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.

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.