia Yes
7 No Social Yes
Ages ranged from 63-93; three men and four women.
One of the most important findings of this audit was that six out of
the seven patients admitted required active treatment (intravenous fluids
+/- intravenous antibiotics) which made their admission necessary. The one
remaining patient did not require active hospital treatment but was
admitted for social reasons beyond the control of the admitting doctor.
From this it can be seen that none of these seven admissions were
It can be seen from the results that very few patients were admitted
to the general medical ward at Salford Royal Hospital with suspected H1N1
during the first wave of the pandemic. Of the seven that were admitted
none tested positive for the H1N1 virus on direct swab results. This
indicates that we were unable to correctly identify those patients who
were infected with the H1N1 virus during admission. This has implications
for patient treatment.
Patients were isolated in a bay with others who had suspected H1N1
influenza. As we are not correctly screening those with the virus we are
at risk of exposing an unwell patient to fellow patients who may or may
not have the virus. This is unavoidable unless we are able to correctly
identify those with swine ‘flu on admission either via strict criteria or
a rapid laboratory test, neither of which were available at the time. We
are also exposing the patient to the risks and side effects associated
with antiviral therapy (oseltamivir) without an accurate way of assessing
whether a patient is likely to be unwell as a result of the virus. 
There is little doubt that this will continue to be a problem with anti-
virals such as oseltamivir as they require to be started early in the
disease process to be of benefit.
With the implementation of precautions such as isolation bays we are
also creating addition work for already stretched staffing resources.
During the first wave of the pandemic the isolation bay never reached
capacity. The downside of this was that in a busy teaching hospital the
utilisation of beds was below maximum.
Another point that became clear with the results was that in five out
of the seven patients admitted with suspected H1N1, swab results were not
available prior to their eventual discharge from hospital. This has
treatment implications not only for the patient but also for the contacts
at their place of discharge.
It is clear that our methods of detecting suspected H1N1 infected
patients were not accurate and that this had the potential to have an
effect on patient safety. It is beyond the remit of this audit to address
all the issues raised, however, until superior methods for rapidly
detecting Swine ‘Flu in patients are discovered these issues will continue
to be a problem.
1. Echevarría-Zuno S. Infection and death from influenza A H1N1 virus
in Mexico: a retrospective analysis. Lancet. Epub 2009 Nov 11.
2. Fitzgerald DA. Human swine influenza A [H1N1]: practical advice
for clinicians early in the pandemic. Paed Resp Rev. 2009 Sep;10(3):154-8.
Epub 2009 Jul 16.
3. Novel swine-origin influenza A(H1N1) virus investigation team.
Emergence of a novel swine-origin influenza in humans. NEngl JMed
4. Jefferson T et al Neuraminidase inhibitors for preventing and
treating influenza in healthy adults: systematic review and meta-analysis.
Competing interests: Table 1; Reason for admission and if admission was required.
Dear Tony Delamothe,
I am happy that the truth behind most of our claims in
medical science is slowly but steadily coming out and the
BMJ is helping that process. It brings to mind what Bernard
Shaw once wrote: “Science is always wrong; with each
solution that it claims it brings in more problems.”
Any one who goes through many of my rapid responses in the
Journal and my blog on swine ‘Flu will know that from day
one I strongly suspected the motive behind this swine ‘Flu
advertisement in the name of “science”. Advertisement is
the legal way to lie. One question that I asked in September
2009: “Why did the WHO raise swine 'Flu to pandemic level 6,
has never been answered. Dr. 'Flu, (Albert Ostenhaus) and
many other great names have been exposed now. Swine 'Flu is
not the only area where this happens.
It is there in literally every area of medicine where the
vested interests operate right from the time in the very
early 20th Century, when a byproduct of petroleum, Nujol
(new oil), was palmed off as cancer cure when oil sales hit
rock bottom during the great depression of 1930s. “The swine
flu pandemic has been named as the “most ambitious scam and
corruption of our time” after pharma has been found to be in
bed with the World Health Organisation.” (1) With 80% of
WHO funding emanating from Pharma lobby how could one expect
the former to be honest? Story goes on and on.
The WHO, however, had assured us to expect a lethal global
pandemic from this same virus in the fall of 2009, just
exactly, we were told, when the vaccine “against” this newly
lethal killer virus will be ready. The gullible public was
astonished and awed by the ability of these organizations to
predict the future and prepare for it so profitably. The
story of the billions spent on the absurd Avian Flu (H5N1)
vaccines and the useless antiviral, Tamiflu, for avian 'Flu,
is now history. We could now add Swine 'Flu to that list.
