Thursday, April 30, 2009


How long does the virus live on surfaces?

The flu virus can live on a hard surface for up to 24 hours, and a soft surface for around 20 minutes.

How quickly might swine flu spread?

After infection, it takes less than two days for symptoms to start, at which point people are most infectious.

Evidence from previous outbreaks suggests that one person will infect about two others, and that influenza spreads particularly rapidly in closed communities such as schools or residential homes.

If swine flu is going to spread worldwide, experts predict that local outbreaks will be seen within the next two to three weeks.

How dangerous is it?

It is difficult to judge this at the moment. While there have been deaths in Mexico, and the death of a 23-month-old child in Texas, symptoms exhibited by people in other countries have been relatively mild and only one person has died of the virus outside of Mexico.

Also, it appears that early doses of antiviral medicines such as Tamiflu are effective in helping people to recover. In the UK we have enough antivirals to treat half the population if they were to become ill.

How does swine flu cause death?

Like any other type of flu, people can die from swine flu if they develop complications, like pneumonia.

Why is the death rate higher in Mexico than other countries?

This is not yet understood and there could be a variety of explanations. It may be that people affected in Mexico may have sought treatment at a much later stage than those in other countries.

General living and nutritional standards may also play a role. Other experts have suggested that there may even be a second separate virus circulating in Mexico that is having an impact, but this is not known.

What can I do?

You can reduce, but not eliminate, the risk of catching or spreading swine flu by:

  • Always covering your nose and mouth with a tissue when coughing or sneezing.
  • Disposing of dirty tissues promptly and carefully.
  • Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face, or to other people.
  • Cleaning hard surfaces, such as door handles, frequently using a normal cleaning product.
  • You can also prepare now and in the build-up to a pandemic by:

  • Confirming a network of ‘flu friends’ – friends and relatives – who could help you if you fall ill. They could collect medicines and other supplies for you so you do not have to leave home and possibly spread the virus.
  • Knowing your NHS number and those of other family members and keeping them in a safe place. You will be able to find your NHS Number on your medical card or other items such as prescribed medication, GP letter or hospital appointment card/letter.
  • Having a stock of food and other supplies available at home that will last for two weeks, in case you and your family are ill.

Who should be wearing a facemask?

The Health Protection Agency (HPA) recommends that healthcare workers should wear a facemask if they come into close contact with a person with symptoms (within one metre) to reduce their risk of catching the virus from patients.

However, the HPA does not recommend that healthy people wear facemasks to go about their everyday business.

Why shouldn't the general public wear facemasks?

Because there’s no conclusive evidence that facemasks will protect healthy people in their day-to-day lives.

The virus is spread by picking up the virus from touching infected surfaces, or by someone coughing or sneezing at very close range – so unless you are standing close to someone with the virus, wearing a facemask will not make a difference.

There are concerns about the risks posed by not using facemasks correctly.

Facemasks must be changed regularly as they are less effective when dampened by a person’s breath. People may infect themselves if they touch the outer surface of their mask, or may infect others by not disposing of old masks safely.

Finally, wearing a facemask may encourage complacency. People need to focus on good hand hygiene, staying at home if they are feeling unwell, and covering their mouth when they cough or sneeze.

So why have other countries gone down this route?

This is an issue which each government has considered separately. France is encouraging the general public to buy their own masks for use as a precaution, but it is not stockpiling masks centrally from government funds and neither is the US.

In other countries there is an existing culture of wearing facemasks for either the prevention of spreading illness or preventing the risks of pollution; this is not the case in the UK.

Is swine flu treatable?

Testing has shown that the swine flu can be treated with the antiviral medicines oseltamavir (brand name Tamiflu) and zanamivir (Relenza).

See Treatment for more information

The UK already has a stockpile of antivirals sufficient to treat up to half the population, which is a reasonable worst-case scenario. However, the drugs must be administered at an early stage to be effective.

What do antivirals do?

Antivirals are not a cure, but they help you to recover by:

  • relieving some of the symptoms,
  • reducing the length of time you are ill by around one day, and
  • reducing the potential for serious complications, such as pneumonia.

How large is the UK's stockpile of antivirals?

