Over ten years ago the world faced a different flu pandemic, H1N1 swine flu. Swine flu was described by the then chair of the House of Lords Science and Technology Committee as being a real time test of the UK’s preparedness in dealing with a pandemic virus. Some of the issues raised at that time have also been raised in the context of the current Covid-19 pandemic.
Swine flu outbreak in the UK: 2009–10
Although hundreds of people died as a result of swine flu, its overall impact was less severe than had been feared at first. In July 2009, the then Chief Medical Officer for England, Sir Liam Donaldson, initially estimated that between 19,000 and 65,000 deaths could occur in the UK as a result of swine flu. These estimates were subsequently scaled down. During the 2009–10 outbreak, the total number of UK deaths caused by swine flu was 457. The number of deaths in hospitals resulting from Covid-19 has already exceeded this number. As at 30 March 2020, 1,789 hospitalised patients who tested positive for coronavirus had died.
As with the strategy for combating Covid-19, the response to the swine flu outbreak addressed issues to do with both logistics and increasing public awareness. To combat swine flu, the Labour Government launched a swine flu information line enabling members of the public to use an automated telephone service to diagnose their symptoms. The Department of Health focused on the mass distribution of ‘antiviral’ drugs such as Tamiflu. The Government also launched an advertising campaign designed to help members of the public understand how they could limit the spread of flu, including the ‘catch it, bin it, kill it’ slogan. Its planning was shaped by the 2002 strategy, Pandemic Flu: A National Framework for Responding to an Influenza Pandemic.
Swine flu: Lords scrutiny of UK preparedness
Just prior to the swine flu outbreak, the House of Lords Science and Technology Committee had begun a follow-up inquiry to its 2005 investigation of the UK’s pandemic flu planning. The committee reported in July 2009 as the UK was preparing for the spread of the pandemic.
The committee broadly welcomed the then Government’s preparations, noting that the World Health Organization had described the UK as one of the countries best prepared to deal with a pandemic flu outbreak. However, the committee did raise some concerns. These included:
- The delay in the proposed creation of a new body to support the NHS, the National Pandemic Flu Service, as set out in the Government’s strategy. An interim service had been established instead. In the Government’s response to the report, it argued the delay had been necessary to ensure the service provided was sufficient to meet demand.
- Criticism of the Government’s decision to create a swine flu information line in addition to the existing NHS Direct service. The committee argued this might create confusion as to which service the public should use. The Government said the swine flu information line should remain separate to prevent the expected high volume of calls from affecting existing services.
- A warning that demand for intensive care beds might outstrip supply. The committee argued the Government needed to ensure NHS hospitals had the support to make the ethical decisions about the allocation of these services and to avoid the risk of litigation. The Government said that the guidance currently in place, including from the General Medical Council, would be sufficient to ensure NHS staff were able to make these decisions.
During the subsequent debate on the report in the House of Lords on 7 December 2009, the committee’s chair, Lord Sutherland of Houndwood (Crossbench), stated that the UK had been fortunate that the impact of the swine flu outbreak was more mild than initially expected. He warned of the danger of complacency, including within the Department of Health. He also called for more testing of the UK’s preparedness to respond to a pandemic flu outbreak.
Combating pandemic viruses: comparing 2009 and 2020
Since 2009, there have been changes to the UK’s approach to pandemic viruses. The current UK influenza pandemic preparedness strategy was updated in 2011. In the same year, the Coalition Government created a new body, Public Health England, whose remit includes overseeing national issues such as influenza pandemics and other population-wide health threats.
The Coalition Government also launched the 111 telephone service for NHS Direct, intended to act as a single point of contact for non-urgent medical enquiries. A multi-agency test of government’s pandemic flu strategy, called Exercise Cygnus, took place in 2016. There have been calls on the Government to publish the results of this exercise.
Covid-19 is a form of coronavirus, hence the strategy to deal with this new virus is different to that for influenza. For example, scientists are working on which antiviral treatments are most effective against Covid-19. The National Pandemic Flu Service remains in existence but has not been deployed.
Despite these differences, the supply and demand for critical care services remains relevant. Critical care capacity in the NHS was raised in the House of Lords by Baroness Thornton (Labour) on 23 March 2020. Baroness Thornton noted that Northwick Park Hospital in London had ran out of critical care beds and had asked neighbouring hospitals for assistance. Lord Bethell, the Parliamentary Under Secretary of State at the Department of Health and Social Care, said that the Government was taking action to increase care-bed capacity in the NHS, through freeing-up existing beds and using beds in independent hospitals.