Ministers moved yesterday to strengthen Britain's defences against a threatened flu pandemic by boosting the country's stockpile of anti-viral drugs to 50 million courses, as the World Health Organisation raised the swine flu alert to level five – one short of a full pandemic.
An advertising campaign will be launched today warning of the threat from swine flu and the importance of basic hygiene to reduce the risks.
All frontline NHS staff are to be issued with packs of anti-viral drugs for their personal use, should they have contact with an infected person, and stocks of antibiotics are being increased.
Earlier three new cases of swine flu were confirmed in Britain: in a 12-year-old girl from Paignton, Devon; a 41-year-old woman from Redditch; and a 22-year-old man from north London.
Amy Whitehouse, the 12-year-old, fell ill after returning from Mexico on the same flight as the Scottish newly-weds Iain and Dawn Askham, from Polmont, near Falkirk, confirmed as the first British cases on Monday.
The girl's school, Paignton Community College, closed yesterday for a seven- day period. All 230 children in her year group were given anti-viral drugs, along with her family and other contacts.
The new victims, who are mildly ill and recovering, had all returned from Mexico. They bring the number of confirmed cases in Britain to five.
Another 78 suspected cases are under investigation; people who have had contact with those patients are being monitored.
Alan Johnson, the Health Secretary, informed a press conference at the Department of Health yesterday that Britain had built a stockpile of 33 million courses of anti-viral drugs, enough for half the population, which was "far higher than any other country."
It was now to be increased to 50 million courses which would come through "in the coming weeks". Further cases of swine flu were "inevitable", he said.
The WHO said last night that it now believes a global outbreak of the disease is "imminent". The updated level five alert signifies sustained human-to-human spread in at least two countries.
Margaret Chan, the WHO chief, told a news conference in Geneva last night that it is "all of humanity that is under threat in a pandemic". She added: "While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalise the organisation, communication and implementation of the planned mitigation measures is short."
Meanwhile the European Commission's most senior health official Robert Madelin warned last night that "thousands of lives" could be at risk and that existing vaccines may not provide immunity, but added that a new vaccine to deal with the new specific threat could be ready within seven months.
The announcement came after authorities in the US confirmed the first death from swine flu outside Mexico. A 23-month-old Mexican girl on a family trip to Texas fell ill and was taken to hospital in Houston where she died on Monday night. There are 16 further confirmed cases of swine flu in Texas.
Barack Obama offered his prayers to the family and said the US government was doing "whatever is necessary" to contain the threat. He warned parents to prepare for school closures and the public to take care with hygiene. He has requested $1.5bn (£1bn) in emergency funding to combat the threat.
In London, Professor Sir Liam Donaldson, the Government's Chief Medical Officer, said the move to phase five was a "signal to countries' governments to ramp up their pandemic preparations".
Tests on eight people who had come into contact with the Askhams, the honeymoon couple from Falkirk, were found to be negative, suggesting that, to date, spread of the infection had been prevented in Scotland. Results on one further contact are still to come through.
Professor Donaldson said: "So far all the [British] cases have been imported. We are not seeing ongoing transmission. That is the key feature we are looking for that would indicate an escalating situation. We have not seen that yet."
However, Spanish authorities later confirmed the first case of swine flu in Europe in a person who had not been to Mexico. Other countries outside Mexico with confirmed cases of swine flu include the US, Canada, New Zealand, Germany, Austria, Spain and Israel.
Mr Johnson said all passengers on flights returning to the UK from Mexico would be given advice on swine flu and the Health Protection Agency is to monitor arrivals at airports. Passenger records, normally destroyed after 24 hours, are to be kept for seven days to allow contacts to be traced.
He said that basic hygiene was the key to protection for individuals. A mass public health campaign with press, television and radio adverts will begin today and every household will receive an information leaflet on swine flu, to be posted from next Tuesday.
"The three rules for seasonal flu are the same for swine flu: if you cough or sneeze, use a tissue to cover your mouth and nose, throw it away carefully after use, wash your hands. The message is: catch it, bin it, kill it," Mr Johnson said.
He rejected suggestions that face masks be provided for public use, stating that there was "no convincing evidence that they were effective".
Surgical masks incorporating a filter, which are fitted to the wearer's face, are provided to frontline health staff and more are on order. Health department officials denied that 32 million were expected, quoted by a manufacturer, but declined to name the true figure.
Professor Donaldson agreed thatface masks for the public were of very little value, saying that scientific evidence had showed this to be the case: "They get moist and that enhances the risk of the virus transmitting. The virus is so small it can go through the pores in the mask and it gives a false sense of security."
In the event of a pandemic, anti-viral drugs would be distributed from local pharmacies, to avoid large numbers of ill patients congregating at surgeries.
Diagnosis would be made over the phone or internet, using an automated system, and arrangements made for relatives or neighbours to collect drugs.
Last night a Department of Health spokeswoman said it was "business as usual". "Still just five cases in the UK and the evidence that early anti-virals, such as Tamiflu, are helping people to recover. It is important to emphasise we are still not in the pandemic stage."
Professor Donaldson said there was "always a risk" of the virus becoming resistant to the drugs. But they had been extensively used in Japan against seasonal flu for several years and "not much resistance" had emerged there.
The shadow Health secretary Andrew Lansley welcomed the Government's decision to increase the anti-viral stockpile and procure face masks for NHS staff.
"We will need to explore further possible counter-measures including whether the Government will now provide anti-virals preventatively to all those who have come into contact with people who are infected; how the Government proposes to fill the gap caused by the delay in setting up the National Flu Line, which won't be ready until the autumn; and whether it will be the Government's intention to close schools for three weeks at a time if a case of pandemic flu is identified," he said.
Expert opinion: What will happen next?
Dr Alan Hay, director of the WHO World Influenza Centre, Mill Hill, north London
People in the UK die from influenza every year and if swine flu was epidemic in the UK, then it is likely people would die. The number of cases over the next few days and weeks will be crucial. At this stage, the confirmed cases of swine-like flu in the UK are very few and so far people are only experiencing mild symptoms. It is important to remain calm.
Professor Peter Dunnill, biochemical engineer at University College London
Historically, some pandemic viruses have been mild in the first phase, but later, as selection of the fittest works on the virus, they can be more virulent... If the swine flu is not too severe [it will] result in deaths potentially in some healthy people but the majority will be fine. If it mutates to be more severe or if a more virulent virus pandemic occurs, people may wish for more government financial commitment.
Jeff Evans, senior lecturer in disaster healthcare, University of Glamorgan
The UK has been preparing for an outbreak of pandemic flu for many years... However, the biggest resource for dealing with a pandemic flu outbreak is the public. Self-reliance is going to have to play a big part.
Professor Paul Hunter, expert on health policy at the University of East Anglia
Although it is always very difficult to predict the course of an outbreak this early on, the fact that cases are already being reported from around the world is of concern. This suggests to me that the virus certainly does have epidemic potential. Without a widely available effective and safe vaccine, it would be difficult to do much to control the spread, though those countries like the UK with large stockpiles of anti-virals will be able to reduce the severity of any impact.
Professor Angela McLean, director of the Institute for Emerging Infections, University of Oxford
The important question now is what will happen with the newly seeded epidemics outside Mexico? Will they be self-limiting, can they be contained by local interventions or are they causing widespread community outbreaks? Because influenza makes people ill very soon after infection those situations should become much clearer within a week or two. If there are large outbreaks it will be important to know which age-groups are worst affected. Once that information is available it will be possible to make a considered response to this situation.