A shot across the bows

Now that the global outbreak of swine flu has finally been officially declared a pandemic, anxiety levels among the public seem, ironically, to have declined in inverse proportion to the number of confirmed cases. A poll of 1,000 adults, published online by the British Medical Journal, found only 24% were anxious about the outbreak with only 2% reporting "high anxiety".

As efforts focus now on treating rather than containing the virus, the mass media coverage has slowed from a flood to a trickle. Familiarity breeds contempt, and clearly the death of one high profile entertainer sells more newspapers than the prospect of 100,000 people a day in the UK alone becoming mildly ill.

But there are still a number of risks associated with the pandemic. Barely publicised is the report of the first case of resistance to Tamiflu in Denmark. This is not surprising - the annual seasonal flu virus is also capable of developing resistance; a Tamiflu-resistant strain emerged last year and is still in circulation.

Of course, the more people who are given Tamiflu or Relenza, the greater the chance of the virus developing resistance to the drugs. Although doctors in the UK have the discretion not to prescribe antivirals, the pressure on them to do so will be enormous and difficult to resist.

And now that the containment strategy has been abandoned, swabs are no longer being taken from people with flu-like symptoms to confirm or refute the presence of H1N1. Antivirals are therefore likely to be given to many people who never had swine flu in the first place, and for those who do have it, the drugs will probably be too late to do them any good.

Another interesting side-effect of the pandemic is that Tamiflu looks set to displace Viagra as the subject of most junk emails, according to the Royal Pharmaceutical Society. Although the UK has a massive stockpile of the drug, some people are resorting to the internet to create their own private stash "just in case". The chances are high, though, that they will be stocking up on sugar or rat poison rather than the real thing.

But perhaps the greatest risk is complacency. Just because this strain is mild, it doesn"t mean that the next pandemic will be as benign. The first skirmish has caused relatively few casualties, but there are almost certainly fiercer battles ahead.