The government has 23 million treatments of Tamiflu and 10.5 million treatments of Relenza.

Will antivirals be given to people without flu symptoms?

Yes. The government is currently giving antivirals to the close contacts of the confirmed cases. The government will keep this under review as the situation develops.

The definition of close contacts is based on Health Protection Agency guidance, which states that individuals exposed to a probable or confirmed case within a distance of one metre or less and for longer than one hour should be offered antivirals as a precautionary measure.

How will I gain access to antivirals?

Arrangements are being put into place with local healthcare services for antivirals to be made available to those who need them.

People with symptoms and others at risk will be assessed by their GP. If antivirals are required, the GP will contact the local health protection unit, which is coordinating the distribution of antivirals.

If you have flu-like symptoms and are concerned, stay at home. You can check your symptoms on the Flu symptom checker (links to external site) or call the swine flu information line on 0800 1 513 513. If you have taken these steps and are still concerned, call your GP or NHS Direct on 0845 46 47. Do not travel out to your GP or hospital.

Is there a vaccine?

No. Influenza viruses change very quickly. For a vaccine to provide adequate protection it needs to be adapted to the particular strain in circulation.

Scientists are already working to develop a new vaccine for swine flu, but it could take up to six months to develop and manufacture enough supplies to meet what could be huge demand. The UK has agreements with manufacturers who will produce a vaccine when it becomes available.

It may take up to 12 months to have sufficient stockpiles to immunise 100% of the population.

Why does it take up to six months to produce a swine flu vaccine?

The flu vaccine production process is long and complicated. Traditional flu vaccine production relies on technology based on chicken eggs. This production technology is labour-intensive. To counter this, the government's plans include two manufacturers, only one egg-based, thus maximising chances of early development.

The flu vaccine production process is further complicated by the fact that flu virus strains continually evolve. Therefore, once a pandemic strain is identified and made available by the World Health Organization, it will take four to six months before a specific vaccine is available and evaluated for safety. However, it will be considerably longer before this vaccine can be manufactured in sufficient quantities for the entire population, given that international demand will be high.

If other countries are also being given advance supply guarantees, will we get ours first?

The agreements set out the contractual obligations, which include the delivery profiles that both manufacturers will work to for the UK supply. There are penalty clauses in place if the manufacturers fail to meet the agreed profiles.

Does the current seasonal flu vaccine work?

The current seasonal flu vaccine is designed to protect against H1N1, but it is unclear as yet whether this will offer any protection against the current strain of swine flu.

How many stocks are available of seasonal vaccine?

Flu vaccine is produced each year for the seasonal flu. Discussions are ongoing with manufacturers about how much may still be available. However, the government has determined that there are 430,000 doses of vaccine available in the UK.

Who will be a priority for vaccination?

It is important to be clear that the UK response will centre around antivirals, which are generic drugs to limit the symptoms of viruses, rather than vaccination.

There is no specific vaccine for swine flu and there is unlikely to be one available in the near future. The government has enough antivirals to treat half the population, which is the proportion who will require them in the ‘reasonable worst-case scenario’ pandemic, so it is unlikely that antiviral treatment will need to be prioritised.

What is a 'pre-pandemic' vaccine?

This is a specific vaccine against the virus most likely to cause a pandemic: the government has a stock of A/H5N1 vaccine ('bird flu' comprises strains of A/H5N1).

Will the current H5N1 pre-pandemic vaccine be effective?

The current government stockpile of H5N1 pre-pandemic vaccine, which was intended for healthcare workers, is unlikely to be effective against swine flu (A/H1N1).

What extra antibiotics have been purchased?

Antibiotics will play an important part in the response to a pandemic. The government has worked with clinicians to develop clinical management guidelines that identify the types of antibiotics needed to treat the complications arising for pandemic flu.

Work to advance further purchases has been going on as part of the government's preparations, and this is now currently being accelerated.

Why do you need antibiotics in a pandemic?

While antivirals may reduce the number of complications, there are still likely to be significant numbers of complications occurring in a pandemic. Some of the most common include bacterial infections in the respiratory tract and lungs. Antibiotics are needed to treat such complications.

Antibiotics will be used to treat people in the community if they develop complications. In hospitals, antibiotics will be used to treat the sickest patients and may reduce the length of hospitalisation.

