Posts Tagged ‘pandemic’

Overreacting to H1N1: WHO and China Try to Banish Ghosts

Tuesday, June 30th, 2009 by Mike Hartung

chinah1n1With the benefit of a few weeks of perspective on the H1N1 outbreak, it’s possible to conclude that the some of the initial response qualifies as overreaction. Let’s start with the World Health Organization’s declaration of a pandemic. Observers such as Michael Fumento have argued that the WHO adopted a “pandemic” definition that is skewed toward human transmission of animal viruses even if the transmission rate and virulence are modest compared to seasonal human flu viruses. Fumento suggests that the WHO declared a swine flu pandemic in part to justify the expenses incurred at the WHO’s behest over the past five years to ready the world for an avian flu outbreak that is still  confined to people living in close proximity to infected barnyard fowl. We may be readier than ever, but is the WHO risking its credibility in an attempt to justify our readiness?

Similarly, China, haunted by its slow and clumsy handling of the SARS outbreak a few years back, is now using a heavy hand with international visitors suspected of carrying H1N1. The U.S. State Department has issued a travel alert citing China’s quarantine measures as posing unwarranted risks. Even slightly elevated body temperatures (as measured by remote sensing devices) have resulted in airline passengers being placed in quarantine under conditions where suitable drinking water, food and sanitation are wanting. Children have reportedly been separated from parents and communication has broken down between members of families’ travel parties. This “get tough” approach appears to be clearly out of proportion to the risks posed by H1N1 and can be traced to a desire to banish the ghost of SARS past.

As the H1N1 story continues to unfold, we hope that major players like the WHO and China find a more proportional response. Overreacting can compromise the credibility of worldwide efforts to keep us safe and produce unnecessary risks as well. Look for future posts that strive to put travel health risks into perspective.

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H1N1 Flu: What We’ve Learned So Far

Tuesday, May 5th, 2009 by Frank Gillingham, MD

h1n1strain

As the evidence mounts that the H1N1 virus is beginning to stall out at as a “near pandemic” (currently WHO Level 5), what have we learned so far? First, although intense media coverage has sparked the sales of face masks and engendered a great deal of anxiety, CDC and WHO officials and the federal government have managed the outbreak with steady hands and cool heads (VP Biden excepted), resisting calls for borders to be closed; Containment is not feasible in a world so tightly knit by trade and travel patterns. As a prime example of how interdependent we have become, the New York Times noted that the base ingredient for the antiviral drug Tamiflu, shikimic acid, is manufactured mainly in China. Sealing our borders could leave us defenseless against H1N1.

Second, geneticists, who are sequencing H1N1 and posting the results on the Internet are beginning to conclude that the virus in its current form spreads barely well enough to keep itself going.  The transmissibility appears to be no speedier than ordinary flu which kills 36,000 annually in the U.S. and an estimated 250,000 – 500,000 worldwide.

Third, the story is not over. H1N1 may yet adapt to people in a dangerous way, which means that next winter we may be in for an unpleasant surprise. The virus, which so far has resulted mostly in mild illness, may have a much more devastating effect next flu season, which runs each year from November until March.  The good news is that scientists should have ample time to create a vaccine for this new H1N1 strain before next October, as vaccines typically take 3-4 months to develop.  It is likely that the WHO will recommend inoculation concurrent with the annual flu vaccination.

While we watch and wait, we should recognize that the term “pandemic” only describes how widely an infectious agent is distributed, not how severely it affects the population.  Unless we see a dramatic change in the next few days, it looks as though the current H1N1 virus will be manageable, at least for the next few months, as it takes up residence in the realm of human antagonists.

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Before You Say “Pandemic”, Consider the Source

Wednesday, April 29th, 2009 by Frank Gillingham, MD
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World Health Organization

As quickly as swine flu is popping up around the globe, “news” about swine flu is being consumed at an even faster pace.  If you ever played Whisper Down the Lane, you know that information often changes as it passes from person to person. With the advent of social networks such as Twitter, basic facts can morph into panicky fiction as quickly as a text message is transmitted.

