Scott McPherson's Web Presence

The World Health Organization has moved the planet to full pandemic status. Just moments ago, Dr. margaret Chan declared a flu pandemic.

Won't change things much, save for vaccine preps and some other housekeeping items. But it does restore this virus to the forefront of public thought, which is a good thing.

One thing you need to be aware of: Do NOT place your faith in vaccines anytime soon. The earliest anyone will see a swine H1 vaccine is October, and those batches will be reserved (under pandemic Phase Six protocols) for first responders, the military, and decision-makers. This includes police, fire, and EMS personnel, trauma center and emergency room personnel, and the like.

So the chances of you getting a swine flu shot within that first batch are very low. But do not fret. The virus in all likelihood will come back to us well in advance of the vaccine, meaning it will only be helpful to the rank and file toward the end of the second wave, or possibly prior to the third wave of the pandemic.

A lot of false hope is placed on vaccines. More emphasis needs to be placed on the things Momma taught us:

1. Wash your hands vigorously.

2. Cover your cough and smeeze with your sleeve or tissue.

3. Keep a respectable distance from strangers.

These things, and not a vaccine, not Tamiflu and not any other pill, shot or med, will help us through any pandemic of any lethality.

Scan these blogs, and also if you are a businessperson, you may want to jump over to my other blogsite,http://blogs.computerworld.com/were_in_a_pandemic_but_theres_still_time_to_plan for additional analysis.

A report in today's New York Times says that as many as a half-million Big Apple residents may be displaying symptoms consistent with swine H1N1 influenza.

The city has twelve reported deaths that cre confirmed swine H1 cases. Three new fatalities -- a person under 40, a person under 60, and a person over 65, brought the city's total into the double digits.

It is absolutely clear that the virus has not abated, has not gotten weaker, and if anything may be headed in a different direction. From Manitoba, Canada, and as reported by veteran flu blogger Crof (of British Columbia) on his site H5N1:

Manitoba adopts pandemic response

Via the Globe and Mail, a remarkable report:Manitoba adopts pandemic response. Excerpt:

As the World Health Organization vacillated over whether to call the flu outbreak a full-blown pandemic yesterday, Manitoba shifted to a disaster footing, warning people away from hospitals, closing some northern schools and placing more flu victims in intensive care.

The Winnipeg Regional Health Authority posted flyers throughout city hospitals asking the public to limit hospital visits and urging people with flu symptoms to stay away altogether.

Nurses and physicians within those hospitals are straining to contain a surge in severe cases of the flu that appears to be unique in the country.

Yesterday, two more flu sufferers were placed in intensive care, bringing to 27 the total number of people on respirators due to flu symptoms.

More on this in the Winnipeg Free Press. Manitoba seems to be taking H1N1 a lot more seriously than the rest of Canada is.

Manitoba is seeing something in its "surge" sufficient enough to cause the province to move quickly and forcefully.  Twenty-seven people on respirators is clearly not a good thing.  The conventional wisdom is that when a flu sufferer goes on a ventilator, recovery is far from assured. 

It is time to stop counting positive test swabs and it is time to start counting employee absenteeism and school absenteeism.  Of course, schools are closing for the summer, so we are losing one of our most critically important "sentinels."  Still, we have summer school in places where it is still funded, and colleges still have summer semesters.  This, along with workplace absenteeism, is where we will get our data on the spread of the virus and its severity.

Also, Indonesia is reporting its first round of confirmed swine flu cases, and Egypt is trying to desperately contain what it believes to be its first cases -- at the American University in Cairo.  Recall that both of these nations lead the world in human H5N1 infections, and getting reliable information out of Jakarta on flu infections is like asking North Korea for nuclear advise. 

WHO set to declare Phase Six at emergency meeting in Geneva.

Finally.  Tomorrow, Thursday, June 11, 2009, the World Health Organization is expected to relent and finally declare what the world already knows; namely, that we are in the beginning of the first honest-to-God flu pandemic since the 1968 Hong Kong H3N2 influenza pandemic.

Dr. Margaret Chan, the head of the WHO, has been working with nations to make sure a move to Phase Six does not create some sort of bureaucratic nightmare.  Also, there has been concern that a move to officially declare a pandemic would provoke some sort of panic.

