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Public warned off web swine flu drugs

Fourth death in UK as chief medical officer says Britain has enough Tamiflu and online pills may be counterfeit

The government’s chief medical officer has warned the public against panic-buying swine flu drugs online after it was revealed that the number of new cases of the virus could reach 100,000 per day.

Professor Sir Liam Donaldson said Britain had a large stockpile of Tamiflu, the antiviral drug used to combat infection with the H1N1 virus, and there was no need for people to buy what were likely to be counterfeit medicines on the internet.

His comments came as a 19-year-old man was confirmed today as the fourth person with swine flu to die in the UK. The teenager from south London, who had other serious health problems, tested positive for the virus after his death on Wednesday.

The health secretary, Andy Burnham, yesterday told MPs the spread of swine flu in the UK could no longer be contained.

He said predictions showed the figure of up to 100,000 new cases diagnosed every day could be reached by the end of next month.

In a Commons statement yesterday, Burnham said the country had moved into the “treatment phase” of its response to the flu pandemic.

No more schools will be closed unless forced to by a lack of staff or if pupils are especially vulnerable.

Families and others in contact with infected people will not be given preventative antiviral drugs – a move some doctors predict could push people to go to internet pharmacies.

Donaldson told GMTV there was considerable concern that people might buy counterfeit drugs.

“People shouldn’t buy Tamiflu from the internet,” he said. “We have got a massive stockpile in this country, and everybody can have access to it through the National Health Service.”

The Royal Pharmaceutical Society’s director of policy, David Pruce, said most Tamiflu for sale online was probably fake because no legitimate online pharmacy would sell it.

“These sites could be based anywhere in the world,” he told BBC Radio 4′s Today programme. “They could be selling anything from sugar to rat poison.

“Counterfeiters are very good at producing goods that look like the genuine article. When it’s counterfeit medicines and you’ve got really no idea what’s in the tablet or the capsule, you’re taking your life in your hands.”

Pruce added that while people could get a private prescription for Tamiflu from their GP, there was no point in taking the drug unless they had symptoms.

There are now 7,447 diagnosed cases in the UK, but the number is doubling every week.

People who think they may have flu are advised to go online and check their symptoms on the NHS website or call the swine flu information line on 0800 1 513 513.

Anyone still concerned after that should phone their GP, who can provide a diagnosis over the phone.

If swine flu is confirmed, they will be issued with an authorisation voucher, which a “flu friend” can take to an antiviral drug collection point, which may be a pharmacy or a health centre.

The first doses of swine flu vaccine will arrive in the UK in August. Although the government has ordered enough for the entire population, it will arrive in batches.

At-risk groups – especially those vulnerable because of diseases which have compromised their immune systems or affect their breathing, such as asthma – would get it first.

The shift in the government’s swine flu strategy came as the World Health Organisation warned that the spread of swine flu was now “unstoppable”, with a total of 112 countries reporting nearly 77,201 infected people and 332 deaths since April.

Dr Margaret Chan, the WHO director general, told an international conference on swine flu in Mexico: “With well over 100 countries reporting cases, once a fully fit pandemic virus emerges its further international spread is unstoppable.”

Chan said there was “good reason to believe” the swine flu pandemic would be “of moderate severity, at least in its early days”.

But she said that while most deaths had so far occurred in people with serious underlying medical conditions, there were a few exceptions that raised alarm.

“For reasons that are poorly understood, some deaths are occurring in perfectly healthy young people,” she said.

“Moreover, some patients experience a very rapid clinical deterioration, leading to severe, life-threatening viral pneumonia that requires mechanical ventilation.”

So far, the fatality rate appears to be low. In the UK only four people have died. All had significant underlying health problems.

Jacqui Fleming, 38, of Glasgow, was the first person in the UK to die after contracting the virus. Fleming died last month, two weeks after her son, Jack, was born 11 weeks prematurely. The boy died later but had not contracted the virus.

The second victim was a 73-year-old man from the Inverclyde area of Scotland. Then a week ago today six-year-old Sameerah Ahmad, who was born with a rare life-threatening disease, became the youngest UK victim to date.

Health experts believe more people have caught swine flu but have shown no symptoms.

