Does WHO Need to Declare Flu a Full Pandemic?

Reuters reports that the WHO is in a bind: H1N1 continues to spread, and qualifies as a pandemic because it's "spreading freely in two regions of the world." But infections are mild, and people don't want to hear about it anymore.

With most people breathing easier about H1N1 flu, the World Health Organization finds itself in a bind about how to respond to the continuing spread of the virus whose effects have proved mainly mild.

The United Nations agency's guidelines state that as soon as the virus starts spreading freely in two regions of the world, its six-point pandemic alert should be raised to the top notch.

With infection numbers rising in Europe, public health experts are struggling to decide whether it is worth sounding the full alarm over H1N1, which is treatable with existing drugs and appears less severe than seasonal flu in most cases.

Source: Reuters. Does WHO need to declare flu a full pandemic? Reuters

The focus is now on the Southern Hemisphere as it enters its winter flu season. Whether or not a lethal pandemic strain emerges in the next 3-6 months will depend on how H1N1 moves and evolves in the world's Southern climes. There's no guarantee either way.

However, mild or not, the current strain is pandemic by the rules. People should know, and be officially informed.

Fukadu said the other day at a WHO conference they were looking for more evidence of sustained H2H in the "wider community". Cases so far are connected to "institutions" (schools I guess) and people connected to the sick person. They want to see it is popping up in the community at large before going to phase 6. I guess they are also waiting on more test results to determine the extent of H2H.

I honestly don't know what 'officially informed' would do for anyone. People know about it, know the effects, how to help prevent it, and how prolifant it is. I'm really not sure that any further 'alerts' are going to make people more prepared or more knowledagle.

I do know that many around these parts would loooove a level 6 just because it's a full pandemic at that point, and they can nuts with new conspiracy theories. Still a bit baffled by some people love a disaster.

But really, what will level 6 achieve, other than to panic people?

Originally posted by fleabit

But really, what will level 6 achieve, other than to panic people?

It would honestly reflect the WHO's system: once a flu is "spreading freely in two regions of the world" it qualifies as a pandemic. It also clarifies that a "second wave" is more likely - allowing naysayers the opportunity to educate themselves and prepare.

cosmicpixie - thanks for your comments and info.

Cases so far are connected to "institutions" (schools I guess) and people connected to the sick person. They want to see it is popping up in the community at large before going to phase 6.

Is this still the case - or are there more community cases now??? Also, do you think it really matters if cases are clustered like that? (Ie., Seems to mean it's less virulent and easily spread???)

It would honestly reflect the WHO's system: once a flu is "spreading freely in two regions of the world" it qualifies as a pandemic. It also clarifies that a "second wave" is more likely - allowing naysayers the opportunity to educate themselves and prepare.

Well, it might accurately reflect their scale, but it wouldn't signal a second wave at all, there is nothing in alert level 6 that indicates a second wave is even being considered.

Considering how panicky a level 5 made everyone, I'm not certain a level 6 is in anyone's best interest. If there is news regarding a second wave, that should go out as an urgent and separate message to the public. I think the may have stuck with their rating scale, had not the media completely blown this out of proportion.

Three Japanese people, who had recently travelled to Canada have been confirmed seopositive for H1N1 (A). They were NOT in Mexico. I think we'll see a WHO Level 6 in a day or so.

news.xinhuanet.com...

Originally posted by CultureD
I think we'll see a WHO Level 6 in a day or so.

news.xinhuanet.com...

Hmmm. We should have seen one a while ago. BUT - the WHO is using every inch of wiggle room they've got because a level 6 will stop trade and travel. ...And guess where the money comes from to pay their salaries?

That's pretty shallow, to assume that they won't declare a higher level alert because they fear they won't get paid due to trade being affected. How ludicrous. But then, people can't wait to tear up ANY official body, some people live for that I guess. Makes them feel big.

It could simply be that while it might meet their 'official' criteria, it isn't near severe enough to have them risk panic. And just see how people flooded hospitals, and how ridiculous people get on this site, to see how panicky people can get.

reply to post by soficrow


Soficrow-
You're correct (as everl!!!)

