Answers on the Pandemic

Here is some question and answer on influenza pandemics from the Toronto Public Health site and the CDC offering background on the Swine Influenza (swine flu), "a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs" that is now affecting human in an imminent pandemic.

On a mildly interesting note, the CDC question and answer references a case in Wisconsin from 1988.

Can humans catch swine flu?

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

And from the Toronto Public Health site:

What is Pandemic Influenza?

An influenza pandemic occurs when there is an abrupt and major change in the protein structure of the Influenza A virus resulting, in a new strain. Because people have little or no immunity to this new strain, it can spread quickly, causing outbreaks in one or more countries or worldwide. This is called a pandemic.

How often do flu pandemics occur?

Flu pandemics have historically occurred three or four times each century. There were three flu pandemics in the last century (1918, 1957 and 1968).

CDC: 'Rapidly Evolving Situation'; WHO Raises Alert

Update: The World Health Organization (WHO) Director-General has raised the level of influenza pandemic alert from phase 4 to phase 5, signaling a broader outbreak among world populations. [WHO graphic has phase 4 circled and has not been updated yet.]

The WHO defines a Phase 5 alert as: follows: "Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short."

The CDC site reads:

This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.

The WHO Director-General's statement:

Ladies and gentlemen,

Based on assessment of all available information, and following several expert consultations, I have decided to raise the current level of influenza pandemic alert from phase 4 to phase 5.

Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world.

On the positive side, the world is better prepared for an influenza pandemic than at any time in history.

Preparedness measures undertaken because of the threat from H5N1 avian influenza were an investment, and we are now benefiting from this investment.

For the first time in history, we can track the evolution of a pandemic in real-time.

I thank countries who are making the results of their investigations publicly available. This helps us understand the disease.

I am impressed by the work being done by affected countries as they deal with the current outbreaks.

I also want to thank the governments of the USA and Canada for their support to WHO, and to Mexico.

Let me remind you. New diseases are, by definition, poorly understood. Influenza viruses are notorious for their rapid mutation and unpredictable behaviour.

WHO and health authorities in affected countries will not have all the answers immediately, but we will get them.

WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels.

The results of these ongoing assessments will be issued as public health advice, and made publicly available.

All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.

At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

I have reached out to donor countries, to UNITAID, to the GAVI Alliance, the World Bank and others to mobilize resources.

I have reached out to companies manufacturing antiviral drugs to assess capacity and all options for ramping up production.

I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine.

The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?

It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. We need to continue to monitor the evolution of the situation to get the specific information and data we need to answer this question.

From past experience, we also know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries.

No matter what the situation is, the international community should treat this as a window of opportunity to ramp up preparedness and response.

Above all, this is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic.

As I have said, we do not have all the answers right now, but we will get them.

Pandemic Level Raised

The World Health Organization (WHO) Director-General has raised the level of influenza pandemic alert from phase 3 to phase 4, the first stage of "response and mitigation efforts".

A pandemic is broadly defined as an epidemic (a sudden outbreak) affecting a whole region, a continent, or the world.

Just the flu so far and raising the level does not imply anything about how bad the Swine Flu bug will make you feel if you catch it.

Besides washing your hands often and not going to Mexico unless you have to, another good idea is not reading Richard Preston or Daniel Kalla for a while.

From the WHO:

In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans.

Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.