Pandemic Plan

The obvious becomes official: WHO declares Phase 6 flu pandemic

Based on mounting evidence, the World Health Organization today declared that "the scientific criteria for an influenza pandemic have been met" and raised the pandemic alert level from Phase 5 to Phase 6. As WHO Director-General Dr. Margaret Chan stated, "The world is now at the start of the 2009 influenza pandemic."

Actually, it likely will end up being the 2009-2010 pandemic or the 2009-2011 pandemic, because historically that's how long pandemics last. Spreading across the globe in multiple waves usually. (Indeed, Dr. Chan today cautioned, "Countries where outbreaks appear to have peaked should prepare for a second wave of infection.")

Dr. Chan's prepared statement to the press was pretty concise and paints the picture as well as the experts can see it for now. So, I'm reproducing her statement in full below.

However, if you don't want to read it all, I've summarized these highlights:

* This particular influenza A H1N1 strain is entirely new and spreads easily from one person to another.

* Nearly 30,000 cases have been confirmed in 74 countries. [Those are just laboratory-confirmed cases. Actual case count may be in the hundreds of thousands. -Chirp]

* "The virus writes the rules" and the situation "can change very quickly."

* At least initially, the pandemic is expected to be of moderate severity, although that can vary from place to place.

* Thusfar, the overwhelming majority of patients have mild symptoms.

* This H1N1 virus prefers young people. In major outbreaks, most cases have been under the age of 25. Most severe and fatal cases have been in ages 30 to 50. (This is unlike typical seasonal flu, where most fatalities are elderly.)

* Many cases have occurred in people with underlying chronic conditions. HOWEVER, "one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people."

* Pregnant women are at increased risk of complications.

* We do not yet know how this virus will behave under conditions typically found in the developing world. Unlike the "moderate" severity in well-off countries, "it is prudent to anticipate a bleaker picture as the virus spreads" to less-developed countries.

* A characteristic of pandemics is their rapid spread to all parts of the world. "Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection."

* Vaccine manufacturers will soon finish production of vaccine for seasonal flu and will then have full capacity available to produce pandemic vaccine. [Caution: Don't overly rely on pharmaceutical solutions. The vaccine may not be ready to begin production for weeks/months. Even then, production is limited, given a world population of 6.7 billion. Initially, vaccine will be allocated to people in critical roles/conditions. There will be no vaccine for many, especially in developing countries. -Chirp]

* Until vaccine is available, use non-pharmaceutical interventions for some protection.

* WHO recommends no restrictions on travel and no border closures.

* "Influenza pandemics ... are remarkable events because of the almost universal susceptibility of the world's population to infection. We are all in this together, and we will all get through this, together."

WHO very close to declaring the obvious - a pandemic is underway

From the excellent journalistic pen of Helen Branswell (Canadian Press) today, about the pending declaration of a flu pandemic, the politics that has delayed the announcement, and the view that the pandemic initially will be considered "moderate," not "mild":

The World Health Organization is very close to declaring the first influenza pandemic since 1968, the agency's senior influenza expert suggested Tuesday.

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.

European officials extend shelf life of Tamiflu

According to a report in the UK-based Manufacturing Chemist, the European Medicines Agency (EMEA) has extended its authorization for using the antiviral drug Tamiflu, as swine flu continues to spread. The EMEA...

...has recommended that the shelf life of Tamiflu capsules be extended from five to seven years. This will formally apply to newly manufactured Tamiflu capsules and EMEA has also recommended that capsules already on sale be sold for two years beyond their current five-year expiry date, should the World Health Organisation (WHO) declare a pandemic [which could happen any day -Chirp]. Also, in such circumstances, EMEA said patients who have Tamiflu capsules that have recently expired should not dispose of them.

The agency has also advised that after a WHO pandemic declaration, Tamiflu should be used to treat babies under one-year-old plus pregnant or breast-feeding women, sweeping away earlier official cautions.

WHO's Chan addresses Exec Bd of World Food Program

In an opening address today at the Annual Session of the Executive Board of the World Food Program, Dr. Margaret Chan, the Director-General of the World Health Organization, included these comments concerning the imminent flu pandemic and its impact on less-developed countries:

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.

Peter Sandman on "Antipathy to masks"

From a June 4 update to his ongoing commentary on the unfolding flu pandemic, risk communications consultant Peter Sandman talks about the probable value of surgical masks (and N95 respirators) during flu outbreaks and the illogical advice from most public officials about mask use:

Sources say WHO will declare a pandemic within 10 days

Sources tell Bloomberg News that the World Health Organization (WHO) will declare a pandemic (Phase 6) within the next 10 days. The WHO is worried the move could cause unnecessary panic. Technically, a flu pandemic isn't defined by its severity, but by its geographic spread. The challenge is how to explain that the new H1N1 swine flu is now global, but not severe. Solution: WHO is considering adding a 3-point severity scale to the Phase 6 geographic definition.

There's so much we don't know about H1N1 swine flu

The Effect Measure public health blog has a good summary about what we know and don't know about the novel H1N1 swine flu. As with flu, in general, there's a lot we don't know.

We know what we see happening. We don't know what hasn't happened or what we don't have information on (like an accurate estimate of CFR or prevalence).

Dr. Henry Niman says dominant spread of H1N1 indicates pandemic

Dr. Henry Niman says CDC surveillance shows H1N1 swine flu continues rising in the U.S. as seasonal flu declines - now showing a "swine flu-to-seasonal flu" ratio of 10-to-1.

He says the current increase in H1N1 swine flu in the U.S. has been masked to varying degrees by reporting protocols. Additional H1N1 swine flu testing is finding more community transmission and "will clearly demonstrate that the pandemic is at phase 6."

Dr. Niman founded Recombinomics, Inc. and specializes in the study of how viruses rapidly evolve. Recombinomics offers consulting on viral evolution and consequences.

By building your inventory, you're part of the solution

Do this - If you like peanut butter, buy a jar of peanut butter every week for the next 10 weeks. Mark each jar with the date you bought it. The next time you need peanut butter, use the first/oldest of these jars - and buy a replacement jar (and date it).

So what do we have here? We have a 10-jar supply/stockpile of a long-shelf-life food staple - in perpetuity. If you continue the process of "use the oldest and replace with another" (manufacturers and accountants call this "first in, first out" or FIFO), you will always have a 10-jar supply of peanut butter. Always. It never gets stale, having to be thrown away. You waste no money. You just buy in advance. It's as if you put part of your grocer's inventory in your pantry.

CDC recommendations for N95 respirators and facemasks

The U.S. Centers for Disease Control and Prevention (CDC) has revised its recommendations for the use of respirators and facemasks to reduce the community spread of the H1N1 Swine flu.

Although N95 respirators and surgical facemasks are not guaranteed to prevent you from catching the flu, both can provide protection.