Show Hide image

A right pig’s ear

The government panicked over the threat of swine flu – and got its response completely wrong

Brace yourself - swine flu is on the rise again. The second wave coincides with mounting disquiet among doctors about the way we as a nation are responding to the disease. A recent survey by Pulse, a leading GP periodical, found that 61 per cent of family doctors believe the government should review its policy of blanket provision of Tamiflu to all suspected sufferers. It also reported a growing number of cases that have resulted in death or serious harm after conditions such as meningitis have been misdiagnosed as flu, and wrongly treated.

Swine flu has wrong-footed everyone. For many years it was assumed that when the next pandemic arrived, it would create havoc: thousands would die in Britain alone; the exponential demand for services would be mirrored by the decreasing number of healthy doctors able to deliver them; societies would crumble. This projection was based in part on the 1918 global flu pandemic - which caused an estimated 50 to 100 million deaths - coupled with the high fatality rate among the few hundred cases of "bird flu" (H5N1) over the past few years.

In the UK, huge quantities of antiviral drugs were stockpiled, plans for establishing a national pandemic flu phone line were laid, and organisations both public and private were exhorted to draft detailed contingency plans for when the carnage began. Both chambers loaded, the shotgun was trained on the far horizon, the collective eye of the viral surveillance world squinting down the barrel, seeking out the first sign of an emergent threat.

Along came swine flu (H1N1). To be clear: people have died - 82 in the UK and an estimated 4,041 worldwide, at the time of writing. According to the World Health Organisation (WHO), roughly 60 per cent of the severe or fatal cases have occurred in recognised risk groups, such as people with grave underlying health problems; the remaining 40 per cent have affected fit children and adults. Each death is tragic, but the mortality figures are tiny, viewed against the millions of mild cases globally.

Writing in the British Medical Journal in September, Peter Doshi, a doctoral student at the Massachusetts Institute of Technology, proposed a framework to differentiate between disease patterns. Type 1 infections are widespread and severe - exactly the kind towards which the current pandemic flu plans are geared. But swine flu sits in Doshi's type 3 - widespread but usually mild. These different beasts present different challenges, but because pandemic planning failed to anticipate anything other than a type 1 scenario, swine flu has triggered a completely inappropriate response.

Marginal effects

Central to doctors' unease is the National Pandemic Flu Service (NPFS). Telephone-based and web-based assessments of symptoms are made using a computer algorithm. If the computer says "swine flu", patients are given antiviral medication, usually Tamiflu. The problems are twofold.

First, data from the Health Protection Agency, which conducts confirmatory laboratory tests on a sample of cases, shows that less than 10 per cent of NPFS diagnoses are correct. The other 90 per cent of supposed swine flu sufferers have other illnesses whose symptoms happen to overlap. (Doctors fare only slightly better, diagnosing at best a quarter of cases accurately.) Second, the drugs being doled out are by and large worse than useless, even in the correctly diagnosed cases. Tamiflu makes only a marginal difference to the course of uncomplicated flu and causes side effects in up to 40 per cent of people who take it. On the whole, these are just bothersome - vomiting is the most frequent - but serious, even fatally adverse reactions do occasionally occur.

In late August, WHO advised that antivirals were not necessary for fit patients suffering from uncomplicated swine flu. The Department of Health defends its continued policy of Tamiflu-for-all on "safety first" grounds. Its concern is those exceptional cases of severe disease in fit individuals, where Tamiflu might (no one knows for sure) make a difference if started early. However, the logic - that it is better to treat everyone than risk missing those who might have benefited - belongs to a strategy for dealing with a Doshi type 1 pandemic, where the chance of severe disease is high. For swine flu, damage from indiscriminate use of antivirals outweighs the supposed benefits of catching atypical cases early.