It is at times like these that we need to carefully search out credible sources of information. Let’s take a moment to look at two authoritative sources of international health news and the arbiters of the term “pandemic”: the United Nations World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC).

In an effort to provide meaningful and consistent characterization of flu outbreaks, both the WHO and the CDC have formulated rating systems.  The WHO rates the severity of an outbreak of a new contagion using a six-phase system ranging from no-risk (Level 1) to pandemic (Level 6):

1.       No animal virus has caused human infection

2.       An animal influenza virus has caused at least one human to become ill

3.       An animal influenza virus has caused sporadic cases or small clusters of people to become ill, but there is no sustained human to human transmission (current level of avian or “bird’ flu worldwide)

4.       Verified human-to-human transmission of enough volume to cause community level  outbreaks (such as the swine flu outbreak at the school in Queens, New York)

5.       Human-to-human spread into at least two countries in close proximity without a known host travelling from one country to another (Tourists who return home from Mexico and become ill do not meet this test)

6.      Community level outbreaks on at least two continents (Pandemic)

Don’t even try to “tweet” this important information on Twitter.

Once a pandemic has been declared by the WHO, the CDC uses a “Pandemic  Severity Index” to rate flu outbreaks based on the number of anticipated deaths.  Category 1 outbreaks have an expected death toll limited to less than 90,000, while category 5 puts the number at almost 2 million.  The CDC developed this system in response to the Avian Flu threat in 2007 in order to standardize the level  response taken by  public health agencies around the U.S. and the world. 

Word is just in that the WHO has raised its pandemic alert to Level 5. Let’s keep the WHO criteria firmly in mind as the contagion spreads. There are 36,000 deaths in the U.S. each year from flu complications, and we have a long way to go to reach Category 2.

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Swine Flu Outbreak: More Answers Needed

Tuesday, April 28th, 2009 by Frank Gillingham, MD

swineflumexico428Not since the panic of 1976, when a Fort Dix, New Jersey soldier died and four of his fellow recruits became ill, has there been such attention paid to swine flu.  The 1976 “outbreak” triggered a massive effort from the US government to immunize the entire population. The pandemic never materialized despite only 24 per cent of the population receiving the vaccine, and some criticized our government for making much ado about nothing.  Moreover, there were over 500 cases of Guillain Barre Syndrome attributed directly to the vaccination.  Are we currently heading down the same path, or is there good reason to be concerned about an emerging epidemic?

Each year, anywhere from 250,000 to 500,000 people die worldwide as a result of influenza. So what is so different about the swine flu? In 1976, scientists were very concerned because the swine flu isolated from the Fort Dix soldiers closely resembled the flu strain responsible for the pandemic of 1918 that killed countless victims worldwide. Unlike the human influenza A strains that circulate each year, and for which the World Health Organization develops annual vaccines, the swine flu’s primary host is the pig, and is an unknown entity without a “track record” of virulence. As such, epidemiologists do not know what to expect. Generally speaking, new flu viruses are harder for the immune system to defend against, so they can reproduce rapidly and overwhelm the body’s defenses. Ironically, the body can even overreact to a new virus- the so called “cytokine storm”- which may lead to grave illness or death.

The seriousness of the current swine flu from Mexico has yet to be determined.  Several dozen cases have been reported in five states over the past few days, but no one is yet critically ill.  On the other hand, there are already over 140 deaths reported in Mexico from (presumably) the same strain.   History does not help us. In 2007, there was a little publicized outbreak of swine flu in the Philippines that resulted only in mild illness. There were also about a dozen cases of swine flu reported in the United States between 2005 and 2009 – none of them lethal.

A pandemic has three features- the ability to spread rapidly among humans, the ability to cause serious illness in a high percentage of those infected, and novelty in the world of flu viruses.  So far, the Mexican swine flu has proven to only have one of these features- it is a strain not previously identified. We will be watching (and posting) as this story unfolds.

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