Of course, we will not know the exact nature and shape of a pandemic until the virus emerges, but we can make assumptions based on the best available evidence to assist our planning. Since these are estimates, planning must be flexible enough to allow adjustment once the characteristics of the virus are known. This must include the capacity to scale up or indeed scale down.
Scientific and modelling analysis will continue as the virus emerges and the pandemic progresses and this may help us to adjust our response as more information becomes available.
Range of possible excess deaths based on various permutations of case fatality and clinical attack rates, based on Scotland and UK populations
Area of Policy Response | Phase 4 Small cluster of cases with limited person to person transmission | Phase 5 Large cluster(s) of cases with person to person transmission. | Phase 6 Increased and sustained transmission in general population (pandemic confirmed) |
UK alert level 1 cases outside UK | UK alert levels 2-4 cases in UK |
Transport/ Travel |
International travel advice | In formulating travel advice, the Government will consider WHO advice. Consular staff will give advice to British Nationals as the situation develops and risks increase, to ensure their awareness that the travel advice may change soon, and should they wish to return to the UK, they should act quickly. |
Advice against non-essential travel to affected areas | Advice against non-essential travel to affected areas | Advice against non-essential travel to areas where pandemic confirmed. In certain circumstances, the advice may be against all travel to an affected country or region - if law and order has broken down, and/or the health care is unable to treat British Nationals, and/or the British Embassy/consulate is closed; such advice would be subject to agreement between FCO, DfT, DH and CO and ministerial clearance. |
International travel restrictions | Based on the evidence currently available, the Government would not recommend or impose any other international travel restrictions |
Border closures | Based on expectation of limited public health benefit and considerable downsides from closure as well as implementation and enforcement difficulties, planning presumption is against closure of UK borders. Other countries may close their borders. |
Airport closures | No imposed closures in the UK, but airports may find they have operational difficulties in Phase 6 if staff are absent and/or if airports overseas have operational difficulties or close. |
Health screening | Based on available evidence, no entry or exit screening will be imposed in the UK. If recommended by WHO, or other countries impose requirements (such as a country requiring all incoming flights to undergo exit screening), the Government would consider screening on a case by case basis, bearing in mind the lack of evidence to support screening. |
Financial assistance to airlines / travel industry | No plans for Government assistance. Subject to extent of impact, the Government may consider at the time and/or during the recovery phase. |
Domestic travel restrictions | Business as usual as far as possible | Subject to nature and spread of virus, the Government may advise against non-essential travel but not impose restrictions. |
Hygiene measures on public transport | Public advice from the Scottish Executive Health Department and HPA will encourage general good hygiene practice in reducing spread of infectious diseases e.g. regular hand washing | Advice to keep using public transport whilst adopting basic hygiene measures and staggering journeys where possible. May also want to consider limiting non-essential travel. |
International | |
Repatriation of dead bodies | Normal arrangements will apply at airports to receive any dead British nationals who may be part of the early clusters. Family/insurance to meet costs. | Ports of entry may need to supplement reception arrangements. Family/insurance to meet costs. |
Repatriation issues (live/well) | Subject to extent of disruption to air travel, British nationals may be stranded overseas at any Phase (although more likely at 5 and 6). Given the potential scale & numbers of countries involved, the Government is unlikely to arrange repatriation. |
Advice from embassies to British nationals overseas | Plan for Phase 6, including whether to stay or leave and local access to health care. British Nationals may wish to return to UK in Phases 4/5. Flights and/or consular support may be reduced in Phase 6. | Plan for arrival of the virus in host country, or, if already arrived, review local access to healthcare. Flights and/or consular support may be reduced. |
Medical assistance to British Nationals overseas | British nationals will be advised to plan for a potential pandemic including medical arrangements if not entitled to treatment from the host country |
Government liaison with other countries | Foreign and Commonwealth Office ( FCO) will lead on liaising with Governments in other countries to ensure full understanding of impacts and response measures during each phase. |
Essential services |
Health care | Normal service levels | NHS plans to care for large numbers of cases and will provide essential care |
Community Care | Normal service levels | Disruption expected from staff absence and ill carers, particularly at pandemic peak. Prioritisation of services required. Local co-ordination will be required to ensure appropriate step down care. |
Domestic travel/ public transport | Normal service levels | Business as usual as far as possible. Some disruption expected from staff absence particularly at the peak of the pandemic. Relaxation of working time regulations may be considered if required to maintain services. |
Essential repairs or maintenance of power lines, telecoms, gas pipelines and energy supply | Normal service levels | Essential repairs will continue. Routine repairs may be curtailed by staff shortfalls - particularly at peak of the pandemic. |
Capacity of telecoms/ level of service | Normal service levels | Near normal service levels expected. Staffing shortfalls may result in a gradual increase in time taken to respond to customer calls and routine repairs. 1 |
Availability of fuel | Normal service levels | Fuel supplies expected to be maintained. May be occasional local shortages if peak absences coincide with technical or weather-related supply difficulties. |
Maintenance in the energy, telecoms and fuel sectors | Maintenance programs as normal | Routine programmes may be disrupted if peak absences coincide with technical or weather-related supply difficulties. |
Provision of water and sewerage services | Normal service levels | Near normal levels. Essential repairs to maintain water and sewerage pipework, but non-essential work may be curtailed. |
Food / supplies | Normal service levels | Near-normal service levels, but may be reduced choice and localised short-term disruption to availability due to staff absences. |
Finance - cash circulation, banking and payment systems | Normal service levels | Near-normal service levels, but may be some disruption due to staff absence at peak. |
Post Office | Normal service levels | May be some disruption due to staff absence at peak of the pandemic, but daily deliveries and collections will be sustained as far as possible |
Provision of local services e.g. refuse collection | Normal service levels | Subject to staff absences particularly at peak of the pandemic, there may be some short-lived disruption to essential services such as refuse collection. |
Education/social mixing | |
Schools, nurseries and group childcare settings | Business as usual | Subject to impact of the virus, the Executive may recommend that Strategic Co-ordinating Groups (and Local Authorities) close schools and child-care settings to children, when the first clinical cases are confirmed locally and remain closed until pandemic is over. 2 |
Further and Higher Education | Business as usual | No plans to advise further education establishments to close. Decision for each institution based on a risk assessment and its situation. |
Advice on social gatherings, such as attending UK sporting, arts events and conferences | Business as usual | Business as usual, as far as possible, subject to sensible basic hygiene precautions including robust advice to their customers that they should stay at home if they are ill or have flu-like symptoms. If schools and child-care facilities are shut to reduce spread of the virus, children should not mix with other children and adults for the duration of closures. In early stages of Phase 6, the Government may advise against international events held in the UK if delegates/ teams/ performers expected from affected countries |
Advice on use of public places | Public advice from the Scottish Executive and HPS will encourage good hygiene practices in reducing the spread of the disease eg regular hand washing | Business as usual as far as possible. The public will need to apply sensible hygiene precautions. |
Broadcasting | |
Public service broadcasts | Business as usual | Business as usual, as far as practicable. May be some re-adjustment of services. |
Benefits | | |
Sickness absence policy, including statutory sick pay | Business as usual | Guidance regarding Statutory Sick Pay ( SSP) will be issued by HMRC at time of pandemic. Most employers will be paying Occupational Sick Pay ( OSP) that must be at least as generous as SSP. Rules for controlling payments are for employers to determine. |
Benefits payments | Business as usual | Business as usual, as far as practicable. |
Pharmaceutical and other interventions | |
Antiviral Medicines | | Antivirals given preferably within 12 hours (but up to 48hrs) is the main medical countermeasure and will be used mainly for treatment. National stockpile allows for treatment of some 25% of population. Initially all patients symptomatic for less than 48 hrs will be given antivirals unless contraindicated. Consumption will be monitored and prioritisation introduced only if that becomes necessary. |
Access to antivirals | Normal supply may remain available for seasonal influenza cases at Phase 4 and 5. Limited amounts of the national stockpile are predistributed to Health Boards currently (5% to mainland boards and 10% to the islands). Main stock would be distributed to NHS Boards at Phases 5 or 6 but not made available until UK alert level 2. | Antiviral may be used initially to treat cases and for containment. When infection is widespread for treatment only following telephone based assessment/ authorisation and collection from distribution points by friends/ relatives |
Face masks | Advice provided to public and business regarding Government policy. Specific infection control guidance provided for a number of sectors. | Protection advised for health workers and others in close/regular contact with infectious patients or considered at occupational risk |
Antibiotics | SEHD will seek to enhance stocks | For secondary infections/ complications as per guidelines |
Pre-pandemic vaccines | 270,000 doses of H5N1 vaccine has been ordered for healthcare workers. Final decisions will be made on the timing of inoculations. | May offer limited protection if used as a pre-pandemic vaccine prior to cases in the UK, depending on match with pandemic virus but stocks are limited |
Pandemic -specific vaccine | A specific vaccine can only be produced once the pandemic virus has been isolated and the vaccine developed and manufactured (4-6 months). | The UK will secure sufficient vaccine for the entire population as soon as that is available. Likely to be at least 4-6 months i.e. well after the first wave strikes the UK. Delivery schedule would make prioritisation inevitable. |
Other consumables and essential medicines | SEHD will seek to enhance stocks and supply of those essential medicines for which there is likely to be a greater demand. | Implement changes to medicines legislation or regulations where necessary, to ensure ease of access. |
Communications | |
Isolation of cases/ stay at home. | Possible implications for returning travellers with symptoms and their contacts in Phases 4, 5 and UK alert level 1 of Phase 6 i.e. isolation of confirmed cases and voluntary quarantine at home of suspect cases and/or their close contacts . | Those who believe they are ill will be asked to stay at home in voluntary isolation. Voluntary home isolation may be recommended for close contacts at early stages to contain/slow the spread. |
Health messages to public | Significant increase in public information at Phase 4 - proportionate to levels of risk. Different communication products such as leaflets, door drops used during Phases 4 & 5 emphasising basic hygiene measures and re-assuring the public. Regional/local communications to be consistent with national messages | Main messages to include: stay at home if ill, basic hygiene, how to obtain help and antivirals. Other areas may include advice on use of face masks and other Health and Safety advice on issues such as air-conditioning in the workplace. Messages to be consistent. |
Information to public. | WHO updates on location(s) and areas affected and advice will be reflected in overseas travel advice. A national door drop and advertising campaign will take place in Phase 5 alerting the public to the heightened risk, emphasising the need for personal preparation and socially responsible behaviour. A public information film will demonstrate how to slow the spread of the virus and a dedicated action line will be available. Information materials will also be available through primary care, pharmacies and on the Scottish Executive website. | WHO will provide Department of Health ( DH) with regular updates on countries affected. DH will maintain liaison and cascade. | The Scottish Executive will report to DH the numbers ill. DH will provide these on a regional basis to CCC. This may be made available to the public via DH, Scottish Executive and/or Health Protection Agencies websites & media briefings. |
A second wave of advertising will run in Phase 6 providing basic facts and advice on the measures people can take to help slow the spread. The dedicated information line will continue to operate and an updated public information film made |
Excess deaths | |
Managing excess deaths | Planning will continue in preparation for the arrival of the pandemic in Scotland and consequent additional deaths expected to occur (scale will be dependent upon nature of the virus). | Planning is underway to minimise delays to the death certification and registration processes. Further measures are being considered for the reasonable worse case scenario (63,700 deaths) |
Response and co-ordination | |
Response, planning and coordination of response across central and local government | The Ministerial Group on Civil Contingencies ( MGCC) will meet as required to agree early policy decisions in Scotland and to urge completion of planning. Strategic Coordinating Groups will meet as required to promulgate policy decisions/advice and maintain overview of response. | The Justice Department will assume responsibility for coordination across the Scottish Executive. The MGCC will meet regularly to maintain an overview of the impacts on Scotland, agree policy and allocate resources. Strategic Coordinating Groups will meet regularly to maintain overview of regional impacts, identify resource issues and promulgate policy and information to the public |
Civil Contingencies Act 2004 | Emergency regulations may be used if it is necessary and proportionate to do so and if the legal safeguards in the Act are met. The scope and content of emergency regulations will be dependent on circumstances at the time. |
Liaison with business community and Financial Authorities | Government would liaise and share information with business community and financial authorities through established stakeholder groups. At local level, business community and financial authorities would work with the Strategic Co-ordinating Groups ( SGCs) |
Research and development into animal and human influenza viruses has made - and continues to make - an important contribution to shaping and informing pandemic preparedness planning and remains particularly vital to improving understanding of the health and wider impacts of any new virus, which by definition are difficult to predict.
Epidemiological models help us to understand how the disease might spread and the likely effectiveness of countermeasures, whilst operational models look at how we might best implement those countermeasures. Where possible, assumptions for models derive from data from previous pandemics but where that is not available information about known influenza viruses provides a source for estimates. UK modellers are amongst the world leaders in this work. Health Protection Scotland in liaison with the Statistical team in Applied Mathematics ( STAMS) Strathclyde University work closely with colleagues across the UK in the development of such models for use by the NHS in Scotland.
Continuing to improve the evidence base - and to apply the results of research and modelling to the development of plans - is of critical importance to the UK's strategic and operational approach to an influenza pandemic. As knowledge and information are constantly advancing regular reviews and revisions of plans at all levels are essential. To ensure that the best scientific advice is fed into policy, the Department of Health is advised by a Pandemic Influenza Scientific Advisory Group (to which SEHD & HPS contribute), whose meeting minutes are published on the DH website together with a regularly updated summary of the current position on mathematical modelling.