# 3564
It’s an astonishing number, really.
In the first week of operation, the NHS hotline has reportedly given out 150,000 vouchers for Tamiflu over the phone.
Unlike most countries, where antivirals are being reserved for those with high risk comorbid conditions – like pregnancy, diabetes, or chronic pulmonary disease – or for those with particularly severe symptoms, antivirals according to this report are being handed out to just about anyone with flu-like symptoms.
Swine flu: 150,000 people take up antiviral drugs
David Rose
(AP)
An estimated 150,000 people were prescribed with antiviral drugs last week following the launch of the swine flu hotline and website.
The Health Protection Agency estimated that a further 110,000 new cases in England last week were diagnosed by doctors.
At present Tamiflu (oseltamivir) is being offered to anyone with identifiable swine flu symptoms.
Access to the treatments remains patchy, it has been claimed, while researchers say that some groups may benefit more than others from taking the drugs.
Since the launch of the National Pandemic Flu Service last week people suffering symptoms have been able to take an assessment questionnaire over the phone or on the internet.
Those who appear to have the H1N1 virus are given a unique number which can be given to a friend who can then pick up the prescription. There are over 1,100 collection points for the drug.
This sort of liberal dispensing of antivirals is a two-edged sword.
It may very well reduce the number of hospitalizations, and even deaths, that a country might experience. It may also reduce the spread of the virus, by limiting the amount of virus being shed by those infected.
But there are potential downsides as well.
There is considerable concern that overuse of antivirals could lead to resistance developing in the virus. Already nearly all seasonal H1N1 viruses tested show resistance to Tamiflu, and the fear is that the novel H1N1 could follow suit.
That may not happen of course.
Or it could happen, whether antivirals are liberally dispensed or not. There is a lot here, we simply don’t know.
Additionally, Tamiflu is a drug. And like all drugs, it can had adverse side effects. Most that have been reported have been mild, but there is always a tradeoff between the risk of taking a drug and the benefits derived.
If a large number of people are taking Tamiflu that don’t really need to be taking it, then they are presumably incurring some small additional risk. How small that risk might be is hard to gauge.
Politically, I’m sure it is very difficult for the NHS to deny hot line callers antivirals when A) they have them stockpiled and B) GPs are overwhelmed and cannot guarantee to see and evaluate patients during the critical first 24-48 hours of an illness.
All it would take to undermine public confidence in the NHS’s pandemic plans would be for someone to be denied antivirals who really needed them, and for them to come to a bad end.
The tabloids would have a field day with that kind of story.
Difficult questions, and no easy answers.
And issues that the US, and other countries are going to have to wrestle with over the next few months as well.
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2 comments:
Must consider another factor going on here. Britain's health system has conditioned its citizens that medical treatment is not as immediately available as we find here in the U.S. This is a delicate way of saying that everything is delayed substantially. There are enough stories about this that I believe that to be a true condition in their socialized health system.
I don't think it takes too much imagination that such a conditioned population may find it quite tempting and easy to falsely claim symptoms of flu to a layperson staphing their phone banks, just so they can get their Tamiflu pre-emptively, shall we say.
Folks pretty much know by now that Tamiflu is most effective when started very early after onset of symptoms, and with the high incidence of reported cases in that country, it would take a very honest and selfless citizen to resist resorting to such a tactic, especially if they're considering their families, aside from themselves personally. From their past experience, this is one time they don't want to wait (most likely too long) for a potentially life-saving drug.
This, of course, would contribute to these reports of such an unusually high incidence of infection for any one country, rendering their statistics less reliable.
Paul.
This, of course, would contribute to these reports of such an unusually high incidence of infection for any one country, rendering their statistics less reliable.
Very good point that should really be considered when interpreting the figures from the UK.
I assume, however, that the regular "ILI" statistics published by the NHS are still based on 'real' doctor visits and not on the new internet/phone-based prescription system, right ?
P.S.: Regarding the importance of the early tamiflu treatment time window : Consider the very sharp exponential growth curve of virus spread in a newly infected person where the number of virus particles doubles, say every half an hour, then every hour of delay of treatment means a four-fold multiplication of virus load that could have been prevented (or attenuated) if one had taken the medication only one hour earlier !
I am almost sure that even the often cited '48 hour window' is way too late in order to significantly influence the total virus load, which, by the onset of symptoms has already reached a substantial proportion of the maximum load (this explosion of virus load and the following immune response is the reason why we experience the symptoms in the first place, so at this time it is already rather 'late' in terms of preventing virus replication)
So in order to be really efficient, the antiviral must be applied even before the virus 'explosion' ni ones body takes place, i.e. as in post-exposition prohylaxis, or literally immediately when (not 24 or 48 hours after) the very first signs of the infection.
Due to the exponential growth of the viral load, the effectiviy of treatment decreases exponentially with every hour lost ...
With this in mind it is understandable that the most rational approach for the indivdual is to obtain the mediaction pre-emptively to have it already at hand when the very first symptoms appear and/or to protect their family members via prohylactic treatment.
If this behaviour is best for the community at a whole is, however, a different question as pointed out in the original article ....
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