On Thursday June 11th the WHO raised the pandemic alert to Phase 6 of a possible 6 indicating that the H1N1 “swine flu” pandemic was no longer “highly likely” but rather “under way.” This is no small change — it marks the first global flu pandemic in 41 years. The last outbreak, the Hong Kong flu of 1968, resulted in 700 million deaths worldwide. Declaring a pandemic requires evidence of widespread disease transmission in two or more regions around the world. The change on Thursday reflects data that shows that in addition to the Americas (Mexico and the U.S.) Australia has experienced a sharp rise in H1N1 cases. All together the latest data report that there are nearly 30,000 cases of the H1N1 flu in 74 countries, with 144 confirmed deaths.
In most of the United States, this major announcement went without much fanfare. Compared to the initial media storm about the “swine flu,” many major papers did not even mention the news on the front page. But perhaps rightfully so. The WHO, CDC, and other leading organizations in fact stressed that the change in the alert level primarily reflects the fact that the scientific criteria for pandemic had been met — a nominal change, though admittedly historic. The H1N1 epidemic was fundamentally no different on Thursday June 11th, the day of the announcement, than it was the day before on June 10th. Yes it is spreading. Yes we need to remain vigilent. But overall, there is no cause for increased or renewed concern.
Here at my hospital, however, entirely coincidentally, the H1N1 epidemic took on new meaning. In the 2 to 3 days following the announcement we found that our hospital was in the midst of an H1N1 outbreak. As has been noted across the globe, most of the victims of our outbreak are in their 20s — in our case, young medical residents. Over the past four days, we have had (by my count at least) 7 house officers diagnosed with the H1N1 flu, with more cases likely to be detected in the coming days. Just when we thought we had survived the Swine Flu scare relatively intact, it has reared its head again.
The outbreak has been an education in preventive health. Earlier I blogged about the importance of hand washing as a primary strategy for containing transmission ( http://beyondapples.org/2009/05/01/washing-our-hands-of-the-swine-flu/ ). Now I am learning first-hand about other important strategies. All 7 medical residents have been asked (in a few cases compelled) to immediately cease all patient care for the next 7 days. The scene was chaotic — the morning of the outbreak residents with known infection or with any symptoms of the flu were being shooed out of the hospital while they frantically finished up their work, making sure there would be no loose ends in their patients’ care. Now I and others have been asked to replace them on the wards and take care of their patients while they recover. Because I am working in the “epicenter” of our outbreak, the medical intensive care unit, and will probably be exposed to the virus, I am taking medical prophylaxis against the flu – a once-daily pill of oseltamivir (commonly marketed as Tamiflu) for the next 5 days.
As Dr. Margaret Chan, director-general of the WHO, said in her press release June 11, 2009: “ The world is now at the start of the 2009 influenza pandemic.We are in the earliest days of the pandemic…Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection.We are all in this together, and we will all get through this, together.”
I wish everyone the best of health during this pandemic. As I go into the heart of my own hospital’s mini-epidemic to take care of critically ill patients whose doctors have already fallen sick, I can only hope the same for myself and my colleagues.