Government expecting thousands of new swine flu cases 'every week' » Health » 24dash.com

Some parts of England have too many cases of swine flu to continue with a policy of containing the outbreak, the Government said today.

London and the West Midlands have sufficiently high numbers to move towards a policy of outbreak management, which will see people with swine flu clinically diagnosed rather than being confirmed by laboratory reports.

Swabbing will take place only for a small number of cases to keep track of the strength of the virus.

Doctors will also use the drug Tamiflu more selectively, targeting only those people with symptoms.

This means that anyone who has come into contact with somebody with swine flu will probably not receive the drug as a precaution.

Chief medical officer Sir Liam Donaldson stressed that many parts of the country were still in the containment phase and were treating people prophylactically.

Sir Liam said there could be "tens of thousands of cases" of swine flu each week by the autumn. The virus is more likely to thrive in the colder months.

So far 3,597 cases of swine flu have been confirmed in the UK but the true figure is thought to be higher.

Efforts to contain the outbreak to date have taken up a lot of resources but have been successful, Sir Liam said.

But the Government had not envisaged that a policy of containment would last forever.

As well as a high number of cases in London and the West Midlands, east Berkshire has been marked out as a "hotspot" for swine flu. Scotland has also been badly hit.

There are three stages of swine flu management:

Containment: People with swine flu have their diagnosis confirmed by lab reports. They and anyone who has come into contact with them are given the antiviral drug Tamiflu. Most parts of the UK are still in this phase.

Outbreak management: People are diagnosed by a health professional without the need for lab confirmation, and are given Tamiflu. Swabbing takes place only on a small sample of cases. People who have come into contact with a swine flu victim are unlikely to receive Tamiflu as a precaution. London and the West Midlands are in this phase.

Treatment: The detail of this phase is still being worked out. The Government envisages that not everybody with swine flu will receive Tamiflu, which may be reserved for at-risk groups. Tracing of contacts and treating people as a precaution stops. Pressure on GP services is eased as more people receive a diagnosis via other routes. The Government wants this phase to be adopted by the whole of the UK when it occurs.

Sir Liam said: "We still think we are heading for the largest surge of cases in the autumn and winter.

"When you move to treatment phase, you need to time that correctly."

He pointed to three possible scenarios for the virus as the UK enters winter.

The first is that the virus remains relatively mild, the second is that it mutates into something more severe, and the third is that it combines with another virus subtype to create another strain.

The Government has signed contracts with GSK and Baxter for the supply of 130 million doses of swine flu vaccine - enough for the entire population.

The first delivery is expected in August, and 60 million doses should have been delivered by the end of the year.

The remaining doses will not arrive until next year.

However, Sir Liam said the vaccine was important because previous pandemics had left a legacy of a high death rate for three years after the start of the outbreak.

The vaccine would therefore offer protection in the years ahead, he said.

No decisions have yet been made on who will get the vaccine first.

Health Secretary Andy Burnham urged people to continue observing good hygiene, such as washing their hands, covering their mouth when coughing and disposing of dirty tissues.

"If you have flu-like symptoms and are concerned, the advice is to stay at home," he said.

Mr Burnham said the approach to date had been to work on containing the virus.

"Our approach has focused on containing the spread and working with the local NHS to identify cases and isolate them as quickly as possible and treat them with antivirals and treat those around them and offer prophylactic treatment to those around them.

"This is very resource-intensive, but it has been highly successful."

But he said some parts of England have now moved beyond that stage.

The Department of Health has written to flu directors at strategic health authorities to clarify the approach around moving to outbreak management.