We should all be very grateful to Egypt

The Economist runs an article this week about the Egyptian campaign against Swine-Flu, that looks vastly more effective than that run in the UK, where the government has in effect given up. ( Note the Egyptian measures - eg staggering playgrounds & isolation rooms- in schools could be repeated in the UK to at least change the profile of the coming outbreak, which is the biggest threat to us right now ie a peak that we don't have the resources in hospitals to deal with like respirator beds - but it seems to be too much trouble here ).

Its true the Egyptians made a decision that seems more based on their desire to oppress their Christian minority early on of killing pigs, which has lead to its own problem is alternative food waste disposal.

But what the article misses is what the world is really afraid of. H5N1 - bird flue - has made the transition from animal to human in a number of cases in Egypt, and if it mixes inside a human with the easy to spread but currently mostly mild H1N1 swine flue then the deadly pandemic strain could be let lose on the world.

Hence the actions of the Egyptian government and people matter far more than those else where.

Prevention rarely has an obvious reward, but we may all have had reasons we will now never know about to be grateful to Egypt.

One thing Govt has learnt from NASA

And that's new management.

The endless delays on the original Shuttle project are now largely forgotten. But at the time the style of dealing with such government agency failure was know as "doing a NASA".

The trick was not to announce each bit of bad news as it came long. Instead you stored them up and got them all out of the way at one time.

Hence the first flight dates for the shuttle would go back in jumps every so often.

A similar thing is happening with Swine Flu in the UK. The HPA is in no rush to issue a day by day set of updates. every week or so will will get sudden jumps in figures.

Now the cause of preventing panic is a good one - so their actions are not necessarily irresponsible. But they are also very convenient for the failing state organisation that is managing this outbreak.

Many of us are now getting first hand stories of the mess that handling swine flu has become. Some people get Tamiflu - others don't ( different GPs - same town ).

One person I heard of yesterday had tried 4 different health care contact points (NHS direct, GP etc ) to get help for his wife who showed symptoms of Swine flu and has MS. Eventually he had to refuse to leave a hospital before they would issue any.

Health care people I know report confusion and a lack of information.

And the governments response ? To send their minions on camera to say we are best prepared. ( As ever they ignore specifics ).

This Labour government is now dangerously low on credibility, just when it most needs to be believed

Once when your prime minister told you something, especially when backed by figures or statements from our impartial civil and public services you'd believe him/her.

Those days we're doomed to end from May 1997 onwards.

New Labour - the party that won power through the dark arts of media manipulation, stories, media grids and its smear campaign ( remember sleaze ).

Labour held power though daring people to call them liars ( remember "I'm a pretty straight sort of guy" ) and meaningless, but focus group tested, catch phrases such as "education,education, education".

Then when that was no longer enough they bullied and coerced ( please note their first reaction is still to trash the reputation of the person saying something inconvenient rather than answer the point as is evidenced here ). They placed their people in as Speaker, head of the BBC, Chief constable of the Met etc etc.

But then that wasn't enough to hold back reality - so they started lying more openly. The most notorious being the WMD claims made by Blair with one particular press officers help at No 10. Blair hid behind the security services. He produced dossiers and told us in hushed terms that it was the best work of the security services, some internally tried to warn him and then the media - but one of their number has now died under suspicious circumstances. The man who organised the smear campaign against John Major's government could not stand supporting going to war on this basis. He resigned, and then not long afterwards died whilst walking on MOD land.

Labour's credibility at this point is requiring some very robust action. So they bullied the BBC and launched a witch hunt followed by the Hutton White wash ( so good that Alistair Campbell and Cherie Blair signed copies at Labour fund raisers ).

Labour promised that Helmand province would just be a policing operation. The coffins filled with our son's and daughters tell a different story.

Labour said Military commanders had what they needed and had asked for. They lied.

Labour down graded the ministry of defence by giving it a part time minister, then 4 others in short order. The current incumbent is ranked 21 out of 23 in the Cabinet.

Labour - and its disgraced leader Gordon Brown - said that helicopter numbers for the troops has increased to mislead the public into thinking that provision had improved when in reality troops had increased in the same proportion.

