GPs are to carry out widespread swine flu testing of patients in three hotspots where the infection appears to be taking hold in Scotland, signifying a dramatic shift in the fight against the outbreak.
The Herald has learned that new advice to family doctors, quietly changed in the past two days, recommends that all patients with severe flu-like symptoms and who live in the three areas affected by serious cluster outbreaks - Argyll & Bute, Paisley and south Glasgow - should be tested as a matter of course.
The move is in response to the gathering pace of the disease, with another huge leap of 31 new confirmed infections yesterday marking a near-doubling of cases north of the border in the past 48 hours alone.
Cases of swine flu are expected to accelerate as the strategy of containing the outbreak shifts to one of widespread testing or "coping", which will inevitably uncover greater numbers of infected people.
Before, the test was only offered to such patients who had been in contact with another carrier or who had recently travelled abroad, leading to concerns that some cases were going unreported.
Priority test areas have now been created in Argyll and Bute - which covers Dunoon where more than 60 people are now infected - Paisley and south Glasgow in a bid to handle the spread of the virus.
Last night, Health Secretary Nicola Sturgeon reported that the number of confirmed cases of swine flu in Scotland was now 119.
In comparison, England, which has 11 times the population of Scotland, has just 2.6 times the level of swine flu infection with 317 confirmed cases.
Professor Hugh Pennington, emeritus professor of bacteriology at the University of Aberdeen, said that the original approach to handling the outbreak was "too restrictive" and welcomed the change in the way GPs assessed patients for the H1N1 virus.
He said: "It means that we have pulled back from the policy of containment where you aggressively pursue each case and target those who have come into contact with other cases. Clearly that policy is too restrictive and this change addresses that.
"They don't want a mad rush of tests from Shetland to Stranraer, and I don't know if the system would cope with that, but what they have to do is create a balance that doesn't test the system beyond its limit but on the other hand gives a good clinical service to those living in such places where there have been clusters, such as Greenock and Dunoon."
He added: "I think it is fair to assume that you will now get a greater number of cases. Once the virus has shown that it cannot be contained you have to move to treat patients as they appear."
None of the new cases reported yesterday are travel-related and 21 of them are in the NHS Highland area, which covers Dunoon. A 23-month-old toddler from Lothian has also been diagnosed, but is not in a serious condition.
Three people remain in intensive care at the Royal Alexandra Hospital in Paisley where a 44-year-old woman is also being treated in the high dependency unit.
The condition of a 37-year-old man critically ill in Glasgow's Victoria Infirmary has now improved. Another 56 possible cases under investigation. Under further alterations to the Health Protection Scotland guidelines for diagnosis, all those in Scotland who are aged under 50 with pneumonia or another acute severe respiratory disease will be tested for swine flu.
Health Protection Scotland said last night that the new recommendations had "cascaded" down to public health boards, but no information could be given as to whether surgeries were expected to open longer, or if extra stocks of the anti-viral Tamiflu was required.
Dr Ken Lawton, chairman of the Royal College of GPs, said that GPs were "switched on" to the threat of swine flu.
"These new guidelines will mean more people being tested but it will help to differentiate between normal flu and those who have swine flu.
Ms Sturgeon said that the outbreak in the Argyll and Bute area had led to the closure of Kirn Primary and Inellan Primary in Cowal for seven days, following the diagnosis of three primary seven pupils who attended a school trip together. All 70 pupils and 20 staff who attended the event will all be offered Tamiflu, as will 230 pupils in the third year at Paisley Grammar School.
"We have always said that we expected to see an increase in cases in Scotland," Ms Sturgeon said last night.
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