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Swine Flu

Volume 710: debated on Monday 27 April 2009

Statement

My Lords, with the leave of the House I should like to repeat a Statement made by my right honourable friend the Secretary of State in another place. The Statement is as follows:

“With permission, Mr Speaker, I should like to make a Statement on the reports of human cases of swine influenza, known as the AH1N1 infection, in some parts of the world, notably Mexico and the United States of America.

The outbreak began in Mexico on 18 March and as at 9 pm last night there have been over 800 cases and 89 deaths in that country. However, to date, only 18 cases have been confirmed as being caused by the AH1N1 virus and it is highly possible that other, more routine causes of infection are currently circulating in Mexico.

On Tuesday last week, under the terms of the international health regulations, the United States reported seven cases of the AH1N1 infection. On Friday 24 April, the United States Centers for Disease Control confirmed that samples from Mexico contained the same virus as those in the United States.

Twenty cases have now been confirmed in five different states of the USA; four have been confirmed in Canada and one in Spain. Suspected cases have also been reported from New Zealand, France and Israel, although it is important to note that these are suspected cases and have not yet been confirmed as the AH1N1 infection.

In the UK, 25 cases under investigation have been reported. Eight of these have proved to be negative, and three are currently undergoing further specialist tests. These patients are in isolation wards in hospital, after recently travelling in Mexico. People who have been in close contact with them are currently being contacted. The remaining 14 suspected cases are undergoing initial investigation and are sufficiently well to be managed in the community.

It is too early to say whether the cases in Mexico and the US will lead to a pandemic. Scientists do not yet understand the extent to which cases in Mexico and the US are linked and are not yet able to make a complete assessment of the health implications of this new virus.

A pandemic is declared when the World Health Organisation raises the pandemic alert to Phase 6. This means that there is widespread person-to-person transmission of a virus in the general population. At the moment we are at Phase 3.

The director-general of the WHO, Dr Margaret Chan, has declared that this is a public health emergency of international concern. The WHO is convening a committee of experts from around the world which is meeting this afternoon to review the situation and determine what further action is required at a global level.

In deciding the pandemic alert state, the WHO bases its decision on expert scientific advice based on the available epidemiological and scientific evidence. The range of symptoms in those affected is similar to those of regular human seasonal influenza. It is important to note that, apart from in Mexico, all those infected with the virus have experienced mild symptoms and have made a full recovery.

The swine flu that has been isolated in Mexico and the United States is sensitive to the antiviral drugs Tamiflu and Relenza. These drugs are effective in treating the illness, provided they are taken quickly enough. These medicines can reduce the length of symptoms and usually their severity.

I would like to outline to the House the measures that we are taking in response to this situation in the UK. The UK has been preparing for a flu pandemic for the past five years. We have established a stockpile of enough antivirals to treat more than 33 million people—that is, half the population of the UK. All NHS organisations have pandemic flu plans in place and the Department of Health is now working closely with the NHS to ensure that these plans can be put into action so that antivirals can be made available to the public very rapidly, should we reach that stage.

Over the weekend, the Government have been putting in place precautionary measures to implement the plans we have been developing in the case of more widespread infections in the UK. I have spoken to ministerial colleagues and my opposition shadows this morning, and I will be convening a meeting of the Civil Contingencies Committee immediately following this Statement.

We have enhanced our port health checks so that passengers arriving in the UK with symptoms of illness are identified and assessed. Information is being made available to passengers arriving at ports and we have provided urgent advice to doctors.

Should the virus start spreading widely in the UK, we propose to use our antiviral stockpile for the treatment of symptomatic patients. We already have an advanced agreement in place with manufacturers should a vaccine be developed, although it is important to note that it will be some time before scientists can develop a vaccine, as this virus is not yet sufficiently understood. Experts are currently examining whether vaccination with regular, seasonal flu vaccine can in any way boost immunity to the H1N1 strain, and we are considering how best we can use the limited stocks that are currently available within the UK.

