WHO separates alert phase announcement from science
According to WHO, we are still currently at stage 3 of pandemic alert. There has been arguement in the posts that we should be at 4, maybe 5. The WHO stages are included in the CIDRAP updated Panflu document here: http://tinyurl.com/opus5
“In general, isolation of patients in the community and quarantine of contacts are measures that have not been shown in past pandemics to be effective in preventing transmission outside of closed settings (such as dormitories or military barracks) and are not recommended once a pandemic is well established. However, WHO recommends aggressive measures to detect and isolate cases and quarantine their contacts in situations where human-to-human transmission of a potential pandemic influenza strain is highly localized and limited (ie, during the pandemic alert period [Phases 4 and 5]).
Also at CIDRAP http://tinyurl.com/hk3pv “We conclude that the benefit of a strategy to contain pandemic influenza at its source will be to postpone the time to the next pandemic, not to prevent a pandemic from ever occurring. If at least one containment attempt of an introduced pandemic-capable strain will be necessary, it is likely that multiple containment attempts will be necessary.”
By going to stage 4 or 5, all sorts of hell breaks loose and we see major & devastating consequences to economies. I think after reading both articles that I can see why WHO moves slowly and the massive amount of work that they have ahead of them.
If containment works to delay, and multiple containments are neccessary, we could see a significant period of pre-pandemic hardship and still get smacked up the head by a strain that emerges and moves undetected in one of the less “transparent” countries.
“For most realistic scenarios, containment provides only a small expected gain in time to a pandemic. The expected gain is generally less than the expected time to the next pandemic. Because of its potentially limited impact, we therefore conclude that containment should not form the centerpiece of a pandemic control policy.”
So, panflu is inevitable, and rather than waiting for level 6 to be declared - “Of course, we might never have the opportunity to implement any of these responses; the first containment attempt might fail. Therefore, if we identify measures that would be useful following a successful containment effort, there is likely to be a strong case for implementing those measures now, rather than waiting until the first introduction of a pandemic strain.”
What do folks think about this? Should we be seeing containment now?
And are we seeing containment now in some places? Wouldn’t travel restrictions to africa and asia need to be set up at stage 4 or 5, before we get to level 6?
Containment where, Montanan? Should all Germans euthanize their cats on government order? Should sparrows be shot out of the sky?
What are you suggesting?
I am thinking about travel.
Melanie, I think your post was kinda snotty.
Nah. I’m going to wait it out here, as I think most will.
What does it mean when WHO announces stage 4 or 5? What actions will being taken? How will our lives be affected? Could stage 4 or 5 last a long time? If stage 4 or 5 is declared and one is traveling, will you find yourself stuck away from home?
My forum heading was truncated from Containment/Quarantine WHO - I am interested in the next two levels of the pandemic alert and what we might expect to see happening around the world. Also, aren’t some containment exercises happening now, culling, pets indoors, communities isolated for a short time…so are we actually in phase 4 and seeing the implications of that?
There are quarantine zones already in use, Melanie, in some places abroad.
Various kinds, but some quite strict, (China?) some at least until quick test results are done, some just to disinfect cars and trucks and check for poultry, some the people stopped in their house and the child in France not allowed home? Some people being given Tamiflu when their flocks or family members get sick and die.
http://www.todayonline.com/articles/102848.asp …”Officials have extended a quarantine area around the villages to a 10-kilometre (six-mile) radius encompassing the national zoo and the Petronas Twin Towers, the worlds second largest building…”
(Sometimes it is not made clear what they mean by quarantine zones. Not sure what the rules or restrictions are -someplaces just may not be letting poultry in or out?)
I do think travellers could be trapped abroad. Montanan.
If there are any plans to repatriate personnel or ordinary citizens, I think it will be problematic, and they’d likely (except for VIPs of course, darn) be warehoused in quarantine in the airport for a few weeks, on arrival.
Unless they’ve given up all hope of containing a pandemic and just let people travel at their own risk once they are back.