About a year and a half ago Gordon Brown told us how our economy was best placed in Europe for the coming "downturn" ( as the ever helpful to Labour BBC re-badged the recession ). That turned out to be rubbish. Indeed much of our problems were caused by Brown with his economy fueled by debt.

Education is now an embarrassing word for Labour - they have even abolished the word from ministerial titles as they only spend capital money on further ed colleges in their constituencies.

A few months ago Brown told us all how the UK amongst the best prepared in the world for a Flu pandemic.

Then the truth emerged that the NHS had no where near enough face masks ( countered with spin and lies about their effectiveness - you don't need them anyway we were told ) before ordering another massive batch for the NHS.

The government failed to react to the returning people from Mexico. Hence our outbreak is a few months ahead of most of the rest of the world ( we only lag behind Mexico and the US - where Quarantine really isn't an option ). Those few months may cost dearly as the wait for the first vaccine for the most vulnerable.

But we are told the NHS is ready - just unable to cope. ( Hidden away from public view ethics committees will be drawing up the rules of who dies and who lives by rationing access to the totally inadequate supply of ventilators for the most serious cases. ).

NHS Direct can't cope, GPs can't cope. No one knows who's getting Tamiflu and who isn't - though anyone who pops up on the radio gets shouted down by this government and its henchmen.

Now we are told deaths could range from 15k to 65 k most likely ( with the doomsday 750k still not ruled out ).

But do they have the credibility needed any more to carry this off ?

What is of course missing from the reassuring statements about seasonal flu killing so many each year is that this time it won't be Granny and Grandpa ( who have immune systems that can fight this flu ) but young Jimmy, Jane and Mum and Dad.

Even if the total deaths were the same as seasonal flu - they would be far more visible and impact a very different section of the population.

The government says today - Don't Panic. ( And its a responsible message at this time ).

But their history of lies, deceit, misdirection and spin make them very unlikely to be believed, and panic is a very real possibility ( and direct consequence of the lies, spin and deception that have been listen above and come from the dark heart of the New Labour project ).

How long before you hear of scuffles and unrest at Hospital A&E units ? Who is going to believe what they say as they try to calm worried parents and anxious families down ?

We have to trust to God and luck - because its all too clear the Labour government is not trust worthy or trusted by anyone.

[ This is of course why any patriotic Labour MP should vote for country not party and end this government. But they won't as many of them are second rate or morally compromised who put their life careers in politics with its offer of gold plated expenses and pensions way above the good of their fellow man. ]

Swine flue looks like its about to take off in the UK

I was looking at the reasonably good Fergus on Flu blog on the BBC, specifically this post which show the escalation of cases in different countries.

It occurs to me that the UK is seeing the sharpest rise, with an accelerated exponential like increase.

Having looked at some of the epidemic escalation profiles this looks ominously like the start of the first big wave of the outbreak.

Perhaps the heat wave etc will knock it back, but I'm not so sure.

I wonder why the UK has such a sharp rise in cases now - compared to other countries ?

More lessons to be learnt perhaps.... lets all hope it continues to be mostly an inconvenience.

Confusion reigns over swine flu, and the disease continues to make progress

In Mexico

The Mexican government is revising down the number of deaths it ascribes to swine flu from 178 to 101. The number of cases reported have varied from 2000 to 300 depending on what appear to be random factors.

In addition they have taken the bizarre step of the 5 day quarantine of its population ( though the WHO and everyone else refuses to ban air travel, sayings there "no evidence to support*" such a ban).

The quarantine itself will not stop the epidemic in Mexico, it will just delay its peak a little. Effectively the Mexican government is trying to put of what is now inevitable by 2-3 days. I wonder what they need to do with that time ? Maybe they are urgently trying to gain stocks of Tamiflu or such ? The logic behind their decision doesn't seem apparent.

The information that reaches the public domain has been low quality and poor in Mexico. Hospitals have been told to keep quiet. The situation looks confused and there is the potential that the Mexican government is hiding something big. ( There are areas where people say there is now flu at all and they are cross at being sent home ).

