Posted on behalf of Declan Butler:
Two main news items today from the World Health Organization’s weekly media briefing on the H1N1 swine flu. First, the agency is receiving reports that infections in Inuit communities in Canada are showing "disproportionate numbers of serious cases occurring,” said Keiji Fukuda, WHO’s interim assistant director-general for health security and environment. The agency is seeing “a larger number than expected of young Inuit people developing serious illnesses requiring hospitalization.”
There are few other details available at the moment, and Fukuda says it’s too soon to start speculating on causes, such as genetic, environmental or due to underlying diseases. But the Inuit were among one of the groups that suffered the highest mortality levels in the 1918 pandemic. “This is why these reports raise such concern for us,” he said. It’s also the sort of country- and community-specific impacts that WHO will be keeping its eye on worldwide in the months to come, as the severity of the virus could vary widely from place to place.
Elsewhere the clinical picture as the virus spreads in the Southern Hemisphere remains similar to that seen in the Northern; mostly illness from which people recover by themselves, but also cases of viral pneumonia, where the virus itself and not secondary bacterial infections cause respiratory distress or failure, leading to hospitalization, mechanical ventilation, and sometimes death – with 140 deaths being officially confirmed. “There remains a great deal of concern,” said Fukuda, that half the deaths continue to be in healthy younger people, as in past pandemics and H5N1 avian flu, whereas seasonal flu hits the elderly and young children hardest. On the three-point severity scale of mild, moderate or severe, the current situation is currently ‘moderate.’
Much of the rest of the briefing focused on the question of when WHO will declare a full-scale pandemic based on worldwide spread of the new virus. Fukuda faced a barrage of questions asking why WHO had not declared a pandemic given community spread in Australia, and in some other European and Southern Hemisphere countries, in addition to that in the Americas. Fukuda all but agreed that a pandemic declaration was now inevitable, and the question was more of preparing countries “to know how to take that news,” by offering clearer guidance to countries on how they should adapt their pandemic plans – largely built round the deadlier H5N1 virus – to the current virus, and taking time to explain to the media and others what a pandemic meant.
Most of the concerns he mentioned about declaring a pandemic before countries were prepared had more to do with trade than health: that people might have concerns about eating pork, that pig herds might be culled, and that trade embargoes, travel bans, or border controls might be introduced. One concern mentioned was related to health; the risk that worried people without the infection might flood hospital emergency rooms and so divert resources away from those with real healthcare needs. These are all valid concerns and the agency is coming under pressure from member states to ensure that its declaration of a pandemic when it comes does not create an unwarranted overreaction. That risk may be overstated though; it has been fairly obvious for weeks that we were already in a pandemic. It is by no means clear that when WHO finally gets round to announcing the obvious in front of the cameras, that this will change much.
Nature’s swine flu coverage is collected here.