The real challenge of a Doshi type 3 pandemic is identifying the small minority who actually and urgently require help. These could be those rare individuals with severe flu, or they might be patients in the early stages of another serious disease such as meningitis. Doctors are good at doing this (though far from infallible) and many GPs believe that only medically qualified staff should be undertaking flu assessments, but this is not achievable, given our capacity for mass hysteria. During the first wave of swine flu - before the NPFS was launched - the NHS front line was overwhelmed by waves of worried callers in flu hot spots. One of the main reasons for setting up the NPFS was to prevent a meltdown in services, but it should now change its focus from diagnosing swine flu (at which it is hopeless) to identifying patients in trouble.

The trickiest problem is when patients who initially feel mildly unwell start to deteriorate. The Department of Health stresses that patients are advised to consult a doctor if they get worse, but this fails to appreciate the Tamiflu effect. Having been "diagnosed" with swine flu and put on antivirals, patients are then falsely reassured that appropriate treatment is under way. By stopping its blanket use of Tamiflu, the NPFS would greatly increase the likelihood of patients consulting a doctor if they deteriorate.

Lessons in planning

Swine flu may in time be seen as a great learning opportunity. It has exposed a rigidity in pandemic planning that needs urgent correction. WHO has a scale to denote the spread of in­fection - level six being pandemic. It needs to develop a simple, parallel system to differen­tiate between Doshi types, one that should trigger responses appropriate to the particular challenge posed.

For now, the Department of Health should stop sticking doggedly to contingencies laid against a very different threat. The public and the NHS need clear identification of the at-risk groups and a message that the danger of swine flu, for everyone else, is almost certain to be minimal. They also need information about the warning signs of a more serious problem. The vast stocks of antivirals should be left on the shelf to go quietly out of date.

Yet it may be too late. Another facet of the Tamiflu effect is that we have educated hordes of people that what they thought felt like just a bad cold (and, most of the time, was just a bad cold) needed treatment with powerful drugs involving mystical rituals with a special authorisation number and a flu friend. Doctors will be dealing with mass hysteria in the face of ­minor illness for some time to come.

Phil Whitaker is a doctor and novelist. He is currently working on his fifth novel, "Sister Sebastian's Library"

 

Computer says flu

What do malaria, meningitis, diabetic coma, leukaemia and appendicitis have in common? They are just a few of the conditions that were originally diagnosed as swine flu during the first wave of the pandemic. Most patients have lived to tell the tale; some have not. The case reports have been appearing in the letters pages of medical journals, and on discussion forums of networking sites for doctors. The GPs reporting them are frequently unsure who in authority should be informed.

In fact, the National Patient Safety Agency (NPSA) has been tasked by the Department of Health with investigating alleged misdiagnoses. In a statement, John Scarpello, NPSA deputy medical director, confirmed that the agency had received "a small number of reports where swine flu may have been misdiagnosed", but was unwilling to go into detail while the facts had not been established. Given that the reporting system is entirely voluntary, and few clinicians know to contact the NPSA, this "small number" of reports is likely to be the tip of an iceberg.

The National Pandemic Flu Service is a first: never before have patients been diagnosed by computer or unqualified call-centre staff. There is a real need for research to examine this approach, yet none appears to be planned. The Department of Health refers inquiries about patient safety to the NPSA, while the NPSA believes commissioning such a study would be outside its capacity and brief.

Phil Whitaker

This article first appeared in the 12 October 2009 issue of the New Statesman, Barack W Bush

Martin O’Neill for New Statesman
Show Hide image

1966 and all that

A year of World Cup glory, meeting Paul McCartney and eating placenta.

Fifty years ago this Saturday, on 30 July 1966, I was at Wembley. I have my ticket and my programme to prove it. I also have my 1966 ­diary, which I am looking at now. I was 30, weighed ten stone and eight pounds, and my waist was 32 inches – about as hard to believe now as England winning another World Cup final.