Here is Australia’s advice to its citizens who are traveling abroad: (from http://www.smartraveller.gov.au/zw-cgi/view/TravelBulletins/Health_:_Avian_Influenza]
Travel Bulletins Health: Avian Influenza This Bulletin is current for Thursday, 02 March 2006. The Bulletin was issued on Friday, 24 February 2006, 18:24:51, EST. [top] Summary
Montanan:
I wrote this as part of a response on another thread, but I think it might address some of your questions.
From the WHO global influenza preparedness plan. On page 44 of the plan, in Annex 1 there is a table with a list of recommended actions.
Quote: “Recommend deferral of non-essential travel to and from affected areas.” N for no is indicated for phase 3. Y for Yes is indicated for phase 4 and phase 5. Also, please read the comment on the right of this table.
On page 29 the WHO recommends that on declaring phase 4, unaffected countries should “Activate pandemic contingency planning arrangements.”
These will be different for each country. The point is most countries will *not* activate their planning arrangements until phase 4 is declared by the WHO. A big mistake, IMO. Activate them now for crissakes. It’ll take at least a year to get ready.
Monotreme. I have been trying to avoid commenting but…please don’t give up until they change their behavior.
Tom DVM – at 21:42
I’m glad you’re addicted ;-)
Tom DVM: Don’t worry, I’m indefatigable. Or so some have said ;-)
Also, stage 4 activates vaccine development. I suppose they are waiting until it is more obvious which of the many variants is the guilty H2H party. It does seem like stages 4, 5, and 6 will come much faster upon each other, rather like a plummet into the abyss, I guess.
>>>Australians who live in an avian influenza affected area for an extended period should consider, as a precautionary measure, having access to influenza antiviral medicine for treatment>>> I really do not see how this can be accomplished as a practical matter. Most of these drugs require rx and at least in my experience in the US, doctors are not willing to prescribe drugs based on “precautionary measure”. Is it different in Australia?? I realize there has been some discussion about obtaining drugs over the internet, but many people are not aware of that and some internet providers are not legit. So how is the citizen expected to have access to antiviral medicine as a Precautionary measure??
Monotreme, could you please post the specific URL for the WHO plan which contains the section you quote, including: “Recommend deferral of non-essential travel to and from affected areas.” I have read and searched my way through the checklist, the plan, and the exec summary but cannot find it.
Thanks.
Path Forward: Here it is: English Updated November 2005 pdf 266kb
According to the definition on the above WHO plan, it seems that we should be in Level 4. Remainds me of the events with hurricane Katrina….all the signs pointed to a disaster however nobody wanted to create a panic and look what happened. Very sad……….
U.S. Department of State, Consular Information Sheet - Medical Insurance:
“…Americans should consider that many foreign doctors and hospitals require payment in cash prior to providing services and that a medical evacuation to the U.S. may cost well in excess of $50,000″.
Re: Phase 4. The WHO pandemic preparedness plan also mentions “Consider activating internal WHO contingency plan.” (page 30 of http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf)
There is a link to the WHO internal contingency plan on the Flu Wiki “International Bodies” page, here: ttp://fluwikie.com/index.php?n=Geographic.International#WHO .
Thanks to all who offered info. Path Forward, I can’t access your link now, will try later. I have friends traveling to china, thailand and africa in may. Am concerned more that they will get stuck somewhere if stage 4 or 5 is declared rather than them actually contracting bf during their travels.
Montanan, I entered the link at 12:45 wrong. Sorry about that.
It should be:
http://fluwikie.com/index.php?n=Geographic.International#WHO
The WHO internal contingency plan is posted on a file accessible via http://www.misau.gov.mz/pt/content/download/652/2827/file/ which is on the website of the government of Mozambique, of all places. My guess is that they posted it without realizing it is intended to be an internal document.
