The ‘swine flu’ pandemic in the UK has triggered rapid changes, both in Government strategy for dealing with the disease and in public attitudes towards it. Beyond the short-lived market opportunities opened up by the crisis, what are the lessons for companies supplying infection control products?

Pigs have wings

In April of this year, reports of an outbreak of ‘swine flu’ in Mexico that had caused 159 human deaths sent the world into panic. The H1N1 influenza virus spread rapidly into the USA and more slowly into Europe. On 12 June, WHO declared the first influenza pandemic in 41 years.

By July, swine flu was so widespread in the UK that it was no longer possible to trace infection routes. The focus of Government strategy thus shifted from containment to treatment. However, the need to protect both health professionals and patients in clinical settings means that infection control has remained a significant aspect of the management of the pandemic.

Some key features of H1N1 infection in humans have become clearer with time. The virus is highly contagious, depending on respiratory pathways of infection. It is less dangerous than was initially feared: the conditions of poverty and lack of healthcare resources in Mexico increased the incidence of fatality. So far, though over a million people in the UK are thought to have contracted swine flu, there have been fewer than 100 fatalities – a lower fatality rate than for many strands of seasonal flu. Significantly, most elderly people appear to have some degree of acquired immunity to the virus.

The types of healthcare product relevant to tackling the pandemic fall into four main categories:

• Face masks for respiratory protection.

• Products for cleaning hands and surfaces.

• Diagnostics to identify those infected.

• Drugs and devices to treat those infected.

To see how the pandemic has affected each of these market segments, it’s useful to take an overview of the UK’s swine flu experience.

Summer of spam

Early media reports of the swine flu pandemic used terms such as ‘killer disease’ and ‘deadly virus’ that swiftly created an atmosphere of panic. However, WHO recommended no travel restrictions. The relatively low mortality rate associated with H1N1 did more to calm public fears than any improvement in the level of reporting. One UK newspaper, having reported that model Jordan was ‘battling the deadly virus’, showed her sunbathing on holiday three days later.

Media and political pressure undoubtedly contributed to the swift Government response, which included the appointment of Ian Dalton as National Director for Flu Resilience and the establishment of a phone helpline service with its own prescribing capability.

Early data indicated that those most at risk of serious effects from H1N1 infection were pregnant woman and people with chronic conditions such as asthma, cardiovascular diseases, diabetes and obesity. Systematic targeting of the most at-risk individuals with antivirals and hospital care when they present with swine flu symptoms has greatly reduced the fatality rate in the UK.

The Government’s declaration in July that the swine flu pandemic was impossible to contain, and that the focus of the NHS response had to be on the treatment of those infected through antivirals and the forthcoming vaccine, took some momentum away from strategies for preventing infection. However, the latter have remained relevant – both in the community, where those infected live and work, and in secondary care, where patients and health professionals are highly vulnerable to infection.

Prevention and cure

The Health Protection Agency declared in April that the use of face masks or respirators in the community would be ineffective in preventing the spread of the virus. Instead, emphasis has been placed on hand washing, covering the nose and mouth, and rapid disposal of used tissues: the slogan Catch it, bin it, kill it has been echoed by companies producing hand wipes, gels, sprays and other infection control products.

A report from business analysts Frost and Sullivan in May identified the key role of “devices like face masks, gloves, gowns, sterilisation and disinfection products” in preventing H1NI infection. The report noted that in the USA, the spread of swine flu had triggered widespread public purchasing of N95 respirator face masks. Increased demand for medical gloves, already widely used by urban street cleaners and refuse collectors, was expected.

The report also noted that the most severe cases could greatly increase the need for mechanical ventilators and other respiratory aids used in intensive care units. According to the report, a tenfold increase in the demand for ventilators in the UK was expected. An increased need for face masks in clinical environments was also predicted. The DH ordered 32 million face masks in May for use in clinical settings. However, these do not appear to have been deployed.

Another medical technology predicted to see increased demand due to the pandemic was fever screening equipment. An ISO technical report published in May outlined how the effective use of screening thermographs at key locations, such as international airports, could help to contain the spread of H1N1. It recommended their use in entrances to hospitals, workplaces, schools, train stations and other infrastructure facilities.

At the World Health Assembly in late May, it was stated that swine flu “is a subtle, sneaky virus. It does not announce its presence or arrival in a new country with a sudden explosion of patients seeking medical care or requiring hospitalisation. In fact, most countries need a sudden explosion of laboratory testing to detect its presence and follow its tracks.” In other words, medical technology must be used proactively to track and control the disease.

The panel below lists some examples of medical technologies launched or modified in 2009 in response to the swine flu pandemic. They illustrate the wide range of strategies available to fight the disease. The market penetration achieved by these products depends as much on social and economic issues of disease management as it does on their clinical efficacy.

Seen and not herd

Undoubtedly, some of the products launched by medtech companies in the early months of the swine flu pandemic will play an ongoing role in tracking, containing or treating the virus. Other may be judged unnecessary or too costly, given the fact that in most cases the infection has moderate effects and responds well to antivirals.

The emergence of more virulent strains of H1N1 would certainly demand a swift escalation in the armoury of medical technologies used to fight the pandemic. Even without that, the synergy between disinfection strategies for countering H1N1 infection and the ongoing war against healthcare-acquired infections will undoubtedly favour that product segment.

To some extent, the rapid rise and fall in market access for medical technologies relevant to the prevention or treatment of swine flu is a lesson in the power of media-driven health panics to disrupt the market. In the longer term, however, it underlines the point that medical technologies launched to address a specific health issue are most likely to succeed where they connect with existing health systems and the wider context of health needs.

SWINE FLU AWAY

Medtech products launched in 2009 to help fight the H1N1 virus include:

• Rapid response swine flu test – Diatherix in the USA launched a viral respiratory panel able to detect H1N1 as well as other specific influenza viruses. Based on a rapid response, molecular-level assay, the test is able to confirm swine flu from a nasal swab in less than six hours.

• Mobile decontamination unit – the SmartQ Breezer, distributed in the UK by Leisurely Life, is an electric fan fitted with a tubular UV-A light catalyst. The system distributes hydroxyl radicals through the air, destroying virtually all airborne viruses, bacteria and spores.

• Face mask with built-in filter – the Covaflu FFP3 (filtering facepiece) mask blocks more than 99% of airborne virus droplets that are 0.3 microns in diameter. UK company Clinova increased its production of this CE-marked product by 10,000% in response to the swine flu pandemic.

• Hand-held screening device – Envision ALR accelerated its development of a new nanotechnology-based diagnostic system to launch this electronic device, which can be used at the point of care to identify H1N1 infection in seconds from a blood pinprick or saliva sample.

• Blood filtration system – the Hemopurifier from Aethlon Medical, used to reduce viral load in patients with HIV and hepatitis C, has been confirmed as an effective way to treat H1N1 infection. This could become a crucial therapy if a strain of H1N1 evolves that is resistant to antivirals.

• Germ-killing face mask – the BioMask, from Hong Kong biotech company Filligent, kills 99.9% of airborne pathogens (including H1N1) on contact. Designed for use in pandemic conditions, the mask contains a patented textile layer that captures and destroys viral and bacterial particles.