There may not have been much news at the CDC briefing, but it is coming thick and fast now. The CDC works through state health departments and defers to them on information about what is going on in their localities. Hence all questions about this were deflected at the 1 pm CDC briefing. I think I understand the thinking behind this but it doesn’t serve the goal of getting the information out there quickly. CDC needs to be the information clearing house for all the swine flu news going on around the country and they need to do with absolute transparency. Here’s what has developed since that briefing.
Kansas: According to AP and other sources, Kansas Department of Health and Environment has confirmed two cases of swine flu. Details yet to come.
New York City (Queens): About 100 students at St. Francis Preparatory School have come down with a febrile respiratory illness with sore throat and myalgia. There were 200 absentees at the school at the time. The NYC Health Department is saying that the illness is influenza A that is untypable in their laboratories (see here for more explanation of the testing routine). This is the way the current swine flu virus appears when seen by most laboratories, so confirmation that it is the same virus as in Mexico will require use of a special diagnostic primer now available in the CDC labs in Atlanta. Definitive results due tomorrow, but this is almost certainly swine flu with person to person spread. The incubation period seems very short, 1 – 2 days. All illnesses are said to be mild with no hospitalizations. Again the contrast with Mexico is striking. Previous reports said that one or more of the students had recently been in Mexico. No details were given in the NYC Health Department briefing.
World Health Organization (WHO): For the first time since the International Health Regulations started coming into force two years ago, WHO convened its Emergency Committee to advise the Director General, Dr. Margaret Chan, whether the developing swine flu situation constitutes “a public health emergency of international concern.” WHO has announced that the Committee has indeed made this judgment. Such a declaration allows WHO to ask for various disease control measures, including travel advisories and even border controls. Under international law prior to passage of the IHR WHO was not permitted to call for any measures that might infringe on the national sovereignty of a member state (see this post and the links there at the end of the first paragraph for more explanation).
So far, so good. There is another part to this, though. On the basis of such a declaration the Committee through the Director General may change the pandemic threat level from phase 3 to phase 4, (or, some would argue, even more appropriately to phase 5). According to a statement released by WHO hours ago, the Committee and the DG are declining to do so at this time:
Based on this advice, the Director-General has determined that the current events constitute a public health emergency of international concern, under the Regulations.
Concerning public health measures, in line with the Regulations the Director-General is recommending, on the advice of the Committee, that all countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.
The Committee further agreed that more information is needed before a decision could be made concerning the appropriateness of the current phase 3. (WHO)
The failure to change the threat level reveals what many people have being saying for some time: the WHO threat levels are totally irrelevant and meaningless. The definition of phase 4 is significant spread with a novel flu virus. There may be reasons — practical, political or even scientific — not to say we are in phase 4, but a failure to describe the current situation isn’t one of them. In other words, the WHO threat level descriptions are meaningless and have nothing to do with what is happening on the ground. Failure to recognize this by overhauling the criteria to match the facts, is a guaranteed way to send what is left of WHO’s credibility down the toilet.
When asked about this at the CDC briefing, the very sensible response was that CDC will do what it needs to do regardless of what WHO says the threat level is. I’m sure WHO would make the same response. If so, who needs the WHO threat levels?
There are now lots of terrific bloggers and sites active on this. None of us can cover it all. Here are some (but not the only) good ones: H5N1, FluWiki, DemFromCT, Avian Flu Diary, CIDRAP, Aetiology. Apologies to those I am leaving out (lots of great flu forums that are the best source for what the rest of us haven’t reported yet; Crof’s H5N1 sidebar has a pretty complete list).