An excerpt from the WHO internal contingency plan, under the heading of Background information…
“There is currently rising concern that a new influenza virus with pandemic
potential may emerge and spread. WHO and influenza experts worldwide
are concerned that the recent appearance and widespread distribution of an
avian influenza virus named A/H5N1, has the potential to ignite the next
pandemic. Available evidence points to an increased risk of transmission to
humans when outbreaks of highly pathogenic avian H5N1 influenza are
widespread in poultry. Experts agree that the virus is now permanently
established in poultry populations in large parts of Asia. All prerequisites for
the start of an influenza pandemic have been met save one: the establishment
of efficient and sustained human-to-human transmission of the virus. As the
number of human infections increases, so does the risk that the virus will
mutate in ways that improve its transmissibility among humans, thus
triggering an influenza pandemic. Historically, influenza pandemics have
spread in waves, rapidly encircling the globe and then subsiding after around
2 years…”
Especially interesting is “All prerequisites for
the start of an influenza pandemic have been met save one: the establishment
of efficient and sustained human-to-human transmission of the virus….”
By this definition we are at level 5
Very good point MaMa.
MaMa – at 22:17 Thanks. I would prefer my friends not to travel but it is essential for their business and probably, the last time in some while before they will be able to do so again.
Definitions of WHO pandemic phases:
3. No or very limited human to human transmissin 4. Evidence of incresed human to human transmission 5. Evidence of significant human to human transmission 6. Eficiant and sustained human to human transmissin
By these definitions we are currently clearly on level 3. Up to date there has been no comfirmed case of one human infected from another human. All human cases of H5N1 are due to close contact to infected domestic birds (chickens, ducks…)
Definitions of WHO pandemic phases:
3. No or very limited human to human transmissin
4. Evidence of incresed human to human transmission
5. Evidence of significant human to human transmission
6. Eficiant and sustained human to human transmissin
By these definitions we are currently clearly on level 3. Up to date there has been no comfirmed case of one human infected from another human. All human cases of H5N1 are due to close contact to infected domestic birds (chickens, ducks…)
Dejan-
Many family clusters in multiple locations have shown bimodal (staggered) disease onset dates indicating efficient H2H transmission in 2006.
Dejan - please review. This is why we have concerns. And the ‘all human cases are from infected birds’ is not true. There are a handful of suspicious H2H cases acknowledged by CDC and WHO.
Dejan - Probable person to person transmission of H5N1 was published here.
H2H would likely express itself as a cluster, but there’s no reason to think that all (or even most) of the documented clusters are due to H2H transmission, (as opposed to common exposures). Not to mention that in each instance field investigations were done to determine this.
“Handful of suspicious cases” sounds a lot like “No or very limited human to human transmission”, i.e., phase 3
NS 1 at 7:10 wrote:
“Many family clusters in multiple locations have shown bimodal (staggered) disease onset dates indicating efficient H2H transmission in 2006.”
I think you meant INEFFICIENT H2H transmission.
None of the clusters seem to have led to any community transmission, or tonumerous generations of transmission.
All the cases that are confirmed sound like either the result of 1. direct exposure from birds, or 2. inefficient, very limited, dead-end transmission between people closely exposed to each other, or 3. “origin of exposure unknown,” but not part of apparent multi-generation H2H spread.
Last two posts appear to me to be correct, as I have argued elsewhere. I just took exception to “no H2H”. Very limited H2H still puts us in stage 3.
Nonetheless, the importance of clusters is as a starting point to investigation. That investigation may yield nothing, but the investigation should be done nonetheless.
Although this post is from the CDC site, and I have only been following fluwiki for a couple of weeks, and don’t know who or who has not seen this, but I found it very enlightening. I was most interested in reading what the hospitals are actually being told to do in the event of a Pandemic. Kind of scary that they are planning on limiting access, closures and enforcing access. I particularly found interesting:
Facility access
Hospitals should determine in advance the criteria and procedures they will use to limit access to the facility if pandemic influenza spreads through the community.
