WHO makes some changes

indigo girl · Jun 9, 2009

Not surprising that they would do this given the enormous political pressure. All they will likely do is add a severity index to their phases. The index will change as more info becomes available on the outcomes.

This aticle also mentions Dr. Friedan the former head of the NYC health department who will be taking over as head of CDC. He speaks of the need for more information. Everything that these organizations do will be based on the data coming in from the field. Undoubtedly there will be some surprises. There always is with influenza.

"There are still lots of unanswered questions [regarding H1N1 flu] - its case fatality rate, vaccine efficacy, the potential impact on the elderly," Frieden said, adding, "The key is getting data; one of the most important things is global data." The CDC is helping to support the efforts of global health officials tracking the spread of H1N1.

All of the above are important to know. Interestingly, thus far the impact on the elderly is barely noticeable. The cases have been mostly in young people, and that includes hospitalizations and deaths, most unusual for influenza...Not surprisingly, pregnant women are increasingly noted as a risk group that is experiencing poor outcomes.

indigo girl · Jun 9, 2009

Emergency services vital in a time of global crisis

Dr Margaret Chan

Director-General of the World Health Organization

Please note that she is not using the word "mild" to describe the risk to modern countries, and to the developing world she describes the risk as a more severe crisis. These are not idle words. As we look at the events happening amongst the First Nation people in the more remote areas of northern Canada right now, and what has already occurred in Mexico, it becomes rather easy to understand what she is talking about.

We are just at the beginning of what could turn out to be a hugh event that may take well over a year to unfold. No one yet knows what will happen but, minimizing the risk is unwise. It is entirely possible that the impact will be tremendous even if this is not a category 5 pandemic.

http://www.who.int/dg/speeches/2009/wfp_executive_board_20090608/en/index.html

Ladies and gentlemen,
We are near the start of the first influenza pandemic of this century. Up to now, cases of the new H1N1 virus have been detected, investigated, closely tracked, and reported in well-off countries.
On present evidence, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity in countries with good health infrastructure and adequate resources.
But we are wise to anticipate a bleaker picture in the developing world. Mortality at present is low, but we are seeing some disturbing signs.
This is a contagious virus that shows a preference for younger age groups. Most cases are concentrated in people under the age of 20.
Cases of severe and fatal infection are occurring in young adults between the ages of 30 and 50, and not in the frail elderly, as is usually seen during epidemics of seasonal flu. We know, too, that the risk of severe illness is greater during pregnancy and when certain underlying chronic conditions are present.
Around 99% of maternal mortality, which is a marker of poor quality health care during pregnancy and delivery, occurs in the developing world. As I mentioned, poor countries bear the greatest burden of chronic diseases, where the average age of onset is also earlier than seen elsewhere.
We must all be deeply concerned about the impact that even a moderate pandemic will have on vulnerable populations.
Once again, it does not take much to push people living on the margins of survival over the brink.

indigo girl · Jun 9, 2009

World getting 'very close' to swine flu pandemic: WHO

http://news.smh.com.au/breaking-news-world/world-getting-very-close-to-swine-flu-pandemic-who-20090610-c2f2.html

The World Health Organisation on Tuesday assessed that the world was getting "very very close" to a swine flu pandemic, saying that it was racing to prepare countries for such a situation.
"We are getting very very close," said Keiji Fukuda, WHO assistant director-general, noting that in Australia, there was now "a great deal of activity in Victoria at the community level."
Under the WHO's guidelines, one key criteria for declaring a pandemic would be established community spread in a country outside the first region in which the disease was initially reported, in this case, outside the Americas.
The WHO has so far left its six-level pandemic alert scale unchanged at phase five, signalling that a pandemic is "imminent."
The UN health agency's guidelines had initially focused on the geographical criteria to justify a phase change. However, member states have called on the agency to take other elements, such as severity of the disease into account.
On Tuesday, Fukuda played down the role of severity, saying that "by going to phase six, what this would mean is that the spread of the virus continues and activity has become established in at least two regions in the world.
"It doesn't mean that the severity of the situation has increased," he said.
But when asked if the situation in Australia, where 1,211 cases of infections have been recorded, warranted a phase change, Fukuda would only say that the world was "getting very, very close" to a pandemic.
"The declaration of phase changes... is not simply getting up in front of press cameras or making an announcement. It's really a way of preparing the world to deal with the situation," said Fukuda, adding that a "great deal of work has to be done."
This includes ensuring that countries had the information and tools to handle increased numbers of patients as well as to deal with inquiries from the population.

Fukuda pointed in particular to the situation in Inuit communities in Canada where "a disproportionate number of serious cases is occurring.
"At this time, we know that a larger number than expected of young Inuit people did develop serious illness and has had to get hospitalised," he said.
Fukuda said he was unable to pinpoint the reasons for the trend.
"We know in past pandemics that Inuit populations were very severely hit, that's why these reports raised such concerns to us," he said.

oramar · Jun 9, 2009

Emergency services vital in a time of global crisis
Dr Margaret Chan
Director-General of the World Health Organization
Please note that she is not using the word "mild" to describe the risk to modern countries, and to the developing world she describes the risk as a more severe crisis. These are not idle words. As we look at the events happening amongst the First Nation people in the more remote areas of northern Canada right now, and what has already occurred in Mexico, it becomes rather easy to understand what she is talking about.
We are just at the beginning of what could turn out to be a hugh event that may take well over a year to unfold. No one yet knows what will happen but, minimizing the risk is unwise. It is entirely possible that the impact will be tremendous even if this is not a category 5 pandemic.
http://www.who.int/dg/speeches/2009/wfp_executive_board_20090608/en/index.html

Other flus have made repeat passes over a period of years. Since this is novel I would not be surprised if it is around for a while.

indigo girl · Jun 10, 2009

WHO 'very close' to declaring a pandemic, concerned about Manitoba cases

http://chealth.canoe.ca/channel_health_news_details.asp?news_id=28223&news_channel_id=1020&channel_id=1020

More excellent reporting from Helen Branswell at Canadian Press on the politics of pandemics. She always gets it right.

I wish that they would stop arguing about this, and just get on with what needs to be done.

Dr. Keiji Fukuda all but acknowledged that a swine flu pandemic is underway, saying the WHO is aware there is "a great deal" of community spread of the virus in at least one part of Australia - a fact which under the WHO's definition should trigger a pandemic call.
He also said the WHO is concerned about reports of severe illness among First Nations people in Manitoba, noting that in previous pandemics such populations have been hit particularly hard.
"I believe that WHO is very close to going over the scientific credibility cliff, from which it will be hard to get back up out of that gorge if they hit the bottom," declared Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
Several infectious disease experts in Australia have also said transmission in that country has crossed the pandemic threshold, the BBC reported. The WHO's pandemic alert scale says a pandemic will be underway when there is evidence of sustained community spread in countries in two different WHO regions.
Even WHO Director General Dr. Margaret Chan seemed to suggest Tuesday that those conditions may have been met. Chan told reporters in Geneva that "on the surface of it" the evidence needed to declare a pandemic may exist. But she added she will have a conference call Wednesday with governments to clarify what the true conditions are on the ground.
But Osterholm said the WHO has the evidence it needs, with ongoing and out-of-season spread in the Northern Hemisphere and now community spread in the Southern Hemisphere.
He suggested some countries have been dragging their heels on conducting surveillance for cases, trying to avoid triggering the pandemic call. He declined to name names.
But others have questioned case counts from the United Kingdom and Spain, where authorities initially discouraged most doctors from testing people for swine flu unless they had been in contact with a known case or had recently travelled to a place where swine flu was spreading. Community spread can only be observed if people who haven't travelled and don't have links to cases are tested.
"Absence of evidence is not evidence of absence," Osterholm said. "There are some countries right now who are making it difficult to find cases. And WHO knows this."
"But the point is there is enough evidence in enough places," he continued. "When you have the kind of transmission going on in the Northern and Southern Hemispheres that we're seeing right now, that is dramatic."
Fukuda's remarks seemed to imply part of the rationale for the delay was a desire to prepare the world psychologically for the call, so that countries don't impose unhelpful measures and people don't panic. He listed travel bans, border closures and trade embargoes as the types of measures the WHO believes would be counterproductive at this point.
He said the agency is working hard to explain what declaring a pandemic actually means.
"It's a little bit paradoxical. You would think that by going up a scale, that it would mean that the level of concern should go up. But really what the going up the scale would mean is that we are seeing greater spread of the virus," said Fukuda.
"It does not mean that the severity of the situation has increased or that people are getting seriously sick at higher numbers or higher rates than they are right now."
Fukuda suggested the pandemic declaration, when it comes, will be accompanied by a statement describing the pandemic as being of moderate severity, noting there is concerning evidence that in vulnerable populations the virus may exact a higher toll than elsewhere. He pointed specifically to the reports emanating from Manitoba.