With the NHS issuing warnings about a "second surge" of a highly contagious illness, a pharmacist has outlined how to distinguish it from other ailments. Last week, the NHS cautioned about the second peak of norovirus infections after the vomiting bug reached its highest level so far this winter.

Releasing new data, the NHS said the average number of patients in hospital with norovirus each day last week climbed to more than 1,000 for the first time this winter, at 1,012. Throughout January, the average number of norovirus patients in hospitals per day increased by more than 2.5 times from the beginning to the end of the month, from 361 to 950.

Levels remained stable in the first week of February, the NHS said, before climbing again for the second week running, sparking concerns of a second surge. NHS doctors have called on the public to help stop the spread of norovirus to family members and colleagues by taking straightforward steps, including proper hand hygiene and staying away from schools and workplaces until they have been symptom-free for two days.

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NHS national medical director, Dr Claire Fuller, said last week: "It's vital that we do all we can to avoid a second surge in norovirus at a time when the NHS remains flat out coping with winter pressures. The public has a huge role to play in stopping the spread of this bug by taking some simple precautions like good hand hygiene with regular handwashing with soap and water.

"If you have symptoms, stay home, rest and drink fluids, and please don't go to places like schools, workplaces, hospitals and care homes until you have been symptom-free for at least two days. If you have any concerns about norovirus symptoms, local pharmacies can provide support and advice and remedies, or please contact 111 or use 111 Online."

Sheena Bagga, pharmacist independent prescriber at LloydsPharmacy Online Doctor, explained: "The main symptoms of norovirus, such as diarrhoea and vomiting, are common to many illnesses, so it can be difficult to know whether you actually have norovirus. One key sign of norovirus is that the symptoms appear suddenly and typically include nausea, vomiting and diarrhoea.

"Other possible symptoms are a high temperature, headaches, stomach pain and general aches. Norovirus usually develops quickly, with symptoms peaking within 24 to 48 hours and most people start to feel better after a couple of days.

"The difficult thing about norovirus is that the symptoms can overlap with other illnesses. For example, appendicitis can present with vomiting, diarrhoea, and pain. However, a key difference is that with appendicitis, the pain usually starts around the belly button and then moves to the right side of the abdomen, whereas with norovirus, the discomfort is more general and spreads around the body.

"Another difference is that appendicitis pain tends to worsen steadily and is not relieved by passing stools or vomiting. Should any of these symptoms present, it's important to seek urgent medical attention.

"Pancreatitis is another condition that shares similar symptoms with norovirus, but the key distinguishing feature is pain - it is typically much more severe and concentrated in the centre of your abdomen. Other warning signs, such as yellowing of the skin or eyes, persistent vomiting, or extreme tenderness in the stomach, should prompt urgent medical attention.

"Other clues that it may be norovirus rather than a more serious condition include the presence of multiple cases in your household or workplace, and a rapid onset of symptoms. Red flags that should never be ignored include severe abdominal pain, blood in vomit or stool, high fever, or confusion, which may indicate a different, more serious illness."

If you suspect you've got norovirus, ring 111 if diarrhoea persists beyond seven days and vomiting continues past two days. Dial 999 or get yourself to A&E if you experience any of the following, as they might signal something far more serious:

• Vomiting blood


• Green vomit (adults) or yellow-green vomit (children)


• Suspect you may have swallowed something poisonous


• Stiff neck accompanied by pain when exposed to bright lights


• Sudden intense headache


• Sudden intense stomach pain


• Severe difficulty breathing


• Display blue, grey, pale or mottled skin on the lips or tongue. For individuals with darker skin tones, this discolouration may appear on the palms of the hands or soles of the feet

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