Define “essential” and “non-essential” visitors with regard to the hospital and the population served. Develop protocols for limiting non-essential visitors. Develop criteria or “triggers” for temporary closing of the hospital to new admissions and transfers. The criteria should consider staffing ratios, isolation capacity, and risks to non-influenza patients. As part of this effort, hospital administrators should: 1) determine who will make decisions about temporary closings and how and to whom these decisions will be communicated, and 2) consult with state and local health departments on their roles in determining policies for hospital admissions and transfers. Determine how to involve hospital security services in enforcing access controls. Consider meeting with local law enforcement officials in advance to determine what assistance, if any, they can provide. Note that local law enforcement might be overburdened during a pandemic and have limited ability to assist healthcare facilities with security services.
Small clusters puts us at stage 4, according to the WHO plan. There are many, many small clusters. The question is, how does one interpret them? If all the family members get sick at the same time, the assumption is that they were exposed to the same source, ie, no human to human spread. However, if the caregiver gets sick a week after the person they were taking care of, and both were infected with H5N1, the most likely explanation is that the caregiver was infected as a result of inefficient human to human spread. There are many examples of this. There would be more, but the Director-General of the WHO, and the possibly the Turkish government, are supressing the information re: Turkey. Still no symptom onset dates or relationships between the most of the confirmed cases in Turkey. Anyone think they need more time to collect this information? The Turkish press published this information months ago.
Monotreme – at 22:03
Not necessarily, since the same point source of infection can exist throughout a given period of time. An infected area may expose a family to H5N1 over a week or two; the second member (or third) that gets sick 10 days later could have gotten the illness from the environmemnt as well as another person.
I don’t believe you can interpret clusters without field investigation; that’s why collecting clusters is worrisome but not proof; it’s a signal to investigate.
If there is any doubt whatsoever as far as what level we should be, it seems WHO should air on the side of caution. Level 4 would open up alot of closed eyes giving folks a chance to prepare just in case. My 2 cents….
This just out
http://www.juiceenewsdaily.com/index.php/2006/01/23/mutated-bird-flu-found-in-turkey/
DemFromCT
It is certainly possible that one person could be exposed to bad chicken and the person who takes care of them could, conincidently, also be exposed to bad chicken a week later. My point was: what is more likely? When you look at the clusters as a group, how believable are multiple conincidental environmental exposures separated in time? I need to look at some infectious disease textbooks, but I suspect that family clusters, with cases spread out in time, are classic signs of human to human transmission. I think the only reason the common exposure hypothesis is being uncritically accepted by the WHO is because the Director-General doesn’t want to damage China’s economy by declaring phase 4.
Anonymous is right in saying that we should err on the side of caution. Instead, the WHO is erring on the side of money.
I’ve got a question. How can H-H transmission be proven definitively? Is it possible with blood tests? Or is it a matter of hypothesizing the likelihood of H-H transmission based on the abscence of any other possibility? If it goes H-H efficiently it would of course become obvious quickly, but in the case of ‘small clusters’ how is this determined?
Good question MaMa.
When reporting, why doesn’t WHO (and for that matter, the CDC) use the categories “suspect” and “probable” as they did in SARS cases? Why only confirmed?
MaMa: Good question. The answer is that there is no ethical way to decide for certain whether a small cluster is due to common exposure or transmission that requires close contact, especially when the virus is endemic in poultry in that region. Hence, we must resort to arguments regarding the likelihood of conincidental common exposure at different timepoints. The only way to be sure that the virus can be transmitted human to human by close contact would be to deliberately infect one group of people and then have another group of people take care of the first group without PPE. Obviously this would be immoral. The next best type of experiment would be to infect one group of experimental animals with H5N1 and put them in close contact with an uninfected group of animals and see if the latter group gets infected. In fact, this has been done, with cats. Guess what? The cats who were put in close contact with infected cats also got infected. All of them. Cats are mammals, like us.
I find the cirumstantial cluster evidence and the direct animal experimental evidence quite convincing. We should be at phase 4.
