Swine flu pandemic? It feels like a phoney war

Dr John Crippen is the pseudonym of an NHS doctor who writes a popular medical blog. This is his account of the view from the GP's surgery

• Dr John Crippen
• The Guardian, Friday 1 May 2009
• Article history

Oh! God, now I know it is serious. The Health Protection Agency has sent me an algorithm to tell me how to deal with swine flu. It arrived today in an email with one of those red exclamation marks at the side. An algorithm, for those who don't know, is a "finite sequence of instructions, an explicit, step-by-step procedure for solving a problem". It is very complicated. I do not understand it. Fortunately the primary care trust has also sent me a red exclamation mark email with instructions I can understand: "The main message remains: always use a tissue to catch coughs and sneezes, throw away used tissues and regularly wash your hands."

I can relate to that. Trouble is, it makes me giggle. I can't get that old jingle, from somewhere in early childhood, out of my mind. "Coughs and sneezes spread diseases, trap your germs in your handkerchief." It has rhythm. It is best recited in a "Mail train" monotone. Lovers of Tony Hancock will want to sing it to the tune of Deutschland, Deutschland über alles.

Doctor, you're not taking this seriously. Actually, I am. We have all read our way through the mountains of circulars that have arrived. We are having a daily practice meeting. We have one partner designated to take all the "flu"-related calls so our advice is consistent. Yesterday we had two such calls: a patient just returned from Turkey who had diarrhoea and wondered if it could be flu, and an elderly lady wanting advice about her husband who has respiratory problems. Should he be started on Tamiflu? Simple answer: No.

Today, so far, there have been no calls at all. We have 15,000 patients and are close to one of the larger airports in England, but have not seen a case of flu. We have not had a single patient worrying that he or she might have flu. It feels like a phoney war. We have seen two patients with heart attacks, three acute asthmatic attacks, and a child who had swallowed an implausibly large piece of Lego. Such is general practice.

We met at lunchtime, not to talk of heart attacks and Lego, but of flu. There have been deaths in Mexico. There has been one in the US. Our Indian partner said: "There were 2,000 deaths, mainly children in Africa and Asia, yesterday."

Our medical student looked shocked: "I didn't know swine flu had reached that part of the world." "It hasn't," said our partner. "I'm talking of deaths from malaria. But that isn't news, is it?"

We were silent for a while. Time to get things in proportion.