H1N1 Swine Flu ‘Likely’ to Be Most Widespread Pandemic Ever

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Related subjects: Diplomacy & Politics, Global, Health Science, Healthcare Policy, Humanitarian Crisis, In the Loop, J.E. Robertson, Open Government Comments (5)

15 July 2009 :: J.E. Robertson

Margaret Chan, director general of the World Health Organization (WHO), has told the Guardian newspaper’s Aida Edemariam that swine flu, the A/H1N1 multiple-reassorted virus strain, could be “the biggest” pandemic ever seen, in terms of its spread to so many countries around the world, though that doesn’t mean it will be the most deadly.

Chan specified:

If you’re talking about mortality then it’s different. 1918 is the biggest in terms of mortality. I would not like to make any predictions … I hope we don’t see the 1918 picture. But we should expect to see more people infected, and more severe cases coming up, including deaths…

Edemariam has written that “Swine flu is probably already much bigger than anyone knows”. In 2007, the WHO published a report titled “A Safer Future”, which projected that a major flu pandemic could affect as many as 1.5 billion people worldwide; Chan describes that scenario developing from swine flu as “Quite likely”.

She said, however, those figures would not be reached “in one run”, projecting the disease would spread in two or three major waves over multiple years. One concern of many in the public health field is that during that time, preparedness in certain regions may falter, and governments may shift their funding to other priorities. While it took several weeks for the virus to spread to three continents, the last month has seen a more rapid proliferation.

In early June, some 74 countries had confirmed cases of H1N1 infection. That total has now been confirmed to be at 140. There are estimates that as many as 1 million people in the US may be infected, though the WHO reports a total of confirmed infections across the world of 94,512, resulting in 429 deaths.

The WHO now also recommends that all nations begin national campaigns of vaccination, prioritizing medical personnel and first-responders. In the US, there are efforts at various levels of government to step up public health preparedness. The state of Ohio’s Department of Health now projects a more virulent strain of H1N1 will surface in the next few months.

Ohio will get $9.8 million in federal funding to fight the spread of the virus, part of a $260 million initiative of the Department of Health and Human Services (HHS), a response to the virus’ quick spread across the US this spring. The Dayton Business Journal reports:

Over the next few weeks, the Ohio Department of Health in conjunction with 130 local health departments throughout the state will determine what projects and activities will see the funding. The state Department of Health said the federal government is expected to provide a free H1N1 vaccine to states so the grant money will not be used to buy medical supplies of vaccines or antiviral medicines.

A supply of free vaccine may be one of the necessary logistical mechanisms for combatting the spread of the pandemic. Economic barriers to effective treatment and distribution of preparedness measures means a lax response and more cracks for the virus to slip through, infecting more people who will transmit the infection to others.

Ohio has received $19 million in “pandemic planning” funds from the federal government between 2005 and 2008, so continuing to guarantee the effectiveness of planning now in the face of an evolving pandemic is essential. In a high-level UN meeting in Cancún earlier this month, Dr. Chan told North American officials, including Mexico’s Pres. Calderón and the US secretary of HHS, Kathleen Sebelius, that the pandemic is now “unstoppable”.

Chan said that travel bans will no longer be effective at stopping or slowing the spread of the virus or impeding cross-border spread. She noted that the entire human population is more or less susceptible to a flu pandemic and for that reason, it will ”hit a given area in the epidemiological equivalent of a tidal wave”.

The WHO chief told the Cancún flu summit:

In densely populated areas, we see a steep increase in the number of cases, with a sharp peak, followed by a steep decline. Once the virus has swept through a susceptible population, transmission may continue, but at a much lower intensity.

She noted that Mexico, especially Mexico City, saw this “tidal wave” trend back in April, with the US following close behind. She noted that other nations are now experiencing the peak moment of infection (of the first wave) and that other nations will soon follow. She also warned that “we need to watch very carefully what happens during the current winter season in the Southern Hemisphere”.

She noted that “Constant, random mutation is the survival mechanism of the microbial world. Like all influenza viruses, H1N1 has the advantage of surprise on its side.” Chan also added that the human world needs to address the pandemic’s advantage of surprise with “science, and of rational and rigorous investigation … supported today by tools for data collection, analysis, and communication that are unprecedented in their power”.

She urged “collaboration and solidarity” and praised the international community for exhibiting those qualities in response to the H1N1 threat. The WHO maintains a comprehensive index of all “guidance documents” to help public health officials around the world cooperate in what may be the most coordinated, persistent, real-time epidemiological response.

Though the swine flu scare caused many to fear pigs would infect humans —Egypt culled millions of animals, despite not one single case of swine infection with H1N1— there has been no evidence of a direct transmission from pig to human. But researchers believe the pandemic status of the virus spreading in the human population means the risk of it jumping from human being to pig is now more significant.

• W.H.O. Reports A/H1N1 ‘Swine’ Flu Pandemic is Unstoppable
• WHO Declares Influenza A H1N1 a Global Pandemic
• Factory Farms Could Be Promoting Dangerous Disease Agents
• Yi Guan, Virologist Famed for Isolating SARS, Says WHO Slow on H1N1
• Is Swine Flu Outbreak Contained? WHO Says No ‘Local Spread’ Outside N. America [May 2009]
• Egypt Pig Cull Suggests Ethical Risks of DNA-based Public Policy
• Obama Weekly Address: Gov’t Actions to Address H1N1 Outbreak (video + transcript) [May 2009]
• México en cuarentena por gripe H1N1 durante dos grandes fiestas nacionales
• White House Update on the H1N1 Influenza & Suggested Protective Measures (transcript) [April 2009]

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