[Closed] H1N1 - Future lessons from the past

As the “lockdown” memes have aged a bit, I’d thought I’d distract myself from cleaning toolboxes and taps by looking at government planning and response documents re pandemics.

The first one I zoomed into was:

The 2009 Influenza Pandemic
An independent review of the UK response to the 2009 influenza pandemic
Dame Deirdre Hine, DBE FFPH FRCP

To be found directly here:

Link

Or, in context, here:

Link

Now, I barely remember this ‘Swine Flu/A(H1N1)’ pandemic. There have been others, famously the Spanish Flu (1918/19, possibly started in America, about 40 million dead-including my gran’s sister, apparently), but also ‘Asian Flu’ (1957) and ‘Hong Kong Flu’ (1968).

The first case of H1N1 emerged in Mexico, circa 23rd April 2009 – it’s thought to have started in Mexico or America.

It seemed to affect a disproportionate number of young people.

There was a clear “first” and “second” waves of the infection in the UK.

It was “over” by 18th March 2010 with 457 UK dead.

In the response review document I reference, what stands out by absence are references to testing capability, contact tracing efforts, PPE and supply chain issues and “economic shock”.

There is little about UK “economic shock” mitigation but the H1N1 pandemic had a low, overall economic impact.

There is little or no reference to PPE or supply chain as, possibly, it was not an issue with H1N1.

The document identifies the weakness of modelling pre/during the “first wave” but its later strength.

It could have reasonably been expected that knowing the initial failure of modelling for H1N1, the initial response to Covid-19 should have been an immediate worse-case (or Wurst-kase if you’re a sausage and cheese fan) response, with the “herd immunity” concept never making out of the data lab.

There seemed to be a staggering amount of systems and organisations involved in the response to H1N1 – far beyond what I was aware of at the time.

I’ve picked out a few references I’ve found interesting (I have no professional or technical knowledge of the subject):

Page 8, Recommendation 8 – An off hand, reference to blood testing.

Page 12, Chapter 6: Treatment: - The document often refers to antivirals that provide treatment. In this, and other flu pandemic planning/exercise response documents I’ve looked at, much weight is put on the effectiveness, stock and use of antivirals such as Tamiflu in controlling the pandemic, at least in the early phase.

For Covid-19, stockpiles of antivirals are not referenced as a potential source of mitigation. There appears no current drug treatment and the bullishness of this document (and others) in the effectiveness of antivirals may go some way to illuminating the “failed” treatment response to Covid-19

Page 22, 1.19 – Interesting data value of £1.6 million for saving a life – Not sure if this is a cost or “benefit”!

Page 28 – Contains what I think might be the second reference to (lab) testing.

Page 31, 10 June - “Ministers agreed that the current containment phase should be moderated, as it was highly labour-intensive and therefore unsustainable. This meant moving away from laboratory testing of all cases…” - Here, testing is being “abandoned” due to its resource requirements. Did this experience colour the current testing capability response?

Yet on the next page : “Although much uncertainty about the data remained, SAGE advised that there was evidence to show sustained community transmission in the West Midlands and also the Clyde Estuary area of Scotland. “ - So the level of contagion was not clear but testing had been scaled back (or possibly entirely given the boot, in the community).

Page 33, 2 July – Uh ho: “Cases would be identified through clinical diagnosis, not swabbing, and contacts would no longer be traced.” - Sounds depressingly familiar.

Page 53, 3.51 - “For my part, I was surprised that video-conferencing was not used.” In 2010.
About 10 years ago.
Any yet, the government was doing it for the “first time”, 10 years later. Using an insecure product (Zoom) that did not support end to end encryption.

Page 56, 3.63 – The “medium-range” planning for deaths for a future flu pandemic was suggested to be 210,000 – 315,000. Eak!

Page 68, 4.40 and Page 69 Recommendation 8 – I dont know what to say about this. This is two paragraphs about “serology” – blood testing. And that’s it. That’s the recommendation re testing.

Page 76, 4.62 – Ooo! Look! If you work on a national pandemic response, you have to do it for free!

Page 85, 5.23 – A reference to testing and contact tracing.

Page 102, 6.31 – Lab testing abandoned, number of cases moved to “estimated”.

Page 105, 6.44 - “ Under these worst-case planning assumptions, demand – particularly for ventilation – would exceed available resources rapidly as the pandemic developed..”. Hmmm...

Page 113, 7.8 - “Time before vaccine became available: production timescales and the product licence approval process for pandemic-specific vaccine take around four to six months…” (2010).

Compare that with (From Guardian, 19/03/2020):

“This month, Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases and a member of Donald Trump’s taskforce, said a vaccine was 12 to 18 months away – an expectation echoed by the UK chief scientific adviser Sir Patrick Vallance”.

So either they were wrong in 2010, or we’ve gone a bit backwards.