I know there is money to be made- and a level 6 would COST money- my feeling is that everyone knows this was level 6 a while ago- but to initiate that would mean ciruclating troops out of Iraq and Af., as the US has too few Nat'l Guard here to enforce quarantines, etc. So instead, "they'll" keep writing scripts, report only deaths, not those who've contracted the virus, and wait until a vaccine is made, to force upon us in the fall ( BBC reports the UK has the sequenced virus; it matches the Mexico strain, and they expect a vaccine by autumn). Seems all in charge are waiting for the burn this fall, and are doing their level best to prevent Level 6 until they have the boosted pharma economics, a cowed population, and a new re-assortment to get all the lemmings to report for their vaccine.
In re-reading this I sound paranoid- but I think it's a fairly accurate conclusion- thoughts?

reply to post by fleabit


Fleabit-

No matter how level-headed this all seems to be in your opinion- which I respect, though I disagree with you, respectfully, a Level 6 designation by the WHO criteria has already been met:

www.who.int...

This page shows a model for H5N1 outbreaks, but is applicable to any and all pandemic situations.

Specifically, from who.int:

"Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way."

The fact that Japan now has over 5 cases, amongst people who travelled to Canada, not Mexico, and the fact that cases are spreading between spouses, parents and children, schools and day-care centers, all point to community transmission outside the initial outbreak. We've been Level 6 for at least 2 weeks- but countries (I believe) are saving that designation until the autumn, when troops are home to enforce it, and the economies have rebounded enough to sustain at least a quasi-martial environment, with quarantine, etc.

Originally posted by CultureD

I know there is money to be made- and a level 6 would COST money- my feeling is that everyone knows this was level 6 a while ago-

Agreed - level 6 a while ago. But the designation would cost big time - stocks would be hit hard, and on top of the global financial crisis, it would trigger a deep, deep depression.

instead, "they'll" keep writing scripts, report only deaths, not those who've contracted the virus,

Reports say most places are testing ONLY those sick enough to be hospitalized. The old trick - don't test, don't know.

Seems all in charge are waiting for the burn this fall,

Yup. They don't want to panic the masses. But it looks bad.

and are doing their level best to prevent Level 6 until they have the boosted pharma economics, a cowed population, and a new re-assortment to get all the lemmings to report for their vaccine.
In re-reading this I sound paranoid- but I think it's a fairly accurate conclusion- thoughts?

Paranoid but accurate. ...I think the decision was made long ago to allow this pandemic to evolve and proceed. The choice was human depopulation versus rethink/revamp the entire economic system. A no-brainer from the business perspective.

Does mostly mild mean - nobody is dying in the streets? No blood running out of visible, or unpleasant orfices at inconvenient moments?

You have a flu with a known kill rate that is CONSERVATIVELY 4%, proven, in a developing nation.

The 1918 flu qualified as a level 5 pandemic.

Further, it is a pandemic NOW. It doesn't need to be a level 6 to be a pandemic.

FURTHER than that, in truly economicly-rich-nation narcissim you are under the impression that since it isn't killing more than a few people HERE yet then it doesn't count as a pandemic. You know, it only hits pandemic status if it starts killing the peoples of the richest nations on the planet. No narcissitic bias in THAT at all.



[edit on 2009/5/11 by Aeons]

[edit on 2009/5/11 by Aeons]

reply to post by soficrow


Soficrow and cosmicpixie-

Here in Illinois, school closings due to positive tests of students or teachers have been suspended, as some quarter million parents cannot "take off work to look after their children". So, once more, economy triumphs over common sense. I'm not a parent, but an aunt, and if my little ones were attending a school with confirmed cases that DIDN'T close, I'd be more than happy to risk my job over the health of my family.
I think this is an example, as well, of trying to "prove" other methods of "community" dissemination. If schools stay open and others don't take ill, the CDC and WHO have an excuse to stay at 5- according to the semantics of their criteria.
On the other side of the coin, on this forum, in the MSM and according to the reporting agencies, families are infecting one another, people are taking ill at malls or theaters, etc. So there is no justification, in my mind, NOT to declare a Level 6. It's obvious to anyone but the most oblivious or obtuse observer that we are IN a pandemic. Millions needn't die to prove it. As I've said (and bored you, most likely), WHO is saving Level 6 for the autumn, when troops are back, martial law might be implemented if required, and a hastily made vaccine will be available to those who march dutifully to the clinic to receive it. Certainly in the US we are nowhere NEAR ready for that scenario- financially, or in regards to meds or manpower.
If someone attempts forced vaccinations, however, I can only say I am glad I learned how to aim a pistol......

reply to post by Aeons


WELL said, Aeons.