Can children take antivirals?

Yes, on the advice of a doctor. Tamiflu is safe for infants aged one and older, at a reduced dose. Relenza (an inhaler) can be used by children aged five and older under the supervision of an adult.

Can babies under the age of one take antivirals?

Tamiflu and Relenza are not licensed for use in babies under the age of one. However, Tamiflu may be used under the supervision of a doctor if your baby is ill.

What are UK authorities doing?

The Health Protection Agency (HPA) is monitoring the situation closely. There is currently a very low level of flu activity in the UK.

The HPA and the NHS have systems in place that will alert public health authorities of any unusual strain circulating in the UK. The World Health Organization (WHO) has rated the UK, alongside France, as the best-prepared country for a swine flu outbreak.

Won't hospital capacity be inadequate?

Most flu sufferers can be cared for appropriately at home. It is not feasible to expand or staff additional hospital capacity to the extent necessary to meet the level of demand that a pandemic might generate.

Is it safe to eat pig meat?

Yes. The WHO says there is no evidence that swine flu can be transmitted through eating meat from infected animals. However, it is essential to cook meat properly. A temperature of 70°C (158°F) would be sure to kill the virus. Pig meat includes pork, bacon, ham and pork products.

Last reviewed: 30/04/2009

Forum on virus influenza A (H1N1) flu - BBC

I'm not worried. I have a full blown gas mask with activated carbon filters. The fabric face masks don't work. The question is, have I the courage to wear the gas mask to work? Will I be arrested in the street by the Police for wearing it for potentially causing panic or distress among my fellow citizens? Why bother spending money and using face masks which are known not to be effective?
Kelvin, Manchester

many more.

Wedding couple honeymoon to Mexico catch swine flu. Latest NHS advice & TV ads

Page last updated at 04:20 GMT, Friday, 1 May 2009 05:20 UK

The newly-weds who were the UK's first swine flu cases have spoken of how they feared they might die from the virus.

Iain Askham, of Polmont, near Falkirk, told the Daily Mail: "You try to stay calm but at the back of your mind there is the possibility that you might die."

He and wife Dawn believe they caught the virus on a flight back from Mexico.

Test results will reveal later whether a friend of theirs is the first person in the UK to have contracted the virus without having visited Mexico.

The man was named by the Daily Mail as Graeme Pacitti, 24, who it said had been in contact with Mr Askham after their honeymoon.

He has been referred to as a "probable" case by Scottish Health Secretary Nicola Sturgeon.

UK flu map

So far eight swine flu cases have been confirmed in the UK but this would represent the first case of onward transmission of the virus in the country.

Ms Sturgeon said: "Obviously the circumstances around this individual do give us cause for concern - the symptoms don't give us cause for concern, but the circumstances give us cause for concern."

Mr and Mrs Askham returned to their home on Thursday having been treated for five nights in separate isolation rooms at Monklands Hospital, Airdrie.

"It was particularly hard to bear, because I knew that Dawn was next door and that she wasn't well," Mr Askham told the newspaper.

"She was so close and yet I could not reach her. I just wanted to give her a cuddle and reassure her."

'Responding well'

The couple said they believed they contracted the virus on their flight back from Cancun, during which several passengers were coughing and sneezing.

Of the eight cases confirmed in the UK so far, three are in London, there has been one each in Newcastle upon Tyne and Redditch, Worcestershire, and a 12-year-old girl has tested positive in Paignton, Devon.

All of those diagnosed are thought to have responded well to treatment.

Mexico: 168 suspected deaths, 12 confirmed
US: one death, at least 109 confirmed cases
New Zealand: 3 confirmed, 13 probable cases
Canada: 19 confirmed cases
Spain: 10 confirmed cases
UK: 8 confirmed cases
Germany: 3 confirmed cases
Israel, Costa Rica: 2 confirmed cases each
The Netherland, Switzerland, Austria: 1 confirmed case each

A total of 230 possible cases are being investigated in the UK.

However, Dr Alan McNally, senior lecturer and influenza diagnostics researcher at Nottingham Trent University, downplayed the significance of the suspected case linked to the Askhams.