In the US the official figures show 27,725 Americans have contracted H1N1, with 127 deaths.

The Centres for Disease Control and Prevention, in Atlanta, estimate that one million Americans may have caught swine flu but not been to a doctor, suggesting fatality rates are as low as 0.012%, Burns said.

The European Centre for Disease Prevention and Control reported on Thursday that of 69,177 cases which had been detected worldwide only 328 people had died – a fatality rate of 0.47%.

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Swine flu ‘can no longer be contained’

More than 100,000 people could be diagnosed with swine flu every day by the end of August, the government said, announcing that the disease can no longer be contained in the UK.

A Commons statement by the health secretary, Andy Burnham, marks a watershed in the spread of the flu. No more schools will be closed, unless forced to by the lack of staff or if the pupils are especially vulnerable. Families and people in contact with those with flu will not be given preventative antiviral drugs.

The new policy of treatment for those with diagnosed illness, rather than containment, has already begun in the hotspots – chiefly London, Birmingham and Scotland.

The change of tactic is the predicted response to the swelling number of people infected. There are now 7,447 diagnosed cases in the UK, but the number is doubling every week. If they continue in this way, said Burnham in his statement, “we could see over 100,000 cases per day by the end of August”. He later stressed that the figure “is a projection. It is not a fact. This is how the disease could develop and we don’t know.”

Those sorts of numbers would put a heavy burden on the NHS, which is already feeling the strain in some areas. The new strategy will help keep those with possible symptoms out of GP surgeries.

People who think they may have flu are now being advised to go online and check their symptoms on the NHS website or call the swine flu information line, on 0800 1 513 513. Anyone still concerned after that should phone their GP, who can provide a diagnosis over the phone. If swine flu is confirmed, they will be issued with an authorisation voucher, which a “flu friend” can take to an antiviral drug collection point, which may be a pharmacy or a health centre.

But health officials in Scotland doubt the virus will spread dramatically across the UK, as it seems to have peaked in Scotland, which saw the first big outbreaks, and the first two deaths in Europe.

The rapid spread of the virus has slowed down in Paisley, which suffered the second largest outbreak, and it has disappeared in Dunoon, where a coachload of football fans were infected. In Glasgow, until recently the worst affected area of the UK, infection rates have stabilised. After infection rates peaked at 111 confirmed cases on 25 June, the rate in Scotland has remained steady at an average of about 60 new cases a day over the last week. There is no evidence that infection rates in Scotland, where the virus first arrived in late April, were doubling.

Dr Harry Burns, Scotland’s chief medical officer, said he was “now optimistic that sometime over the next few weeks, the rate of transmission will begin to slow down” [in Scotland].

It was entirely possible, he added, that the outbreaks elsewhere in the UK would also slow down in a matter of weeks.

The fatality rate also appears to be low. In the UK, only three people – all with significant underlying health problems – have died out of 7,447 confirmed cases. Health experts believe more people have caught swine flu but shown no symptoms.

In the United States, the official figures show 27,725 Americans have contracted H1N1, with 127 deaths. The Centres for Disease Control and Prevention, in Atlanta, estimates that a million Americans may have caught swine flu but not been to a doctor, suggesting that fatality rates are as low as 0.012%, Burns said.

The European Centre for Disease Prevention and Control reported on Thursday that of 69,177 cases which had been detected worldwide, only 328 people had died – a fatality rate of 0.47%.

However, Sir Liam Donaldson, the chief medical officer, said that it was not yet possible to work out the death rate from the virus, “given the unreliability of the data”, but that it would become clearer in the coming months.

The first batches of vaccine will arrive in August.

Although the UK has ordered enough for the entire population, it will arrive in batches. At-risk groups would get it first, said Donaldson: those especially vulnerable because of diseases which have compromised their immune systems or affect their breathing, such as asthma.

New flu strains cannot be eradicated. They simply become part of the seasonal flu mix. Donaldson said that swine flu could continue to cause extra deaths for five years. “We will need the vaccine in years to come,” he said.

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Swine flu ‘can no longer be contained’

More than 100,000 people could be diagnosed with swine flu every day by the end of August, the government said, announcing that the disease can no longer be contained in the UK.