Flu vaccination might be bad for children even otherwise as
shown in this report. Ironically, as shown by Neil Z. Miller
in his excellent book -- Vaccine Safety Manuel -- once the
flu vaccine was given to small children the death rate from
flu increased 7-fold. Not surprising, since the mercury in
the vaccine suppresses immunity.
• 1999 -- - 29 deaths
• 2000 -- - 19 deaths
• 2001 -- - 13 deaths
• 2002 -- - 12 deaths
• 2003 -- - 90 deaths (Year of mass vaccinations of
children under age 5 years)
• 2006 -- 78 deaths
• 2007 -- - 88 deaths
• 2008 – 116 deaths (40.9% vaccinated at age 6 months
to 23 months) Even the adult pneumonia figures do not show
swine 'flu in bad light.(2)
Douglas C Wallace so elegantly showed that every
single chemical molecule aimed at a reductionist target only
damages the hard ware (mitochondria) of the human cell. His
new MITCHIP has been able to study any drug and its effect
on the cells. Human cells work as whole universe in
themselves. They work the same way irrespective of where
they are and what their morphology is: their physiology
remains the same. (3)
When will human greed stop making money from human
The caption, although sometimes attributed to Mark Twain,
because it appears in his posthumously-published
Autobiography (1924), this should more properly be ascribed
to Disraeli, as indeed Twain took trouble to do: his exact
words being, ‘The remark attributed to Disraeli would often
apply with justice and force: “There are three kinds of
lies: lies, damned lies, and statistics”.
2) Blaylock R. Swine’Flu-one of the most cover up in
American history. www.russellblaylockmd.com
3) Wallace WC. Mitochondria as Chi. Genetics 2008; 179:
Competing interests: No competing interests
Your editorial brought to mind a London doctor, Dr Herbert Barrie,
(1) Department of Paediatrics, at Charing Cross Hospital, London, who
wrote a letter related to what he considered a ludicrous whooping cough
campaign in 1982:
"Hardly a day passed without the latest whooping cough returns
appearing somewhere. "Pertussis peaks Again," "Epidemic Claims Another
victim," or "Killer disease Strikes Again" (all the way from the first to
the 12th) were typical headlines. A recorded message phone-in service
encouraging parents to have their children vaccinated was set up.
Terrified parents were greeted with a hair-raising series of paroxysms
from a child close to expiry, followed by a diatribe on the imminent
dangers of death, brain damage, and lasting lung disease. The message
ended, in the tradition of such commercials, with the urgently voiced
hysteria-toned exhortation: "If your child has not been vaccinated, do not
delay. There is an epidemic. Get your child vaccinated now!" More
coughing. The campaign of terror was on."
..."Panic-stricken parents of 5 year-old children were telephone me
to be told one thing, only to be told something different by the media
from a leapfrogging Health Department. Polite enquire whether primary
pertussis vaccination of older children was soundly based on field trials,
and scientifically respectable, extracted the convoluted reply that there
were no such trials, but that there was no reason to think that it would
not be equally beneficial. Much publicity was given to the vaccinations,
like sacrificial lambs, of the Health Minister's own infant daughter and,
with even less justification, bonny Prince William. Of all the infants in
the land, the latter's supremely sheltered care would render a chance
encounter with a Bordetella pertussis about as remove as catching green
Dr Barrie went on to explain why the campaign was ludicrous,
commenting, “Why all the fuss about a dozen possible mismanaged whooping
cough deaths, when we have an annual toll of 1,500 cot deaths, 2,000 child
deaths from accidents, and 2,500 avoidable perinatal deaths?”
Sounds like 2009 to me. The point is that campaigns of terror,
conflicts of interests, and misdiagnoses as a result, permeate every fibre
existing in both medical history and current medical practice.
In the last two years, New Zealand has experienced widespread
whooping cough, but after the vaccine used in this country showed at most
30% efficacy, it’s been very notable that there has been total silence in
terms of the past whooping campaign of terror to exhort parents to
However, apart from the many cases of pertussis, last year there were
a few cases of measles in the South Island, and even fewer still in the
North Island. Up ramped the campaign of terror. A friend of mine who had
taken her daughter to the doctor with a sore throat a month ago, rang me
after her daughter’s doctor pronounced, “Your daughter has measles and
this is your fault because you didn’t vaccinate!” And so on ad nauseum.
Didn’t sound like measles to me, so my friend went to another doctor, who
swabbed the child, who was later found to have a strep throat.
When doctors believe prescribed campaigns of terror to such a degree
that often they can’t see what’s in front of their own eyes, it’s patients
who pay. There is no answer, because campaigns of terror are a
fundamental cornerstone of medical culture today. After all, where would
GSK and others be without the money that comes from selling fear?
(1) AM J Dis Child September 1983 Page 922-923, entitled "Campaign
Competing interests: No competing interests