Many people will wish to know whether they should wear face masks. Although we are aware that face masks are being given out to the public in Mexico, the available scientific evidence does not support the general wearing of face masks by those who are not ill while they are going about their normal activities. We are, however, urgently looking into how we can increase our stockpiles of face masks for healthcare workers who are treating sick patients. We have also published infection-control guidance for support staff treating or caring for people who have symptoms.

We already have well advanced plans for providing information to the public in the event of a pandemic—in particular, about what people can do to help themselves in the event of swine influenza being confirmed in the UK. Updated information is available on the NHS Choices and HPA websites, and further information is also available for health and social care staff on the Department of Health website. We are putting in place an information line containing recorded, up-to-date information for those who want to know more about this type of flu. In addition, NHS Direct is providing information to people who have recently travelled overseas and are worried that they may have symptoms.

There are three key messages I would like to stress at this stage. First, it is important to emphasise that in all cases outside Mexico the symptoms of this illness are mild and all patients have made a full recovery. Secondly, we can all take simple measures to prevent infection—in particular, covering the nose and mouth when coughing or sneezing and washing hands regularly. Anyone who develops flu-like symptoms should go home and contact NHS Direct or their GP by phone. Thirdly, anyone who has recently travelled to the affected areas and is experiencing influenza-like illness should stay at home to limit contact with others and seek medical advice by phone from a local health professional or NHS Direct.

In line with advice from the WHO, there are currently no travel restrictions on those who are planning to visit affected areas. Anyone planning to do so is advised to ensure that they take the measures I have outlined to prevent infection and to consult a doctor immediately if they show signs of flu-like symptoms. To enable local health services to respond to the pressure that the possibility of a pandemic may bring on services, we are working with primary care trusts to ensure that arrangements are in place to support the distribution arrangement for antivirals, should that become necessary,

There is trepidation and concern across the world. Here in the UK, we are monitoring the situation very closely, alongside the WHO and our international partners. The UK has been preparing for such an occurrence for a number of years and the World Health Organisation has recognised that the UK and France are the two best prepared countries in the world. I will of course keep Parliament fully updated on what is obviously a rapidly developing situation”.

My Lords, that concludes the Statement.

My Lords, I thank the Minister for giving me a copy of the Statement an hour or so beforehand. I also want to express our deepest sympathy for all those affected by this outbreak. I congratulate the World Health Organisation on its rapid response when the outbreak came to light in Mexico. It has greatly improved its all-round performance under the very able leadership of the director-general, Dr Margaret Chan, who was appointed two years ago.

Perhaps I can reassure the Government that they can count on our full support in their efforts to prevent the spread of this disease. We shall do all we can to boost the nation’s morale and confidence that the epidemic will be contained. The fact that the UK is among the best prepared countries is in no small measure due to the constant pressure applied to the Government, since 2004, by Mr Andrew Lansley in another place. It is a pity that the Government refused his request for a debate on the pandemic influenza in January. I am sure that if our Minister, the noble Lord, Lord Darzi, had been in another place, he would have insisted on such a debate and would have excised the objections from the congenital snag hunters.

Can the Minister tell the House how the Government propose to inform the public if the national flu contingency plan is triggered? I assume from the Minister’s Statement that the national flu line service is not yet ready. Perhaps he could tell us when it will be ready. The EU has advised against non-essential travel, but the UK Government have not followed suit. Perhaps the Minister could say why that is so.

On face masks, the Minister and I are very well aware that if a mask is lowered, as it often is, and left for a while round the neck, it is much less effective when returned to the face. Perhaps that could be emphasised.

