AFD - Pandemic Stage Level News, Controversies

[sharon sanders]

A Pandemic By Any Other Name . . .



# 3236


The debate over whether to declare this outbreak of H1N1 to be a pandemic continues between member nations of WHO gathered in Geneva this week, with political and economic considerations apparently taking precedence over established (and presumably science based) criteria.

Declan Butler of Nature editorializes for us on this debate (follow the link to read it in its entirety).


When is a pandemic not a pandemic?

Arguments about the pandemic status of swine flu are a distraction from tackling the outbreak, warns Declan Butler.
Declan Butler
As the influenza A (H1N1) swine flu virus fans out across the globe, there can be little doubt that we are already in the early stages of a flu pandemic. Nonetheless, there is considerable resistance to calling it a pandemic.

On 29 April, the World Health Organization (WHO) moved its assessment of the pandemic threat to phase 5 on its six-point scale, indicating that the new virus had caused "sustained community level outbreaks in two or more countries in one WHO region".

And that is where the threat level has sat ever since ? one point short of official global pandemic status. The current definition of phase 6 requires that there are "sustained community level outbreaks in at least one other country in a different WHO region". That criterion will almost certainly be met sooner or later.

Yet this week Margaret Chan, director-general of the WHO, came under pressure from member states ? including the United Kingdom and Japan ? to move the goalposts to delay or prevent a move to phase 6, by redefining it to include an assessment of the severity of the disease, and not only its geographical spread.

Adding that requirement of severity may sound like common sense. But it is not, because the severity of a pandemic is unpredictable. The flu might fizzle out; or it could go away for months only to come back with a vengeance, creating as much devastation as the 1918 flu outbreak, which caused an estimated 50 to 100 million deaths worldwide.
(Continue . . . )

 

[sharon sanders]

Re: AFD - Pandemic Stage Level News, Controversies

WHO To Change Criteria For Declaring A Pandemic



# 3243

WHO rethinks criteria for Phase 6 pandemic flu


Fri May 22, 2009 12:12pm EDT

GENEVA, May 22 (Reuters) - The World Health Organisation has changed its view on the criteria for raising its global flu alert, saying on Friday that it needed to see signs of severe effects before declaring a Phase 6 pandemic is underway.

"What we are looking for and what we will be looking for is something, events which signify a really substantial increase in risk of harm to people," Keiji Fukuda, the WHO's acting assistant director-general, told a news briefing.

The WHO previously said its six-point scale reflected only the way a virus is spreading, not is severity. Fukuda said the U.N. agency was now seeking signals that "the risks for people have significantly gone up" before moving the alert from the current Phase 5. (Reporting by Stephanie Nebehay, Katie Reid and Laura MacInnis)
​

This isn?t the first time that politics and economic considerations have trumped science, nor is this the most egregious example.

It is merely the most recent.

We are now left with subjective (and unclear) criteria for what is, or is not, a pandemic.

Or to put it less precisely:

What we are looking for and what we will be looking for is something, events which signify a really substantial increase in risk of harm to people - Keiji Fukuda
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Presumably they will eventually come up with something a little more tangible, something a little more concrete than looking for `something?.

I hope so.

Not only does all of this `negotiation? over the definition of a pandemic look unseemly, it now puts Director-General Chan in the unenviable position of having to decide when a pandemic is a pandemic, without a clear cut definition.

The added criteria, that they must see `something? or `events? that signal a substantial increase in risk to peopleassumes we get accurate, honest, and timely surveillance and reporting from around the world.

Something we haven?t seen whole heck of a lot of out of places like China, Myanmar, Indonesia, and North Korea over the past few years.

​

I have to assume the political pressure exerted by some of its member nations was considerable ? perhaps even insurmountable for the Director General.

A reminder that, for all the good the WHO does around the world (and it does), it still operates at the behest, and often at the pleasure, of its member nations.
​

And the fears of member nations that a pandemic declaration might exacerbate the woes of an already struggling global economy are probably legitimate. I imagine it would impact some sectors, particularly travel and tourism this summer.

Perhaps the H1N1 virus remains relatively benign. There is always that possibility. This decision may not directly come back to haunt us. At least, not with this virus.

But anytime we allow science to bend to political arm twisting, we find ourselves perched on that proverbial slippery slope.

Is it enough that an accepted objective standard be economically or politically inconvenient for it to be discarded?

What if it offends a religious or cultural belief? Should we discard it then?

Where do we draw the line?

​

Serious questions we should be asking ourselves, that go well beyond today?s decision by the WHO.

 

[sharon sanders]

Re: AFD - Pandemic Stage Level News, Controversies

Fukuda: ?Very Close?



# 3312



While not everyone is convinced of the wisdom of doing so, the WHO (World Health Organization) appears poised to announce a move to level 6 on the pandemic alert scale in the near future.

Based on the existing criteria, their can be little doubt that the conditions for declaring a pandemic have been met. There are still calls, however, for some kind of severity index to go along with any pandemic designation.

The problem the WHO faces is that the impact of any influenza pandemic is likely to vary considerably across geographic, societal, and economic landscapes.

