With permission, Mr. Deputy Speaker, I would like to make a further statement on swine flu.
We continue to watch with concern the situation in Mexico and the USA, and to be guided by the World Health Organisation about further changes to the alert level. On Monday evening, the World Health Organisation raised the alert level to 4. That indicates that there are clusters of outbreaks and that the disease is being passed from person to person. In a press conference late this afternoon, the WHO indicated that although the alert level is still at 4, we may be approaching a phase 5 alert. That would mean that there are large clusters of outbreaks but that person-to-person transmission is still localised, which would suggest that the virus is becoming increasingly better adapted to humans. The WHO message is clear: countries across the world must do everything in their power to prepare for the possibility of a full-blown phase 6 pandemic.
I would like to update the House on how this very fast-moving situation is affecting the UK. It was confirmed on Monday that there were two cases of swine flu in Scotland. Both patients are recovering well. As the Prime Minister told the House today, there are now three additional confirmed cases in the UK. A 41-year-old woman from Redditch and a 22-year-old man in north London have both contracted the virus. The 41-year-old is in isolation at home and has already responded well to treatment. Five of her close contacts have also been treated with antiviral drugs. The 22-year-old man in London has been admitted to hospital.
The other confirmed case is a 12-year-old girl in Torbay, in Devon. The Health Protection Agency has identified that she has been in close contact with 50 people. As a precaution, antivirals have been given to a total of 230 people in the school—the entire school year. On the advice of the Health Protection Agency, the head teacher is closing the school today. It will be closed for approximately seven days, including the weekend.
All cases that have been confirmed so far are among people who have recently been in Mexico, which is the main affected area. So far, all those who have contracted the disease have experienced relatively mild symptoms and are recovering well—that is all those outside Mexico.
In light of recent events and to strengthen further our contingency plans, I have taken the following steps. I confirmed in my statement on Monday that we have built up a significant stockpile of the antiviral drugs, Tamiflu and Relenza, to prepare for this situation. Both those drugs have proved effective in relieving the symptoms of those who have been infected, but we will now increase this stockpile to cover 80 per cent. of the population. That does not mean that we expect anywhere near that number of people to be affected. It does mean that we will have enough antiviral drugs to treat 50 million people, and make sure that all front-line NHS staff have their own supplies of antivirals as a preparatory measure.
In addition to increasing availability of antivirals, we are increasing our stockpiles of antibiotics. Although antibiotics have no impact on the flu virus, they will be essential for dealing with any complications such as pneumonia, which might arise from infection.
On face masks, as the chief medical officer reiterated today, there is no convincing scientific evidence that the widespread issue of such masks to healthy members of the public can stop the disease spreading. Moreover, they can give false reassurance and encourage people to ignore basic and straightforward hand hygiene measures, which have proved effective. However, specialist and other types of face mask are useful for front-line NHS staff who care for infected patients, if the face masks are the appropriate type, worn correctly, changed frequently, removed properly, disposed of safely and used in combination with good hygiene measures.
Although we have a supply of face masks for NHS staff, we need more. In the past 24 hours, we have completed contracts for more than 60 million masks, which will start to become available this week. They will be both surgical and respiratory masks, giving staff a broad range of protection when they come into contact with infected patients.
Providing information to the public is one of our strongest lines of defence. A mass public health campaign will begin tomorrow, with print, TV and radio adverts. They will warn the public about swine flu and remind them to cover their noses and mouths with tissues when they cough and sneeze and, then, to throw the tissue away and wash their hands—the same good, basic hand hygiene advice that applies to all types of colds and to seasonal flu. In addition, a leaflet will be dropped through people's doors from next Tuesday, providing information on the steps that they can take to protect themselves from infection, and telling them what to do should they contract the virus. From tomorrow, members of the public who want further information will be able to ring a single number, 0800 1 513 513, for regular recorded updates on the situation.
The threat that we face is serious, but we have never been as prepared for a pandemic as we are now. The plans that we have in place are robust and have been thoroughly tested. Scientists know more about flu now than they have ever done. When our country last faced the threat of a flu pandemic, in 1968, there was no national plan and most measures that are available today did not exist. If a pandemic emerges, no one can turn back the tide, but, with international co-operation, scientific endeavour, effective plans and dedicated front-line staff, we can reduce its impact and ensure that we avoid the level of sickness that was experienced in the three pandemics of the last century. I shall ensure that Parliament is properly updated as the situation develops.
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I am sure that the House is grateful to the Secretary of State for his update on the impact of the swine flu outbreak, and I thank him for the further steps that have been taken following the statement on Monday. He knows, and I told the House, that for a long time we have pressed for the acquisition of a strategic stockpile of face masks, and, although it had not been done beforehand, it will be done now, and that is welcome. Equally, we pressed for an extension to the antiviral stockpile, and the Secretary of State has now said that it is available. Two questions arise from that, however. Does he intend to acquire the additional stockpile to pursue a strategy of treatment for all cases that may emerge, and does he intend to provide, prophylactically, as a preventive measure, antiviral drugs to the close household contacts of those who are infected?
There are two questions about the distribution of Tamiflu to NHS workers, too. First, will it be extended not only to NHS front-line workers, but to front-line workers in other care home contexts? Secondly, is the distribution intended for their use if they become symptomatic, or if they are exposed to the virus?
The Secretary of State talked about the acquisition of a further stockpile of antivirals, but on what timetable does he expect that additional Tamiflu to be received? He has reached the point at which he is giving us, quite properly, the information about what is happening, but I do not sense that we have been told the Government's strategy. Will the Secretary of State take this opportunity to clarify the current strategy? We lack certain evidence about the nature of this virus and its spread, and the impact on humans, but good evidence is emerging that it may be a relatively mild strain of flu, although it is spreading fast. We therefore have the capacity, as he illustrated, to take quite an aggressive strategy against it in the United Kingdom and commit ourselves to ensuring that antiviral treatment will be available for all cases, pursuing household prophylaxis—preventive measures with all close contacts—and securing 100 per cent. vaccination as soon as a vaccine becomes available. Can he confirm that were there to be a second wave, antibiotic stockpiles would already be available for those with complications arising from flu infection? In that context, is he confident that we will have an antibiotics stockpile for 14 per cent. of the population, as indicated by Department of Health modelling?
I say all that about a strategy because, as the Secretary of State will recall, in September last year the scientific pandemic influenza advisory committee—an easy name to remember—did a modelling summary of what we know, which said:
"Having taken 2 to 4 weeks to build up in the country of origin, pandemic flu could take as little as 2 to 4 weeks to spread...to the United Kingdom"— indeed it can—and that we should
It went on to say:
"Contact tracing"— the Secretary of State did not talk about that, but it is important to emphasise—
"of the first few hundreds of cases in the UK will be essential for the accurate determination of disease parameters."
We must ensure that we contact-trace all those who are exposed to the virus in the short run. The committee set out how the strategy that I described, using all those interventions, might be
"sufficient to limit the number of cases, hospitalisations and deaths to the levels of the targeted strategy...even if one component intervention is ineffective".
Where school closures are concerned, the modelling said:
"Combined with a household prophylaxis policy (as opposed to simply treating cases), closing schools can have an important effect on the profile of the epidemic and the overall number of clinical cases (in adults as well as children)."
The Secretary of State said that Paignton community college would be closed for a week, but the modelling would assume that it would be closed for three weeks. If a case of flu is identified at the school, do the Government intend that it will be closed for three weeks?
Let me ask about the national flu line; I know that the Secretary of State is disappointed that that is not available. The Prime Minister said during Prime Minister's questions that interim measures would be put in place. Clearly, the telephone number that the Secretary of State mentioned is not such a measure. GPs across the country need to know how they can access good information and advice. Updates provided to front-line clinicians—for example, an RSS feed on a six-hourly basis, with a clinical focus—would be an important facility for them to have available. They also need to know how they can access Tamiflu if they have patients who require it.
Does the Secretary of State have any further results from inquiries into why cases appear to have a high mortality rate in Mexico but not in other countries? What does the Health Protection Agency at Colindale know so far about the character of this virus and its interaction with humans?
The Secretary of State knows that were the flu to become more severe, we would need substantial numbers of critical care beds and ventilators. Since the United Kingdom has substantially fewer intensive therapy unit beds than other countries, and those are working at full capacity for most of the time, how does he intend that we would cope with a doubling or tripling of the need for intensive care beds?
On pig welfare, will the Secretary of State confirm that there is no evidence to suggest that there is a case for any cull of pigs or other livestock, and will the Government, through their veterinary contacts, try to encourage other countries in the direction of reasonable and proportionate measures?
Looking beyond our own shores, what discussion have the Government of this country had with the World Health Organisation about how the supply of antivirals will be prioritised to countries that have now placed orders? While obviously our first responsibility is to ensure that every possible protection is in place for the people of this country, what further can we do through the WHO to support the least developed countries? If we do not support them, there is a risk, as the Secretary of State will know, that a pandemic will expose the gap between rich and poor in this world—that we will protect our population effectively but find that there are literally millions of deaths in the poorest countries in the world. What are we doing to try to reduce that risk?
The hon. Gentleman asked some very important questions. On antivirals—this also relates to one of his other points—at this stage we have the ability to isolate and contain this flu. As he says, it is mild so far, so we can use the antivirals as a prophylactic at the moment. That is one reason we have ordered extra supplies—so that we do not dilute the provision of antivirals if we do get to the stage of a full-blown pandemic. The use of antivirals is indeed in preparation for treatment but also, on a prophylactic basis, a preventive measure in all the outbreaks that are occurring at the moment, so that we can contain them.
As far as NHS staff are concerned, as the hon. Gentleman knows, the framework we have announced is for NHS staff and staff in adult social care, and he made an important point about that. NHS staff are being issued with Tamiflu as a prophylactic. It is actually more important to them than face-masks, so that is the idea. The problem with people using it as a prophylactic, as the chief medical officer would say if he were at the Dispatch Box, is that they have to keep taking it, and then when they stop taking it, they become immediately prone. However, it will help NHS staff to have that there ready for the next stage.
The hon. Gentleman asked when the supplies will be ready. It will be the end of May at the latest, in accordance with the contract that we have signed. The antibiotic stockpile will cover about 14 per cent. of the population, in accordance with the strategy.
The hon. Gentleman raised the issue of contact tracing, which has worked very well both in Scotland initially and in England. It is a very important part of the strategy, and the Health Protection Agency and others are helping. The HPA's announcement today was that every single flight that comes in from Mexico, wherever it lands, will be met by its officials, and that we will ask the airlines to keep the records that they normally destroy after 24 hours for at least a week. There will be other measures to ensure that we can better use contact tracing quickly.
The hon. Gentleman asked about school closures. As he well knows, the framework mentions trying to keep schools open, because if we close the schools, nurses will have to look after the children and we will get into a bad situation. At the moment, during this phase 4 containment stage—we have to make a distinction between the phases—it makes sense to close Paignton community college. The initial decision by the head teacher and the education authorities was to close it for a week, and obviously they will review that based on advice from the HPA.
The hon. Gentleman also mentioned the national flu line. The concept of the flu line does not exist anywhere else in the world. We signed the contract with BT in December. That line will be set up for a stage when we are in considerable difficulties and people cannot leave their home, or are advised not to, so that they can ring a number and find a nurse at the other end who can ask some simple questions and give them a code, and someone can go on their behalf to collect the antivirals. That system will not be up and running until October. We can discuss all the reasons why afterwards, but in the current situation it will not be available until then. Every single health authority has been told to build into its plans arrangements on the assumption that it will not have the flu line available, and those arrangements look very robust. I am considering ways in which we can improve them, perhaps by getting NHS Direct and its single number to be part of them. We are currently considering all the possibilities for doing that, but if we cannot have a replica of the national flu line, we will have robust systems for distribution of antivirals around the country when we move to that phase.
We know nothing further about Mexico at the moment. As far as I know, there is no further information. The World Health Organisation is very aware of the need to ensure that the matter does not become a case of rich versus poor. Curiously, there have been no cases in Africa. The WHO feeling was that, given the number of people with low immunity, cases would have been reported there, but, at the moment, that has not happened.
Although my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs is not here, I think I can safely say that we would not follow the route that Egypt announced today. As I said on Monday, we see no reason to affect the British pig industry—and no reason for any country, anywhere to start slaughtering stocks.
May I also thank the Secretary of State for early sight of the statement and for keeping me directly informed daily about the development of the potential pandemic?
Clearly, it is commonly accepted that this country is one of the leading countries for preparedness, but now it has come to applying the plans. It is important for people to remain calm, but that requires confidence in the system, and confidence that the procedures are robust, that there is absolute clarity about the advice, and that all parts of the system—from the national to the regional to the local—work in concert.
There was a report in today's Evening Standard and on the BBC, which raises some concern about clarity of advice. First, it appears that there are shortages of Tamiflu in pharmacies in many parts of the country. What is happening to ensure that Tamiflu gets to the pharmacies so that doctors and patients can get hold of it when needed?
There are reports in London of confusion about whether health protection units or GPs should carry out the tests. There is also confusion about whether patients should go to the GP practice. A case has been confirmed directly to me of a patient being told to go to the GP. There are other cases of people being advised to stay at home and that someone will visit them. Will the Secretary of State provide absolute clarity on all those matters to ensure that people understand what to do?
The Secretary of State said that masks are available only for health and care workers, yet he is ordering 60 million. That seems a substantial number for that purpose. Will he clarify precisely the range of people who should use them? Will they be available for informal carers, who look after people at home? If so, will advice be given to that end? If someone is confined at home because of a potential outbreak, what about other people in the home? Can they carry out their normal business and leave the home, or should they be confined, too?
On school closures, it is an anxious time for parents, with many schools preparing for the exam season. Are there contingency plans in place and will advice be given to the education system to ensure that people understand what is supposed to happen?
There are reports today that the French will make a request to the EU tomorrow to suspend all flights to Mexico. What is the Government's response to that?
How much money has been allocated in the Department of Health to tackling the potential pandemic? Will the Secretary of State confirm the assumptions on which the Department is working about its progression?
On the important question of the availability of antivirals, it is important to stress, as we did on Monday—I certainly did in a conversation with Mr. Lansley—and make it clear to the public that the Tamiflu that can be bought at the chemist is not depleting the stocks that we have made available in the event of a pandemic. Those stocks are protected—they are in warehouses and they are secure. Obviously, we must take measures, as the various regulatory agencies have done, to ensure that no system of selling Tamiflu is developing now. Measures have been taken to avoid that and to ensure that we keep stocks of Tamiflu available for the patients who need them, rather than for people who are stocking up personally.
I have read some of the reports about London, and we will ensure that matters are clarified. Certainly, the leaflet that people will receive from Monday and the advertising that goes out tomorrow will make what happens clear. The health protection units will be crucial to ensuring that we get to the people who have symptoms of swine flu. We will ensure that we put all our resources into isolating and dealing with those cases properly.
The advice that we give to patients is to contact their GP on the phone or NHS Direct if they feel that they have symptoms and to take it from there, not to go to their GP's surgery.
The figure of 60 million masks has to be seen in context. Some of them come from different suppliers and have to used and replaced, depending on the supplier and the quality of the mask. Sometimes masks have to be replaced two or three times a day or even hourly. That is the thing about facemasks, and that is why I emphasised how important it is that we have NHS staff who are trained to use them. If people do not replace them regularly or if they do not wear them or dispose of them properly, they could make the problem worse rather than better. The numbers of masks that we need cannot be defined at this stage, but we know that we need lots, because we are not talking about one for each person. Rather, we need replacement masks as well.
We depend for our best analysis of how swine flu is spreading on the WHO's advice. There is no one in greater authority, more respected or in closer touch with the WHO than the chief medical officer, Sir Liam Donaldson. His reputation is standing us in good stead. He has close links with the WHO, and we are ensuring that we receive information very quickly about its assessment of how things are going. It is important that, instead of individual countries deciding to go solo on this issue, international co-operation continues to drive the science.
I am sorry, I did not answer the hon. Gentleman's point about the suspension of flights. We will know more about that when we discuss it tomorrow morning. Up until now, the Foreign and Commonwealth Office advice, on a phase 4 alert, is that people should go to Mexico only if they have pressing business and have no alternative.
Would my right hon. Friend take this opportunity to pass on our congratulations to those working for the chief medical officer and to others in the national health service on the state of their contingency planning and the practical measures that they have already put in place? Will he also point out, particularly to the news media, that, in an imperfect world, if the incidence of flu substantially increases, there will from time to time be errors, mistakes and delays? They are unavoidable in an imperfect world, but they should not be exploited to try to stir up hysteria among the general public, who are usually a lot more sensible than the news media, particularly the BBC's "Today" programme.
My right hon. Friend raises an important point about the chief medical officer, whom I have mentioned, and about NHS staff. One of the reasons we are well prepared is that we have an integrated universal health system. That is of enormous benefit in so many ways, particularly at a time such as this.
In general the news media have been quite responsible on this issue. There has been the odd exception—I think that my right hon. Friend was referring to that—but in general, people understand that we live in an imperfect world. There is enormous pressure on the NHS, and on public services in general, but by and large that has been recognised and there has been responsible reporting of the issue, particularly in the broadcast media.
May I thank the Secretary of State for his statement today?
The thoughts of my constituents are very much with the child who has caught the flu and her family and with her friends and their families. There is a great deal of anxiety in the community as a consequence of recent events. I would like to praise on record Jane English of Paignton community college, Anthony Farnsworth of the primary care trust and Torbay council, all of whom have, in different ways, been roped in during this emergency, which is effectively what it is, and who have all handled the situation extremely well. However, there are some questions that I would like to ask. Paignton community college has two sites: a lower school and an upper school. When people say that the college is closed, do they mean both sites, or do they mean just the lower school site that this pupil was attending? The stockpile of antivirals—
Order. I understand the hon. Gentleman's anxiety, and I called him to speak right away because of the case in his constituency, but he must understand that this is a statement, and that there are other— [ Interruption. ] Don't worry, I will call Mr. Steen as well. Nobody has to get into a panic. The one thing that I do not want is Members putting a series of questions to the Secretary of State, so we will stop at that and let the Secretary of State answer.
I appreciate the role of the hon. Gentleman in his community, and this must be a very difficult time. We will try, as we did this morning, to keep him aware of developments in his constituency. I am afraid that I do not know whether they are closing both sites or just one. I am pretty sure that everyone is acting in the best interests of the children, but I do not have an answer to that question at the moment. I do know that the hon. Gentleman is absolutely right to say that everyone locally has behaved in the most responsible fashion. I believe that the little girl is responding well to treatment, and we very much hope that we will be able to contain this case as successfully as we are containing other cases around the country.
I thank the Secretary of State for his statement, and for the huge amount of work that he is doing in preparation for dealing with this crisis. He mentioned the disparity involving the death rate in Mexico and the cases elsewhere. I realise that it is difficult to get information, but what representatives does he have in Mexico, and what co-operation is he getting to enable him to find out the exact strain of this virus, the location of the pig farm that it is presumed to have come from, and the way in which it mutated there? That information will clearly have an enormous effect on how fast or far it might spread.
I am afraid that I do not have any more information on the mystery of what is happening in Mexico. The Americans are certainly working very hard on this. There was a report today of the death of a baby in America, which is the first death outside Mexico. It was a Mexican baby who had gone across to America to be treated. So we just do not know, yet, but the scientists are working very hard to find the strain of the virus and to produce a vaccine. That is their major preoccupation at the moment, but it will be some time before we know those things. I will keep the House updated, and as soon as we know anything, I will report it to the House.
The Paignton community college happens to be in my constituency, although I do not know exactly where the child in question lives. There is widespread concern in south Devon that it will become a no-go area, that people will be told not to travel there by train, that the hotels will empty and that no one will go near the place. I think that the Secretary of State has an obligation to explain just how serious a threat this is, and just how serious it is for people not to get worried about travelling, and to carry on with their present arrangements. Can he give the House that assurance?
I certainly can. This is a phase 4 alert, but even if we were at phase 6, we would not be advising people to stop travelling around the country. If we were to do that, we would actually make the situation worse because important people would not be able to get to work and we would have a worse situation on our hands. On the situation in Paignton, I have now responded to both Members concerned, because there was some ambiguity about which constituency was affected. I hope that we have made it abundantly clear—we certainly did so at the press conference earlier—that the little girl was on the same plane from Mexico as the two affected people in Scotland. There is a clear link with Mexico. She is taking the antivirals and responding extremely well. We have contact-traced everyone who was involved with her, and there is absolutely no reason for anyone not to travel to Paignton or anywhere near there.
The virus has already jumped between species. Although the pathogenesis might be complicated, it is obvious that we need a mechanism for dealing with animals as well as humans. What mechanism has the Secretary of State put in place for the Secretary of State for Environment, Food and Rural Affairs to ensure that the animal health laboratories at Pirbright and Weybridge are able to carry out full surveillance of the appropriate animals to ensure that the virus does not jump between species in this country?
My hon. Friend raises an important point of which my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs is fully aware. At the moment, we are not at any stage where we have any fear of this being something that is affecting animals in this country. We do not import any pigs or pig products from Mexico. The various agencies are keeping this under review, but our primary concern at the moment is that this is affecting humans. We need to keep the other issue under close oversight, obviously, but as I say, I do not want any message from the House suggesting that we have a problem with the UK pig population.
Many schoolchildren and their parents in Devon and elsewhere will be very concerned about this, not least if there is an extension in terms of quarantining schools that may have these outbreaks. Will the right hon. Gentleman consult the Secretary of State for Children, Schools and Families to ensure that there is provision for those who are barred from attending school when it comes to their exams?
I will talk to my right hon. Friend, but at the moment it is far too early to be thinking about that. I repeat that we are looking to isolate and contain this, which means it makes sense to close the school in these circumstances. I hope that other schools will not be affected, in Paignton or anywhere else, but we need to look at this on the basis of which phase of the situation we are in at the moment, and the advice of the local education authority and teachers. We will also have to deal with the situation with exams, which we dealt with during the floods a couple of years ago, as part of those measures.
Will my right hon. Friend advise the House that the measures announced today will apply throughout the UK? Will he also clarify who will have overall responsibility for dealing with this issue in the UK?
These measures will apply within the UK. This is a United Kingdom strategy. It would be ludicrous for us to have any other strategy but a UK strategy. The devolved Administrations are working extremely well with us. They are at the civil contingencies committee meeting every day. As to who has the lead on this, that is not a question that should arise. We are working together very effectively to deal with this problem.
If there is any doubt, the upper school is, I believe, in the constituency of Mr. Steen and the lower school in the constituency of my hon. Friend Mr. Sanders, and the child concerned— [Interruption.] The child concerned is in the school in my hon. Friend's constituency.
Considering that there are large numbers of elderly people and particularly vulnerable groups in south Devon, and considering the difficulties and fears that they face, will the Secretary of State meet a delegation of south Devon Members of Parliament, perhaps along with Members from other areas that are affected, to discuss these issues, because there are a number of questions that we wish to put?
I will consider whether one of the ministerial team can do that. This is a hectic time and the situation is moving quickly. I suggest that if we can deal with some of those questions in correspondence or phone calls, we will. If hon. Members require a meeting, of course, as with all Members of the House, we will ensure that that is facilitated.
I wonder whether the Secretary of State will help us. Although it is absolutely clear that the problems for humans are the key issue, it is important, in advance, to ensure that all the veterinarians in the European Community have made the decision that they will act in concert. Although we do not import from Mexico, historically we have found that if such action is taken when there is not a problem, so to speak, people at least know what will happen. I have some personal experience of that aspect.
The right hon. Gentleman certainly has more experience than I have on these issues. I will ensure that the points made by him and by my hon. Friend Mr. Drew are drawn to the attention of my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs tomorrow, so that we can consider giving proper information to Parliament and elsewhere about how we are dealing with these specific issues of whether there could be a switch over into the animal population.
Will the Secretary of State confirm that one of the cases to which he referred in his statement has occurred in the borough of Barnet? Will he join me in sending the good wishes of the House for a swift recovery to the individual concerned? Will he give reassurance to my constituents in Chipping Barnet that every possible effort is being made to trace those who have come into contact with the individual concerned? Will he ensure that Barnet's primary care trust and Barnet council are fully briefed on the situation? At the moment, the council is anxious to do everything it can to help, but is finding it difficult to get information about what is happening from the Department of Health.
Yes to all those questions. If problems getting in touch with the Department of Health are being experienced in the hon. Lady's constituency, perhaps she will let me know the nature of those. Today has been difficult, because the cases were reported around the late morning and midday, and the gentleman concerned is now being treated in hospital. We will try to resolve any breakdown in communications.
That is what we are trying to do. Those concerned have had a connection with Mexico or people on flights from Mexico—that is the basic issue. We want to differentiate those people who are just feeling ill and those who have a link to Mexico. At the moment, not a single case has arisen anywhere that does not involve a recent trip to Mexico.
In outlining his plans for barriers and chemoprophylaxis, the Secretary of State has rightly focused on health care staff. Were the situation to go to level 6, however, he would have to consider other infrastructure-critical workers. I wonder what thought he has given to that, and which workers he has identified as potentially being in need of prophylaxis to keep our infrastructure on an even keel.
We have considered that, and it is set out in some detail in our framework for when we move to phase 6, and indeed to phase 5, when some of the preparations will start. I do not want to list the workers concerned, because such a level would involve fatalities, and an awful lot of staff would be covered. Perhaps when we move to that level, a full list of people—
The hon. Gentleman asks, "When?" from a sedentary position. As the World Health Organisation is now considering moving to phase 5, we should not be optimistic that the situation will stay at phase 4. At that stage, we will make it absolutely clear that other workers—too many to mention in this statement—will need to be covered.
Will the hygiene advice to households include more than the basic hygiene rules mentioned in the Secretary of State's statement, so that those who have to nurse relatives at home can attempt to replicate some sort of barrier nursing domestically?
Not at this stage, although the basic hygiene messages are the important ones at the moment. The hon. Lady makes an important point about the role of carers, if we move to a full-blown pandemic, in collecting antivirals and so on. We want everyone, including carers, to abide by those basic, good-sense messages about hygiene, in all spheres.