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Analysis : Closer to a pandemic


By Amando Doronila
Editorial Consultant
Philippine Daily Inquirer

Posted date: April 28, 2009


THE WORLD Health Organization raised yesterday its global alert over swine flu from three to four but stopped short of declaring a global emergency. The alarm level was raised after an emergency meeting of global health officials following reports that the toll of flu-related deaths reached 149 in Mexico and swine flu cases in the United States doubled to 40.
Dr. Keiji Fukuda, World Health Organization assistant director general, said the decision signaled a “significant step towards pandemic influenza,” although “we are not there yet.” The increased threat level “signifies that we have taken a step closer to pandemic,” he said, adding that “it is possible that as the situation evolves over the next few days we could move into Stage 5.”

According to the WHO six-stage alert system, “a pandemic is an unexpected outbreak of disease that spreads from person to person across borders. Pandemics occur when a new influenza A-type virus, to which, almost no one has natural immunity, emerges and spreads internationally.”

Bloomberg television says the US Department of Health and Human Services estimates that a moderate pandemic will kill 209,000 people. A flu pandemic as severe as the one in 1918 would kill 1.9 million.

The raised alert level means that health officials need to prepare for a pandemic, though it is not inevitable, Fukuda said.

This is the first time the risk has risen about level 3 on the WHO’s six-step alert system since the current scale was adopted in 2005.

On the WHO pandemic alert scale, the phases are:

Phase 1: No viruses circulating among animals causing infections in humans.

Phase 2: Animal influenza virus causes infection in humans, and is considered potential pandemic threat.

Phase 3: Influenza causes sporadic cases in people, but no significant human-to-human transmission.

Phase 4: Verified human-to-human transmission able to cause community-level outbreaks. Significant increase in risk of a pandemic.

Phase 5: Human-to-human transmission in at least two countries. Strong signal pandemic imminent.

Phase 6: Virus spreads to another country in a different region. Global pandemic under way.

According to BBC news, level four means the virus is showing a sustained ability to pass from human to human, and is able to cause community-level outbreak.

“This can really be interpreted as a significant step towards pandemic influenza,” Fukuda said. “But also, it is phase that says we are not there yet. In other words, at this time we think we have taken a step in that direction, but a pandemic is not considered inevitable.”

Fukuda said the virus has become too widespread to make containment a feasible option. “Countries must focus on trying to put measures in place to protect the population,” he said.

Experts do not recommend closing borders or restricting travel. “With the virus being widespread, closing borders or restricting travel has very little effects in stopping the movement of this virus,” Fukuda said.

The first batches of swine flu vaccine can be ready in four to six months, but it will take several more months to produce large quantities.

According to health experts, the virus comes from the same strain that causes seasonal outbreak in humans. But they say this newly-detected version contains genetic material from versions of flu which usually affect pigs and birds.

BBC News quoted Mexico’s Health Minister Jose Angel Cordova as saying the suspected death toll from swine flu had risen from just over 100 to 149. Of that number, 20 cases have been confirmed as swine flu.

All those who died were aged between 20 and 50, Cordova said. “We’re in the decisive moment of the crisis, the number [of deaths] will continue rising.”

He said nearly 2,000 people have been hospitalized since the first case of swine flu was reported on April 13.

Dr. Richard Besser, acting director of the US Center for Disease Control and Prevention, said that so far the virus in the US seemed less severe than the one in Mexico.

The best way to keep the disease from spreading, Besser said, would be by taking everyday precautions such as frequent handwashing, covering up cough and sneezes, and staying away from work or school if not feeling well.

There is no vaccine available to prevent the specific strain now being seen, he said. But some anti-flu drugs do work when someone gets sick.

Confirmed cases of swine flu have been reported in the following places: Mexico, 20; US, 40; Canada, 6; Spain, 1; United Kingdom, 2. Suspected cases of swine flu are being tested in Israel, Brazil, Guatemala, Peru, Australia, New Zealand, and South Korea.

Amid the raised level of pandemic alert, the world was reminded of the devastating outbreaks of flu pandemics, including:

• The 1918 Spanish flu pandemic. Regarded as the most devastating outbreak of modern times, it infected up to 40 percent of the world’s population and killed more than 50 million people, with young adults particularly badly affected.
• The 1957 Asian flu, which killed two million people. It was caused by a human form of the virus H2N2 combining with a mutated strain found in wild ducks.
• The 1968 outbreak that was first detected in Hong Kong and caused by a strain known as H34N2. It killed up to one million people globally, with those over 65 most vulnerable.

The last flu outbreak poses an added threat to the world economy as it starts showing tentative early signs of recovery from the global recession. The outbreak threatens to batter tourism as well as the food and transport industries as several countries have warned their nationals from taking unnecessary travel to countries in North America suspected to be centers of the virus.





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