Monotreme- Thank you very much for replying. WHO says there is evidence of increasing clusters, but not convincing evidence, alot of room for biased interpretation there IMO. Essentially the current phase is the guesswork of the General Director based on incomplete information. I agree with your estimation. We should be at phase 4.
MaMa: No problem. Also, we should not forget that the Director-General has a lot of information that we don’t have because he’s suppressing it. I think we can learn a lot by what he suppresses. For example, the Turkish data on symptom onset and the relationships between the patients. We have to read the WHO press releases the way Russians had to read Pravda during the Soviet era. They knew it was filled with misinformation and half-truths, but they could still figure things out by focusing on strange omissions. The lack of basic epidemiological information on the Turkish cases qualifies as a strange omission.
One way for H2H to be ‘proven’ is if in a particular location, there is an index case who was infected with a newly mutated strain which has not been found before and has not been found in local poultry, and subsequent to that a cluster appears that is epidemiologically linked to this case and has this mutations, while other human cases (not epidemiologically linked) in the same area at the same time or prior to that have the old strain.
Monotreme- I think it’s wisest to read between the lines. If WHO has the information and is not releasing it the most likely reason seems to me to be that it contradicts their stance at stage 3. From what I’ve read lately about releasing this data is that it should be released as soon as available. That isn’t happening.
anon_22- thank you for clarifying that. It makes sense.
Montanan- I neglected to say “you’re welcome” before, sorry about that. I hope that your friends have a safe and enjoyable trip. Thank-you for starting this thread. I have learned a great deal.
anon_22: Good point. Of course we would have to have the sequence data. Oh that’s right, most of it is being witheld. Hmmm.
Not looking good.
GENEVA - Bird flu is unprecedented in its scope as an animal disease, costing the world’s agriculture industry more than $10 billion and affecting the livelihoods of 300 million farmers, the World Health Organization said Monday. The U.N. agency is meeting in Geneva to discuss global efforts to prepare in case bird flu mutates into a form easily passed between humans, potentially triggering a global pandemic. Dr. Margaret Chan, who is spearheading WHO’s efforts against bird flu, told more than 30 experts that the top priority was to keep the deadly H5N1 strain of bird flu from mutating. “Should this effort fail, we want to ensure that measures are in place to mitigate the high levels of morbidity, mortality and social and economic disruption that a pandemic can bring to this world,” she said. WHO says
This is the first thing I’ve seen from WHO in a while. Any ideas when they will update the number of cases, or why we haven’t seen an update since March 1? Is there another place to find out the confirmed cases in animals or humans?
I have been wondering if this weeks meeting is a precursor to them upping us to level 4. Because of the political/economic consequences it is a serious step. In the full meeting outline, they did say they will have to submit results of the meeting for member comment before creating action steps. So, level 4 by May?
We truly feel that this present threat and any other threat like it is likely to stretch our global systems to the point of collapse, said Dr. Mike Ryan, director of epidemic and pandemic alert and response at WHO. http://tinyurl.com/hwyrr
This is the first time world health authorities have tried to stop a global influenza pandemic before it begins. Chan referred to the spread of severe acute respiratory syndrome, or SARS, as evidence of “how much the world has changed.”
“No one can say when this will end,” Chan said. http://tinyurl.com/e7vmu
Monotreme, you write: “I find the cirumstantial cluster evidence and the direct animal experimental evidence quite convincing. We should be at phase 4.”
My main challenge question for you is: What is the largest specific (unofficial, non-confirmed) cluster you find convincing as evidence of Phase 4? Approximately how many generations of H2H spread do you think it included?
I am not one those who believes that WHO thinks we are at Phase 4, but is not telling. That doesn’t mean I think they reveal everything they suspect or know. I wish they would tell us more about the kinds of things they “know” but are not telling (and explain why they are not telling), and I wish they would tell us more about the kinds of things they “suspect” but are not telling (and explain why they are not telling).
I believe that diplomatic and political contraints explain part, but not all, of this, and I would like to push WHO to separate out diplomatic contraints from other excuses that easily hide behind legitimate diplomatic constraints. This is always a “limits to transparencey” problem, in all agencies, not just WHO.
