Swine Flu Reaches Switzerland and the Netherlands

Switzerland and the Netherlands confirmed their first cases of swine flu today, hours after the World Health Organization raised its global epidemic threat level to phase five – the second highest – in recognition of the growing number of countries affected by the virus.

There are now 12 countries that have reported cases of the H1N1 strain, six of them in Europe. Both the Dutch and Swiss cases – a child and 19-year-old student respectively – had recently returned from trips to Mexico. The Swiss student was mistakenly released from a hospital, after test results were misinterpreted, and then hastily readmitted. Switzerland has a further 29 "suspicious" cases.

Phase five indicates the disease is able to spread easily between humans and is a strong signal that a pandemic is imminent. It can lead to governments bringing in measures to prevent its spread, including travel restrictions and trade limitations.

The next phase, six, is a full-blown pandemic, characterized by outbreaks in at least two regions of the world.

The increase in threat level comes after a 23-month-old Mexican child died in Texas, becoming the first person to die from swine flu outside the country of origin; while in Spain officials confirmed the first case of the disease in a person who has not traveled to Mexico.

The WHO raised the alert level from three to four on Monday, the first time it has ever intervened to increase its pandemic threat warning. It said countries should activate their pandemic plans and remain on high alert.

Last night, the director general of the organisation, Dr Margaret Chan, announced the change at a press conference in Geneva and said action must be taken with "increased urgency". She said: "Influenza pandemics must be taken seriously, precisely because of their capacity to spread rapidly to every country in the world.

"All countries should immediately now activate their pandemic preparedness plans. It really is all of humanity that is under threat in a pandemic."

She added that, on the positive side, the world was better prepared for an influenza pandemic than at any time in history.

Measures taken because of the threat from avian influenza were an investment, and there was currently benefit from that investment. "For the first time in history, we can track the evolution of a pandemic in real time," she added.

She said new diseases by definition were poorly understood. "Influenza viruses are notorious for their rapid mutation and unpredictable behavior. WHO and health authorities in affected countries will not have all the answers immediately, but we will get them."

Barack Obama described the situation as "serious" in a press conference last night and urged the public to show "great vigilance" in responding to swine flu.

He said, however, that there was no need for panic and rejected the possibility of closing the border with Mexico.

"At this point, (health officials) have not recommended a border closing," he said. "From their perspective, it would be akin to closing the barn door after the horses are out, because we already have cases here in the United States."

Peru later diagnosed its first case of swine flu, which appeared to be the first case in Latin America confirmed outside Mexico.

The health mMinister, Oscar Ugarte, subsequently announced the suspension of all commercial flights arriving in Peru from Mexico.

Mexico's government said it was temporarily suspending all nonessential activity of the federal government and private business as the number of confirmed swine flu cases jumped.

Mexico's president, Felipe Calderón, has told citizens to stay home from Friday for the five-day partial shutdown of the economy.

In his first televised address since the crisis erupted last week, he told Mexicans to stay home with their families. "There is no safer place than your own home to avoid being infected with the flu virus," he said.

Non-essential federal government offices will be closed from 1-5 May and all non-essential private businesses must also close for that period however essential services such as transport, supermarkets, trash collection, hospitals will remain open.

In the UK, five people have been confirmed as having been infected with swine flu. They include three people who returned on the same charter flight from Cancún, Mexico – a 12-year-old girl from Torbay and a couple from Polmont in Scotland who had been on honeymoon.

The number of suspected cases in the UK had risen to 78 by yesterday afternoon, but that figure continued to fluctuate as new suspected cases emerged and others were ruled out as negative.

Professor Sir Liam Donaldson, the government's chief medical adviser, said: "Phase five indicates that WHO considers a global pandemic to be imminent, whereas at phase four a global pandemic is not inevitable. A change to phase five is a signal to countries' governments to ramp up their pandemic preparations – which we are already doing. We have been planning for a situation like this for some years. The preparations we have in place and are continuing to make will help to ensure we respond well in the event of a pandemic."

Alan Johnson, the health secretary, said the government was obtaining extra antiviral drugs that would protect 50 million people, amounting to more than three-quarters of the UK population.

Last night, the European commission's most senior health official said that potentially thousands could die. Robert Madelin, director general for consumer health policy, said it was not a question of if people would die, but how many.

He said there was confidence that Europe was well prepared for a pandemic. But when asked if people could die, he replied: "Every year 2,500 people die of the flu in Europe; the question now is not whether people will die, but whether it will be thousands, tens of thousands or hundreds of thousands."

A British flu expert said the rise in threat level was not an "end of the world scenario". Dr Alan McNally explained that this meant the disease had been spread between humans in two countries: Spain and Mexico.

The senior lecturer and researcher into influenza diagnostics at Nottingham Trent University said no human-to-human cases had yet been reported in the UK, but that some could occur.

He said: "The vast majority of people have been going around treating this as a bit of a joke but that stage has now gone. The time has come to have a bit of common sense about it."

NHS Direct, the health and advice information service, released figures last night on the number of people visiting its website to find out more about swine flu.

A spokesman said more than 63,000 people visited NHS Direct on Tuesday this week, compared with around 39,000 on Tuesday last week. Of those, 16,638 people used the Cold and Flu Self Assessment Tool.

Monday saw an increase of about 30,000 hits on the website compared to the same time last week.

Meanwhile, 13,481 telephone calls were taken by the service yesterday. Of these, 1,659 were related to swine flu.