In short given that Mexico is the centre of a world wide emergency its a surprising mess.

* The "there is no evidence to support" is the new official statement for we're not going to do it so there.

In the UK

We seem to be having trouble with our testing. The first human to human transmission in Scotland initially tested negative, but was retested latter.

The second human to human case was from a man who believes he caught it in a meeting with a woman who's only symptom was to cough once and she tested negative for swine flu.

A number of possible conclusions can be drawn:

1) Human to human transfer is quite effective.
2) The current testing isn't.
3) The stay at home if you have symptoms the self quarantine line bleated out by the government and all its agencies is ineffective - since some cases are:

a) ignorant they have a disease they need to report
b) show no symptoms
c) on the day when they are infectious but not showing symptoms.

If all three points are true, and I think there's evidence starting to stack up to support them, then the government has lost its ability to do anything other than moderate the outcome of events.

It is now very likely that unidentified cases, may be without symptoms, are now wondering around the UK leading to a exponential increase in cases, currently untracked by the government.

We are told a day or so ago that 260 cases where awaiting test results ( which we know know are much less than 100% effective - so do those who get negative results, but are in fact infected go on to spread the disease - the answer must be yes ). The number of out standing tests is now over 300, and I assume rising. Update 2May09 - this number has just climbed to 600. That may indicate more effort to trace potential contacts of existing cases ( in which case good ) or it may be an indicator of a spread of the disease (v bad ). We will need to await on confirmed cases to be sure. There seems to be some sort of delay processing tests or perhaps their results are being held back from the media as final preparations are made for a winder sense of panic ( If this is true I think it underestimates the British people, who will stay calm if they are honestly dealt with ).

Perhaps the virus will die out by itself, because the government's plans are not proving very effective at containment.

As I've said in comments else where we are going to have to trust to dumb luck rather than a dumb government.

PS The game of catch up continues to be played by our "best prepared in the world" government. Today its "where are all the anti-biotics day". You see its the secondary infections that seem to kill in swine flu's case rather than the cytokine storm that is feared in the cases of H5N1. The government thinks it might now have enough, or panic over stocking could cause shortages ( which at the peak of a bad epidemic means deaths ). Again it is clear they have not worked this through properly. These are simple issues that a systematic review would have identified ( if civil servants have problems with this then they should contact a professional engineer, we know about managing risks and consequences and identifying them ).

I heard a cross official on R4's news lunch time on Friday complaining that they had made it clear where Tamiful could be obtained from and they'd explained it to GPs ( who are continuing to be confused about the new supply chain the govt is putting together - after all why use a tried and tested system when you can invent one at short notice ? ). He doesn't get it at all. What matters is what is happening - if his communication hasn't worked, then he is at fault. But in true UK public servant mode what matters is who you can point the blame to, not getting the job done.

This is again why the military need to be put in charge. Senior and Junior officers rely on the men under their command for their very lives, and are committed to effective results in a rapidly changing and confusing situation. just the skill set we need rather than the box ticking, blame shifting, procedure referring to mentality of civil servants.

Ok a bit of a rant, but I don't like where this could be going. The UK Govt has been effectively decapitated by Labour's internal worries, just at the point that the danger to its population is the greatest its been since the end of the cold war. Lets hope we are lucky.

Government still behind the cruve again on swineflu

Take this advice current on the HPA's web site (Standard practical advice for investigating individuals with possible swine influenza infection v1 30 April 2009):

1. Which patients should be tested?
Currently we do not have transmission of swine influenza
A within the UK.
To be considered for testing a patient should have:
• Fever greater or equal to 38°C or history of fever,
AND flu-like illness or other severe illness suggestive
of an infective process
AND
• Onset within seven days of travel from an area known
to have cases of swine influenza. The updated list is
available at on the HPA website.

That means no secondary infection cases are automatically tested.

This document may have been downloaded and could be referred to for days by "health professionals".

Just a few hours ago the first confirmed human to human transmission case was identified in Scotland. Remember this case happened because someone was allowed to wonder round the country of a flight from Mexico and go out drinking with their rugby club.

If anyone from the HPA reads this here is what you need to do:

Put at the heading of each document a date by which that document should not be refered to any long and redownloaded. Currently you might like to restrict that to every 6 hours. ( Its only a little help to put a version number on because odds are the document's been printed out and is blue tacked to someone's office wall for goodness knows how long. Right now that has a real impact ).

Did no one think this stuff through ? The control of documentation is basic practice int he Engineering world, I'm just appauled by all of this. Command and control is definately lacking.

Update: They seem to have woken up in part to this on some other documents - other algorithm documents advice checking with the web site before taking action. Better to put an expired notice on it !

PS I'm told that health care professionals have had a hard time getting on the HPA web site at all today. Now maybe that's just a local internet connection thing, but maybe nobody stress tested their systems and its another sign that things have not been worked through.

And if there is a vaccine - which country will benefit ?

Assuming things carry on in there current direction with Swine Flu and at least epidemics, develop, and I'm hoping it doesn't, let me introduce you to the next political hot potato - vaccines, or rather their availability.

If mortality is high, how long will they be tested for ?

Not all countries are equal for flu vaccines.

The UK, I think, has a major production capability. The US doesn't.

Will the EU "order" that all stokpiles of vaccines produced must be equally shared ?

So that could lead to producer countries allowing some of their citizens to suffer so that other countries citizens don't.

Given Gordon Brown's weak caving in over the UK's over paying into the EU budget and its partial refund ( he believed the French would think about changing the EU CAP in exchange for more EUgeld from the UK and took their word for it !! Ha. ) I'd like to send someone else to Brussels to bargain for UK lives.

Of course perhaps the vaccine can only be made in France ( no question how they'll act) or Germany. In which case we'll be in the beggers position.

My guess is they will try to fix this one behind closed doors, and not even tell us about it.

Update: Fox News is now running with this in the US - since the US lacks vaccine manufacturing capacity.

And he said the United States wouldn't necessarily have the upper hand in seeking a hoard of those doses, since much of our vaccine manufacturing is done overseas -- in countries like France, Belgium, Germany and Great Britain.

"That's going to be a very delicate discussion and argument," Halsey said, when asked about how the vaccines could be distributed globally. "The countries where the manufacturing takes place are going to have some say in this."

I say again do you want Gordon Brown negotiating the number of vaccine doses we should keep ?

Andrew Lansley on the gaps the Govt has left in the UK's preparedness for Pandemic Flu

H/T To Con home and Playpolitical

The government is still not acting fast enough on swine flu

Take the following notes from the US CDC (Cnetre for Disease Control ) web site, I've underlined the key part:

How can someone with the flu infect someone else?
Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

And yet the UK Govt is sending people home and letting them off airplanes from Mexico to wonder round the country with the advice to phone NHS Direct / their GP is they feal unwell.

It could be too late. There may now be a number of people without obvious connections to those who returned from Mexico wondering around the country shedding virus, some of whom haven't developed symptoms yet and maybe some are carriers with very mild cases.

We have confirmed cases with considerable geographic spread already and advice which might identify cases one day after they become infectious.

Things are on a knife edge right now. Perhaps the initial wave of infections can be contained. Perhaps human to human transmission will prove harder in the UK. The government has decided to gamble.

What they could have done was book a nice friendly hotel to Quarantine people in for 5-7 days on their return from Mexico.

Instead, because the guidance says so, they have let people fan out across the country.

This could yet be a very costly mistake.

There is a real lack on initiative in government right now - all they think about is how they might look to head of criticism ( hence ordering supplies which they know propoably they should have ordered years ago ).

Lets hope this doesn't take hold.

The government is forced to act on face masks - but probably too late

The Labour government are now starting to try and run to catch up. The Telegraph reports orders for 30 million face masks. ( How realistic is that at short notice with very high world demand ? But better to try than to give up ! )

I think they have just woken up to the political implications of being the only country not to be able to provide masks to its population.

