The bird flu files: How Britain would fight a pandemic

IoS obtains Whitehall contingency plans as new report says bird flu is spread by poultry trade. Marie Woolf and Geoffrey Lean report

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As bird flu crept closer to Britain's shores last night, with the discovery that a turkey farm in France was riddled with infection, top planners in Whitehall have begun to draw up emergency preparations for a pandemic that could, if the worst happens, kill hundreds of thousands of people in the UK. This news coincides with a report that says factory farming and the international poultry trade are largely responsible for the spread of bird flu, and wild birds are being unfairly blamed for the disease.

The report says the deadly H5N1 virus developed inside intensive poultry units in Asia and has proliferated through exports of live birds and the use of chicken droppings as fertiliser. Its publication by Grain, an agricultural pressure group, chimes with the likely route of infection at the French turkey farm. Though the farm was close to where two infected wild ducks were found, all its 11,000 turkeys were kept indoors and had no contact with wild birds.

Dissident scientists accept that the flu began in wild birds, but say it developed in the cramped conditions of Asian factory farms. Research published in the official journal of the US National Academy of Sciences blames the poultry trade for the virus spreading from China to Vietnam.

BirdLife, a charity, says the virus's spread across Russia last summer ­ widely attributed to migrating birds ­ took place when birds were moulting and unable to fly. It adds that an outbreak in Nigeria took place on a factory farm far from migratory routes.

The new Whitehall guidelines, obtained by The Independent on Sunday, are contained in a 12-page Cabinet Office document headed "Contingency Planning for a Possible Influenza Pandemic". They paint a picture, in the event of a serious outbreak of a virulent, mutated form of bird flu, of a land where entry at ports is restricted, major sporting and music events are banned, and some companies have to function with one-third less staff. Where people live in close proximity to each other, such as in boarding schools, care homes and prisons, some form of quarantine may have to be enforced.

The contingency plans warn that the threat posed by H5N1 avian flu must be judged "one of the highest current risks to the UK". They even say that an outbreak on the scale of the 1918 flu pandemic, which wiped out an estimated 50 million people world-wide, could not be ruled out.

The document says that once it arrives in Britain, the mutated virus is expected to "spread quickly through the population", posing a deadly threat not only to human health but to the economy. With people having no immunity to this "novel virus", officials say that " the base scenario" is for an epidemic to strike a quarter of Britons in several waves. They estimate this could result in 53,700 deaths, four times as many as flu normally causes.

But, in what it calls the worst case, half of the population could be infected and, with a fatality rate of 2.5 per cent, this would mean 709,300 people could die.

To cope with such a crisis, the document says a number of measures might have to be introduced. These would include:

* Travel restrictions

* Major sports events, rock concerts, public meetings and even opera performances being cancelled to stop the virus spreading among the audience

* Boarding schools, prisons and care homes being required to set up isolation rooms

* Businesses needing to plan now for up to 30 per cent of their workforce being off sick.

Cabinet Office officials last week called in industry and business leaders to tell them of the guidelines and ask them to ensure that the private sector starts planning for a possible epidemic. The contingency study says that firms must make plans now to "limit illness and death arising from infection" and to keep businesses running with several weeks of high levels of staff absenteeism. The plans are designed not only to prepare for mass absenteeism but to keep Britain running if transport, hospitals and other essential services are hit by the illness.

"We cannot confidently predict what the impact of the next pandemic will be," the Cabinet Office document says. "Much will depend on the characteristics of the virus, such as its clinical attack rate, the severity of the illness it causes and the resulting case fatality rate. These parameters will not be known until the pandemic virus emerges."

Companies should identify now which part of their business they could close if hit by major staff shortages. It says they should consider "which services could be curtailed or closed down during all, or the most intense period, of the pandemic".

Businesses are warned that they must take steps voluntarily to help the Government reduce the impact of a flu pandemic. If the virus hits on the scale that is being prepared for, they would be expected to cope without direct government help or the intervention of the armed forces.

The Government has ordered sufficient antiviral drugs to treat the 25 per cent of the population who are expected to become ill. These drugs will be the "only medical countermeasure" in the absence of a vaccine, the document says. But it warns the drugs being stockpiled "should not be regarded as a silver bullet solution" by employers.

Under the Civil Contingencies Act, introduced in 2004 by Tony Blair, the Government has the right to adopt powers at its disposal to bring in the Army to take control of essential industries, including fuel depots.

"Planning should proceed on the basis that emergency powers will not be used," the document says, "but if the virus turned out to be more virulent than... planning assumptions, so that the balance of advantage changed, there might well be a case for requiring, rather than advising, such measures to be implemented."

Death: Hundreds of thousands could die if virus spreads

WHAT IT SAYS:

For planning purposes, the base scenario is for a cumulative clinical attack rate of 25 per cent of the population over one or more waves, each of around 15 weeks duration. The second wave may be the more severe. This would give rise to an estimated 53,700 excess deaths in the UK across the whole period of the pandemic. This compares with 12,000 excess deaths per year from seasonal flu. For planning purposes, the reasonable worst-case scenario is for a cumulative clinical attack rate of 50 per cent of the population, spread over one or more waves with a case fatality rate of 2.5 per cent. This combination would give rise to an estimated 709,300 excess deaths in the UK.

WHAT IT MEANS:

The Government is preparing for the worst-case scenario with avian flu hitting up to 50 per cent of the population. Around 12,000 people die each year from flu, but the Government is preparing for a pandemic that hits the population in waves killing up to 700,000 people. The Government admits that it does not know how virulent the virus would be, but its experts are anticipating that in one wave of the flu alone, around 350,000 people could die.

Infection: 'Virus may spread within two weeks of hitting UK'

WHAT IT SAYS:

Transmission of the pandemic virus from person to person will be through close contact. Evidence suggests that the most significant transmission routes will be through large droplets (eg from coughing and sneezing) and through direct and indirect contact with infected people. Airborne or fine droplet transmission may also occur. This means that the virus is expected to spread quickly through the population after it arrives in the UK - it may take only two to three weeks.

WHAT IT MEANS:

The Government is preparing for bird flu, mutated so that it becomes highly infectious to humans, to sweep through communities by way of the lightest sniffles and coughs. Humans would have no immunity to the virus. Once it has reached the UK, outbreaks are inevitable across the whole country. Businesses should take steps to stop staff returning to work early to minimise risk of infection, and individuals will be asked to take responsibility to protect themselves from the virus and to try to lessen the spread. They should take basic precautions such as washing their hands and covering their mouths when coughing.

Quarantine: Concerts and football games could be cancelled

WHAT IT SAYS:

A third possible element of the response is the use of measures which would reduce social mixing and thereby aim to reduce exposure to the virus. These could include postponing large-scale public gatherings and events, particularly those with participants travelling from overseas. If organisers went ahead with events, they would need to consider droplet spread in seated venues and the most appropriate management of areas of close human-to-human contact on entering or leaving the venue. Cases in closed communities such as care homes, convents, boarding schools and prisons would require careful management, with quarantine measures put in place to stop the rapid spread of infection.

WHAT IT MEANS:

Rock concerts, football matches, even classical music festivals would be cancelled to prevent mass infection. Guest performers from countries hit by the virus would be told not to come to the UK as a precaution. Public events that are not cancelled would have to be planned with the utmost care, with steps taken to prevent crowding. Organisers would have to protect staff as well as ticket holders.

Ports and airports: Emergency powers would be enforced if necessary

WHAT IT SAYS:

Exit screening at ports would be introduced should the UK be one of the first countries affected by the pandemic virus. It is unlikely that ministers would make implementation of such measures compulsory under available powers or under additional powers that could be secured under the Civil Contingencies Act, not least because of the difficulties of enforcement. But if the virus turned out to be more virulent than current planning assumptions, there might well be a case for requiring, rather than advising, such measures to be implemented.

WHAT IT MEANS:

Ministers would be prepared to introduce emergency powers, which would allow them to effectively take control of the country. They want businesses and emergency planning authorities to comply with government orders voluntarily. They should also plan on the assumption that the Army will not be there to help. But the Government is warning that if adequate precautions are not taken to control the disease, "civil contingencies" powers exist that would allow it to take control of fuel supplies and transport, and to run the country.

The Economy: Up to 30% of staff may be off ill in some companies

WHAT IT SAYS:

As a rough guide, organisations employing large numbers of people with flexibility of staff redeployment should ensure that their plans are capable of handling absence rates of up to 15 per cent over the two- to three-week peak of a pandemic. Small businesses or larger organisations with small, critical teams should plan for a level of absence rising to 30 per cent at peak, perhaps higher for very small businesses with only a handful of employees. Employers should note that absentee rates could be higher than the estimates given here if the nature of the virus means that people take longer to recover from infection, or if some age groups of the population are affected more severely than others.

WHAT IT MEANS:

To prevent the economy from grinding to a halt, businesses should put plans in place now to ensure that they can operate if almost a third of their staff is struck with flu. They should assume that staff will be absent for at least eight working days. Bosses should also be prepared for extra absences due to deaths in the family or the need to look after sick family members. Companies should establish contingency plans, particularly if their workforce is small, or made up of older people who may be hit hardest by the disease. They should identify which parts of the businesses they could survive without during a pandemic virus.

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