But separate from that, I would like to better understand the reasoning of people “outside the system” who are so very certain that we are at a higher phase than WHO says we are. Outsiders have been sure of this for over a year, but I do not see any clear signs of it. Only cloudy signs that do not turn out to have been The Start of Something Big. Eventually one of these Cloudy Signs may be It, but so far, no cigar, as far as I can tell.
Montanan, !I have been wondering if this weeks meeting is a precursor to them upping us to level 4. Because of the political/economic consequences it is a serious step. In the full meeting outline, they did say they will have to submit results of the meeting for member comment before creating action steps. So, level 4 by May?”
No, this meeting is the planning meeting for setting up the containment procedure, as formally proposed in their January 27 draft protocol for rapid response, which can be found here http://tinyurl.com/br8nm
On page 12 of this document,
“6. Pandemic phase assessment A WHO decision to change the phase of pandemic alert will be made separately from the decision to initiate a rapid response or rapid containment effort. Since a change in phase is expected to trigger a number of potentially cascading actions by countries, possibly including travel restrictions and border closures, such a decision will be highly visible and is expected to have significant political, social and economic implications. The decision to declare a phase change will be made by the WHO Director-General after briefings and consultation with WHO technical staff, the WHO Pandemic Task Force, and other advisers as deemed necessary by the Director-General.”
This means that they have de-coupled the anouncement of phase 4 from science, formally acknowledging the need to take politics into account. Which is good and bad. The good thing is that containment or other epidemiological efforts can start and not be hindered by political necessity to pretend these outbreaks are not happening. The bad thing is that those of us who think early announcement of phase 4 is conducive to global preparedness will be even more disappointed.
http://tinyurl.com/pu2fw …”Events in recent weeks justify our concern,” said Chan.
Scientists say the deadly virus is mutating steadily and may eventually acquire the changes it needs to be easily transmitted from human to human.
Because people lack any immunity to it, it could sweep the world in a matter of weeks or months, killing millions and bringing economies to their knees.
Even if a pandemic cannot be stopped, public health interventions such as quarantines might buy time to allow countries to tighten their control measures, the WHO says.”
Thanks anon_22 – at 11:33
I wanted to put this in new thread and call it “learning on the fly” but this news report provides a little more illumination about what the WHO meeting is accomplishing:
“One of the key challenges for experts is how to define the early warning signs of a pandemic strain of influenza.
Under the latest proposals seen by AFP — which are expected to change — a combination of signals are under consideration, including clusters of respiratory disease and changes in the human influenza virus.
Epidemiological signs could occur with a cluster of more than 20 cases of moderate or severe respiratory illness, and possible deaths, in a “specific setting” such as a family, hospital or school, or a limited area such as a village, according to the draft.
Other factors for concern could include clusters in several locations, the presence of H5N1 or concurrent seasonal influenza.
Countries would be urged not to wait for the completion of a full investigation into suspected signs and alert the WHO within 24 hours.” http://tinyurl.com/oexyy
Path Forward: By definition, large clusters don’t occur at phase 4. Clusters larger than 25 trigger phase 5. Phase 4 is triggered when there are multiple small clusters. I have documented some of these here?. The first cluster listed, which occured in a family traveling to Fujian province in China in 2003 is quite convincing to me. 7 year old girl dies of pneumonia on Feb 4. No test for H5N1. Her father becomes ill on Feb 7 and dies on Feb 17. H5N1 infection is confirmed. The girl’s brother gets ill on Feb 9. H5N1 infection is confirmed, but he recovers. I think its highly likely that the girl also died of H5N1 infection. She is not counted as a postive because she wasn’t tested. She was buried in mainland China. You can read more about this case here.
There are many clusters just like this on the Clusters page. Of course the most convincing cases may be in Turkey. But officially, we don’t know about these because the WHO is suppressing information on symptom onset dates and the relationships between the patients. And we know the problem is with the WHO and not the Turkish government because there have been numerous reports desribing these facts in the Turkish media. Why do you think the WHO is suppressing this information?
