OK

Well, that's a loaded question, and the short answer is, we don't know yet. But here's a little that we do know about pandemics.

A pandemic is defined as: a new virus to which everybody is susceptible; the ability to readily spread from person to person; and the capability of causing significant disease in humans, said Dr. Jay Steinberg, an infectious disease specialist at Emory University Hospital Midtown in Atlanta. The new strain of swine flu meets only one of the criteria: novelty.

History indicates that flu pandemics tend to occur once every 20 years or so, so we're due for one, Steinberg said.

"I can say with 100 percent confidence that a pandemic of a new flu strain will spread in humans," he said. "What I can't say is when it will occur."

Point number one: this is a novel, never before seen virus. Humans do not have protection, though there may be some cross protection. So, that makes it dangerous and worth watching.

Point number two: we don't know anything about how easily this particular virus spreads from person to person. That's partly because we know more about the few US cases and less about the many Mexican cases.  We don't know how many reported suspected cases in Mexico are actually swine flu. Only a handful of cases in Mexico have been confirmed by US and Canadian laboratories. That still leaves us with worry, but not hard fact.

Point number three: that's about how much illness it causes. In the US, not much. For Mexico:

"Public health officials in Mexico began actively looking for cases of respiratory illness upon noticing that the seasonal peak of influenza extended into April, when cases usually decline in number," the medical alert said. "They found two outbreaks of illness -- one centered around Distrito Federal (Mexico City), involving about 120 cases with 13 deaths. The other is in San Luis Potosi, with 14 cases and four deaths."

Authorities also detected one death in Oaxaca, in the south, and two in Baja California Norte, near San Diego, California.

So what do the authorities say? They say this:

"Our concern has grown since yesterday in light of what we’ve learned since then," said Richard Besser, acting director of the CDC, said during a conference call today with reporters. "This is something we’re worried about and taking very seriously. We are moving quickly, being very aggressive in our approach."

and

"This has a sense of urgency about it," [William] Schaffner, chief of preventive medicine at Vanderbilt, said in a telephone interview today. "They are asking us who work in hospitals to go to our emergency rooms and our pediatric wards to gather specimens and start testing them."

But none of that means this will develop into a pandemic. It does mean we are closer now than at any time in recent memory (and it could still fizzle out. Remember, we still don't know a lot about Mexico's cases, the vast majority of which have not been analyzed.) So, as we follow the news, let's review our flu and pandemic prep advice. Here's the basics: avoidance.

  1. Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
  2. Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
  3. Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
  4. Clean your hands. Washing your hands often will help protect you from germs.
  5. Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
  6. Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

You can always add

  1. Don't travel to countries in the midst of a novel flu outbreak. (of course, the official CDC advice is go, but practice 1-6).

Here's a status note from Reuters:

The experts will not necessarily issue firm recommendations on Saturday. Once more details are clear about the virus and its risks, the emergency panel could recommend a change in the WHO's pandemic alert level -- currently at 3 on a scale of 1 to 6 -- or recommend travel advisories to control the flu's spread.

and from Bloomberg:

The World Health Organization is set to declare the deadly swine flu virus outbreak in Mexico and the U.S. a global concern, potentially prompting travel restrictions, said a person familiar with the matter.

An emergency committee of the WHO in Geneva will declare the outbreak "a public health event of international concern" in a 4 p.m. teleconference today, said the person, who spoke on condition of anonymity because the meeting is confidential. In response, WHO Director-General Margaret Chan may raise the level of pandemic alert, which could lead to travel restrictions aimed at curbing the disease's spread.

You can take a look at the CDC and WHO visualization of how pandemics develop and are classified. Take a look, just so you're more familiar with it, as it may come up in the weeks ahead (click for bigger version.)

Along the top are the WHO phases. We are currently in phase 3, and that corresponds with the Pandemic Alert Period. Skip the USG stages because they are not widely used. At the bottom, CDC has corresponding "intervals" for the graph, and they correspond to functional "what do I do and when" information about a potential pandemic. Moving from WHO phase 3 to 4 ("you are here") means moving from CDC interval "investigation" to "recognition". That's exactly where we are - investigation. But even so, should something untoward develop there'd be time do do some preparation before we moved into the "initiation" and the shit hits the fan "acceleration" interval, even if this goes sour some time in the near future.

However, moving from investigation to recognition (i.e., WHO phase 3 to 4, or movingt the right of the big red line) would trigger all sorts of changes and alarms and trip wires in pandemic plans developed by companies and countries, and that might have an effect on travel advisories. Some multinationals might call for ex-pats to return home, just as one example. Airlines and tourism might take an economic hit (that happened to Canada during the SARS epidemic in 2003, and Canadians are still sore at WHO for acting (in their view) too precipitously in issuing travel advisories.

All this is given to give you a flavor of the complex decision making that needs to go on. WHO will be meeting in emergency session to do just that, but it's not as easy as simply saying "be cautious", not when so many factors come into play. And for a look at school closures, I refer you to this previous post when we talked about exercises and seasonal cases in Hong Kong that closed their schools.

In the meantime, we'll be tracking it here, along with the rest of the country, and we'll update periodically as needed. And if you want to know what preparations you can take, go here. It's a site we set up with Idaho's Emergency management team exactly for that reason. Or download this flu prep manual. We put it there so you could. This is an excellent opportunity to think about the unthinkable. And if nothing develops, you'll be better prepped for the next natural disaster that does happen.

Originally posted to Daily Kos on Sat Apr 25, 2009 at 07:29 AM PDT.

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