On Saturday, we posted on the WHO phases and the chart that was likely to change. As a reminder:
Before today:
Today:
On the advice of the Committee, the WHO Director-General decided on the following.
The Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4.
The change to a higher phase of pandemic alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.
As further information becomes available, WHO may decide to either revert to phase 3 or raise the level of alert to another phase.
This decision was based primarily on epidemiological data demonstrating human-to-human transmission and the ability of the virus to cause community-level outbreaks.
Given the widespread presence of the virus, the Director-General considered that containment of the outbreak is not feasible. The current focus should be on mitigation measures.
The Director-General recommended not to close borders and not to restrict international travel. It was considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention.
After today:
So that little line moves right, and we are now in the "recognition" interval on the bottom. There's a confirmed human outbreak overseas (several, actually - US, Canada, Spain and Mexico). And to clarify things further, WHO has redefined what their phases mean:
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause "community-level outbreaks." The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion. [my bold]
Note that last bit I bolded. Will we continue to move right? Will it go all the way to Phase 6? We don't know. We don't know if it's a Mexican or a US-style outbreak (the US version at this time is very mild.) We'd love to know why the Mexican numbers are so much worse, but we are going to have to wait on that and accept some uncertainty.
CDC says nonetheless, that we have both individual and community responsibility. Dr. Richard Besser, Acting CDC Director asks:
What would I do if my child′s school were closed?
What would I do for child care?
Would I be able to work from home?
It′s time to think about that so that you′re ready in the event that there were a case in your child′s school. It′s time for businesses to review their plans and think about what would I do if some of my workers couldn′t come to work? How would my business function? Think about that.
We can think about that (actually, we have been thinking about it for years.) CDC is thinking about it - they're outlining when schools should close (NYC did the right thing in Queens). We can anticipate that there will be more cases in the US, the first case in your state if you've had none so far, and if it's a child or adolescent, schools may need to close on a local basis on the advice of state and local public health. 14 schools have closed in Texas. Your state and local folks are wresting with this just like Mike Bloomberg did. This is to be expected, is supposed to happen, and should not change the perception of what we are seeing. We'll undoubtedly hear about new cases tomorrow, and the next day, and in new places. That's what flu does. That's why we are following it.
This virus may be a lengthy issue for us, not a three day story. It may be a fizzle, it may be a slow burn. It's got "pandemic potential". But the attention of every planner and emergency manager has now been focused by the change in WHO phase. It doesn't matter what you call it, we are now in the "recognition" phase... of something.
The best place for information you can rely on is CDC and your state and local public health department. Yeah, you should have funded them better, and you'll have the opportunity to do so in future. For now, treat them like the professionals they are and check back with them frequently in this evolving situation.