Also, please don’t disregard the animal studies. These unequivocally show that horizontal transmission occurs between mammals.
As far as “the big one” goes, phase 4 is not phase 6, although the WHO is trying very hard to get people to confuse the two. Sustained and efficient transmission is *not* required for phase 4 or even phase 5. Those terms are reserved for phase 6, pandemic onset. If your point is that the pandemic has not started yet, I agree, but that is not phase 4.
I worry about phase 4 but phase 3 is very limited H2H and that seems to be where we are at.
Monotreme, “As far as “the big one” goes, phase 4 is not phase 6, although the WHO is trying very hard to get people to confuse the two.”
Okay, I get the phase 4 is not phase 6 part, but I don’t understand the rest of your comment.
Have to give WHO some credit on this one. True i think some more acknowledgement of clusters should have been included. But thier seeming more like the organization that eliminated smallpox. Maybe that and the expierience with sars has affected thier abilities to operate within a structure. Which has to operate within a funded orginization. Let’s face it. Money in the current situation we call society talks and instructs. With the cost of the sars episode to world economies, Possibly they have had some restrictions in this case. Not saying i think it’s right to endanger humanity over economic concerns. But then again i don’t have the wieght of such concerns when i voice my opinion. Just hope it’s not to late for an affective response.
DemFromCT: Phase 4 is small clusters, which is where we’re at, IMO. What evidence would convince you that we were at phase 4?
BTW, thanks for fixing the sidescroll!
Montanan: WHO’s own pandemic plan defines Phase 4 as “Small cluster(s) with limited human to human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans”
Phase 6, pandemic onset, is defined as “increased and sustained transmission in general population”
You can get the plan at this site: WHO global influenza preparedness plan. The actual plan is a pdf entitled: WHO/CDS/CSR/GIP/2005.5 Download the one of the language of your choice.
WHO spokespeople have lately indicated that they are looking for sustained and efficient transmission in order to raise the alert level. They don’t seem to want to use the “C” word (cluster).
The consequence is that everyone who is depending on the WHO for a head’s up before the pandemic begins, which is pretty much most of the world, is not going to get one. Criminal behaviour in my book.
Monotreme – at 19:48 “WHO spokespeople have lately indicated that they are looking for sustained and efficient transmission in order to raise the alert level. They don’t seem to want to use the “C” word (cluster).”
Yes, that was part of my confusion and the reason I started this thread a few days ago. It seems from some evidence, that in some places we have seen level 4 activity with h5n1. But no announcement that the level has changed from WHO. When you read the news releases from their meeting today, you see level 5/6 activity being prepared for, but no indication that we are ever going to go to level 4, we’ll just skip right on through to 5 or 6.
And, from today, “One of the key challenges for experts is how to define the early warning signs of a pandemic strain of influenza.” It seems like they are bypassing their own established protocol now and looking to get member country consensus before they ratchet up the threat level.
Their timeline for training teams for containment begins in May 2006. But the types of containment activities reported seem more level 5/6 than level 4.
It seems like containment and the threat levels are no longer linked together, as you could have containments, but no increase in the official level of pandemic alert. “The consequence is that everyone who is depending on the WHO for a head’s up before the pandemic begins, which is pretty much most of the world, is not going to get one. Criminal behaviour in my book.” I think I have to say “ditto” at this point.
I read the WHO global influenza preparedness plan and found some of the language to be typical government-speak (I used to have to review NIH documents and state Medicaid manuals and have a lot of familiarity with open-ended cya government-speak.)
I found this on WebMD. It’s helpful in that it is all in one list. Moderators please remove if it has been posted elsewhere.
