Swine flu: a doctor's advice

Editorial Department • Published 29 Oct 2009 09:00 0 Comments

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Dear Sir, - I would like to share with your readers my experiences with the current pandemic outbreak of H1N1 "swine" flu in Fermanagh.

I was on duty when the first case of swine flu in Fermanagh was confirmed back in late June. At that time the main strategy in dealing with the flu outbreak was to treat the individual and protect the close contacts as best we could with advice on how the virus is spread and Tamiflu when appropriate. Reducing contact with the ill patients was and still is a priority. We did not know then how ill people would become and just how serious this flu is. The hope was to keep the numbers of cases down to a minimum. However, things have moved on a lot since June.

Now, in October, we realise that this flu bug is very easily transmitted between people, spreading easily to others around the infected individual by droplets from coughs and sneezes in the air and on surfaces in the immediate environment. Therefore it is essential to keep the tissues supply going, keep surfaces beside the patient clean with antiseptic, use Paracetamol or similar medication for the fever and aches and pains and perhaps a cough bottle to ease the cough. Patients with more serious problems like dirty phlegm, wheezy breathing, vomiting or who are very weak, need to get more specific advice from their local surgery or pharmacy on how best to manage their illness.

The H1N1 virus seems to make the vast majority of people quite unwell, some only mildly ill and a small number very ill indeed. Initially doctors were advised that, to make a diagnosis of flu, a fever of 38 degrees was needed, plus three symptoms from the following list - general aches and pains, sore throat, headache, cough, vomiting, sniffles and fatigue. Having confirmed quite a few patients as having this flu over the past few weeks, I and colleagues around the UK, now realise that the fever, in adults especially, may not be so marked, perhaps their temperature only marginally elevated. Many people now have thermometers at home - the normal temperature is 37 degrees Celsius or so (98.4 Fahrenheit). A mild fever would be under 38C or 100F. Small children spike a fever much more readily and so the fever is not such a useful guide.

I have spoken several times with the virus laboratory in Belfast where all the swabs are processed, most recently this past weekend, and I can confirm that there is currently only the H1N1 flu in Northern Ireland. There is no other milder flu here now. If you feel unwell with the symptoms stated above, you probably have the flu. You may well not be very sick. Many patients are telling me they do not think they could have this flu and are continuing to go to work, shop in the supermarkets and send their children to school. Please think again... If you feel a bit shivery, maybe a bit achy, have a sore throat and a sniffle, feel unusually tired and have a slight cough, becoming worse but probably not much spit, you have the flu and should stay at home "out of the way". The main reason the numbers of cases is rising so fast recently is that people who have this illness are not following this advice. I have phoned several people to tell them that the swab results are positive for swine flu, to find they have gone back to work!

Most people who have uncomplicated flu should be fine after 7-9 days and can return to work 2 days after their coughing has stopped. Children are usually not so good at covering their mouths when coughing and so they must be fine before returning to school. Remember, pregnant ladies are at particular risk from this virus and school age children commonly bring bugs home from school to their mums.

The swine flu vaccines are beginning to be given in Northern Ireland this week. Unfortunately there are only small numbers coming through to us each week and the programme of vaccination will continue right up to Christmas and possibly beyond. Your local practices will be inviting in patients for vaccination, most at risk people first according to government advice. Please take up the invitation and protect yourself and your family. If you think you might have had the flu but were not swabbed and therefore confirmed to have the flu, then come in and be vaccinated and be sure you are protected. This past weekend we have started vaccines in Lisnaskea and there has been an excellent uptake so far.

In dealing with the many requests for advice coming into the surgery each day recently, the doctors and nurses appreciate your patience. The phones are going all day, usually into the evening and advice offered to ensure everyone is looked after and treated safely. Relatively less ill flu victims are contacting their community pharmacies who can issue medicines under the Health Service minor ailments scheme and they are also working tremendously hard to keep everyone supplied with medicines to aid their recovery.

In the middle of all this activity surrounding the H1N1 flu, there is inevitably going to be less time to deal with "routine" health matters like monitoring chronic illnesses, form filling and minor surgery procedures. Again, I would ask patients to be patient with us, be prepared to wait a little longer than usual for appointments and we will try our best to meet all the needs you have as soon as possible. Some patients have asked us to certify that they are fit to go back to school or work. I am afraid that we have not time to see patients who have recovered. Their own judgment, or that of Mum and Dad, will have to suffice! Or if required to official purposes, perhaps a few questions on the telephone will suffice to ensure everyone is happy.

Finally remember, the government has ordered something like 60 million doses of vaccine for the UK so, when all the "at risk" patients have had their vaccines, the general population will be offered vaccinations till they are all gone - the vaccine must be given out, it is specific to this flu and will be out of date early next year! The object of the exercise now is to reduce the spread of the flu until as many as possible have had their vaccine and developed immunity. As soon as we get vaccines delivered to us, they will be given to you. And, by the way, if you have had the swine flu, you will not get it again, but the seasonal flu, which is a different virus, may well arrive later in the winter! And so it goes on...!

John Porteous

GP Lisnaskea

This letter appeared in Impartial Reporter 29 Oct 09

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