"We know that [the flu] is transmitted from human to human, it has happened in other parts of the world and we know it will happen here.

"I know that there will be interest in it because members of the public will see that they don't need to have been to Mexico to get it."

Showing symptoms

Cases of swine flu have been confirmed in 12 countries across three continents.

In cases outside Mexico, where 168 deaths are being linked to swine flu, the virus does not appear to be severe, although one death has been confirmed in the US.

Use clean tissues when you cough or sneeze
Bin tissues after use
Wash hands with soap, hot water or gel

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The World Health Organization (WHO) has set its pandemic alert level at five - but says it has no immediate plans to move to the highest level of six.

Chief Medical Officer for England, Sir Liam Donaldson, has said the UK is well prepared for the spread of swine flu.

He added: "What we will see is many, many more cases, and inevitably some serious cases - but on the whole people make a good recovery from flu."

It was impossible to predict how many deaths there could be in the UK until more was known about the strain of the swine flu virus, he said.

Sir Liam ruled out screening all British travellers returning from Mexico, saying it was more important to "concentrate the public health attention" on those showing symptoms.

Advertising campaign

Some 28 suspected cases are being investigated in Scotland.

There are so far no confirmed swine flu cases in Wales, although 19 people have been tested for the virus.

Six people in Northern Ireland have also been given anti-viral drugs as a precaution, but none of them has tested positive either.

On Thursday, health chiefs in the Irish Republic said one man had tested positive for swine flu - its first case.

Precautions being taken in the UK include enhanced airport checks, an expansion of anti-viral stocks from 35 million to 50 million by the end of May, the ordering of extra face masks and delivery of information leaflets for every family.

Supplies of antibiotics are to be increased to deal with any complications arising as a result of flu infections.

An advertising campaign to help prevent the spread of the virus has also been launched.

The Department of Health's Catch it, Bin it, Kill it! adverts urge people to cover coughs and sneezes with tissues, throw them away and wash their hands

Meanwhile, the WHO has announced it will call the virus influenza A (H1N1), rather than swine flu, which it says is misleading as pork meat is safe and the virus is being transmitted from human to human.

Members of the public can call 0800 1513513 for recorded information about swine flu. In Scotland, anyone with concerns about the virus can call 08454 24 24 24.

An advertising campaign urges people to catch the sneeze before binning the tissue

Swine Flu Leaflet (pdf) from NHS

Call the Swine Flu Information Line on 0800 1 513 513 to hear the latest advice.

If you have taken these steps and are still concerned, call your GP. Or you can call NHS Direct on 0845 4647 in England,

Stay at home.
Check your symptoms on if possible.
Call the Swine Flu Information Line on 0800 1 513 513 to hear the latest advice.
If you have taken these steps and are still concerned, call your GP. Or you can call NHS Direct on 0845 4647 in England,
They will give you advice on your symptoms and the next steps you should take.
Do not go into your GP surgery or local accident and emergency department unless you are advised to do so or you are seriously ill, because you might spread the illness to others. Ask a flu friend to go out for you.
The Swine Flu Information Line on 0800 1 513 513 will be updated regularly.

Time line of development of pandemic worldwide 18 March - 30 April 2009

As countries around the world prepare for an imminent pandemic of swine flu, the government of Mexico, where the outbreak began, is urging millions of people to stay at home.

Suspected cases are being reported around the world, including South Africa, South Korea, Guatemala, Peru, Australia and Brazil.

This map is being updated regularly with confirmed cases and confirmed deaths around the world. Use the slider below the map to see how the virus has spread.

How the UK is trying to contain flu

Page last updated at 13:08 GMT, Thursday, 30 April 2009 14:08 UK

By Nick Triggle
Health reporter, BBC News

Nurse taking swab test
A flu pandemic is imminent, experts say

World experts may be saying a flu pandemic is imminent, but on the ground health protection officials in the UK are still battling to stop its spread.

The approach is simple - isolate the virus and kill it before it spreads.

Health Secretary Alan Johnson has called it the "containment stage" - and it is the method that is being adopted in other countries that are seeing swine flu cases.

It basically involves putting a ring around any outbreak and trying to zap it quickly.

