GP blog: where has all the flu gone?
Updated on 10 August 2009
Although you would expect to see less people with flu at this time of year, the fall in swine flu patients contacting a surgery in over the last week has been dramatic, writes Dr Peter Stott.
Where has all the flu gone? Last week our 'flu clinic' was dealing with 12-20 cases every afternoon. This week we have seen six a day at the most. One day we had no enquiries at all.
Traditionally we expect to see a fall-off in infective illnesses at this time of the year, particularly in children. The schools have all broken up and this reduces the chances for children to pass illness from one to the other and for them to take it home to the adults.
People are going away on holiday so there is less chance to mix on public transport or at work; and of course, people have other things to think about – things that are much more interesting than going to the doctor – like having a good time.
By far the most important factor is that the schools have broken up. Children are much more tactile than adults and if there is anything contagious about, they are sure to hand it on.
GPs are not alone in seeing less flu. The national flu advice line has also seen fewer enquiries. According to the British Medical Journal, whereas there was a doubling of cases in the weeks leading up to 26 July, after that there were only 10 per cent more each week.
We have however seen a new epidemic of calls – people who have been given Tamiflu and who have developed side effects. So this week, we have had lots of calls from confused people asking whether they should continue to take the tablets.
According to a study by the Health Protection Agency, early in this flu epidemic half of school children given Tamiflu had tummy upsets, headaches, poor concentration, difficulty sleeping or nightmares. In adults, side effects are less common. The most common is diarrhoea which occurs in about 10 per cent.
Some of these problems might not be side effects but have been caused by the flu itself. It is impossible to say and when we try to decide whether people should continue to take the medicine or stop it, every case has to be taken on its merits. If people are over the worst, then it is usually OK to stop.
We have also had problems with requests for sick notes. If you have an illness which lasts less than one week, you can self-certificate. If it lasts longer than 6 days then you need to see your doctor for a 'Med3'.
Most of the people who have swine flu are ill for seven to 10 days. So they need a doctor's certificate, but the regulations say they need to be actually seen before a GP can issue the certificate and we are supposed to be avoiding direct contact.
Most GPs are being pragmatic about this and taking the patient's word over the telephone. However, the government has not issued guidance and it is possible that some people are taking advantage.
GPs are also beginning to get information about this winter's influenza campaign. It seems that there are likely to be two separate vaccinations – one for the expected seasonal flu bugs and another for swine flu. The risk population for each strain is different. So we face the prospect of running two campaigns, which will create quite a workload.
The swine flu vaccination will be aimed at (in order of priority) healthcare professionals, pregnant women, the under 5's, the under 65's with a long-term illness and the under 18s. There will probably be two vaccines for swine flu given three weeks apart.
The seasonal flu vaccine will prioritise different groups. Again in order of priority this will be all patients over 65, patients under 65 with certain long-term medical conditions, healthcare professionals and social workers and poultry workers. As in previous winters, there will only be one vaccination required.
This seems a recipe for confusion and lots of disagreements with patients. It will probably give GP up to three times their usual vaccination workload and affect our ability to provide other types of care.
However, the opportunity to vaccinate does give us a real possibility of improving our 'herd immunity' – something which is really important to do before swine flu comes back with a vengeance.
Dr Peter Stott is a GP at the Tadworth Medical Centre in Surrey.
