Experts believe that the expected flu pandemic could kill up to 3,000 people in the North-East and North Yorkshire. Health Editor Barry Nelson starts a three-part series by examining whether the region's public sector is ready to cope, with a particular focus on Darlington.

THIRTY-EIGHT years since the last 'pandemic' flu epidemic, the region is bracing itself for another bout of potentially devastating illness. No-one knows where it will come from and when it will reach these shores. But experts believe that when the next pandemic - a world epidemic of a previously unknown type of influenza - arrives, it will have a massive impact on everyday life.

Health officials in the region have been told that up to one in four of the population of the North-East and North Yorkshire could become ill over a few months, disrupting everyday life to an extent that has not been known outside of wartime.

And that is just an estimate: some models suggest it could be as high as 40 per cent.

Victims of pandemic flu can expect to develop high temperatures, widespread muscular aches, a cough, a headache and a sore throat. They will probably need to go to bed for seven days. Another week of rest may be needed before the patient is fully recovered.

One senior doctor in the region said the pandemic flu would hit people hard. "Imagine the worst flu you have ever had and double it," the doctor said.

Apart from those directly affected by the illness, there is the knock-on effect of family members deciding to stay away from work to look after their loved ones.

But if the truth is known, nobody really knows how bad it might get.

Because most of us may not have any natural immunity to the pandemic virus, by the time a predicted second wave of influenza sweeps over us it could, theoretically, affect everyone. However there are hopes that by the time a second wave of pandemic flu returns, a protective phenomenon known as 'herd immunity' will prevent a significant number of people from developing symptoms.

But by the time the pandemic is over, as many as 50,000 people - mostly people with existing underlying chronic illnesses - could have died. Even more worryingly, this figure could be much higher as the official estimates are based on a 'middle-of-the-road' estimate.

In North-East terms, this means 2,500 deaths out of a population of 2.5m.

Out of North Yorkshire's population of 569,000, an estimated 569 could die. In Darlington alone, 98 people could die out of a population of 98,000.

Faced with the prospect of mass illness and widespread social and economic dislocation, the public and private sectors in the North-East have been drawing up contingency plans to cope with the crisis.

Dr Nonnie Crawford, director of public health for Darlington Primary Care Trust, a key player in the town's preparations for the pandemic oubreak, is positive and business-like but has no illusions about the treatment options available for people who go down with flu symptoms.

"People have stopped realising that there are some illnesses that we can't treat and this is one of them," says Dr Crawford, adding that there is "absolutely no point" in giving victims antibiotics as the illness is caused by a virus rather than a bacteria.

Once a pandemic is declared in the region, the NHS - including the ambulance service - is likely to shut down routine, non-urgent activities such as planned operations and out-patient appointments and concentrate on dealing with seriously ill flu victims.

It is not known whether the pandemic flu will hit the elderly, the young or working-age people but those with underlying illnesses are the most likely to develop secondary, potentially life-threatening conditions such as pneumonia. It is this group who will be given priority by the NHS.

Dr Crawford says most people who develop symptoms will be advised to stay at home, go to bed, take paracetamol and drink plenty of water.

It is only those who develop serious symptoms who will need to be visited by doctors or specially trained nurses and, if necessary, transported to hospitals.

Most people will be advised to stay away from GP surgeries, NHS walk-in centres and hospitals during the emergency to allow the most seriously ill to be treated.

"We will be doing a lot of telephone triage, giving advice to people on the phone," says Dr Crawford. "The last thing we want is people congregating at hospital accident and emergency departments, which could potentially spread the flu virus."

Anti-viral drugs such as Tamiflu could be given to front-line health workers to try to prevent them becoming ill, but no vaccine is likely to be available for at least four months.

Bryan Rees, the Newcastle-based civil servant who is director of 'regional resilience' in time of emergency says a major exercise involving 80 organisations in September was very useful and would be followed by another exercise later this year. And overall, Mr Rees says he is "encouraged" at the state of the region's preparations for a pandemic.

Dr Hilton Dixon, a Darlington GP who is also medical director of the town's PCT says everyone needed to take the issue seriously.

"It is not if, it is when. We will have a pandemic, it is just a question of when it happens."