In practice, this means when a person is infected they are isolated, as are all the people they came into contact with.

Anti-virals are then given en masse - even to those who are not displaying symptoms - in a bid to ensure it does not spread further.

Experts call this using drugs prophylactically, which basically means using them to prevent the disease developing.

There is sketchy evidence that this actually works, but at worst the drugs will at least lessen the symptoms and shorten the illness if someone does develop flu.


This is the tactic that was taken in Devon when a 12-year-old girl was diagnosed on Wednesday.

She had come in to contact with 50 fellow pupils but the decision was taken to give all 230 pupils in her year anti-virals.

The school has now been closed and local health officials are monitoring developments.

A similar approach was taken for the Scottish couple and the people they had come into contact with. So far none of their friends and relatives have developed the flu.

But there is no guarantee this will work.

The World Health Organization has already declared phase five has been reached - one step away from a pandemic.

This means that sustained human-to-human transmission is being seen within two countries - Mexico and the US.

To put things in proportion, in any flu, even the seasonal flu, there are some deaths, often of elderly people and the very frail
Sir Liam Donaldson, chief medical officer

In the UK, all the cases that have been confirmed were in people who have been to Mexico.

Chief Medical Officer Sir Liam Donaldson admits if the UK were to see onward transmission to people who have not visited the affected areas it would suggest "an escalation of the problem".

He said this would also mark a change in the approach with the anti-virals saved for only those showing symptoms of the flu.

The problem the UK is facing in an era of global travel is that, even if its approach works initially, flu defences are only as strong as their weakest link.


Flu viruses in different species
Phase 1: No infections in humans are being caused by viruses circulating in animals.
BACK 1 of 7 NEXT

Sandra Mounier-Jack, an infectious diseases expert from the London School of Hygiene and Tropical Medicine, said: "Once it starts to spread it is hard to contain.

"The UK has good plans in place but not every country does, so that means even if we slow the spread at this stage, if it gets a foothold elsewhere it gets harder to stop."

It means that while the UK is trying to contain the flu, plans are being put in place for a full-blown epidemic.

Ministers have already discussed restricting travel and public gatherings at their Cobra emergency meetings.


Extra anti-virals and masks have been ordered and a TV, radio and newspaper information advertising campaign started on Thursday.

This will be followed by leaflets which will be delivered to every home in the country next week.

But despite the developments of the last week, experts are still relatively upbeat because of the nature of the flu.

Outside of Mexico it seems to be a relatively mild virus with only one person - a Mexican toddler who had travelled to the US - dying from it.

Sir Liam admitted the flu strain could still mutate into something more deadly.

But he added at the moment most people who get it "will make a good recovery".

"It's a nasty illness, but it's short and they will recover.

"To put things in proportion, in any flu, even the seasonal flu, there are some deaths, often of elderly people and the very frail.

"What we will see is many more cases, but on the whole most people make a good recovery from flu."

The quest for a swine flu vaccine

Page last updated at 11:11 GMT, Wednesday, 29 April 2009 12:11 UK

By Clare Murphy
BBC News health reporter

Vials containing samples of the swine flu virus are making their way from the US to a government laboratory north of London. The race for a vaccine is on.

Seasonal flu vaccine
Manufacturers are currently working on the seasonal flu vaccine

It is a global endeavour and will bring the public and the private together, but it could still take several months before a safe and effective jab is available.

Yet amid all this activity, the answer could in fact be right under our noses.

Tests are being carried out to establish whether the current seasonal flu vaccine could provide cross protection against what we are seeing at the moment, as there are similarities between the H1N1 human flu viruses and the new H1N1 swine flu.

If that were the case - and it's certainly not impossible - we would in the words of one virologist be "home and dry".

Been there before

Even if this does not confer protection, the picture does not appear to be a bleak one.

The spread of bird flu amongst humans several years ago sparked fears that a pandemic was imminent. Plans were developed, expertise harnessed and facilities built for mass production.

If this had happened six years ago we would really be in a fix - we are in a better position than we have ever been in the history of this planet to combat this
Professor John Oxford
Barts and the London School of Medicine

The vaccine industry has started to attract new investment and government subsidies after years of being a pharmaceutical backwater.

"It was a fantastic dry run," says Professor John Oxford of Barts and the London School of Medicine.

"If this had happened six years ago we would really be in a fix - we are in a better position than we have ever been in the history of this planet to combat this."

The World Health Organisation says it is already in touch with vaccine manufacturers - although is not at this stage putting in orders - but initial work is already underway in national laboratories.

The US Centers for Disease Control and Prevention, which is looking at the molecular properties of the virus and why it appears to have been more virulent in Mexico is hoping to have produced a "reference strain" to send to vaccine manufacturers around the second week of May.

The same process will take place in the UK, once the Health Protection Agency (HPA) receives samples of the virus at its laboratories in Potters Bar.

"We will take this virus apart and reassemble it with two genes from the swine virus and the genetic information code for a laboratory virus called PR8 which grows very well in hens' eggs and is safe for human infection,"
said Dr John Wood, from the HPA's National Institute of Biological Standards and Control.

"When we have recreated this new hybrid virus this will be grown in cells and hens' eggs ready to distribute to vaccine manufacturers."

This, he said, should be done within three to four weeks.

Kill not cure

But it may be at least four to five months before a vaccine is ready.

Clearly, if you make a swine flu vaccine and the pandemic doesn't actually occur, we could end up with no seasonal flu vaccine
Chris Viehbacher

Safety is - unsurprisingly - paramount, as vaccines can often be worse than the disease they are trying to combat.

An outbreak of swine flu in 1976 infected 200 people in the US. Only one of them died, but a vaccine administered to 40m people killed 25 and led to 500 others developing Guillain-Barre syndrome, which can be fatal.

For those countries now entering the summer months with the flu season behind them, a delay in vaccine is not a real cause for concern. But in the southern hemisphere where countries are entering their winter months the picture would be different if the outbreak were to worsen.

One way of administering the vaccine could be by adding a swine flu component to the seasonal flu jab given out in the autumn.

But while production facilities are much more extensive than they once were, it could still take several years to produce enough swine vaccine to match global demand if the virus continues to spread and becomes more virulent.

And in the rush to combat swine flu - from which there have been fewer than 10 confirmed deaths - manufacturers still have to keep their eye on producing an effective vaccine for seasonal flu as they do every year.

In the US alone there are an estimated 25-50 million cases reported each year. These result in 150,000 hospitalisations and 30,000 to 40,000 deaths. Worldwide there may be as many as half a million deaths each year.

"Clearly, if you make a swine flu vaccine and the pandemic doesn't actually occur, we could end up with no seasonal flu vaccine," warned Chris Viehbacher, chief executive officer of Sanofi-Aventis.

In any event, swine flu appears to be responding well to anti-viral treatments like Tamiflu and Relenza. These drugs do not attack the virus itself but an enzyme that allows it to spread within the body. Taken promptly, they can reduce the severity and length of the illness.

But production of sufficient quantities - were they needed - could again be problematic, although pharmaceutical giants GlaxoSmithKline Plc and Roche Holding AG have both said they are stepping up production.

NHS on alert for swine flu spread

Page last updated at 11:38 GMT, Tuesday, 28 April 2009 12:38 UK

By Nick Triggle
Health reporter, BBC News

The NHS has started receiving calls from people worried about swine flu

The calls have started trickling in. But staff in GP practices and those working for NHS advice lines fully expect them to become a flood in the coming days as fear over swine flu rises.

On Sunday, 88 people called NHS Direct in England about swine flu. By Monday that figure had topped 1,300.

In fact, the hotline is so concerned about the demand for help and information that it has banned its staff from booking any more leave over the coming weeks.

And in Scotland, where the only two confirmed cases in the UK are, the NHS 24 telephone line has seen the total number of calls jump by a fifth in the past 24 hours to 800.

Doctors and nurses who are assessing patients are already operating under a standard protocol issued by health protection officials.

The system involves taking nose and throat swabs for testing if an individual displays flu-like systems and has been to one of the affected areas.

There are also strict rules on isolating the patients either in hospital or at home.

But the reality facing the NHS is that this could just be the tip of the iceberg.


The World Health Organization has already warned that swine flu cannot be contained and the risk of a pandemic is "significant".

