PUBLIC health officials in Britain are working on a new contingency plan — updating the version that was issued as recently as March. The fears are that when — rather than if — a pandemic emerges, hospitals will be overwelmed, businesses will falter, public transport will be halted and facilities for burying the dead will prove inadequate.

The March plan estimated that 54,000 people might die in Britain as a result of a flu pandemic, more than four times the average death toll from flu in a non-epidemic year. But much higher estimates have emerged from the Civil Contingencies Group in the Cabinet Office, which has reported that as many as one per cent of the population might die — 600,000 people.

In the worst-case scenario, civil society would start to break down, curfews and quarantine zones would have to be established, free movement would be limited and the Army might need to be called in to prevent people from fleeing the cities to reach places of safety.

This may seem an apocalyptic scenario, but the Cabinet Office is now believed to rate pandemic flu among the greatest threats the country faces. Unfortunately, once a pandemic is established, the options are limited. Planning the response comes down to distributing the available antiviral drugs efficiently, maintaining essential services, managing mass casualties and keeping order.

In the worst-case scenario there will be as many deaths in the 12 weeks of an epidemic as there normally are in a year. Every week at the peak of the pandemic, 19,000 people will require admission to hospital.

Critical care beds will prove inadequate, with at least three times as many needed as are available, according to estimates from the Intensive Care Society. About a third of all acute hospital beds will be needed, so elective operations are likely to be cancelled.

Workplaces will be unusually empty, the March contingency plan suggests, with at least double the normal level of absenteeism. Schools will be struck hard, with at least half the children catching flu, and up to 90 per cent in boarding schools. Against this, the Government has at present just one medical intervention — 14.6 million courses of the antiviral drug Tamiflu, sufficient for about a quarter of the population. But the order will take two years to deliver in full, so availability should avian flu strike this winter will be much more limited. By last month fewer than one million courses were in stock.

Nobody yet knows how effective this will be, but when used against normal flu the drug shortens the illness by one day and reduces the symptoms, so it should reduce hospital admissions. But getting the drugs will be difficult, as as preference will be given to those whose absence would cause the most disruption: doctors, nurses, police and army personnel and undertakers.

The other weapon is a protective vaccine, but none yet exists. Even if one is developed it will take four to six months to produce and will be available to even fewer people than antiviral drugs.

Some slowing of the pandemic may be possible by isolating cases, restricting movement of people, limiting public gatherings, closing schools, screening at ports and issuing face masks. But the evidence is that these measures are unlikely to have much impact. They may succeed in creating an impression of action without curtailing the spread of the infection.

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