Published 3 July 2009, doi:10.1136/bmj.b2721
Cite this as: BMJ 2009;339:b2721

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UK government predicts 100 000 new A/H1N1 flu cases a day by September

¹ BMJ

The UK government is planning for a rapid rise in the number of cases of A/H1N1 flu and is limiting provision of antiviral drugs to people with symptoms, while excluding asymptomatic contacts of infected people. The move comes after the revelation that up to 100 000 new cases of the infection could emerge each day by the end of August.

Laboratory based diagnosis of swine flu is to be stopped, and diagnosis should instead be made clinically by GPs. The government advises doctors to stop routine swabbing and tracing of contacts.

Doctors should not limit prescription of the antiviral drug oseltamivir (Tamiflu) to patients they think are at especially high risk but should provide it to all patients with symptoms, because the exact risk profile of the virus is unclear, government advice says.

However, Andy Burnham, the health secretary, warned that conventional risk groups (people aged over 65 or under 5 years, immunocompromised people, and pregnant women) should be dealt with more urgently. He admitted that the evidence for the use of Tamiflu was limited.

England’s chief medical officer, Liam Donaldson, said it was important to treat A/H1N1 flu differently from seasonal flu because younger patients were dying and because patients around the world had died despite not having any specific risk factors.

The vaccine against A/H1N1 flu was in the final stages of development, Professor Donaldson said, and the United Kingdom would take a delivery sufficient to vaccinate half the population.

He explained that the vaccine would have an important role despite the likelihood that vast numbers of the population would be infected by that point. The UK was expected to be one of the first countries to make the vaccine widely available, and it also had the largest stockpile of antiviral treatments in the world, he said.

The vaccine would initially be available to those in conventional high risk groups and anybody in a caregiving position. It will not be allocated specifically to areas with a higher incidence but will be available equally across the nation.

When asked whether swine flu was out of control, Professor Donaldson said that it was "following a predictable path" and was simply a "race against time."

However, Mr Burnham failed to answer the question of whether hospitals were prepared to cope with potentially 100 000 new cases each day.

Members of the general public have been advised to call their GP or the national flu helpline if they experience flu-like symptoms, rather than attending their surgery. Professor Donaldson stated that a diagnosis could then be made over the phone.

Cite this as: BMJ 2009;339:b2721

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