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Flu pandemic has begun

WHO raises alert level to highest level (URGENT-UN-Swine-Flu)


June 12, 2009
By Helen Branswell Canadian Press

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June 11, 2009 – The little virus that came out of nowhere, swine flu, has made it over the pandemic threshold, prompting the World Health Organization to declare Thursday that the globe is experiencing the first influenza pandemic since the Hong Kong flu of 1968.

June 12, 2009 – The little virus that came out of nowhere, swine flu, has made it over the pandemic threshold, prompting the World Health Organization to declare Thursday that the globe is experiencing the first influenza pandemic since the Hong Kong flu of 1968.

The new H1N1 virus, which burst onto the world’s radar a mere nine weeks ago, overtook what had long looked like the most likely culprit to “go pandemic” as flu watchers say, the H5N1 avian flu virus.

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WHO Director General Dr. Margaret Chan announced the decision after going over available evidence about the new virus’s behaviour and spread with the WHO’s emergency committee, a group of experts which has served as a sounding board for Chan during this fast moving outbreak.

“On the basis of available evidence  …  the scientific criteria for an influenza pandemic have been met,” she declared at a news conference in Geneva.

“We are satisfied that this virus is spreading to a number of countries and it is not stoppable.”
Many influenza experts have felt that reality has been clear for awhile.

A number have been critical about the fact that in official terms, the world has been poised on the precipice of a pandemic for seven weeks as swine flu spread from North America to Europe, Asia, the Middle East, Australasia and South America.

Dr. Allison McGeer, a Toronto-based flu expert, suggested political and societal concerns have mired the WHO in a declaration process that has trailed behind the science.

“From a science perspective, anybody will tell you that this has been a pandemic for weeks,” said McGeer, head of infection control at Mount Sinai Hospital where she’s been dealing with seriously ill swine flu patients for some time.

“You can understand why the World Health Organization is having trouble but it does put you in this really odd situation of having a zebra out there that you can’t call a zebra.”

Though some have called the swine flu virus “wimpy” because it causes mild, seasonal flu-like disease in most people, its geographic gains have been rapid and impressive.

By Thursday, infections had been confirmed in 28,774 people in 74 countries and 144 deaths had been attributed to the virus. In reality hundreds of thousands more people have likely made a personal acquaintance with swine flu.

Years of focus on the dangerous H5N1 virus has led some to equate the word pandemic with catastrophe, a perception the WHO sought to soften in recent days.

Chan urged countries not to overreact, and to recalibrate pandemic plans if they were designed as responses to a severe pandemic. In the WHO’s judgment, she said, this swine flu pandemic will likely be one of moderate severity, though she warned that could change.

The WHO has insisted travel bans, border closings, trade embargoes and the like won’t stop swine flu’s spread but will inflict economic pain.

But if some parts of the world are panicking, others are yawning, convinced swine flu is no more serious than seasonal flu.

In countries like Canada where the virus has been spreading for some time, officials worked hard Thursday to get out the word that little will change. Pandemic plans which were years in the making have been activated for weeks.

“We in Canada have been dealing with H1 since the beginning. So going from Level 5 to 6 only reflects broader spread internationally of what we have already seen,” said Dr. David Butler-Jones, Canada’s chief public health officer.

Canada, the third country to find cases and the third hardest hit to date, has confirmed 3,047 cases in all provinces and territories but Newfoundland and Labrador. Canada has recorded four deaths.
Butler-Jones said officials of the Public Health Agency of Canada are working with the holder of Canada’s pandemic vaccine contract, GlaxoSmithKline, to make pandemic vaccine. That contract ensures the first pandemic vaccine produced at the company’s Ste-Foy, Que., plant will be reserved for Canadians.

A spokesperson for GSK said Thursday the Ste-Foy plan has already taken possession of the vaccine seed strain and is now growing up a seed stock to be used to produce first trial lots and then commercial batches of vaccine.

Many steps have to be taken before vaccine will be available, including testing it for safety and to determine what sized dose -and how many doses -each person might need for protection.

But Butler-Jones said if all goes well Canada could start holding swine flu vaccine clinics in late October and finish vaccinating everyone in the country who wants vaccine by Christmas.

In the U.S., the new head of the Centers for Disease Control, Dr. Tom Frieden, said they’ve been operating in Phase 6 mode for some time. He stressed the pandemic call doesn’t signify that anything has changed about the virus itself or the disease it is causing.

“This is not at this point a flu that’s anywhere near as severe as the 1918 pandemic, for example,” he said.

Though the point appears not to be widely understood, the definition of a pandemic relates only to the spread of a virus, not severity.

Some countries had pressured the WHO not to declare swine flu a pandemic because of the current lack of virulence. In the end the WHO resisted the pressure, though it agreed to issue a severity assessment when it declared a pandemic.

A pandemic is declared when the WHO sees evidence of sustained spread in the community in two different WHO regions. In recent weeks spread in Britain, Spain, Japan and Australia has at various times threatened to push the world across that threshold.

But some countries within that group appeared to be reluctant to be the ones to trigger the call. For instance, a number of experts believe Britain’s instructions to doctors on when to test impeded the discovery of spread in the community.

Chan and her officials had discussions Wednesday with health officials from the eight most affected countries -the U.S., Mexico, Canada, Chile, Britain, Spain, Japan and Australia. She said the WHO confronted some with media reports that conflicted with official statements.

In the end, all agreed that they had some degree of community spread and that it was perhaps greater than their surveillance systems could detect.

Instead of naming the country or region which took the virus across the threshold, Chan dealt with them as an aggregate. “Collectively, (with) this group of countries, we are satisfied there is community level transmission.”

The weekly disease journal of the European Centre for Disease Control was quicker to assign blame. The editors of Eurosurveillance declared spread in the WHO’s Western Pacific Region -which contains both Japan and Australia -was the deciding factor.

The WHO’s unwillingness to reveal which country or region had taken the virus across the threshold was criticized by a flu expert who had earlier suggested the agency’s scientific credibility was in peril because of its delay in declaring a pandemic.

“While the announcement is welcome in terms of addressing the science, the lack of transparency in terms of which country’s activities factored in the decision is disappointing,” said Dr. Michael Osterholm, director of the Centre for Infectious Diseases Research and Policy at the University of Minnesota.

Chan suggested it wasn’t just geographic spread that influenced her decision. She said the WHO is concerned the virus seems to be preferentially infecting -and causing severe disease in some cases -in children, young adults, pregnant women and vulnerable populations.

She mentioned specifically evidence of severe disease in aboriginal communities in Northern Manitoba. Officials in Manitoba revealed Thursday that 24 people in that province are in intensive care because of swine flu and two-thirds of them are First Nations people.

That type of pattern of disease, which has been seen in earlier pandemics, is different from seasonal flu, which hits young children and seniors hardest.

Butler-Jones suggested Chan’s decision was reasoned and right.

“Clearly this is a virus which is taking hold and that fits, clearly, the definition of a pandemic,” he said.