I think the WHO is seriously underestimating the ability of the world's population to filter that news and absorb it quietly, without panic and without fanfare.  The world already suspects that we are in panflu status; telling them they are correct will do far more to reassure people there is no coverup going on than to maintain a Phase Five status that is clearly obsolete.

There have been numerous articles regarding the collective inability of the world's animal health and public health professionals to look for the obvious (hogs) when doing their disease surveillance, and instead become preoccupied with avian flu that is still a threat, just not THE threat right now.

And that is very much a mystery, as we all go back to our Powerpoints and update them feverishly for swine flu.  While updating one of my roughly one thousand Powerpoints on the topic, I couldn't help but notice that one slide showed a hog as plain as day, sitting in some Oriental mud puddle, with a chart explaining how pigs are the proverbial "mixing vessel" for flus. 

If we always mention the pig, then why were we not looking at them more closely?  because we were spending more time swabbing dusk and tern behinds in the Alaskan tundra than we were swabbing hog nostrils in Wisconsin and Mexico.

I mention Wisconsin because that state has been a veritable incubator of swine flu.  At last count, some 2,200 cases of human swine H1 infection were reported to the CDC.  This outpaces California, Texas, Illinois, New York and Florida.

What is fascinating is when you look back at the dispersion of the 1946-49 maybe-pandemic of H1N1.  the first big area to be impacted by that epidemic was:  The western and central Great Lakes states.  That would include Wisconsin and Illinois.  If you add up their swine H1 exposure, those two states account for nearly one-third of all US confirmed swine H1 cases.  One-third.  And the last time I looked, neither state borders Mexico, previously considered to be Ground Zero in all this.

I say "previously considered" because someone needs to formulate a theory as to why Wisconsin is the nation's swine flu capital, while not producing a single human death (so far) from the virus.  Why is 2009's flu pattern mimicking that of 1946-48's?  Somebody get a study going on that one, pronto.

I'll have more on that later.  For now, rest assured that by evening drive tomorrow, and thus on the network news shows, we will be at Phase Six.  And Americans, at least, will go on about their business.

A blind man could see it in a minute: the World Health Organization, after a series of good moves and sound decisions, has blown the non-call on its reluctance to move the world to Phase 6 swine flu H1 status.

Why not Phase Six?  A technicality:  According to Helen Branswell of the Canadian press, Chile is in the WHO's North American reporting region.  Now, that is like saying Japan is in the European region.  But apparently the WHO is not too keen on Southern Hempsihere geography, else they would have a separate reporting schema for South America.  factor in Chile, and presto!  You have a Phase Six tripwire.  According to Branswell, however, if Britain or Australia show community spread (and they will, no doubt about that), the WHO has no choice.

Therefore, functionall there can be no doubt -- no doubt at all -- that the world is in the beginning (yes, the beginning) of a real, honest-to-God influenza pandemic. Yet for the WHO and for so many nations whose preparations wholly centered around a killer avian flu with a severe death rate, they failed to take into account one small detail.

What if the pandemic isn't all that lethal?

First answer: Excellent! We'll take a 1957 or 1968-type pandemic over 1918. Or 1830. Or even 1946's near-miss.

Second question: Why couldn't these best and brightest conjure up a scenario that would involve just what we are facing right now?

Second answer: Because public health professionals are not distinguishing themselves well as emergency managers or homeland security planners. It is amazing to see the number of nations who never planned for a minor pandemic, and now are crying to the WHO to loosen the protocols.  Heck, even the WHO itself has flirted with a rewrite of the protocols, although they just announced this week they will not do so.  Good call, Dr. Chan.

For a moment, I want to give some props to the Bush Administration.  The Obama Administration has admitted it is using the Bush playbook for this swine pandemic, and even President Obama has thanked the former president for his leadership in providing a roadmap to management of this crisis. And yes, it is a crisis.  ANY flu pandemic is a crisis-in-the-making.  We won't know just how bad of a crisis it is until many days from now.

Part of that playbook includes the ingenious move by HHS/DHS to classify pandemics according to a kind of Saffir-Simpson intensity scale.  As fans of the Weather Channel and residents of any state within 250 miles of a coastline know, the Saffir-Simpson Scale measures hurricane intensity.  What HHS/DHS did was take that metaphor and apply it to pandemics.

HHS/DHS have been using that Saffir-Simpson scale to measure response and move resources since Day One of this crisis.  It is so simple and easy to understand, more mainstream media attention should be placed upon it.  And I dare say if the other nations of the world had also applied it, or something similar to it, there would not be so much angst and political pressure applied to stifle a Phase Six declaration.

Look at the charts below to understand the United States' approach to this problem.

I frequently refer to this master chart as the "Saffir-Simpson" scale for pandemic lethality.  For those nations lobbying to slam the door on the WHO's desire to declare a pandemic, let me ask: has your planning taken the following items into account? See below.

The way I read it, we are currently somewhere between Category One and Category Two pandemic status in this country.  However, and despite the mainstream media's decision to ignore what is happening all around them, this virus is killing far more Americans now than it did thirty days ago.  It is being reported in the surviving hometown daily newspapers in each edition.  This means the virus is circulating freely in our communities and continues to attack and, sometimes, kill.  It is not going quietly away; it is continuing to spread, which of course is also what we are seeing across the globe.  At last count, some 64 nations had the virus, and no nation is declaring itself virus-free.  Except maybe North Korea, and that nation has collectively lost its mind anyway.

It is almost worthless at this point to try and track numbers of infections strictly by swabbing throats and noses.  We now have to assume, as the New York health officials have assumed, that any case of influenza is now swine flu.  Any case of summer flu (which is unheard of in seasonal flu, by the way) should, by definition, be considered the pandemic strain by default.

My Blackberry is going off multiple times a day with reports of confirmed H1N1 swine flu deaths across America.  Chicago: A 20-year-old pregnant woman dies after giving birth.  Deaths now reported in many states.

People say:  No biggie, it's not a killer, so what's the big deal? 

In Egypt, recent news reports talk of a village with a confirmed H5N1 human case ( a 4-year-old) and some 39 suspected follow-on infections.  A person is testing positive for H5N1 in Egypt at the rate of one every three days.  And we don't have any idea of the number of human H5N1 infections in Indonesia; the Health Ministry adopted a policy of only releasing human H5N1 cases every few months.  the only inklings of what is occurring in Indonesia come from news accounts, many of which are quickly denied by the government.

As swine H1 takes its victory lap around the planet, it will invariably create local versions of itself.  And it will (if it has not done so already) eventually and inevitably be introduced to H5N1 avian flu, either in the respiratory tract of a pig or a human.  How those viruses behave together, only God can predict. 

So let's go to Phase Six, remind nations of the excellent chart and methodology of HHS/DHS, and begin planning for an unpleasant autumn flu season. 

Earlier today, I pointed out with some thumping of the ol' chest that the CDC has indirectly confirmed my theory of late April regarding swine flu; namely, that we could compare this event with the 1946-47 pandemic/epidemic of H1N1 and the 1951 H1N1 severe epidemic to see if there was a correlation.

The New York Times article was the first confirmation of that.  Now, the AP has also written on the topic.  But their story is more precise in the age group (persons ages 60 and above) that seem to have natural antibodies against 2009's swine H1N1. 

A simple subtraction of the number 60 from the number 2009 (or 2008 if you prefer, since the virus apparently first manifested itself in September 2008 in Mexico) yields the number 1948.  This is so close to the 1946-47 severe epidemic that it cannot be considered coincidence.

As I have mentioned many times previously, the 1946-47 epidemic may have, in fact, been a pandemic of influenza.  It was certainly an epidemic, and was by accounts as severe, illness-wise, as the 1957 H2N2 "Asian flu" pandemic, with roughly the same mortality, which was serious but not apocalyptic. 

Textbook research shows that flu seasons had been relatively mild from 1930 until 1946, when all viral Hell broke loose.  A serious antigenic event -- a huge drift, or perhaps a more likely antigenic shift due to reassortment of human flus -- took place.  It rendered vaccines useless (sound familiar?) and started a new chain of H1N1 flu that culminated in yet another antigenic seismic event in 1951.  That virus caused more epidemics until it was deposed by H2N2 in 1957.

It is highly unlikely that antibodies to pre-1946 influenza are helping seniors today.  In my own opinion, it must have been the 1946-47 strain of H1N1.  And that would seem to indicate a swine background for that mutation, but I will leave that for the researchers. 

At any rate, the roadmap is opened up and flattened out for viral researchers.  Good luck to them.