And Her Majesties loyal opposition is starting to push the government. See this quote of Andrew Lansley in the Telegraph:

Andrew Lansley, Shadow Health Secretary, said: "The Labour Government were warned by the industry and urged by us for years that they needed to get a stockpile of face masks ready for front line staff.

"It is now unlikely that we will be able to get these masks by the time we need them. I only hope that NHS staff do not suffer as a consequence. This does not inspire confidence that Alan Johnson is in control of the situation."

He's quite right and this is about time.

It will take more than wheeling out the odd "expert" to say that the British don't need face masks for the "general public" to convince people that the government did a good job in not taking a relatively cheap measure to help protect the population.

For those who are intrested a set of gloves could be more important in public settings.

By the way the most use for face mask would be for preventing disease spread within families in home nursing situation ( see CDC advice here ), and given that the only way to handle the peak of an epidemic is to have people looked after at home this should have been a basic consideration. Brown tells us we are well prepared, its clearly not the case.

To those who read this who are in a position of authority - we don't want panic, but we do now want urgency, effectiveness and competence. Forget about being re-elected and if you can't handle things be honest and hand over to someone who can.

So what's the mortality rate for this swine flu ? Why the mortality in the US compared to Mexico just seems low, but isn't

The current outbreak of swine flu is clearly very contagious. It is also clearly very wide spread in Mexico, given the location foreign travellers are coming how with infections from. The two cases in the UK (Scotland) have already created a significant number of other cases of concern.

You hear case numbers mentioned on the radio, but they are very imprecise. Today's radio 4 Today mentioned 2000 cases - but is that current or in total. If its in total then 150 deaths for 2000 cases is a very alarming mortality rate. I assume there are vastly more cases which people have recovered from than are being reported. (Update Reuters have a report of world case number here - if they contain all known cases rather than current cases then mortality would seem to be indicated as high. The Mexican figures suggest 9% - all the figures I've used here are 0.5% - lets pray that in reality the number of mild and unreported cases in Mexico is far higher as we already know its very infectious.)

However if the flue kills about 0.5% of cases ( at the lower end of the 0.5-2% range UK planning seems to think likely ) then there are 30,000 cases in Mexico.

Mexico city has a population of 20,000,000 and the country 109,000,000. That would mean a final casualty rate of 272,500 - ie quarter of a million, assuming 50% of the population get infected.

The UK equivalent is 150,000 fatalities. If mortality is higher or transmission is more effective then that number goes up a lott ( the govt sees 755,000 as its top end projection ). The weak response from the UK government so far, which has consisted mostly of arrogance about being the best prepared country for the coming storm ( now where have we heard that before ? ) does not fill me with confidence.

Given the high amount of medical attention those lucky enough to be the early victims will receive it reasonable to assume mortality can be kept much lower than that initially.

None of this means the virus, which is now in the UK and US is any less deadly than Mexico.

I assume our media's science correspondents are keeping this quiet. But that's a mistake. To avoid panic people need to be assured that their government is levelling with them.

If we are to accept the decisions of doctors and civil servants about who gets treatment or a ventilator and who dies at the peak of an epidemic we need to have trust and faith that they are being open and honest. The alternative is a break down in public order just at the time that the police and military can't cope.

If the mortality rate is 0.5% then given the 40-60 cases identified outside the US we can't really tell anything about the mortality rate, except to rule out ebola type mortality. So far for the chances of a fatality to reach 50%, without medical intervention, would require 138 cases.

This is why the reports of the disease being milder else where are not reassuring.

Finally

Take a look as some pandemic flu (avian) simulations for the US and the expected profile for the UK. What you'll see is a sort of phoney war at the start, until centres of infection spread then the explosion of cases.

Also a typical curve of the profile of an epidemic from the UK govt report "Pandemic Flu" by the Cabinet office.

Update: Sad news for first US death of a child here. That's one fatality in 68 cases. Not enough yet to be statistically sure of large scale outcomes ( this would roughtly indicate a mortality of about 1.4% despite what is presumably very good health care in the US,. If sustained it would be very bad news. The other key issue is transmission rates [unknown currently] ). Cause for concern and a tragedy for their family.