I am still in the same house, all these decades later, but my telephone number then was GUL 4685. GUL was short for Gulliver, I can’t remember why. In my list of contacts at the end of my diary is Melvyn Bragg, who was another recent arrival in London from Cumbria, like myself and my wife, on PRO 0790. PRO stood for Prospect, I think, which was the exchange name for somewhere over the river, possibly Kew.

My office number was TER 1234. I always thought that was a great and memorable number. It’s only now, thinking about it, that I realise that TER – meaning Terminus –
probably related to King’s Cross, which the Sunday Times was near in those days.

At the top of the charts in July 1966 were the Kinks with “Sunny Afternoon”, which I can well remember, as it was so ironically chirpy, and Georgie Fame with “Getaway”. I liked Georgie Fame – low-key, cool – but I can’t remember that tune. Both were replaced in August by the Beatles’ “Yellow Submarine”/“Eleanor Rigby”.

My day job in July 1966, on the Sunday Times staff, was writing the Atticus column. It still exists, but in a smaller, more skittery format. Previous incumbents included Ian Fleming, John Buchan and Sacheverell Sitwell, who was reputed to have got free Mateus rosé for life after giving the wine its first mention in an English newspaper.

I had been on the paper since 1960, after spending two years as a so-called graduate trainee journalist, mainly in Manchester, which was a laugh. There was no training and there were no lessons in law. You had a mentor for a few weeks and then you got on with it.

In my first few years as the boy on Atticus, I never had my name in the paper. I had to write dreary paragraphs about who might be our next man in Washington, or the bishop of London, or the master of Balliol, as if I cared. I wanted to write about footballers, gritty northern novelists, pop stars.

When I started at the Sunday Times, I felt for a while that people were prejudiced against me, because I was northern and working class and had gone to grammar school and a provincial university (Durham). Everyone else seemed to have been at Oxbridge and gone to public school.

But this prejudice was all in my head, imagined, just as it had been when I used to go from Durham to visit my girlfriend, Margaret – whom I married in 1960 – at Oxford. I was convinced that some of her posh friends were being condescending ­towards me. Total nonsense, but I had a chip on my shoulder for some years. Gone, all gone, just like my 32-inch waist. (I am now 12 stone and the new shorts I bought last week have a 38-inch waist. Oh, the horror.) If anything, these past 50 years, any prejudice has been in my favour.

Harold Wilson was the prime minister in 1966. His northern accent was even stronger than mine. I still have a letter from him, dated 21 March 1963, after I interviewed him for Atticus. In the letter, he ­describes the 1938 FA Cup final in which Preston beat Huddersfield Town 1-0, scoring in the last minute of extra time. At the bottom of the page, in handwriting, he’d added: “after hitting the crossbar”.

What I remember most about the interview was George Brown, who was deputy to
Wilson as Labour leader at the time, hanging around outside his office, drunk. Marcia Williams, Wilson’s secretary, was going around tut-tutting, making faces, complaining about George. I thought she shouldn’t have done, not in front of me, as I was a total stranger and a hack. (I don’t think we called ourselves hacks in those days, which is the normal, half-ironic self-description today.)

Harold was a football man and also a real know-all, forever boasting about his memory for facts and figures. The contents of this letter illustrate both aspects of his character. It led me later to collect a letter or autograph from every prime minister, going back to Robert Walpole. Only took me ten years.

There is a myth that England’s 1966 win helped Labour stay in power – which does not quite stand up. The general election was in March – four months before the final. But Wilson did milk England’s victory, identifying himself and the nation with our English champions.

It is possible that the reverse effect happened in 1970, when Wilson was chucked out and Edward Heath came in. England’s defeat at the 1970 World Cup by West Germany was just four days before the June general election.

***

I got my ticket for the 1966 World Cup final – for one of the best seats, priced at £5 – from my friend James Bredin, now dead, who was the boss of Border Television. Based in Carlisle, Border covered the Scottish Borders and the Isle of Man. It was a thriving, thrusting regional ITV station, now also deceased.