Most of all I want to emphasise that I am very worried indeed that the Government have decided to treat only those with symptoms and not to give the antiviral treatment prophylactically to the family contacts of those who contract the disease. I cannot emphasise strongly enough what a serious mistake that is and I urge the Minister to persuade the Government to change their mind. In the flu epidemic of 1918-19, many returning members of the Armed Forces knocked on the doors of their homes but received no answer as the whole family was dead inside. The Minister has said that we have a very plentiful supply of antivirals, which is great, but they should be used prophylactically to protect family members from this disastrous possibility. Will the Minister give us an assurance that he will use his charm and pressure to get the Government to change their mind?

My Lords, I also thank the Minister for allowing us to see the Statement before he repeated it in this House, and I associate myself with the remarks made by the noble Lord, Lord McColl.

The Prime Minister must be feeling a little like the Pharaoh in ancient Egypt who had the seven plagues visited upon him. I have lost count of the number of plagues that the Prime Minister has had in his 18 months, but he must be wondering what he has to do to make them stop. This is one such and, as ever, the tabloid press are making a feast of it. This morning alone we have had front-page headlines such as “Pig sick”, “Killer pig flu”, “Swine flu sweeps globe”—which it has not yet quite done—and the Daily Mirror modestly asking: “Is swine flu already here?”. The general public are being subjected to those headlines and to all sorts of opinions and advice in the newspapers by medical journalists, ordinary journalists, retired doctors, active doctors, people who are not doctors at all, soothsayers and an awful lot of other people.

What stood out for me was the advice from the 1918 flu epidemic, which recommended that everyone in the population should wash out their nostrils with soap and water—carbolic soap, presumably—night and morning and eat lots of oats. I am not sure whether oats are a good preventative, but it cannot do us any harm to eat more oats, so that is what I shall be doing.

We have had two reports that may be relevant, and I look forward to reading them. There was one in 2007 on controlling international borders and the spread of diseases, which I must confess that I have not read, but I think that the gist of it was that we should not always wait for top-down direction from international organisations but should get active ourselves—which the Government have done, and I give credit to them for that. I understand that the Select Committee on Science and Technology is investigating UK readiness for a pandemic and that that report will be out quite soon.

I shall ask a few questions briefly. First, on the subject of wearing masks, I wonder whether the general public would not feel more comfortable if they were told that on crowded underground trains and aeroplanes it might be prudent to wear masks. After all, it is the hay fever season, so an awful lot of sneezing, coughing and blowing of noses is going on anyway. I, for one, would feel more comfortable, and I ask whether we have a sufficient supply of masks. I presume that they are available from pharmacies, but I do not know. We need to know that and people should make up their own minds whether they wear them.

Will the Minister tell us how long he estimates that it will be before the new vaccine is ready? Do we have firm plans in place for its delivery? Do we have enough staff, enough people on the ground, to immunise people? As it has already been said that the old vaccine confers some immunity against this new swine influenza, I would have thought that it would be prudent to vaccinate the young, fit and vulnerable people with it straight away. Let us use up the old stock, because we will have a new vaccine by next winter anyway. Why not use up last winter's stock to protect our young people, who, it is thought, are the most vulnerable?

I would like to know whether Tamiflu and Relenza will be available off-prescription. I agree with the noble Lord, Lord McColl, that it is better to use them prophylactically for people who have swine influenza among their family circle. Will they be available off-prescription? If so, are the supplies adequate? Do we have a mechanism to ensure that individuals are not stockpiling it already by some means or other to protect their families? When patients are advised not to go to GP surgeries but to call their GPs for advice, what will happen if their condition worsens rapidly? Will GPs do home visits or will those patients who fear that they may have swine influenza be dialling 999 and infecting ambulance crews up and down the country? Do we have a system in place for rapid disinfection of our ambulance services if that occurs? We are told that official advice from the Department of Health is coming. Could we please have it as soon as possible? People are being subjected to so many opinions on this that we need official advice on websites, and in doctors’ surgeries and pharmacies, as soon as possible.

My Lords, I am grateful for that response to the Statement made by the Secretary of State. First, I will try to address some of the very important issues raised by the noble Lord, Lord McColl. On the national flu line, we have a contract with British Telecom, and we anticipate that the flu line will not be ready until the autumn. Lest we forget, most pandemics occur in waves, as we saw in Spanish flu, which was in three waves. Obviously, we are focusing all our efforts on ensuring that the line is available in the autumn. Through the NHS operating framework, we have also ensured that the NHS is ready to deal with such a situation. NHS Direct and all PCTs are looking at the options in which they could release the stockpile of antivirals if such a need arises. I hope I have covered that point.

There has been a fair bit of debate about travel and the evidence of the benefits and disadvantages of the approaches for border closure, an issue raised by the noble Baroness, Lady Tonge. This is still under review. UK nationals may be advised against all essential travel to certain countries or areas during the pandemic through the usual FCO travel advice process. If I remember correctly, we did this in the days of SARS when a statement was released by the FCO. We are keeping a close eye on that. Unlike the United States, we do not have a major border with a country like Mexico where cases have been identified.

The noble Lord raised the issue of wearing masks, and I could not agree more. Most surgical trainees are taught how to wear a mask. If masks are used in certain situations, we have a duty to ensure that they are appropriately worn. I will come back to the issue of masks, which was raised by the noble Baroness. Masks tend to prevent cross-infection from someone who is infected for up to three feet. There is evidence that healthcare providers, such as staff working in health services, should wear masks because they are in fairly close contact with patients. But there is no evidence to suggest that an individual who is not infected needs to wear a mask in open spaces. However, if an individual has the flu, he or she should wear a mask. Perhaps I may remind noble Lords of public health advice that is well known to all of us: if you have the flu you should remain at home. You should not be wearing a mask on the streets. That is the relevant evidence as far as masks are concerned.

On the use of antivirals, there is a debate in the scientific community on whether they should be used as a prophylactic measure. I do not think any other country has adopted a clear policy on household prophylaxis using antivirals, but we should consider it. Much will depend on demand for antivirals, and I have made a point of saying that we have enough to supply 50 per cent of the population. We may look at this again in considering a move from symptomatic patients to looking at close members of the household who might be at risk. However, that is all being kept under review and at the moment the policy is to treat only symptomatic patients because we cannot predict actual demand.

I turn now to some of the points raised by the noble Baroness, Lady Tonge. She asked about new vaccines. It will take a while to map out the mutation of this virus. We know that it is an H1N1 virus and a relative of the Spanish flu virus. I predict that at best it will take three months to come up with a new vaccine, but let us not forget that we also have to build up a stockpile of the drug. That is why the Statement makes it clear that it could take up to a year to acquire an adequate supply.

On whether we have enough staff to administer the vaccine, I think that we are in a good place in that regard. We have done a lot over the past three or four years in getting the public to understand that the ordinary influenza vaccinations that we have been giving to high-risk groups, such as the elderly and the young, are of value. Moreover, one of the advantages of a universal healthcare system where patients are registered across the board is that it puts the UK in a good place to ensure that vaccinations can be made available.

On the point about advice and algorithms in management, we are in the right place to come up with these on either the HPA or Department of Health website, and I have no doubt that the Chief Medical Officer is actively engaged in the process as we speak. I hope that I have addressed the major questions that have been raised.

My Lords, I thank the Minister warmly for his prompt and appropriate repetition of the Statement prepared for the other place. Reference has been made to the fact that the Science and Technology Committee of this House has been engaged in detailed discussions on these matters, and I bring forward two questions which arise from the issue of treating symptomatic patients. This first is this: do the Government have a policy on giving key workers early access to the drugs that are already available? Secondly, are there clear criteria for the identification of these key workers, not all of whom will necessarily be in the health and care services?

My Lords, I am grateful for the noble Lord’s intervention in relation to the work of the Science and Technology Committee, and I await its report. We have a policy in place for ensuring that all key workers in the healthcare system are protected as much as possible, which includes giving them supplies of the antiviral drugs. As I said earlier, we do not yet have a vaccine that we know works in this situation. We have a small supply of the H5N1 vaccine, but it is not effective here. Antivirals will be distributed and certainly all other precautions will be taken. The priority is to ensure that we have not just a competent but a healthy workforce that is able to deal with some of the challenges we will face if this becomes a pandemic.

My Lords, I have to say that I found the noble Lord’s response to the question put by my noble friend about the suggestion that antivirals should be used prophylactically less than satisfactory. As a co-opted member of the Select Committee that is currently looking at this area, we have recently been given some interesting information by the noble Lord’s department. It refers to two published papers on the use of antivirals for post-exposure household prophylaxis. However, let me make it clear that I am not talking about pre-exposure prophylaxis, because I accept that it is probably ineffective.

Perhaps I may quote from the Department of Health paper:

“The modelling shows that antiviral prophylaxis of the household contacts of infected cases given within 24 hours of symptoms appearing in index cases could have a greater impact on a pandemic than a simple treatment policy, reducing cases and hence deaths”,

and goes on to say that it could,

“significantly limit the impact of a pandemic”.

Why cannot the Government now take a decision to embark on this policy? I had a long discussion this afternoon with the noble Lord, Lord May of Oxford, who has repeatedly asked the same question. We are told that the Government are actively examining the feasibility of introducing the policy, but does the noble Lord accept that that is not enough; that there has to be a clear decision that this will be used? If this is not done, I suspect that the Secretary of State will find himself in an extremely embarrassing position if this pandemic subsequently spreads to the whole country.

My Lords, I am grateful to the noble Lord for his advice and for highlighting the evidence base. I agree that there are plenty of studies looking at seasonal flu in which prophylaxis for post-exposure has been used quite successfully, and I have no doubt that that information could translate into a pandemic situation as well. We do not have a view on this now for the simple reason that we need to consider the size of the stockpile we have—which, as I said earlier, will treat 50 per cent of the population—versus the worst-case scenario.

A simulation of, “what is the worst-case scenario, what is our stockpile?” will be carried out and a decision will be made about a post-exposure prophylaxis. I am not excluding it; I am just making the point that we need to wait for evidence of the transmission of the virus and how quickly it is progressing to enable us to evaluate the worst-case scenario versus the stockpile. Otherwise, we may end up in the situation where we do not have a stockpile for treating patients who are infected with the flu. I promise the noble Lord that I will keep a close eye on this. The whole department, including my right honourable friend the Secretary of State, is looking at our policies on a daily basis.

My Lords, I have two questions on the antivirals. My first question is whether we have a sufficiently rapid distribution process to make sure that the antivirals reach the GPs and patients when they need them. My second question relates to the availability of the doses. It is good to hear that we have enough for 33 million people—half the population—but would it not be wise to develop a greater stockpile? We would not then run into the problems that we have heard about in deciding whether to give the drug to close contacts.

My Lords, I am grateful for my noble friend’s intervention. On his first question on distribution, absolutely we need to have a streamlined distribution system. If I could come back to the point raised by the noble Baroness about prescriptions, this is not a situation in which you would have to wait for a prescription. You would make a call, go through your symptoms and your drugs would either be delivered to your household or a member of the family in that household would go and pick them up. We need to make sure, though, that we have a system for monitoring this—in other words, a patient number or a patient identity number—to prevent acquisition of the drugs for the wrong reasons.

I am also grateful for my noble friend’s advice on greater stockpiling. I reassure the House that everyone in the department is calling every manufacturer to ensure that we increase our stock. We have every intention of making sure that we have as much as possible. I have just given the figures about our stockpile of antivirals before the pandemic even hit the news. The House can be reassured that we are doing everything possible to increase our stockpiles, not only of antivirals but of the other medications that might be required in the event of a pandemic.

My Lords, I thank the Minister for the leadership that he is providing and for the Statement he has given us today. However, I want to ask about antivirals and their distribution. Have healthcare workers currently looking after patients who are in isolation been given antivirals that they can start taking at the very first hint of a symptom? In their planning, are the Government considering distributing to first-range frontline workers antivirals that they can hold and start taking at the very first symptom occurring?

The reason that this needs careful consideration is that we know that containment is crucial in any type of epidemic. In the SARS epidemic, from which we can learn a lot of lessons, it was clear that containment—geographical containment and the complete prohibition of movement in and out of the area—was key to what happened. That included the isolation of the healthcare workers who were involved in looking after those cases. I declare an interest as a co-opted member of the committee that is looking at pandemic influenza.

My Lords, I am not entirely sure about the healthcare workers involved in treatment, but I am more than happy to look into that and come back. The current policy, although we are always reviewing this, is that healthcare workers who get symptoms will be given the antivirals, but not in advance of seeing a patient—in other words, not pre-exposure but post-exposure. I am happy to look into that further, though. That policy will continue to change. We are fortunate to have enough stockpiled to treat 50 per cent of the population, so we have leeway, but we could do more. The policy for staff regarding pre-exposure, post-exposure and symptoms could always change.

My Lords, it is reassuring to learn that this virus, H1N1, has, in many cases outside Mexico, produced a mild illness from which people have quickly recovered. There is, however, a microbiological principle that has been recognised for years, although I do not think it happens very often with viruses, called “passage”, meaning that sometimes, when a virus passes from one individual to another and goes on through that individual to another, it may increase in pathogenicity. Is there any evidence to suggest that viruses such as this may in fact increase in pathogenicity through that principle?

Also, is it not in fact an influenza A virus? The seasonal vaccine is effective against certain strains of influenza A. If it is likely that the seasonal vaccine might be of value, would it not be appropriate to be willing to distribute that at an early date if the number of cases increases in the UK?

I am grateful for the fact that there is no ban on travel at the moment, because at the end of next week I am due to travel for 48 hours to Boston, Massachusetts, to speak at a memorial service for a greatly revered colleague with whom I worked in 1953. Perhaps it would be wise if I took some Tamiflu with me. Would the Minister advise me to do so?

My Lords, I am grateful for my noble friend’s comments. I agree with him that the virus could behave in any way. We do not have sufficient evidence to see how it has behaved so far. There are all sorts of thoughts out there about whether it has become milder since it has been in the US. We do not even know where it started, although the major cases are in Mexico. We need to keep a close eye on these issues.

I do not know exactly how much of a stockpile of the seasonal vaccine we have from last year. I do not think the new vaccine is out yet. I am grateful for the noble Lord’s input on that, though, and I will be happy to look at it. Let us not forget that we do not yet have a case in the UK, but I hope I have reassured noble Lords that if there is one, we will look at all these possibilities.

There is no way that a practising surgeon could give advice to my noble friend on whether he should take Tamiflu.

My Lords, the answer to the noble Lord, Lord McColl, about direct travel to Mexico seemed to be slightly equivocal, in as much as it is okay to go there from the UK but not from France. Will he clarify what the position is? What would he recommend with regard to direct travel from the United Kingdom to Mexico, as there is a large volume of traffic? I declare an interest in this.

My Lords, as I said earlier, today, we are not advising any restrictions on travel to Mexico. However, we are advising any person who is travelling to Mexico to be aware of the symptoms and to have clear advice on returning to the UK and on engaging with any passenger who becomes ill. The advice is that we do not have any restrictions, but people should be aware of the issues that have arisen. That could change tomorrow. I made it clear that the FCO is in charge of making the decision, and if it changes, as it did about travelling to Hong Kong during the SARS epidemic, then we will recommend that.

My Lords, I am a member of the Science and Technology Committee looking at this issue and a regular traveller to Mexico; I have been there every year for the past 10 years. I notice that people coming in on BA flights have had detailed information taken and, presumably, a record kept of their home address and where they can be contacted. However, many people flying from Mexico come either via the United States or on one of the European airlines from Madrid, Frankfurt or elsewhere. What steps are being taken to generally acquire knowledge about those who are coming directly or indirectly from Mexico?

My experience of the medical services in Mexico is that they are usually of outstanding quality, and I often wish that our hospitals could be as clean and kept in such a good state as many of its hospitals are. We are quite fortunate that the epidemic has come from a country with high medical standards and not from one of those parts of the world where the attention given to it might have been rather less efficient.

My Lords, I have no experience of the Mexican healthcare system, so it would not be appropriate for me to comment on that. I am aware, however, that at every port of entry there are clear signs saying that if you are arriving from Mexico then you need to contact an office, irrespective of which carrier is bringing you in. It is not a carrier issue, nor is it about your previous port of embarkation; it is about where you are travelling from.

My Lords, the Minister may recall a debate in this House on 24 February of the ad hoc Committee on Intergovernmental Organisations, which dealt with the issue of the spread of pandemic diseases. It confirmed one of the things he has said: that this country is highly regarded around the world for its work within governmental and international organisations.

The committee was concerned about the area between the time that the disease is identified in animals and the time that it transmits to human beings. The majority of these diseases, as the Minister will know, come from the animal population. I appreciate that he may not have the answer to this immediately, but what involvement have we had with the office in Paris that deals with animal diseases, with regard to learning from the current situation, about the transmission point? When did the Mexican Government first become aware that this disease had emerged in the pig population, and at what point did we identify it as transmitting to the human population?

My Lords, I am grateful to my noble friend. I do not have any details about what contacts have happened. I reassure the House that the cross-Government contingency committee in this country, which we have described before as COBRA, is meeting, and the Secretary of State has attended. With regard to our information internationally, however, I could be reassured only that the WHO, as the noble Lord, Lord McColl, said, under the leadership of Margaret Chan, is doing a fantastic job in co-ordinating activities across the globe and trying to address some of these challenging scientific questions.

I also reassure my noble friend that in this country, when it comes to epidemiological science and the issue of cross-transmission, we have the best scientists and they are actively looking at this question.

My Lords, how long do the results of a test take? Is this not an illustration of the need for rapid test results? Also, has there been a restriction on pigs in the infected areas, as pigs are carriers of heavy viral loads?

My Lords, the test takes a matter of hours. It is a PCR test, not a culture-type test, so I can reassure the noble Baroness on that. If there is a pandemic—I hope that there will not be—most people will have their symptoms treated before the test. At the moment, we are testing anyone who may be infected. As for the restriction on animals, I have no information that any pigs in this country are infected with the virus, although I am not entirely sure what is happening in Mexico. We say that this is swine flu, but only a component of the virus is pig-related. This is not a situation in which a pig will infect a human. The virus is mutated. We believe that it has parts of human flu virus, parts of pig flu virus and parts of bird flu virus, but it is H1N1.

My Lords, does the noble Lord agree that we cannot expect a vaccine soon, because the virus mutates rapidly? Therefore, it is important that we should observe simple hygiene practices at home when people have flu. For example, people should not use the same cutlery and crockery as someone with flu, they should not use the same towels, flannels and soap as someone with flu and, if possible, the patient should be isolated within the home, so that the vulnerable—young children and the elderly—are not in immediate contact with them. Would that not be helpful? Will he also say for how long a patient is infective and can pass on the virus?

My Lords, on that note, as we are coming to the end, let me say that I could not agree more with the noble Countess. The most important message that we can get out is about preventive measures. We have all sorts of campaigns, such as “Catch It, Bin It, Kill It”, which means that, if you sneeze, catch it in a tissue, destroy that tissue immediately and wash your hands. These are the most important principles in preventing a pandemic. We are doing everything possible to get that message out to the community. I do not have information on the infectiveness of the virus, but I remind the House that in some cases the patient may be completely asymptomatic but still infective, so the infectivity period is so far hard to judge.