PS My view has now changed from an earlier post. I think this is alarming. Most alarming of all is the thought that the same govt that couldn't control foot and mouth is now going to be responsible for trying to save my family and community.

Shouting fire in a crowded theatre

There are two likely interpretations on the current swine flu outbreak.

1) It an event with high risks, but currently the virus is only causing deaths in Mexico ( and those reports are from the city ). The Authorities are nervous in case theirs a mutation to something more troublesome ( and as the number of human hosts sky rockets the chances of that increase dramatically ). Whilst the death toll of over 100 looks big, its in a city of 20 million people. There will have been a considerable number of other deaths.

Also flights from Mexico haven't been cancelled, which surely would be the case if a high mortality Pandemic was expected. ( Whilst the experts who say the flu can't be contained are no doubt right, it can be delayed giving time for a vaccine to be developed ).

The US has not taken measures that would be required if they saw a clear threat ( schools shut etc ). Update: This is starting to happen and the US has released 25% of its federal reserves of anti-Flu drugs to areas that are likely to be affected.

I wonder if the famous poor air quality in Mexico city has contributed to the deaths. This flu is supposed to be a respiratory disease. Also I wonder if smoking isn't far more common in Mexico?

Hence vigilant but relaxed is the correct outlook.

2) Things are far worse than is being reported. The BBC seems to have a contact in a Mexican hospital who is saying this. Deaths are being hidden as the authorities wish to avoid panic.

Personally I think this is far less likely, though it would be understandable. Its hard to keep a lid on things in the Internet world, I would have thought the BBC should get more sources for their story.

If this is true the lid won't be able to be kept on events for more than a few days, which will then be followed by chaos.

The argument against free speech here is the right to call fire in a crowded theatre case. I think this is mistaken, and trust would be one of the key factors in allowing any government to handle such an epidemic. That trust has to be earned and maintained. If people think they are being routinely lied to then mass panic will be uncontainable. It would be a very bad mistake.

Right now my strong balance of opinion is with 1). Update I'm now leaning more towards 2 based on current information.

Update: Google map of reported cases here - note cases and potential cases in Spain and UK.

This subject has just been covered in some detail on R4's news at one. It makes sobering listening.

Questions are now being asked about why the picture from Mexico is so confused.

Thinking further the fatalities in Mexico rather than the US may be a function of the number of cases. It appears the virus is far more widely present in Mexico than the recorded cases suggest, and hence a low mortality rate would still yield the headline figure of deaths we've seen, but not int he US ( with far fewer current cases ) - and be the same virus.

Good and bad news on swine flu

Reuters has reported that the US Centre for Disease Control now thinks that Swine flu cannot be contained. If it can't be contained there, then global spread must be the most likely outcome.

The good news is that the impact of the disease in the US seems to be far milder than in Mexico. ( Update Looking at the figures I'm now not so sure this is the case. US cases are relatively small and getting high grade medical care. Mortality between 0.5 and 2% is expected for Flu Pandemic - given the number of cases the absence of out of Mexico deaths could just be chance ).

This is one to watch.

Its something the UK Govt is likely to grasp like a drowning man, allow Brown to pose and convene COBRA whilst sounding solemn.

If the UK did want to try to prevent spread here then action is due now. Though from what I've seen of flu outbreak simulations on documentaries its unlikely to be effective.

Update: The Guardian is reporting a member of a BA crew from Mexico city is under observation for flu like symptoms. We all have reason to wish him well and hope its just normal flu. [ Further it turns out he's OK, but there are other suspect cases now in Scotland. ]

Further From NY Times
MEXICO CITY —President Felipe Calderón published an order Saturday that would give his government extraordinary powers to address a deadly flu epidemic, including isolating those affected by the rare virus, inspecting their homes and ordering the closure of any public events that might result in more infection.

23:46 25/4/09 I guess there is tremendous potential for rumour and damaging panic here. However some of the reports from Mexico city are mixed. The BBC has a comment ( unsubstantiated as far as I can tell ) from some saying things are far worse than is being widely reported.

Perhaps a common sense statement and sense of perspective is provided here by Dr Marc Siegel on Fox News' site.