# 3552
In the UK, if you’ve got `flu-like’ symptoms and think you may have the novel H1N1 virus, you are told NOT to go to your doctor.
Instead you are directed to go to a website, or to ring up a hotline number, answer a brief questionnaire . . . and based on that, you either are issued antivirals or not.
Last Thursday, on its first day of operation, the hotline dispense 5,500 courses of Tamiflu to patients who were never tested, and never saw a doctor.
Compare that with Thailand, where there have been more than twice the number of swine flu deaths as in the UK (with roughly the same population).
There, people with flu-like symptoms are `urged to see a doctor immediately’.
Currently only hospitals have access to antivirals (the last I checked, Thai pharmacies don’t stock it). Presumably, if you are sick enough, a doctor will refer you to a hospital.
Clinics 'not trained' to use oseltamivir
- Writer: BangkokPost.com
- Published: 28/07/2009 at 12:06 PM
Antiviral tablets should not be distributed to clinics across the country just yet, according to an official from the World Health Organisation.
"Doctors and nurses at these clinics need to be trained and know whether patients with flu-like symptoms have been infected with influenza type A (H1N1) before prescribing the antiviral oseltamivir directly to them," WHO Collaborating Centre for Research and Training on Viral Zoonoses director Thiravat Hemachudha said on Tuesday.
Oseltamivir should only be given at hospitals for now, because prescribing it to unconfirmed cases may lead to drug resistance, he warned.
He said the fatal cases may have received medication when it was too late, or maybe they only showed symptoms in the later stages.
"In most cases, if the patients' symptoms are clear no doctors would delay give them the medication," he said.
Dr Thiravat said wearing face masks and using alcohol-based hand gels may not be an effective preventative if people do not also avoid crowded places.
He also urged people with flu-like symptoms to see a doctor immediately.
The Thai Health Ministry announced last week that they had 14 million tablets of Tamiflu (1.4 million courses) and had ordered another 1 million courses of the drug.
Enough for 4% of their population.
The UK, in contrast, reportedly has enough Tamiflu to treat nearly 50% of their population (The US has enough for about 25%).
With 20% to 30% of the population expected to be hit by this virus over the fall and winter (admittedly a guess, since no one really knows), Thailand - with only enough antivirals to treat 4% of their population - must be more conservative in how they hand them out.
The concerns over breeding antiviral resistance are genuine, however. In the past 2 years seasonal H1N1 has gone from being nearly 100% sensitive to Tamiflu to being 100% resistant.
Should that happen to the novel H1N1 virus, we’d be down to only one antiviral – Relenza – which is not only in much shorter supply than Tamiflu, is an inhaled powder, which makes it problematic for some patients to take.
The unanswered question before us is which is better?
- To use antivirals aggressively now, while they remain effective, in order to reduce mortality and (hopefully) reduce the spread of the virus.
- Or to conserve antivirals for only the sickest of the sick, so as to limit the potential for resistance to develop?
I’m not sure I know what the right answer is here.
I will admit to being somewhat concerned over how readily Tamiflu is being dispensed in the UK and other countries, but I appreciate that holding onto a stockpile of antivirals until they are rendered useless by a viral mutation makes little sense.
I also recognize the political reality here.
It would be very difficult for the any government to sit on their much vaunted stockpile of antivirals while their citizens succumbed to a pandemic virus.
Eventual Tamiflu resistance isn’t assured, by any means. But we have seen a few scattered mutations, and the concern is these may be harbingers of things to come.
All of which proves how truly difficult these policy decisions really are. There are no immediately obvious `right’ answers here.
Historians, a decade from now, will probably have a better handle on it.
Of course, for a lot of countries, these are just theoretical problems. They have no stockpiles of antivirals, nor are they likely to see any substantial quantity of vaccine for this virus.
