Select Committee on Science and Technology Written Evidence


Letter from Dr Peter Bailey

  I have followed with interest the work of the Science and Technology Committee as it has investigated the response to the threat of pandemic influenza.

  My practice has around 5,000 patients, and there is a staff team of around 20 including doctors, nurses and administrators. We have kept ourselves fully informed about the emerging pandemic of avian influenza and have studied the history and epidemiology of previous pandemics in humans.

  The Health Protection Agency's revised advice in the event of pandemic influenza guesses at an attack rate of 25 per cent and a case fatality rate of 0.37 per cent, giving an excess mortality of 53,700 for the UK as a whole. In view of the 50 per cent death rate for cases of avian influenza in the few humans known to have contracted the disease, this could be a serious underestimate. In 1918, the pandemic was caused by a virus of avian origin and had a case fatality rate of 2 per cent. It would seem prudent to base our plans for dealing with the next pandemic on a pessimistic assumption rather than rely on the most optimistic figures taken from the mildest of recent pandemics.

  Using an attack rate of 30 per cent and a case fatality rate of 3 per cent the UK would see over 17 million cases of influenza and there would be over half a million deaths.

  My practice would expect to see 45 excess deaths during the pandemic. The work load of the practice would rise to unsustainable levels. The Chief Medical Officer's advice of having two separate waiting areas and two separate treatment teams, one dealing with influenza cases and one dealing with ­the rest" is unworkable.

  Among our own clinical team, attack rates are likely to be higher because of constant exposure to the virus. It would seem reasonable to use a figure of double the population average. This would suggest that at least half of the doctors and nurses and administrative staff would become unwell. There is a greater than 1:4 probability that the practice would experience the death of a team member.

  It seems to me that there are many pressing questions that are not answered by the plans that have been prepared so far:

    -     What model is proposed for calculating the number of doses of antivirals to be provided to each practice?

    -     When will stocks be made available to the practices?

    -     How will stocks be distributed?

    -     How should stocks be protected?

    -     Who should be given treatment courses (signs, symptoms, duration of illness, risk exposures etc)?

    -     What arrangements have been made for out of hours access, given that treatment should be started within 48 hours according to the data sheet for oseltamivir?

    -     Have any plans been made to treat front line Primary Care staff with prophylactic antivirals during the course of the pandemic?

    -     How many additional doses of antivirals will be distributed for prophylaxis and who will be eligible for such treatment?

    -     Will non-essential staff be expected to come to work?

    -     Who will determine who is ­non-essential"?

    -     How should Primary Care teams respond to demands for prophylactic treatment in families in which cases occur?

    -     What is the status of existing H5N1 vaccines?

    -     Are there any plans for protecting Primary Care teams using existing vaccines?

  And perhaps the most important question of all:

    -     What behavioural responses to perceived risk are expected in doctors, nurses, ancillary staff and the general public?

    -   Altruism;

    -   Generosity;

    -   Volunteering for overtime without pay;

    -   Good neighbourliness;

    -   Voluntary quarantine by infected cases;

    -   Family support strengthened.

    Or:

    -   Fear;

    -   Anxiety;

    -   Abandonment of influenza victims;

    -   Violent protectionism;

    -   Absenteeism in all sectors but especially health care;

    -   Civil disorder and breakdown of infrastructure (utilities, transport, food supplies, education, broadcasting, law enforcement, mortuary and cremation facilities);

    -   Violence against Primary Care staff and pharmacists;

    -   Theft from treatment centres.

  All these questions require sensible answers and Primary Care teams must be fully engaged in any solutions that are proposed.

November 2005



 
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