We all sat and watched as a developing country (Mexico) tried desperately to get its citizens to hospital, and what- 2 weeks into their outbreak, we release antivirals from the National Security "reserve"? disgusting- not just narcissistic but racist. As soon as the US, UK, the EU starts dropping, Geneve will go Level 6 and Novartis and Roche will be heroes!!!!!!!!
Your analysis was spot on. I don't know how to give you stars yet (newb) but a thumbs up at least, until I figure it all out.

We are at a Level 6 Pandemic Alert, according to the terms established by the WHO.

The World Health Organization has confirmed at least 8480 human cases of swine flu in nearly 40 countries, mostly in the US and Mexico, including 72 deaths.

Japan reports dozens of new swine flu cases
The Associated Press

BUT...

If a level 6 was called, then international travel and trade would be pretty much curtailed. The economy would take another hit, and food would be in suddenly short supply. For starters.

But people are complacent, and don't recognize the need for planning, getting ready and taking care.

Would a clear signal from the WHO make any real difference in terms of helping people to accept and understand the situation?

?

Looks like WHO is extraordinally close to declare a Level 6, due to the situation in Japan, and the death today of the school administrator in NY.

According to the New York Times:
www.nytimes.com...

Cases have also been confirmed in India, Turkey and Chile.

The article also states that Japan uses over 60% of the world's Tamiflu supply- which tells me that if the flu is exploding there, but the population has been using Tamiflu at their leisure, I must expect to see resistant strains emerge from that ecology- just as we drove antibiotic resistance on ear infections, etc., without cultures to ascertain whether infections were viral or bacterial.

If a country of such high popluation, with incredible person to person activities due to confined spaces for living and working, and an overuse of Tamiflu for viruses of nearly any sort- Japan may become the epicenter of the "new" mutated strain. As well, Asia is a hotbed of Avian flu problems, and while I don't think people are living with their birds in downtown Tokyo or Osaka, in the many rural areas, there is a "perfect storm" brewing very quickly- the explosion of anti-viral resistant H1N1 and H5N1. I think this might be the most unsettling news of the entire outbreak.

[edit on 17-5-2009 by CultureD]

Originally posted by soficrow

The focus is now on the Southern Hemisphere as it enters its winter flu season. Whether or not a lethal pandemic strain emerges in the next 3-6 months will depend on how H1N1 moves and evolves in the world's Southern climes. There's no guarantee either way.

Sofi, I'm wondering why it is that virus' are worse in winter or in the cold?

Is it simply because people stay indoors when it is cold, gather indoors and spread it?

Or does climate actually play a role in defining a virus?

reply to post by soficrow


Flagged. No, I completely agree with you soficrow. They should have done this a week ago, already, or longer. Human to human contact has been confirmed in over three regions of the globe.

I don't know what the hold up is. The levels don't make much of a difference once we know it's already happening.

It's interesting how the epidemiologists are waiting to see what happens in the S. Hemisphere, as most flus peak in the winter (confined spaces, re-circulated air, etc), but we're also seeing this explode as we approach summer in the N Hemisphere. In fact, the majority of the cases- especially severe cases and deaths have happened during WARM weather- when people are outside, windows are open, people are producing Vitamin D, etc.

These strains are not following a typical seasonal pattern. That alone is a warning. We also have a circulating seasonal H1N1 that's resistant to anti-virals; an uprising in H5N1 deaths in Egypt and Indonesia; obvious community transmission, and instead of Americans or Mexicans with underlying health conditions who are dying- the severely ill in Japan are school-age children (in Asia, where avian flu is highly prevalent).

It's getting far more complicated, and we sure did miss our window of containment, didn't we?

Originally posted by Walkswithfish

Originally posted by soficrow

The focus is now on the Southern Hemisphere as it enters its winter flu season. Whether or not a lethal pandemic strain emerges in the next 3-6 months will depend on how H1N1 moves and evolves in the world's Southern climes. There's no guarantee either way.

Sofi, I'm wondering why it is that virus' are worse in winter or in the cold?

Is it simply because people stay indoors when it is cold, gather indoors and spread it?

Or does climate actually play a role in defining a virus?

Ooops. Sorry I missed this.

To answer your questions: Heat kills viruses, but cold preserves them.

H5N1 bird flu survived in cold lakes for over 200 days. This H1N1 swine flu likely has a similar survival time.

...So don't assume the virus dies after a few minutes or days away from a host. Doesn't happen reliably - and the new super-flu viruses seem to be much more rugged and vigorous.