A Commons statement by the health secretary, Andy Burnham, marks a watershed in the spread of the flu. No more schools will be closed, unless forced to by the lack of staff or if the pupils are especially vulnerable. Families and people in contact with those with flu will not be given preventative antiviral drugs.

The new policy of treatment for those with diagnosed illness, rather than containment, has already begun in the hotspots – chiefly London, Birmingham and Scotland.

The change of tactic is the predicted response to the swelling number of people infected. There are now 7,447 diagnosed cases in the UK, but the number is doubling every week. If they continue in this way, said Burnham in his statement, “we could see over 100,000 cases per day by the end of August”. He later stressed that the figure “is a projection. It is not a fact. This is how the disease could develop and we don’t know.”

Those sorts of numbers would put a heavy burden on the NHS, which is already feeling the strain in some areas. The new strategy will help keep those with possible symptoms out of GP surgeries.

People who think they may have flu are now being advised to go online and check their symptoms on the NHS website or call the swine flu information line, on 0800 1 513 513. Anyone still concerned after that should phone their GP, who can provide a diagnosis over the phone. If swine flu is confirmed, they will be issued with an authorisation voucher, which a “flu friend” can take to an antiviral drug collection point, which may be a pharmacy or a health centre.

But health officials in Scotland doubt the virus will spread dramatically across the UK, as it seems to have peaked in Scotland, which saw the first big outbreaks, and the first two deaths in Europe.

The rapid spread of the virus has slowed down in Paisley, which suffered the second largest outbreak, and it has disappeared in Dunoon, where a coachload of football fans were infected. In Glasgow, until recently the worst affected area of the UK, infection rates have stabilised. After infection rates peaked at 111 confirmed cases on 25 June, the rate in Scotland has remained steady at an average of about 60 new cases a day over the last week. There is no evidence that infection rates in Scotland, where the virus first arrived in late April, were doubling.

Dr Harry Burns, Scotland’s chief medical officer, said he was “now optimistic that sometime over the next few weeks, the rate of transmission will begin to slow down” [in Scotland].

It was entirely possible, he added, that the outbreaks elsewhere in the UK would also slow down in a matter of weeks.

The fatality rate also appears to be low. In the UK, only three people – all with significant underlying health problems – have died out of 7,447 confirmed cases. Health experts believe more people have caught swine flu but shown no symptoms.

In the United States, the official figures show 27,725 Americans have contracted H1N1, with 127 deaths. The Centres for Disease Control and Prevention, in Atlanta, estimates that a million Americans may have caught swine flu but not been to a doctor, suggesting that fatality rates are as low as 0.012%, Burns said.

The European Centre for Disease Prevention and Control reported on Thursday that of 69,177 cases which had been detected worldwide, only 328 people had died – a fatality rate of 0.47%.

However, Sir Liam Donaldson, the chief medical officer, said that it was not yet possible to work out the death rate from the virus, “given the unreliability of the data”, but that it would become clearer in the coming months.

The first batches of vaccine will arrive in August.

Although the UK has ordered enough for the entire population, it will arrive in batches. At-risk groups would get it first, said Donaldson: those especially vulnerable because of diseases which have compromised their immune systems or affect their breathing, such as asthma.

New flu strains cannot be eradicated. They simply become part of the seasonal flu mix. Donaldson said that swine flu could continue to cause extra deaths for five years. “We will need the vaccine in years to come,” he said.

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Swine flu ‘can no longer be contained’

Government moves to ‘treatment phase’ as health secretary says infection rate could reach 100,000 a day by end of August

Swine flu is spreading so rapidly across Britain that there could be 100,000 new cases a day by the end of next month, the health secretary, Andy Burnham, said today.

The UK would immediately move to the “treatment phase” of its plan to combat swine flu, meaning doctors would no longer test for the H1N1 virus and urge anyone with symptoms to stay at home, Burnham told the House of Commons.

The first swine flu vaccine would be made available from August, with 60m doses available by the end of the year, he added.

“We have reached the next stage in management of the disease,” Burnham said. “The national focus will be on treating the increasing numbers affected by swine flu. We will move to this treatment phase across the UK with immediate effect.”

