What's the latest with the swine flu H1N1 virus? Here's a few stories that talk to people like they are grown-ups. From Effect Measure:
The unpredictability of flu and difficulty of making any predictions with
confidence is tiring to repeat and tiresome to listen to. Unfortunately that doesn't make it any less true. There are things we know -- because we see them happening -- and things we don't know -- because the information isn't available (like an accurate estimate of CFR or prevalence) or they have yet to happen.
What we know is that we are confronted with a new influenza virus that is spreading with ease outside of its normal season, is infecting an age group that normally doesn't get easily infected (the 5 - 24 year olds), and is causing most of its serious illness and deaths in that same age group. In North America it is now the only significant circulating flu virus, present in all 50 states. WHO's Dr. Keiji Fukuda (WHO presser .mp3) said yesterday that preliminary data from Chile, in the southern hemisphere, suggests it has similarly displaced the usual seasonal flu strains there. 64 countries have now reported over 17,000 cases and there is no doubt this virus is now a pandemic strain, whatever WHO chooses to call it. So that's what we know, because it is happening and we can see it.
Only WHO's Director-General can declare a pandemic, but that seems to be not far off. From ScienceInsider:
Here Comes Swine Flu Phase 6, Severity 1
With a few countries in the Southern Hemisphere reporting a dramatic jump in swine flu cases, the World Health Organization is inching closer to declaring a full-scale, phase 6 pandemic. But WHO, acknowledging that its phasing system needs fine-tuning as it relies only on geographic spread of the novel H1N1 virus, soon plans to institute a severity index to make its warning system more useful to member countries. WHO also wants to provide more tailored guidance to individual countries to help them respond appropriately.
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In fact, Bloomberg reports that the formal designation is just days away.
Swine flu, becoming entrenched in Australia and Chile, will prompt the World Health Organization to declare the first influenza pandemic in 41 years, said three people familiar with the agency’s plans.
Margaret Chan, the WHO’s director-general, will make the announcement sometime in the next 10 days, said the people, who spoke on condition of anonymity because the deliberations are private. The agency, having spent the past five years alerting the world to the dangers of a pandemic, is now looking for a way to declare one without causing panic.
Of course, the only people panicking are cable TV. The rest of us are taking in this story and digesting it over the last month (the advantage of talking about it is that it becomes routine), or simply dealing with flu, and getting prepared to wash our hands and cover our coughs all summer. And since it seems to have started in North America, the WHO designation doesn't make a lot of difference now to the US. Overseas, governments are finicky about being the country to cause the phase change, as if it's somehow their fault that flu spreads like, well, flu.
Australia: Victoria 'losing control' of swine flu spread
United Kingdom: Swine flu: how it has spread through the UK
Japan: Japan Flocks to Ostrich Masks to Help Fight Swine Flu Paranoia
By the way, Southeast Asian countries wear masks readily in public. For the latest on masks and other interim guidance, see CDC and your local health department.
We're in phase 5 now, and the "new" addition to the mix is the idea of separating phase 6 into severity stages, much as the Feds have already done for the US. Swine flu (H1N1 2009) looks like a cat 1 pandemic, based on current severity reports.
For an example of what a category 1/severity 1 pandemic looks like, here's a recent update from NYC:
Illness from H1N1 influenza continues to occur throughout New York City, with most people experiencing only mild illness. Emergency room visits have declined somewhat after spiking dramatically during the third week of May. As anticipated, however, the infections have caused hospitalizations and deaths. More than 300 New Yorkers have been hospitalized with H1N1 flu since late April, and the Health Department today provided the first detailed breakdown of risk factors among those hospitalized. A preliminary analysis of 152 hospitalized patients shows that at least 82% have belonged to one or more groups at higher risk of severe illness or complications from influenza. Those at higher risk of flu complications include:
- People who are over 65, under age 2, or pregnant
- People with chronic lung problems, such as asthma or emphysema
- People with chronic heart, kidney, liver or blood disorders
- People with neurological disorders that can cause breathing problems
- People with diabetes
- People whose immune systems are weakened due to illness or medication
- People under 18 years who are on long-term aspirin therapy
As for the fall, GAO says:
The recent outbreak of the H1N1 influenza virus should serve as a powerful reminder that the threat of a pandemic influenza, which seemed to fade from public awareness in recent years, never really disappeared. While federal agencies have taken action on 13 of GAO’s 23 recommendations, 10 of the recommendations that GAO has made over the past 3 years are still not fully implemented. With the possibility that the H1N1 virus could return in a more virulent form in a second wave in the fall or winter, the administration and federal agencies should turn their attention to filling in the planning and preparedness gaps GAO’s work has pointed out.
Want to see what a second wave in fall looks like? The European CDC (ECDC) has some great teaching material here. 1918 is a graph of deaths from the pandemic that year, whereas 1968 is a graph of influenza-like illness visits to GPs in the last pandemic the world has seen:
While we are not guaranteed a second wave this fall, every flu expert warns that we might see one (we're back to that uncertainty - every recent pandemic has had a second wave, but every pandemic is different.)
Be prepared for the Phase 6 announcement next week. And give some thought to what would happen if, this fall, schools closed in your area. Are you prepared for what that means? Now's the time to shore that up if you are not. And as far as following this story, a pandemic, even a mild one, is a worldwide health event that will hit developing countries hardest, but will affect all of us as well. Ignoring it is the height of irresponsibility. So, while the usual grouches might claim "this is all hype", do yourself a favor and realize that a little preparation in advance goes a long way.
