H1N1 influenza, more commonly known and feared as swine flu, is making its presence firmly felt in the UK. By this point, most people will know someone who has been affected, and most people will have sneaking fears about being next in line. As I write, the National Health Service is about to launch a self-diagnosis website that will enable patients in England to allay or confirm these concerns. If deemed necessary, a prescription of antivirals will then be organised.

This seems reasonable. In a pandemic, NHS services simply can’t operate normally. The internet sidesteps many of the problems – huge volumes of patients, the infection risk of crowded waiting rooms – but it is not without flaws.

Some flu symptoms – a headache, say, or diarrhoea – can be confused with signs of other illnesses, such as bacterial or viral meningitis or gastroenteritis. We get it right most of the time, though this may be down to statistics rather than skill (meningitis, after all, is rarer than flu). We also get it right because when a GP and a patient meet, there is usually a prior relationship, providing knowledge about the patient’s medical history, current medication and social circumstances. A computer program isn’t able to replicate the complex information required for a diagnosis that will ensure the best treatment is made available.

And what is the treatment? Antiviral medication has been stockpiled in massive quantities around the UK. For people at higher risk of complications from flu – children, the elderly, pregnant women and the chronically ill – it may be reasonable to take the treatment. For otherwise healthy people, the benefits are less clear.

A Cochrane review from 2008 examining the effect of these antiviral drugs in healthy adults concluded that, “Because of their low effectiveness, NIs [neuraminidase inhibitors, or antiviral drugs] should not be used in routine seasonal influenza control. In a serious epidemic or pandemic, NIs should be used with other public health measures. We are unsure of the generalisability of our conclusions from seasonal to pandemic or avian influenza.” This seems to me to be the ideal time to get a clinical trial under way and test these conclusions, making the results obtainable for any second wave of infection that may occur.

As for how to diagnose people: even during a pandemic, there may be better half-way measures than offering diagnosis via a computer screen. There are lots of part-time workers in the NHS, many of them female, who might be willing to help out if they can be found places to work from. Perhaps we should slow down and think about how best to use the resources we already have.

Margaret McCartney is a GP in Glasgow.
margaret.mccartney@ft.com

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