The move does not mean the H1N1 virus, which was declared a pandemic by the World Health Organisation last month, is becoming more deadly, just that it can no longer be contained.

Burnham said there was a “considerable rise” in swine flu cases last week.

“We have always known it would be impossible to contain the virus indefinitely and at some point we would need to move away from containment to treatment.

“Cases are doubling every week and on this trend we could see over 100,000 cases per day by the end of August.

“The pressure on the system is such that it is the right time to take this step. Scientists can expect to see rapid rises in the number of cases.”

Burnham added that the public should be reassured by the steps being taken to tackle the virus. He said: “We are the only country in the world to be able to offer anti-virals to everyone as well as those at greater risk.”

The government’s chief medical officer, Professor Sir Liam Donaldson, said the production of a vaccine was “at an advanced stage” and denied that the outbreak was out of control.

Speaking at a special briefing at the Department of Health, he said: “We are continuing to take a very firm grip on this situation. We have a big stockpile of anti-virals, the biggest probably in the world. We have vaccine at an advance stage of production.”

Donaldson added that despite its rapid spread, the virus outbreak was “following a predictable path”.

The Health Protection Agency said a further 458 patients in England had been confirmed with swine flu, while the figure for the UK as a whole rose to 7,447.

Efforts to trace people who had been in contact with swine flu cases would now stop and schools no longer needed to close when hit by the virus, unless particular circumstances made it necessary.

The government has said that not everybody with swine flu would receive anti-viral drugs, which may be reserved for at-risk groups.

The daily collation of swine flu cases would also end because it was proving time-consuming. Instead, “more general” estimates of numbers would be given. Other affected countries already update their swine flu numbers less frequently, such as weekly or every other day.

The Scottish health secretary, Nicola Sturgeon, announced a similar shift in swine flu policy at a simultaneous briefing in Edinburgh.

She said: “We’ve always said it would be impossible to limit the spread of what is a contagious virus indefinitely.

“We’ve always said that, when it did start to spread more widely within communities, we would require to make a judgment about when to shift efforts from intense containment to treatment, or mitigation.”

Sturgeon, who is also the deputy first minister of Scotland, said “high-risk” groups such as children under five, pregnant women and the elderly would get priority access to medication.

Scotland’s chief medical officer, Harry Burns, said the country could expect to have a tenth of the UK cases of swine flu. He predicted there would be about 10,000 new cases a day in Scotland by August.

He said: “It could be a bit less, it could be a bit more. It also presupposes that there isn’t a downturn, if it continues to rise at this rate, and it’s doubling approximately every week, you can do the sums yourself.”

However, Scottish health officials said the swine flu infection rate may have already peaked, as the number of new cases in three hotspots in the greater Glasgow area appears to be in decline.

After infection rates peaked at 111 confirmed cases on 25 June, with Scotland experiencing the first two swine flu deaths in Europe, the rate has remained steady at about 60 new cases a day over the last week.

The rapid spread in two of the major hotspots – Dunoon in Argyll and Paisley south of Glasgow – now appears to have stopped and cases have begun to decline sharply.

The official statistics on the virus were likely to underestimate the true scale of infection in the UK because now only a sample of patients in the hotspots had a diagnosis of swine flu confirmed by lab tests. Many people were thought to have such mild symptoms that they were not bothering to contact their doctors while others were being treated in surgeries without being regarded as suspected swine flu cases.

In swine flu hotspots such as London, the West Midlands and parts of Scotland diagnosis of the virus was already being done by doctors rather than laboratory testing, and tracing the contacts of people with swine flu and the use of preventative anti-viral drugs had stopped. Anti-viral drugs were still being offered to all people with symptoms.

Although a bout of swine flu was currently causing less serious illness than traditional seasonal flu, three people with other serious health conditions in the UK have died after catching the virus and there are concerns it could mutate into a more virulent form.

The chief medical officer, Sir Liam Donaldson, has warned that there may be tens of thousands of cases each week this autumn, because the virus is more likely to thrive in a colder climate.

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Burnham to alter swine flu approach

Health secretary Andy Burnham to make Commons statement on changes to way outbreaks are managed

The government is due to announce a major change in its handling of swine flu outbreaks today, with the daily recording and reporting of cases expected to be abandoned because of the increasingly rapid spread of the virus.