The WHO has developed a system of identifying where the world stands with regard to pandemic flu. The system has six phases: Phase 1 — No new influenza virus has been found in people or animals. Phase 2 — New virus has appeared in animals, but no human cases. Phase 3 — A new strain of animal influenza virus infects humans, but there have not been human-to-human infections. Phase 4 — The new virus passes from person to person, but transmission is limited and confined to a certain location. Phase 5 — There is frequent transmission of the virus between people in a particular place, but it hasn’t spread to the rest of the world. Phase 6 — Pandemic. The virus is widespread worldwide. We are currently in phase 3, which marks the beginning of the “pandemic alert period,” because of what has been developing with avian influenza virus H5N1.
I think WebMD just made up their own interpretation of the phase system. Not very accurate.
(I think H5N1 isn’t even behaving the way the WHO thought a virus would when they made their levels.)
NOT confined to a certain location; H5N1 in birds/animals all over
Asia, Africa, Europe (this month, perhaps, the Americas?)
We have had perhaps human-to-human-to ? but stopped, on more than one continent. Humans in too many countries getting sick; so many places a pandemic strain or strains could mutate.
And it means nothing if the WHO says last Nov. we were at level 3. They stopped updating it; they said (see anon_22 – at 11:33)they act without raising the level now.
…”we want to ensure that measures are in place to mitigate the high levels of morbidity, mortality and social and economic disruption that a pandemic can bring to this world,” …
One measure would be a grassroots education campaign to the public before it’s too late for them to need one.
What evidence would convince you that we were at phase 4?
Multiple clusters shown to be likely H2H by epidemiological field review, rather than circumstantial inference, especially if there were more than 10–20 H2H cases. If the clusters were not exposed to birds, that’s worrisome.
I’m not sure if limited H2H (e.g., a single H2H in 30 countries, no propagation) qualifies. And when i say I’m not sure, that’s what I mean.
crfullmoon – at 22:51 (I think H5N1 isn’t even behaving the way the WHO thought a virus would when they made their levels.) NOT confined to a certain location; H5N1 in birds/animals all over
This is a very good point.
I spoke to a friend who is involved at a ministerial level on avian flu and asked him about WHO not giving out data. He said that whatever the WHO puts out in their outbreak reports have to have the agreement of the country involved. It’s not as if they need official clearance from that country, but more that they will lose whatever goodwill they’ve got with that and other countries if they push ahead without permission. (I think technically they do run the risk of violating that country’s sovereign right if they went ahead without permission.) In that case, the decision to not put out disease onset dates etc for Turkey would have been the decision of the Turkish government and not WHO itself. Ditto for other countries. Just thought this would be important to clarify.
Anon_22: But is WHO pushing at all to get that data out? Is WHO being resisted in this regard or are they colluding with said countries in bottling up the data? And for what reason?
Steady pressure can sometimes get things done without rupturing a relationship. It is done every day from a personal level to the international level.
Whistleblowers needed to determine these answers. Anybody?
“Anon_22: But is WHO pushing at all to get that data out? Is WHO being resisted in this regard or are they colluding with said countries in bottling up the data? And for what reason?”
Wouldn’t be all like to know? :-) I’m afraid I don’t have an answer.
However, there are signs that they may be trying to work round that. That decision to de-couple containment from phase could be one example.
anon_22: I have no doubt that affected countries have a say in what, and whether, information is put out by the WHO. The question is, are they hiding behind this excuse, even when it doesn’t apply? The Turkish outbreak began on January 1 2006. Two months later, we do not have complete information on symptom onset dates or relationships between the patients from the WHO. We have *no* sequence data from animals or patients. Is the Turkish government blocking all this information? I don’t think so. The patient information was released in the Turkish media and translated by Oric at Flu Clinic. No censorhip there. Ian Brown at Weybridge is working on a paper describing the sequences. After Ilaria Capua’s brave denunciation of the secret WHO database, Brown agreed to publish *one* sequence. He is witholding the rest pending publication of his paper. Doesn’t sound like the problem with the sequences is with the Turkish government either. And where is the seroprevalence data? Didn’t the WHO say it was going to be available at the end of February?
Older thread, closing for speed purposes.
check dates