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The flu pandemic: What next? The flu pandemic: What next?
(about 3 hours later)
By Nick Triggle Health reporter, BBC NewsBy Nick Triggle Health reporter, BBC News
The number of new swine flu cases is on the riseThe number of new swine flu cases is on the rise
It may have slipped from the public consciousness for a month or so, but there is now no mistaking that swine flu is on its way back.It may have slipped from the public consciousness for a month or so, but there is now no mistaking that swine flu is on its way back.
The rate of new infections has risen for the second week in a row, leaving experts believing the UK is facing a second peak.The rate of new infections has risen for the second week in a row, leaving experts believing the UK is facing a second peak.
But just how bad will it be?But just how bad will it be?
The truth is that many experts are hesitant about making predictions about what has been dubbed a "Jekyll and Hyde" virus.The truth is that many experts are hesitant about making predictions about what has been dubbed a "Jekyll and Hyde" virus.
While it remains a fairly mild illness for most, doctors are at a loss to explain why some otherwise healthy people develop serious complications.While it remains a fairly mild illness for most, doctors are at a loss to explain why some otherwise healthy people develop serious complications.
So far about a fifth of the 80-plus deaths linked to the virus in the UK have been among people who did not have any previous health problems.So far about a fifth of the 80-plus deaths linked to the virus in the UK have been among people who did not have any previous health problems.
Sir Liam Donaldson, England's chief medical officer and the government's most high-profile figure during the pandemic, has tried to steer clear of predictions.Sir Liam Donaldson, England's chief medical officer and the government's most high-profile figure during the pandemic, has tried to steer clear of predictions.
Worst-case scenarioWorst-case scenario
He has always said a second wave was coming - and now it appears to be here - he says it is impossible to know exactly when it will stop.He has always said a second wave was coming - and now it appears to be here - he says it is impossible to know exactly when it will stop.
The only indication he has given has been the worst-case planning scenarios the NHS is basing its preparations on.The only indication he has given has been the worst-case planning scenarios the NHS is basing its preparations on.
Originally, the government suggested there could be more than 60,000 deaths this winter, but that was later revised down to 19,000 because of the mild nature of the pandemic.Originally, the government suggested there could be more than 60,000 deaths this winter, but that was later revised down to 19,000 because of the mild nature of the pandemic.
And, to put that into context, during the last bad winter flu season a decade ago 19,000 people died.And, to put that into context, during the last bad winter flu season a decade ago 19,000 people died.
But those willing to stick their neck out think the toll will be much lower.But those willing to stick their neck out think the toll will be much lower.
Professor John Oxford, a flu expert from the University of London, believes there will be somewhere between 2,000 to 3,000 deaths.Professor John Oxford, a flu expert from the University of London, believes there will be somewhere between 2,000 to 3,000 deaths.
It may be a mild virus, but it has a sting in its tail Professor John Oxford, University of London expertIt may be a mild virus, but it has a sting in its tail Professor John Oxford, University of London expert
"We are fortunate that the first pandemic for 40 years is proving to be quite mild and the fact that the elderly seem to have some immunity means not as many people will die as could have.""We are fortunate that the first pandemic for 40 years is proving to be quite mild and the fact that the elderly seem to have some immunity means not as many people will die as could have."
But that does not mean the country should rest easy, according to Professor Oxford.But that does not mean the country should rest easy, according to Professor Oxford.
"It may be a mild virus, but it has a sting in its tail."It may be a mild virus, but it has a sting in its tail.
"When you look at the numbers of children being hospitalised and the numbers ending up in critical care, it is happening more often normal flu.""When you look at the numbers of children being hospitalised and the numbers ending up in critical care, it is happening more often normal flu."
Indeed, Professor Oxford calls children "our achilles heel" in this pandemic.Indeed, Professor Oxford calls children "our achilles heel" in this pandemic.
Rates of infection, GP consultation and hospitalisation have been consistently higher among children than any other age group.Rates of infection, GP consultation and hospitalisation have been consistently higher among children than any other age group.
And if the health service is going to struggle in the coming months one of the first areas affected could be paediatric intensive care.And if the health service is going to struggle in the coming months one of the first areas affected could be paediatric intensive care.
Plans are in place to double the number of adult intensive care beds in the NHS to 4,000.Plans are in place to double the number of adult intensive care beds in the NHS to 4,000.
That is made possible because of the large number of high dependency beds - the level below intensive care.That is made possible because of the large number of high dependency beds - the level below intensive care.
But for children there are less than 100 such beds across the NHS, leaving question marks over whether the ambition of getting close to the magical 800 figure will be achieved.But for children there are less than 100 such beds across the NHS, leaving question marks over whether the ambition of getting close to the magical 800 figure will be achieved.
Even Ian Dalton, the Department of Health's national director for flu resilience, has openly admitted it may not be achieved.Even Ian Dalton, the Department of Health's national director for flu resilience, has openly admitted it may not be achieved.