The health secretary, Andy Burnham, is due to make a statement on swine flu in the House of Commons just after midday. With the number of cases confirmed by laboratory tests set to exceed 7,000 today, it is likely that the policy of trying to contain the H1N1 virus may be abandoned in favour of “outbreak management”.

In swine flu hotspots such as London, the West Midlands and parts of Scotland, which have already moved to the outbreak management phase, diagnosis of the virus is now being done by doctors rather than laboratory testing and tracing the contacts of people with swine flu and the preventative use of anti-viral drugs has stopped. Anti-viral drugs are still being offered to all people with symptoms.

Collating daily figures is proving time consuming but the government and other agencies recognise they still need other ways of regularly informing the public.

Other countries already update their swine flu numbers less frequently, for instance, weekly or every other day. Among the options being considered by the government is weekly updates on the spread of the disease, with cases reported as a number per 100,000 of the UK population. This is how traditional flu cases are reported each winter, and with the NHS preparing for tens of thousands of swine flu cases a week by the end of this year, a similar system would be understood by public health experts.

The Health Protection Agency yesterday announced another 342 patients in England have been confirmed with swine flu, while the figure for the UK as a whole rose to 6,929.

The official statistics on the virus are likely to underestimate the true scale of infection in the UK because only a sample of patients in the hotspots now have a diagnosis of swine flu confirmed by lab tests. Furthermore many people are thought to have such mild symptoms they are not even bothering to contact their doctors and others are being treated in surgeries without being regarded as suspected swine flu cases.

Although a bout of swine flu is currently causing less serious illness than traditional seasonal flu, three people with other serious health conditions in the UK have died after catching the virus and there are concerns that it could mutate into a more virulent form.

The chief medical officer, Sir Liam Donaldson, has already warned that there may be tens of thousands of cases each week this autumn, because the virus is more likely to thrive in a colder climate.

Meanwhile, senior doctors have warned parents not to take their children to “swine flu parties” in the hope that they catch the disease now and build up immunity.

Although no firm evidence has emerged that these are taking place, the family website mumsnet.com has seen discussions between parents on whether they should deliberately expose their offspring to the virus in the same way that chickenpox parties are sometimes arranged to allow friends to have the once-only disease at a convenient time.

Richard Jarvis, of the British Medical Association’s public health committee, said: “I think parents would want to take into account that the flu – although this strain is relatively mild for the most part – is something that will knock people off their feet for a few days and we are seeing appreciable morbidity, severe side-effects and sadly the occasional death.”

Scientists have found the first case of the new H1N1 influenza strain showing resistance to Tamiflu, the main anti-viral flu drug, Danish officials and the manufacturer said yesterday. It was expected that the strain would at some point show resistance to Tamiflu, Denmark’s State Serum Institute said. The patient is now well and no further infection with the resistant virus had been detected.

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Public want NHS protected from funding cuts

Sacrifice other departments instead of the NHS, say three out of four people in British Medical Association poll

More than three-quarters of the public – 77% – believe NHS funding should be protected in the face of future spending cuts, an opinion poll has found.

Other departments’ budgets should be sacrificed in order to preserve the health service, the British Medical Association survey heard. Four out of 10 people said they would be willing to pay higher taxes to sustain growth in NHS funding.

The poll questioned 1,071 people in five UK cities – London, Edinburgh, Belfast, Manchester and Cardiff – a week ago, and reflects fears that severe cutbacks are looming.

Nine out of 10 people suspect NHS services will be cut as a result of the recession, and almost as many believe waiting times for treatment will rise; 85% anticipate additional charges for NHS treatments.

The level of public support for the NHS at the expense of other departments is likely to be welcomed by the Conservative health spokesman, Andrew Lansley, who last month stirred controversy when he declared that a future Tory administration would protect the health service and target cuts elsewhere.

The poll, released on the eve of the BMA’s annual conference in Liverpool, gave conflicting evidence about privatisation. Nearly 60% said the private sector should be more involved in providing NHS services but almost half (47%) said there should be no further contracts for commercial companies.

The BMA chairman, Dr Hamish Meldrum, said: “These results show how anxious the public is about the effects of the recession on the health service, with a significant number saying taxes should increase to protect NHS funding. No one wants to see any cuts in the public sector but our poll reveals just how much society values their health service.

“Fear often goes hand in hand with economic slumps, with people worrying what will happen to them and their families in times of ill health. While we appreciate that the government needs to steer the country through this difficult economic period, we urge it not to do so at the expense of NHS funding.”

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PM’s council house plan stirs migrant debate

• ‘Local’ people to be given priority for social housing
• Policy sets out rights from education to policing

Local people are to get greater priority on social housing lists, the government is to announce as it discards its former reliance on centrally controlled targets and ushers in new “entitlements” across all elements of the welfare state.

Ending the target culture established by his predecessor, Tony Blair, Gordon Brown will shift evaluation of public services away from Whitehall to the public, saying that people should have entitlements to personal tuition in schools, minimum GP waiting times and access to police working in neighbourhoods.

Though the prime minister plans to hand to the public the power to evaluate whether they have been adequately cared for, details of what redress people will get will follow in another paper, due to be published in the next few months.

The plan – Building Britain’s Future – is likely to form the basis for Labour’s policy platform before the next general election, and elements of it appear to be an attempt to drain support from far-right parties which blame immigrants for housing shortages. In the European elections three weeks ago, the BNP won two seats in the European parliament.

The policy of greater priority for local people in social housing is likely to attract criticism from senior Labour figures that the entire relaunch is an overtly populist package.

When the then minister Margaret Hodge first suggested in May 2007 that council house allocation should be dependent on length of residence and national insurance payment details, the then mayor of London, Ken Livingstone, said such a move would be “illegal” and “wrong”. Though Hodge used the same language the government uses now, describing a “legitimate sense of entitlement felt by the indigenous family” Livingstone accused her of “magnifying the propaganda of the British National party”.

The then deputy leadership contender Jon Cruddas was also uncomfortable with “racialising arguments over housing allocation” rather than concentrating on the need for more social housing.

But the government may avert this with another element of the package, likely to include a wave of construction of social and affordable housing.

The document will make the current 18-week NHS waiting list target an obligation; alongside a right to a free health test for anybody between the age of 40 and 74. At the moment primary care trusts are not obliged to offer either service.

Cancer patients will also be given the right to private healthcare if NHS hospitals can not see them within two weeks, with the bill met within existing funds.

New rights to one-on-one tuition will be extended into early secondary education.

The policy reboot has to be pulled off against allegations of a dwindling set of ideas after 12 years in government, and diminished public funding.

The Tory leader, David Cameron, has called on the prime minister to apologise after he said that capital expenditure would rise every year to 2012, when it will actually fall after 2010. In an interview with the Guardian on Saturday, the chief secretary to the Treasury, Liam Byrne, confirmed that while current or “day-to-day” spending may rise, capital spending would fall after the current burst to kickstart the economy. The environment secretary, Hilary Benn, appeared to suggest on Radio 4′s Any Questions that his department would have less to spend after the next election.

Yesterday the children’s secretary, Ed Balls, told the BBC’s Sunday AM programme the government had to be “defter and smarter”. Balls, who will also publish an education white paper on Tuesday, insisted the government’s spending plans could be met, despite tough conditions.

Balls is adamant that as the economic outlook improves, Labour will be able to “release resources” to key areas. But he did appear to have modified his position, saying: “We are increasing investment this year and next year.”

The work and pensions secretary, Yvette Cooper, said the targets had helped to drive improvements in a range of public services, but that the new strategy was about improving accountability.

She told BBC1′s Politics Show: “Having made those improvements, the next step we now need is to be able to say, ‘okay, those services are now accountable to local people’. Local people should be entitled to things from their health service, from their education service, and that’s how we measure improvements in future.”

Cooper was unable to say what will happen if the entitlements were not met and insisted the new rights were not a “lawyers’ charter”.

Byrne said that the rules might see patients able to commission a greater number of doctors if waiting lists lengthen, neighbourhood police being ordered to hold local meetings, and councils required to find alternative social care.

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