What might be a mild or moderate pandemic in North America, or Europe, could well be far more devastating in Africa, South America, or parts of Asia.

World 'very close' to swine flu pandemic: WHO

<cite>June 10, 2009 - 2:14AM</cite>
The world is getting "very close" to a swine flu pandemic, a senior World Health Organisation official said Tuesday, noting that there is now community-level transmission in Australia.

"We are really getting very close" to a pandemic, said Keiji Fukuda, assistant director-general, adding that the WHO is now focusing on helping countries to deal with such a situation when it is declared.
​

 

[sharon sanders]

Re: AFD - Pandemic Stage Level News, Controversies

Chan Warns Of A `Moderate? Pandemic In Developed Countries



# 3308



Today Margaret Chan, Director-General of the World Health Organization, addressed the Executive Board of the World Food Programme in Rome, Italy.

Her remarks centered on the efforts of the World Food Programme, but she took time to make some pointed comments about the impending H1N1 pandemic.

I?ve excerpted her comments regarding a pandemic below, but you may wish to follow the link to read her comments in their entirety.

Of particularly interest is her assertion that H1N1 appears poised to deliver a `moderate pandemic? to developed countries, and a more severe crisis to developing nations.

Emergency services vital in a time of global crisis

Dr Margaret Chan
Director-General of the World Health Organization



<Snip>

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.
(Continue . . . )


​

 

[sharon sanders]

Re: AFD - Pandemic Stage Level News, Controversies

Mild And Moderate Pandemics



# 3309



Yesterday Margaret Chan, Director-General of the World Health Organization ? announced: ?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.?

She added that in less developed countries, ?we are wise to anticipate a bleaker picture.?

For those already convinced by mainstream media that H1N1, even if it becomes a pandemic, will be a non-event ? this may come as a bit of a surprise.

After all, we?ve heard report after report from news sources and pundits that this virus is `mild?, `rarely lethal?, and that it may not even qualify as a pandemic strain.

How does this become a `moderate? pandemic, or worse?
​

It helps if we define our terms, based not on Stephen King?s The Stand, but on the HHS?s scale of pandemic severity.




The concept of mild, moderate, and severe pandemics is nothing new, it is something that scientists and public health officials have considered all along.

After all, the 1968 pandemic was `mild?, and 1957 could probably be best described as `moderate?. We have to go all the way back to 1918 to find a `severe? pandemic.

Granted, the press - and by extension, the general public ? seems to have difficulty with the idea that pandemics come in all sizes, shapes, and flavors. To many, a pandemic means death on a massive scale.

But even in the horrific 1918 Spanish Flu, here in the United States, less than 1 person in 150 died (globally, it was closer to 1 in 50).

A terrible toll, yes. But not quite what most people probably envision.
​

To put things in perspective, each year seasonal influenza claims between 30,000 and 40,000 American lives.

Or roughly 1 person out of every 10,000.

And it is against this backdrop that we must compare pandemic scenarios, not the fertile imagination of horror novel authors.

The last influenza pandemic to grip the world began in 1968, and over the course of a couple of years it claimed roughly a million lives. By just about all measures, it was a `mild pandemic?.

Globally, it killed about 1 person in 3,000. Here in the United States, that number was more like 1 in 6,000 (roughly 33,000 deaths).
​

In comparison, the 1957 pandemic was `moderate?, with estimates of global deaths running between 2 million and 4 million, and about 70,000 deaths in the United States.

Globally that meant the 1957 virus killed about 1 in 1400 (assuming 2 million deaths), and in the US, about 1 in 2400.

Or roughly 4 times the normal number of deaths.
​

By the HHS?s definition, a `moderate? pandemic (Category 2 or 3) could be expected to claim somewhere between 100,000 and 900,000 American lives.

Or anywhere from 1 in 3,000 tojust over 1 in 300 lives. Globally, the mortality rate for a `moderate? pandemic would likely be higher.

Developing countries with little access to antibiotics, antivirals, vaccines or even rudimentary medical care, would obviously see a far greater impact than wealthier nations.

Of course, the costs of a pandemic cannot be measured by the number of deaths alone.
​

There are economic impacts, societal impacts, and perhaps most visible of all, the impact on the health care delivery systems around the world.

Hospitals, most of which have precious little surge capacity, would be stretched to the limit and beyond by even a mild pandemic.

During a `normal? flu year, 200,000 Americans are hospitalized due to influenza-related illnesses. During a `mild? pandemic, the number needing hospitalization could easily triple. . . or more.

Waits for triage, and treatment, at emergency rooms, clinics, and doctor?s offices would increase. Some facilities would be overwhelmed.

Hospital beds could become a scarce commodity, elective surgeries could be delayed, and if the demand for ventilators exceeds the supply, some flu and non-flu patients could easily die because the life saving resources they needed were unavailable.

It is unclear how well hospitals would cope with that kind of surge.

A simple, but realistic, example of the kinds of collateral damage that can be brought on by even a `mild? or `moderate? pandemic.
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While there are some who seem intent on downplaying the H1N1 threat, simply because the virus hasn?t lived up to their preconceived image of a pandemic, the people who will have actually have to deal with the outfall from this looming global epidemic are far less sanguine.