And with an average of 80% of the current stock of beds full at any one point, it is not surprising doctors are saying the pandemic presents a "major challenge".And with an average of 80% of the current stock of beds full at any one point, it is not surprising doctors are saying the pandemic presents a "major challenge".
PressurePressure
Dr Ian Jenkins, president of the Paediatric Intensive Care Society, says the next few months could see paediatric intensive care under "a lot of pressure", but is still optimistic.Dr Ian Jenkins, president of the Paediatric Intensive Care Society, says the next few months could see paediatric intensive care under "a lot of pressure", but is still optimistic.
"There is a lot we can do, including moving older and less ill children to adult beds and stopping elective operations."There is a lot we can do, including moving older and less ill children to adult beds and stopping elective operations.
"If the indications from elsewhere in the world are anything to go by we should be okay."If the indications from elsewhere in the world are anything to go by we should be okay.
"But we are not getting complacent.""But we are not getting complacent."
In fact, the experience of southern hemisphere countries that are now coming out of their winters lend weight to the positive outlook.In fact, the experience of southern hemisphere countries that are now coming out of their winters lend weight to the positive outlook.
The death rates have been generally lower than expected with even Australia - one of the worst-hit countries - only seeing 178 deaths despite more than 35,000 people being infected.The death rates have been generally lower than expected with even Australia - one of the worst-hit countries - only seeing 178 deaths despite more than 35,000 people being infected.
The key for the UK is to get the vaccine programme under way, says Sir Liam.The key for the UK is to get the vaccine programme under way, says Sir Liam.
FLU PANDEMICS 1918 - The Spanish flu pandemic remains the most devastating outbreak of modern times. It is estimated that up to 40% of the world's population were infected and more than 50m died, with young adults affected the most1957 - Asian flu killed 2m people. It was caused by a human form of the virus, H2N2, combining with a mutated strain found in wild ducks. The elderly were particularly vulnerable1968 - An outbreak first detected in Hong Kong, and caused by a strain known as H3N2, killed up to 1m people globally, with those over 65 hit the worstFLU PANDEMICS 1918 - The Spanish flu pandemic remains the most devastating outbreak of modern times. It is estimated that up to 40% of the world's population were infected and more than 50m died, with young adults affected the most1957 - Asian flu killed 2m people. It was caused by a human form of the virus, H2N2, combining with a mutated strain found in wild ducks. The elderly were particularly vulnerable1968 - An outbreak first detected in Hong Kong, and caused by a strain known as H3N2, killed up to 1m people globally, with those over 65 hit the worst
"This virus is not a killer, but it can kill and that is why getting vaccination programme going is so important."This virus is not a killer, but it can kill and that is why getting vaccination programme going is so important.
"It does look like this second wave is starting and the sooner we get vaccinating the better.""It does look like this second wave is starting and the sooner we get vaccinating the better."
More than 13m people have been earmarked for the jabs in the first phase of the programme in the UK.More than 13m people have been earmarked for the jabs in the first phase of the programme in the UK.
But the success of it will depend on whether they can be immunised before the second wave gets into full swing.But the success of it will depend on whether they can be immunised before the second wave gets into full swing.
GPs are on standby to start vaccinating, but regulators are yet to license either of the jabs being bought by the UK government.GPs are on standby to start vaccinating, but regulators are yet to license either of the jabs being bought by the UK government.
And even if the next few months go well, there are no guarantees that the pandemic will be a one-winter wonder.And even if the next few months go well, there are no guarantees that the pandemic will be a one-winter wonder.
The last pandemic, which started in the late 1960s, hit the UK hard the first winter, but did not actually peak until the following one.The last pandemic, which started in the late 1960s, hit the UK hard the first winter, but did not actually peak until the following one.
Britons of course did not have access to the array of drugs and vaccines that are being used to combat the pandemic this time round, but despite this there is still a fear which is stalking experts - the threat of mutation.Britons of course did not have access to the array of drugs and vaccines that are being used to combat the pandemic this time round, but despite this there is still a fear which is stalking experts - the threat of mutation.
Flu viruses are altering all the time and the vaccines purchased by the UK government reflect this as they allow for some drift in the make-up of the strain responsible for the pandemic.Flu viruses are altering all the time and the vaccines purchased by the UK government reflect this as they allow for some drift in the make-up of the strain responsible for the pandemic.
But there is always a risk that it could - in time - change so much that it becomes not only resistant to the vaccines, but more deadly too.But there is always a risk that it could - in time - change so much that it becomes not only resistant to the vaccines, but more deadly too.
The World Health Organization has been carefully monitoring cases for signs of this.The World Health Organization has been carefully monitoring cases for signs of this.
So far there has been a little mutation in a handful of cases, but nothing that has caused undue concern.So far there has been a little mutation in a handful of cases, but nothing that has caused undue concern.
However, as anyone familiar with Robert Louis Stevenson's work knows, unpredictably is impossible to second-guess. However, as anyone familiar with Robert Louis Stevenson's work knows, unpredictability is impossible to second-guess.