WHO close to raising alert to highest level for swine flu
The H1N1 outbreak would be considered a pandemic. But the health organization is worried that could lead to border closings, travel restrictions and people with mild illnesses flooding ERs.
By Thomas H. Maugh II
11:49 AM PDT, June 9, 2009
The World Health Organization is inching closer to raising the infectious disease alert level for the novel H1N1 influenza outbreak to its highest level, indicating that a pandemic has arrived, but has delayed doing so in an effort to prepare national health organizations and populations for the impact of such an announcement, said Dr. Keiji Fukuda, assistant director general of the agency, this morning in a telephone news conference.
The number of confirmed cases of the disease rose above 1,200 in Australia on Monday and the virus is no longer restricted to schools and other institutions in that country, suggesting that a community-wide spread has begun. Such a spread in a region outside North America is the primary criterion for raising the alert level to Phase 6.
"One of the critical issues is that we do not want people to over-panic if they hear that we are in a pandemic situation," Fukuda said.
WHO officials worry that a pandemic declaration would lead people with mild illnesses to flood emergency rooms and might lead to border closings, travel restrictions and other "unwarranted" actions.
In the early stages of the current outbreak, Fukuda said, people stopped eating pork, pig herds were killed, and imports of pork were restricted by some countries. "These are the kinds of potential adverse effects" that the agency is trying to avoid, he said.
Reporters repeatedly pressed Fukuda about why, given the clear spread in Australia, the agency has not increased the alert level. "We are really getting very close to that," he said. "We are working very hard to ensure that everyone is prepared for that."
In an effort to mitigate over-reaction in response to an increase in the alert level, the agency last week decided to augment the current warning system with three tiers inside Phase 6 to indicate the severity of the pandemic. Barring changes in the next few days, the agency will most likely indicate that the severity is at the lowest level when the stage is raised, indicating that the virus is spreading through populations, but that its effects remain relatively mild.
As of this morning, Fukuda said, there have been more than 26,000 laboratory-confirmed cases of H1N1, or swine flu, in 73 countries, with 140 deaths. In the United States, the most recent figures form the Centers for Disease Control and Prevention show 13,217 confirmed cases and 27 deaths. Officials believe the total number of cases, both in this country and worldwide, are actually much higher because many people have mild cases and do not receive testing.
Fukuda said researchers have seen few, if any, changes in the virus since its emergence in Mexico earlier this year, and that it still remains susceptible to the principal antiviral drug Tamiflu.
But they are concerned that infections continue in North America and Europe, even though the traditional flu season has ended in the Northern Hemisphere. "The disease patterns are not what we see from seasonal influenza," he said. That suggests that the virus has greater capability for spread than does the seasonal flu virus.
The majority of the infections have been in people younger than 60, which is also different from seasonal flu. That suggests, some experts said, that older people may have been exposed to a different swine flu virus in the past that has conferred some immunity.
About half of the people who have died from the virus were previously healthy, with no underlying medical conditions. "That is one of the observations that has given us the most concern," he said. "We don't know why they died and why other people recovered. We are looking for clues."
And some populations appear to be more at risk for debilitating illness from the virus. In Canada, for example, the Inuit population appears to be especially vulnerable. In some areas, half of those hospitalized are Inuit. "Is it poverty or underlying disease? That's not clear," Fukuda said, but it is something that has been observed in previous pandemics.
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