Oseltamivir and zanamivir (and later peramivir in some countries) played a role in the mitigation effort, sometimes drawing on national stockpiles. Except for Japan, widespread use of antivirals had not been the norm previously. It became standard to recommend neuraminidase inhibitors for treatment of inpatients and high-risk outpatients, and in restricted circumstances for chemoprophylaxis. Innovative delivery schemes were sometimes developed. Those who fell sick in England could have a telephone assessment (taking pressure off primary care) and then if appropriate receive empiric oseltamivir treatment from a local pharmacist. In Norway oseltamivir was made available ''over the counter.'' However in many European settings, reluctance remained among primary care providers to prescribe a drug they were unused to. Another controversy was whether to offer oseltamivir to all those with symptoms or target those at higher risk for complications. The observational data so far suggest that early treatment with neuraminidase inhibitors have worked to reduce severe disease and have not been linked to significant adverse risks [31, 32] . Late clinical presentation and delayed initiation of antiviral treatment have been implicated with more severe complications worldwide, indicating gaps in identifying and treating patients before disease severity increases. While sporadic cases of oseltamivir resistance have been reported in association with a specific mutation (H275Y in neuraminidase), such oseltamivir-resistant viruses have rarely transmitted [3] . Indeed, the pandemic virus has remained genetically and antigenically stable so far.