Pandemic Plan

WHO assesses the severity of a flu pandemic

The World Health Organization today released a discussion titled "Assessing the severity of an influenza pandemic." For those of you who've been following the flu pandemic threat - and preparing, accordingly - this document is mostly old information. But if you're new to the topic, pay close attention; it summarizes numerous key concepts.

One principle of special importance: Even a pandemic virus that initially causes mild symptoms in otherwise healthy people can be disruptive, especially under the conditions of today's highly mobile and closely interdependent societies. Having large numbers of people sick at the same time is one reason why pandemics are socially and economically disruptive. In particular, it has the potential to temporarily overburden health services.

We're in a pre-pandemic phase

The following comes from a Computerworld article (January 08, 2007) about the need for pandemic planning within information technology (IT) departments:

"The probability of a pandemic outbreak is [100%]," says Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis. It's just a matter of when, he says.

The World Health Organization has already issued a pandemic alert for the deadly H5N1 virus, although at this point, the virus still isn't able to spread directly between humans. "What we need to do," says Osterholm, "is emphasize to these companies that, unlike many events [such as tornadoes and earthquakes] that may never happen to a company, this is one that will."

Now vs. 1918: Looking beyond the obvious

A couple of days ago, I noted that some people believe we're much better equipped to deal with a pandemic today than we were in 1918. Some even think a severe 1918-scale pandemic is not possible. I think it's dangerous to make that blanket statement. In fact, some of today's conditions may put us at a disadvantage.

Those who think a severe pandemic can't happen again happily note that we have much better medical knowledge and resources than in 1918. It's been pointed out, however, that it doesn't matter if we have modern medical tools, if we can't deliver enough of them when and where needed. A pandemic will cause a surge in the need for health care. But our "surge capacity" is limited.

As I wrote last month, sickness-related issues - like avoiding sickness, treating the sick, and coping with an overloaded health care system - deal with the most direct consequences of a pandemic. We don't want to make the mistake of just thinking about the direct effects of a pandemic - those which are more readily visible. Rather, we need to look downstream at the relatively hidden indirect effects - the ripples, the domino effects.

Junk science or Junk opinion?

There are differing opinions about whether future flu pandemics can be as severe as the 1918-19 pandemic. And as with religion or politics, some of those opinions come from shallow thinkers while other opinions come from more thorough thinkers.

Yesterday, I talked about the little cluster of reasons given for why "we will never see another 1918." The people who hold this view contend that "flu fearmongers" make misleading or false claims about the possibility of a severe pandemic. And these naysayers give reasons (motives) why fearmongers want you to believe a severe pandemic is possible. ("Flu fearmongers," you realize, would include the World Health Organization, the U.S. Centers for Disease Control and Prevention, national and local governments worldwide, leading virologists, veterinarians, and other experienced medical professionals, etc.) Yesterday, I discussed why I think the naysayers' explanations are poorly thought out.

(Bear in mind, the issue is not whether a pandemic will occur. Health experts are confident pandemics will continue to happen. The question is how severe future pandemics will be. Could they be like 1918?)

You're right, it's not 1918. Is that good or bad?

I know this is long. But it's needed.
I've provided a Summary.
But I encourage you to read the entire post.
I'm trying to help you Think It Through.

	Summary
	Can future flu pandemics be as severe as the 1918-19 Spanish Flu pandemic? Some people say "No, we will never see another 1918" because: Medical knowledge and tools are vastly improved. Crowded, unsanitary conditions in 1918 made it easier for the flu to spread. While those statements are true on their face and seem reassuring, they overlook three critical factors: The difficulty of ordinary systems to cope with extraordinary demands. Capacities can be exceeded quickly. Many ordinary systems have become far, far more complex and intertwined. Some factors in our modern world would pose new, complicating challenges during a pandemic. To illustrate, consider: Insufficient "surge capacity." We know how to make medicines and medical supplies, but we can't make enough in a reasonable time frame. Vaccines would have to be rationed during a pandemic, for example. Supply and distribution chains are global and long. This post and others that follow discuss the false security offered by many "pandemic naysayers."

Study says 1918-like pandemic could kill 51-81 million

The Lancet, the prestigious British medical journal, has published new research which attempts to estimate the mortality if a 1918-category pandemic occurred today.

According to the report, this study was unlike earlier theoretical models which made strong assumptions about attack rates and case-fatality rates among influenza cases. Instead, these researchers sought to conduct quantitative analyses based on actual vital registration data gathered during the 1918-20 pandemic.

Drs. Webster & Govorkova: "it would be prudent to develop robust plans"

The New England Journal of Medicine (NEJM) yesterday published a commentary by Drs. Robert Webster and Elena Govorkova of St. Jude Children's Research Hospital (Memphis, TN). (Thanks to NEJM for making this and two related articles freely available. Journals are not always so minded.)

Drs. Webster and Govorkova open by saying:

There is no question that there will be another influenza pandemic someday. We simply don't know when it will occur or whether it will be caused by the H5N1 avian influenza virus. But given the number of cases of H5N1 influenza that have occurred in humans to date (251 as of late September 2006) and the rate of death of more than 50%, it would be prudent to develop robust plans for dealing with such a pandemic.

In a pandemic, sickness is just part of the problem

Let me be blunt.

If you think pandemic planning is all about how to keep from getting sick, you're missing the point. Well, you're getting part of it; but you're missing two of the three possible dimensions of a pandemic's impact.

We don't want to make the mistake of just seeing the direct effects of a pandemic - those which are more readily visible. Rather, we also need to look downstream at the relatively hidden effects - the ripples, the domino effects. Or, if you will, the "complications."

So let's "Think It Through," shall we?

My outlook on the chances of a flu pandemic

Some of you wonder what I think are the chances of a flu pandemic occurring in the foreseeable future.

Before giving you my opinion, let me give a caveat or two.

I'm no scientist or medical professional. I'm just a liberal arts guy who's been studying bird flu for more than a year and publishing a "citizen journalist" blog. So my comments represent one man's unexpert, limited knowledge. Take this for what it's worth.

"Low probability" does not mean "never happens"

A major flu pandemic is a "low probability, high impact" event. Such an event is unlikely. But if it happens, it's awful.

Here's how Dr. Jeremy Farrar at The Hospital for Tropical Diseases in Ho Chi Minh City expressed it (International Herald Tribune, March 27, 2006):

"I think you have to say we really don't know the odds of pandemic, and people are not comfortable with that," Farrar said. "It could fizzle out and kill 98 people - one more than the number dead today. Or it could be something like 200 million.

"It's terrifying if it happens, but it is very, very unlikely, I think - and it is difficult to balance those facts."

In other words, it's a risk which has low probability ("very, very unlikely") and high impact ("terrifying if it happens").