When it is your job to protect the health and safety of the public, it doesn?t take a 1918-level pandemic to ruin your entire day.

 

[sharon sanders]

Re: AFD - Pandemic Stage Level News, Controversies

Measuring The Severity Of A Pandemic


# 3318




<dl><dd>It was six men of Indostan</dd><dd>To learning much inclined, </dd><dd>Who went to see the Elephant </dd><dd>(Though all of them were blind), </dd><dd>That each by observation </dd><dd>Might satisfy his mind</dd><dd>
</dd><dd>"The Blind Men and the Elephant" </dd><dd>by John Godfrey Saxe (1816-1887)</dd></dl>
This story has been attributed to the Sufis, Jainists, Buddhists or Hindus and has been used by all of them to teach that a limited perspective can lead scholars, teachers, and clerics to the wrong conclusion.

In this story each blind man touches a different part of the elephant, and each comes away with a different opinion of what it must be.

In the Buddhist version, each person decides the elephant must be like a pot (the elephants' head), wicket basket (ear), ploughshare (tusk), plough (trunk), granary (body), pillar (foot), mortar (back), pestle (tail) or brush (tip of the tail)
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And so it is with our global (and even national) influenza pandemic surveillance systems.

We see only bits and pieces of the entire picture, and must try to figure out what the entire elephant (or in this case, a pandemic) looks like based on incomplete information.

If someone has the H1N1 virus, and dies, but was never tested . . . are they a pandemic fatality?

Right now, the answer is `no?. Not officially.
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A great deal has been made about the low number of deaths attributed to the H1N1 virus. `141 deaths? has been bandied about over the past couple of days, particularly by pundits looking to disparage any pandemic declaration.

I doubt, however, you can find any public health official that will proclaim a lot of confidence in that number.

Each day, in the US alone, about 6,500 people die.

Globally? It?s probably closer to 160,000 deaths. How many of these, do you suppose, are checked to see if influenza was a contributing factor?

The answer is: not many.

Of course, by far and away, the vast majority of these deaths are unrelated to the H1N1 virus. We `know? that, even though we are unable to quantify ? with precision ? the number of deaths actually due to the virus.

The `141 deaths? worldwide represents some unknown percentage of the true number of deaths. Just as the 27,737 confirmed cases (as reported in the WHO update #46) represent some percentage of the number of actual H1N1 cases.

No one really knows the size of this elephant, since we are only privy to select pieces.
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It is unlikely that this virus is much more virulent than seasonal flu, else we?d probably have seen some spikes in the 122 MRS (122 Cities Mortality Reporting System).

These numbers do, however, tend to lag several weeks behind reality. So we will continue to watch them.

If, as suggested by CDC officials, the real number of infections in the US is 20 times higher than 13,217 currently reported, then we must be closing in on 300,000 cases nationwide.

And that, admittedly, may be low.

The virulence of this virus has been compared to that of seasonal flu, with some estimates putting it a bit higher. Seasonal flu, it is believed, kills about 1 person out of every 1,000 that it infects.

If this virus is comparable, we should have seen 300 deaths in the United States so far, not fewer than 40.
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But that assumes we can detect and report all of the deaths. And we can?t. We don?t do it for seasonal influenza, and it is unrealistic to expect we can do it for H1N1.

Over the past month, since this virus began to seriously spread across the nation, we?ve had nearly 200,000 deaths from all causes.

It would not be difficult for 260 deaths (or more) to be simply lost in the background clutter.

After all, most deaths do not result in autopsies, and fewer still are ever checked to see if influenza was a factor.

When someone dies from something other than trauma (or misadventure), a chronic illness is almost always cited by the attending physician as the primary cause of death.

Cardiovascular disease, diabetes, COPD . . . If influenza contributed in any way, it is rarely listed on the death certificate.
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The deaths we are hearing about attributed to the H1N1 virus are primarily those that occurred among people being treated for the flu in the hospital when they died.

And in many countries around the world, where medical care is marginal and surveillance is lacking, we probably don?t even hear about those cases.

None of this is to suggest that somehow we are failing to recognize a highly virulent virus.
​

While surveillance may not be perfect (and in some places it is practically non-existent), I believe we?d have picked up on any excessively high mortality rates by now.

The point is, the numbers we see are clearly just part of the elephant. I believe that the CDC and the WHO are already factoring in what they know they can?t see.

I also suspect they are probably pretty close to right when they call this virus `mild-to-moderate? in severity.


​

That could change of course, and will likely vary depending on what populations are being affected. Some regions of the world may see a much worse pandemic than others.

For now, it is too early to place much faith in the partial numbers we are getting. As the southern hemisphere gets deeper into their flu season, we may begin to get a better idea of this flu?s impact.

Until then, about all we can do is accept that we aren?t seeing the whole elephant, and plan accordingly.

 

[The Mountains Voice]

Re: AFD - Pandemic Stage Level News, Controversies

removed - decided not to pick fight