The health service has responded by launching the first stage of it contingency plans.

Patients are being advised to phone their GPs or NHS Direct and NHS 24 if they are concerned they may have swine flu instead of turning up to health centres in person to minimise the potential spread of the virus.

Any face-to-face assessments are meant to be done using facemasks and gloves.

But already questions are being raised about whether the health service is ready.

We need everyone to make sure they are ready. We are not at the pandemic stage yet, but we are on alert and calls are coming in
Dr Maureen Baker, of the Royal College of GPs

A flu line capable of handling 6m calls each week is meant to be set up when the danger of a pandemic is at phase five - it is currently at four - but it will not be available until the autumn as it is several months behind schedule.

Stephen O'Brien, a shadow health minister, said the information line could be "crucial" in the coming days and weeks.

"It is a legitimate concern that a key part of that plan is some way off being implemented."

And not all GP practices have ordered facemasks for staff and nor is each surgery thought to be ready to introduce other measures, such as providing separate waiting rooms for staff in the event of patients swamping clinics.

Dr Maureen Baker, the pandemic flu lead at the Royal College of GPs, said: "Some GPs will have done the preparations and be ready, but we know that will not be the case everywhere.

"We need everyone to make sure they are ready. We are not at the pandemic stage yet, but we are on alert and calls are coming in.

"GPs should be saying to people not to panic, that we are well prepared and that most people who get ill with flu will have a nasty bout of flu and get better within a week, even if it is swine flu."

Doctors have also been asked to ensure they have measures in place to work with neighbouring surgeries to share resources.

Dr Baker added: "Staff may have to be moved around, GPs may find themselves working in different practices. Staff can be affected like everyone else and we have to make sure the system keeps running."

Worst-case scenario

This is very much the worst-case scenario for the NHS and will more than likely happen when a pandemic has been declared.

For that to occur, the virus has to be passed on from human-to-human - something which has not happened in the UK yet although tests are still be carried out on the people who came into contact with the Scottish couple who were diagnosed with swine flu on Monday.

Chief Medical Officer Sir Liam Donaldson said if that happened on a large scale the NHS would ramp up its plans.

The symptoms of swine flu are similar to seasonal flu - sore throat, coughing and fever
If you have these symptoms and have recently been to one of the affected areas phone your GP or NHS Direct
Also, avoid contact with other people as much as possible, cover your nose and mouth when coughing and wash hands frequently
Treatment is available in the form of anti-virals. These are not a cure, but evidence from elsewhere shows that they lessen the symptoms and shorten the illness

Under the contingency measures drawn up, the NHS will cancel non-urgent operations if necessary and give people access to stocks of anti-viral drugs, which while not a cure can lessen the symptoms.

People will be asked to appoint a "flu buddy" to collect the treatment from designated centres around the country.

Sir Liam said: "We have been preparing for the possibility for a number of years and are among the most prepared countries in the world."

But he added at this stage it was important to concentrate on simple steps.

"There are simple steps that everyone can take to help prevent catching colds and flu based on good respiratory and hand hygiene. Always use a tissue to catch your sneezes, throw away used tissues, in which germs can linger and regularly wash your hands.

"Most importantly, if you have come back from Mexico or one of the affected countries and have flu-like symptoms, stay at home and call your GP or NHS Direct."


WHO fears pandemic is 'imminent'

Page last updated at 10:39 GMT, Thursday, 30 April 2009 11:39 UK

WHO's Dr Margaret Chan: 'All of humanity is under threat during a pandemic'

The UN's World Health Organization has raised the alert over swine flu to level five - indicating human-to-human transmission in at least two countries.

It is a "strong signal that a pandemic is imminent", the WHO says.

In Mexico, at the epicentre of the outbreak, people have been urged to stay at home over the next five days.

There are numerous cases elsewhere - the highest number outside Mexico is the US - and Europeans have been told it is certain there will be deaths.


Flu viruses in different species
Phase 1: No infections in humans are being caused by viruses circulating in animals.
BACK 1 of 7 NEXT

Several countries have restricted travel to Mexico and many tour operators have cancelled holidays.

Other countries are resisting calls to implement travel bans or close borders, on the grounds - backed by the WHO - that there is little evidence of their efficacy.

In the latest developments:

  • The Netherlands confirms its first case of swine flu, in a three-year-old boy recently returned from Mexico. Cases have also been confirmed in Switzerland, Costa Rica and Peru
  • European health ministers were set to meet for emergency talks to co-ordinate national efforts to contain the spread of the virus
  • Ghana has become the latest country to ban pork imports as a precaution against swine flu, though no cases have been found in the West African country
  • China's health minister says that the country's scientists have developed a "sensitive and fast" test for spotting swine flu in conjunction with US scientists and the WHO. The country has recorded no incidence of the flu yet.

'Urgent action'

Announcing the latest alert level after an emergency WHO meeting in Geneva, Director General Margaret Chan urged all countries to activate their pandemic plans, including heightened surveillance and infection-control measures.

Mexico: 168 suspected deaths - eight confirmed
US: one death, at least 91 confirmed cases
New Zealand: 3 confirmed cases
Canada: 19 confirmed cases
UK: 6 confirmed cases
Spain: 10 confirmed cases
Germany: 3 confirmed cases
Israel, Costa Rica: 2 confirmed cases each
The Netherland, Switzerland, Austria, Peru: 1 confirmed case each

She said action should be undertaken with "increased urgency".

She added: "It really is the whole of humanity that is under threat in a pandemic."

But she also said the world was "better prepared for an influenza pandemic than at any time in history".

Ms Chan stressed on Wednesday that there was no danger from eating properly cooked pork.

She advised hygiene measures such as hand-washing to prevent infection and said it was important "to maintain a level of calm".

Meanwhile in Mexico, President Felipe Calderon has announced the partial suspension of non-essential work and services from 1 to 5 May - a holiday period there.

In a TV address, he urged people to stay in with their families - saying there was "no place as safe as your own home".

He said he was "proud" of the response of Mexicans to the crisis, and assured people Mexico was well-stocked with anti-viral medicines.

Already, schools across Mexico have closed, public gatherings are restricted and archaeological sites have been placed off-limits.

BBc correspondent Stephen Gibbs
From Stephen Gibbs in Mexico City, Mexico

Since the swine flu outbreak began here, the government has faced the dilemma of wanting to prevent people spreading the disease - without paralysing the economy.

With this latest directive it appears to have struck a compromise.

All "non-essential" areas of the economy are to be shut down, for five days from 1 to 5 May.

The government has not been specific about what it means by non essential - but it does say medical, food, transportation and financial sectors will function as normal.

Mexico is already being hit hard by the global economic slowdown, and the country's finance minister says swine flu could cut a further half-percent of GDP.

The search for the source of the outbreak continues, with the focus on the vicinity of a pig farm in the eastern part of the country.

The Mexican government is urging against jumping to conclusions and is suggesting the possibility remains that the virus originated outside the country.

Officials have put the number of suspected deaths from swine flu in Mexico at 168, although just eight deaths have been confirmed, with 26 infections positively tested.

In Europe, the director-general of health and consumer protection, Robert Madelin, said the continent was well prepared but nonetheless deaths from the disease were expected.

"It is not a question of whether people will die, but more a question of how many. Will it be hundreds, thousands or tens of thousands?", he said, speaking to Reuters news agency.

Movement bans?

At the meeting of health ministers on Thursday, a French proposal of issuing a continent-wide travel advisory for Mexico will be discussed - though it is unclear whether it is in the power of the EU executive to impose such a ban.

Swine flu symptoms are similar to those produced by ordinary seasonal flu - fever, cough, sore throat, body aches, chills and fatigue
If you have flu symptoms and recently visited affected areas of Mexico, you should seek medical advice
If you suspect you are infected, you should stay at home and take advice by telephone initially, in order to minimise the risk of infection

Spain has seen the first case of a person contracting swine flu without having travelled there.

After Mexico, the US has recorded the next highest number of confirmed cases, with 91 - and the first death of swine flu outside Mexico, after a visiting Mexican child died in Texas.

President Barack Obama has urged local public-health bodies to be vigilant and said schools with confirmed cases "should consider closing". About 100 have so far done so.

There are no current plans to close the border with Mexico, Mr Obama said on Wednesday evening.