Intended for healthcare professionals

Rapid response to:


A/H1N1 influenza update

BMJ 2009; 339 doi: (Published 23 July 2009) Cite this as: BMJ 2009;339:b2977

Rapid Response:

Questions about the swine flu strategy

How accurate are the published figures about swine flu? Once the
decision was taken to skip swabs and diagnose on symptoms only, the
figures have surely become very unreliable. Is anyone objectively studying
the percentage of those who have a swine flu diagnosis from the
questionnaire only, who actually have evidence of swine flu virus, so we
can understand just how accurate, or inaccurate the figures are? Reports
such as “100,000 new cases of swine flu last week alone” [1] do indeed
generate alarm. What are the real figures? If nobody is interested to
discover the real figures then maybe at least the reporting should be
changed to “100,000 new cases of flu-like illnesses last week”, or
something similar.

Why are so many patients being prescribed Tamiflu? What we know about
Tamiflu is that it may be able to delay the spread of the virus for a
short period of time (but not prevent it’s spread ultimately); that it can
shorten the duration of the illness by about a day [2] (but not that it
can save lives or even prevent serious complications of the flu); that it
is “an unpleasant experience” to take with side effects ranging from
nausea, vomiting, and hallucinations [3] to serious, rare effects like
Stevens-Johnson Syndrome and toxic epidermal necrolysis [4] .

As we have no evidence that it is safe to take in pregnancy, and best
practice would therefore suggest that it should only be prescribed when
there is significant threat to the foetus, but that’s not the standard
being used. An interview with a pregnant woman on BBC news last week
showed her picking up her Tamiflu even though she personally thought she
only had a cold, because she’d been advised to take the medication on the
basis of “better safe than sorry”.

If seasonal flu kills 8,000 to 9,000 people every year, and up to
19,000 in 2002, has the management of swine flu led to a different way of
dealing with seasonal flu? Will we now see seasonal flu diagnosable online
and by telephone by non-medical staff and the mass prescribing of Tamiflu
every winter?


[2] Treanor JJ, Hayden FG, Vrooman PS, et al. Efficacy and safety of the
oral neuraminidase inhibitor oseltamivir in treating acute influenza: a
randomized controlled trial. JAMA. 2000;283:1016-1024.

[3] BMJ 2009;339:b2977


Competing interests:
None declared

Competing interests: No competing interests

28 July 2009
Robert W Leckridge
Locum Consultant Physician
Glasgow Homeopathic Hospital. G12 0XQ