It's just over a week since I began work as an "agent" at one of the NHS Pandemic Flu Service call centres. Every agent has to ask a series of questions to determine the health of the caller. The third question asked is whether they are conscious. Anxious that the under-qualified staff would not be able to tell if someone requires emergency medical assistance, the assessment instructs them to find out if the caller can't breathe, has turned blue and whether they are having a fit now? When the questionnaire eventually comes round to dealing with the symptoms of flu, the patient is asked if they are suffering from a "new confusion"? If they weren't before, in all probability they are now.
Taking the temperature of the nation over the phone, people are in states of anxiety that range from the heart-breaking to the mind-boggling. For every young mother anxious over the effects of antivirals on their children, there is someone who thinks their nausea might be due to the ice cream they just ate. Some are calling up without a high temperature, others because they're planning a holiday and want to stock up as a precaution. One woman asked what complications might affect her flu-suffering four-year-old with multiple sclerosis and long-standing steroid use.
Many of the questions are so panic-driven they set the alarm bells ringing on default. Nowhere is the caller given space to say how they feel, and the frustration is evident in the number of neighbouring agents mechanically repeating that they are required to ask these questions to increasingly irate voices. For those seeking information, the service directs them to an automated information line. One woman pleaded not to be sent there because, "I just want to talk to a human being".
It is no wonder so many people are confused and panicking. Any queries pertaining to the side effects of antivirals, to alternative medicine and to duration of illness are systematically ignored. One man, calling on behalf of his father who had already used up his allowance of Tamiflu and become ill again, was told to ring up NHS Direct, at which he exploded that he had tried this and would "just be told to ring this number again". Any patient whose symptoms involve having thick or brown phlegm are told they have "complications" and urgently advised to ring their GP. Despite being set up to ease the burden on GPs, there are countless instances when people have been panicked into going to their doctor, only to be told to go to bed and rest. Some have had ambulances sent to them on account of having chest pain through coughing.
The bottom line of the flu service is to tick off the relevant questions to authorise the release of a code for a single, non-repeatable ration of Oseltamivir (Tamiflu) or Zanamivir (Relenza). One of the main delineators between allowing the drug or not is whether the patient has had the symptoms of flu for seven days or less. Yet the British Medical Association (BMA) and Roche, the company that makes Tamiflu, have repeatedly stated that the window for efficacy is the first 48 hours. The BMA goes further, saying antiviral drugs "may" shorten the duration of symptoms by about one day, and is similarly equivocal about the effectiveness of a flu vaccine. Indeed many GPs, according to Dr Ellie Cannon, advise patients not to take Tamiflu on the basis of how many patients suffering with the A(H1N1) strain of flu recover without it. Some callers are inquiring about complementary medicine, but while the BMA sees fit to qualify the effectiveness of antiviral drugs, it has gone all out to cite homeopathic remedies as unequivocally "dangerous". None of this information is provided by the service.
There is more confusion within the BMA. Dr Peter Holden, the BMA's lead negotiator on swine flu, says that health officials are eager to start a mass vaccination campaign. Yet he has also said he thinks the thresholds for issuing Tamiflu have been set too low, which will result in the flu virus developing resistance. It is a confusion that goes to the heart of the Department of Health's policy. In one breath it wants GPs not to dish out pills so eagerly. In the next it has authorised a service whose underlying method is to facilitate the widespread distribution of drugs.
Meanwhile the machine-programmed agents keep to the script, unyielding to the frightened calls of single mothers, the elderly, and those living alone. This depersonalisation at a time of greatest insecurity is harrowing. Already lonely people are told by a machine to stay away from others. The assumption is that a patient will need to have a "flu friend" to collect the drugs, but in many cases people are suffering illness, exacerbated by non-specific fear, alone.
What this pandemic shows is how, as a culture, we have enlarged our networking abilities through digital media and global air travel, while forgetting the people living in the flat below us, or the rooms next door. We are being sold a remedy to get us back on our feet and back to work with the minimal delay, while any knowledge of the freely available herbs that boost our immune systems and relieve symptoms is vociferously belittled. Whether germs, rumour or global panic, our culture turns the ordinary into the sensational faster than you can say "SuBo". But in terms of helping to foster strong, resilient bodies (personal and social) with healthy immune systems and some spiritual fire that knows death is not the soul's terminus, we seem uncomfortably vulnerable.
Mark Jones is a pseudonym adopted for this article only. At other times, "Mark" occasionally contributes to Comment is free under his own name