James’s chauffeur came to pick me up and waited for us after the match, a sign of the importance and affluence of even minor ITV stations. Border contributed quite a bit to the network, such as Mr and Mrs, starring Derek Batey, who presented 450 editions of this very popular national show. Batey was a local lad who started his show business life as an amateur ventriloquist in the little market town of Brampton, Cumbria, before becoming Carlisle’s Mr Show Business. He was so polished – lush hair, shiny suits, so starry, so glittery – that I always wondered why he was not in London, in the West End.

Border TV also produced some excellent documentaries that were networked across the ITV region, two of which I presented. One was about walking along Hadrian’s Wall and the other was about George Stephenson. For a while in the 1970s, I began to think I was going to become a TV presenter, despite being not much good. I was lousy at acting, which you need for television, and disliked asking questions to which I already knew the answers. And it took so much time. For each programme, we spent eight weeks on location with a crew of eight, just to make a one-hour documentary. Now they
do docs in a week with just two people.

For half an hour, I also imagined that I was going to become a playwright. In 1967, I had a play in the BBC’s Wednesday Play slot, awfully prestigious at the time, called The Playground. It was one of those shows that were filmed live and then wiped, so I have never seen it since, nor has anybody else. I blamed that for blighting my playwriting career, though till I was looking in my 1966 diary and saw that I was working on that play, I’d forgotten about its existence. As we go through life, we forget all the paths not trodden.

I’ve boasted endlessly about being at the 1966 Wembley final, and it was so exciting, but I can’t remember many of the details. I must have been aware of Geoff Hurst’s second goal being a bit dodgy, as there were loud complaints from the German fans, but as Sir Geoff, as he then wasn’t, went on to score a third goal, it didn’t really matter. At the time, I considered that the England-Portugal semi-final had been a better game, with our Bobby Charlton scoring two goals against one from Eusebio, but of course winning a final is winning a final and the excitement and the patriotic pride continued for weeks and months. We felt as if it had been our right to win – after all, did we not give the game to the world, lay down the first rules, show all those foreigners how to play our game?

The result was that we usually ignored all the new ideas and developments that were emerging from Europe and South America, carrying on with our old ways, stuffing our faces with steak before a game and knocking back six pints afterwards, a bit like Alf Tupper in the Rover comic. He lived on fish and chips, but on the race track he could beat anyone.

Those funny Continental players started playing in funny lightweight boots, more like slippers or ballet shoes, which seemed barmy to us. How we scoffed. How can you play properly, far less kick someone properly, unless your ankles are encased in hard leather as tough as steel? Who cared if they weighed a ton, especially in wet weather? We Brits were tough.

The top First Division stars of 1966 earned about £200 a week, including bonuses, and lived in £20,000 houses, semi-detached, on new estates with Tudor overtones. The top players drove Jaguars. But most were lucky to afford a Ford Cortina. I had one myself for a while. Awfully smart, or so I thought at the time.

Their basic wages were little more than double that of the best-paid working men, such as a foreman bricklayer or a successful plumber. Their neighbours on their estates were bank mangers or salesmen, a higher scale socially than their own background, but still fairly modest. Not like today. Footballers don’t even have neighbours any more. They are cocooned in their own gated mansions, with personal staff, gardeners, nannies, accountants, lawyers, agents.

Yet despite their modest lifestyles in those days, there were celebrity players, such as Bobby Moore, Bobby Charlton and, before them, Billy Wright, all household names, loved and admired, recognised everywhere.

None of them had an agent in 1966. The nearest thing to it was the system that operated if a team got to the FA Cup final. They would then agree to divvy up the peripheral proceeds, such as money from giving newspaper interviews, posing for staged corny photographs, opening shops, or selling their spare tickets to touts (which they were not supposed to do). They’d appoint some dodgy friend of one of the senior players to arrange the deals and collect the monies for them. Times, they always change. Otherwise, what’s the point, eh?

