Swine flu: are we there, yet?

by revere, cross-posted from Effect Measure

Listening to yesterday’s press briefing with WHO’s Dr. Keiji Fukuda (audio file here), several things seemed clear to me. The first is that everyone, WHO included, thinks a pandemic is well underway. Second, WHO’s efforts to explain why they are not making it “official” by going to phase 6 are becoming increasingly awkward and the explanations manifestly tortured. Essentially what Fukuda said was that WHO was waiting for its member nations to signal they knew it was a pandemic and then WHO would say it was a pandemic. It was reminiscent of the cries of one of the principals of the revolution of 1848 as he chased the mob into Paris’s Jardin du Luxembourg: “I’m their leader! I must follow them!” Third, despite Fukuda’s calm and measured tone, there was an undercurrent of worry. The severity of the not-yet-called-a-pandemic pandemic is now being termed “moderate” (which seems accurate to me). Fukuda explicitly declined to characterize it as “mild.” He also called attention to reports of “disproportionate numbers of serious cases occurring” in Canada’s First Nation (indigenous) community. From the Winnipeg Free Press:

There has been a “surge” in the number of people requiring intensive care in Manitoba hospitals with flu-like illnesses, the province said Monday.As of Sunday night, there were 26 such people in hospital — more than half of them aboriginal. All were or had been on ventilators due to influenza or of an influenza-like illness. Eight persons with severe cases required hospitalization in the past week alone.
Joel Kettner, chief provincial public health officer, said Monday “most if not all” of the cases are expected to be confirmed as the new H1N1 influenza.

[snip]

Kettner said the 26 people on ventilators in hospital are “very ill.”

“Some of them have been on ventilators for several weeks… The pattern has been so far that many of these patients have required several weeks of intensive care before they have recovered.”

He said that in the first week of June, the rate at which people became severely ill with what is suspected as H1N1 was far higher than it was in April or May.

More than half of those in intensive care are First Nations people — status or non-status as well as Inuit.

[snip]

Jan Currie, vice-president of the Winnipeg Regional Health Authority, said there are normally 30 to 35 people on ventilators in Winnipeg hospitals at any one time for a variety of reasons.

The 26 listed by Kettner are in addition to that, she said. The WRHA has acquired 15 extra ventilators and may defer non-urgent procedures that would normally require ICU care. It is also taking steps to provide enough support in intensive-care units and prioritizing patients for personal care home beds.(Larry Kusch, Winnipeg Free Press)

 

As Fukuda points out, influenza took a heavy toll in isolated and disadvantaged communities in earlier pandemics. This is part of a picture of a well transmitted novel influenza virus, circulating out of season and hitting younger age groups differentially, just what one expects from a pandemic strain based on past experience.

The on-again-now-off-again inclusion of severity as a criterion for a pandemic is currently being spun as a descriptor to give member nation’s the best information on the nature of the pandemic they are dealing with. I think that’s a sensible attitude, and I don’t fault WHO. The politics of any intergovernmental agency, especially in the UN system, produce a difficult and treacherous landscape to negotiate. If you’ve never seen it close up, it’s hard to appreciate the labyrinthine and counter-to-common sense ways of the international community. This is not the UN’s fault and certainly not WHO’s. It is the system they (and we) are forced to work within, as mandated by the nations of the world. If the space program becomes robust enough, someday you may be able to opt out for another planet. Until then, it’s no use complaining.

Meanwhile we now have the long predicted influenza pandemic. It’s neither so scary nor so benign that we can afford to either hide under the bed or ignore it. What we must do is roll up our sleeves and manage the consequences.