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Swine flu: NHS moving gradually towards mitigation, HPA expert says

By Steve Nowottny

The NHS is gradually moving towards a mitigation strategy as it struggles to deal with swine flu ‘bursting through the community', a public health expert at the centre of the Government's response has told Pulse.

Professor Anthony Kessel, director of public health strategy at the Health Protection Agency and a freelance GP, warned local policies on swabbing and antiviral use would inevitably have to be adapted as the number of cases in some ‘hotspots' spirals.

‘In terms of national policy we are still in a containment mode if you like,' he said. ‘I think containment is probably becoming a less appropriate word for it, it's more like outbreak management on a national scale.'

‘When it's bursting through to the community, so it's not contained, like is happening in Birmingham, wide-scale antiviral prophylaxis is far less appropriate.'

But speaking just four days before GPs in London were told to use clinical assessment to determine who should be treated, Professor Kessel said he believed moving to a clinical diagnosis of swine flu would be a ‘real problem' because ‘it seems to have a predictive value which is really very low'.

‘When you heighten people's attention, people start going to their GP for colds and sore throats that are not even influenza, let alone swine flu,' he said.

Professor Kessel said early indications were the clinical attack rate of swine flu was ‘similar to or slightly above' seasonal flu rates, between 5% and 15%, and fatality rates ‘pretty low'. But he said it was impossible to predict with any confidence the course of the outbreak.

‘People are saying we're in the first wave. Well, the reality is, we'll only know that a year and a half down the line.'

And he defended the Health Protection Agency against mounting criticism from GPs over its handling of the swine flu outbreak, citing complaints about supplies of swab kits and face masks.

He said: ‘The HPA has been so high profile since this has started there's been a tendency to sometimes think that all these things are our responsibility – they're not.'

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