***

In 1966, two big events occurred in my personal life. In May that year, my son, Jake, was born – at home, in what is now our kitchen. He arrived so quickly that the midwife hadn’t turned up yet and he emerged with the cord twisted around his neck. I managed to untie it, which I have maintained since kept him alive (a trick I had learned at fathers’ classes).

Fathers’ classes – wow, what a novelty that was in the 1960s. Who says we were all chauvinist pigs back then? (Today’s young, female star writers at the New Statesman, probably.) I attended my first ones, at the Royal Free Hospital in 1964, when our firstborn, Caitlin, was about to arrive. I remember immediately thinking when the invite came that I would get 1,000 words out of this – which I did, for the Sunday Times women’s pages.

Also at those first-ever fathers’ classes at the Royal Free was a young BBC producer whose wife was also about to give birth: Wilfred De’Ath. He, too, was desperate to get a piece out of it. (He now writes occasionally for the Oldie, and he appears to be down and out and living in France.)

After Jake’s birth, I got the midwife to give me the placenta and I ate it, fried with onions. Tasted like liver. Another 1,000 words.

The other event of note in my ever-so-exciting life in 1966 was meeting Paul McCartney. When “Eleanor Rigby” came out, I thought the words – not just the tune – were so wonderful. Possibly the best poetry of the year, I said, as if I knew anything about poetry. I went to see him for Atticus in his new house in St John’s Wood, which he still has, being a very conservative feller. I talked to him about the background to the lyrics, as opposed to his hair, which interviewers were still asking him about.

A few months later, at the end of 1966, I went to see him again, wearing a different cap, as a screenwriter. I’d had a novel published the previous year, Here We Go Round the Mulberry Bush, which was being made into a film, with Clive Donner directing. We went to see Paul at his house and discussed with him if he would do the theme tune. He turned us down in the end but it was while I was with him that I suggested that there should be a proper biography of the Beatles. He said Brian (Epstein, the band’s manager) would have to agree – and there and then sat me down and helped me write a suitable arse-licking letter to him.

I eventually saw Brian, after several cancellations, at his home in Belgravia and he played me the acetate of “Strawberry Fields Forever”. I was astounded. It seemed to break every rule of what was then considered pop music. I wondered if all Beatles fans
would take to it. But I could see that it was amazing and perhaps the Beatles weren’t finished, which was what some people were saying in 1966. At my publisher, Heinemann, which paid me £3,000 for the book, there was one director who maintained the Beatles bubble was about to burst.

Brian agreed to my project and offered a clause in the contract that we had not requested or even thought of. He said he would not give any other writer access to the Beatles for two years after my book came out. This was 1966. The book came out in 1968. Two years later, in 1970, the Beatles were no more. Without realising it at the time, I became the only authorised ­biographer of the Beatles.

***

So, 1966, a big year for me, so glad I kept that diary, and also a big year for the nation. I thought at the time that the Beatles were bound to fade, eventually, while England surely would dominate world football from now on. After their humbling by Iceland at this year’s World Cup, I now realise that England will never win the World Cup again in my life, what’s left of it. And probably not even another game.

The only way to rationalise it is to tell ourselves that we are ahead of the game. We are rubbish, but in turn it will happen to all the other so-called advanced nations.

You could say Brexit is a bit like that. We are ahead of the other leading European nations in going it alone, even though it is depressing and awful and shameful. We are advanced in wilfully turning ourselves into a rubbish nation. We are leading the way, as ever. Inger-land, Inger-land.

Hunter Davies’s memoir of the postwar years, “The Co-op’s Got Bananas!” (Simon & Schuster), was published in April, followed by “Lakeland: a Personal Journal” (Head of Zeus). His final book on the Fab Four, “The Beatles Book” (Ebury), will be published on 1 September

Hunter Davies is a journalist, broadcaster and profilic author perhaps best known for writing about the Beatles. He is an ardent Tottenham fan and writes a regular column on football for the New Statesman.

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue