The Home Office last week released a long awaited consultation

document Planning for a possible influenza pandemic: a framework for planners preparing to manage deaths. In the past, the government has been much criticised for its lack of preparedness for a major outbreak of influenza. Recent scares over avian flu have, however, stimulated a significant and ongoing reassessment of risk, and of contingency planning.

The Department of Health’s formal worst-case planning scenario is still one of 50,000 excess deaths from a flu outbreak. That’s a reasonable figure using the outbreaks in the last 50 years as a guide, but the real worst-case scenario is far worse than the pandemics of 1957, 1968 and 1977 suggest. Influenza can easily evolve to become much more lethal. A realistic worst case scenario is one that involves mortality rates on a least the same scale as those experienced in the 1918 flu pandemic – using that example as a model a minimum of at least 300,000 British deaths is a more sensible figure to prepare for. And it could be even worse.

In previous pandemics, the overall UK clinical attack rate has been of the

order of 25% to 35%, compared with the usual seasonal range of 5% to 15%. Cumulative clinical attack rates of up to 50% of the population in total are however possible, spread over one or more waves of around 15 weeks, each some weeks or months apart. If they occur, a second or subsequent wave could possibly be more severe than the first.

Worst case scenarios

Only in March this year did the Cabinet Office and the Department of Health

put their heads together and issue a consultation document acknowledging the possibility that previous worst case planning assumption of 50,000 deaths might be hugely underestimating the potential scale of the problem.

The Home Office now takes a far more pessimistic view than did the

Department of Health in the recent past. In the Home Office’s "reasonable worse case scenario", a flu pandemic "could produce around 650,000 additional deaths across England and Wales, based on a clinical attack rate of 50% and a case fatality rate of 2.5%."

This latest document sets out proposals on planning for the management of

potentially large numbers of deaths during an influenza outbreak. The draft

Framework is aimed at local planners in England and Wales preparing contingency plans for the extraordinary circumstances which might arise, and forms part of a suite of related contingency planning.

The guidance has been produced in consultation with representatives of the

funeral industry, the Coroners’ Society, the Local Government Association,

LACORS and the Federation of Burial and Cremation Authorities as well as with religious leaders and relevant Government Departments. The Home Office Mass Fatalities Section is interested in hearing the views of all those concerned in the management of large numbers of fatalities - both

the corporate views of the representative organisations and those of individuals. Steve Ainsworth

Closing date for comments is 30th November 2007.

The Document can be downloaded from: