The United Nations has estimated that a human influenza pandemic, where a particularly deadly and mobile flu strain spreads across multiple countries, might result in a catastrophic 150 million deaths. According to Jong Wook Lee, director general of the World Health Organization (WHO), “The burning question is, Will there be a human influenza pandemic? On behalf of the WHO, I can tell you that there will be. The only question [remaining] is the virulence and rapidity of transmission from human to human.”
Wide usage of passenger air transportation has dramatically increased the potential for a pandemic. Along with this risk, our understanding of what a flu pandemic might entail has grown considerably. In April 2005, WHO released a revised Global Influenza Preparedness Plan to assist national and local planners in recognizing the symptoms of an emerging pandemic and then respond accordingly. The plan also paints a realistic picture of what individuals can expect if a pandemic does occur.
The new plan charts the emergence of a pandemic over the course of six phases. Phases one and two are referred to as the Interpandemic Period; three, four, and five are Pandemic Alert; and phase six represents a fully evolved global influenza pandemic. The first two phases are typified by a low risk of mass outbreak, though some new influenza strains may be present in animals in phase two.
During phase three, the initial phase of the Pandemic Alert Period, human strains of the influenza virus begin to appear, but the risk of a large-scale outbreak is still low. Authorities may issue vaccinations depending on the availability of prototype vaccines that match the new influenza strain. They may also issue low-level public information alerts targeted to populations near where the new influenza case was first detected. Health workers might trace the spread of the virus in the same way detectives would trace the trail of a criminal-going door to door, seeking out individuals who may have come in contact with infected animals or people. Health organizations will probably urge individuals close to the outbreak to monitor themselves for flu symptoms and may request persons presenting symptoms to wear face masks. New influenza cases would be confined as appropriate to local situations.
During phases four and five of the Pandemic Alert Period, the influenza virus begins to jump from person to person. Individuals who have had contact with symptomatic persons are asked to voluntarily quarantine themselves. Authorities begin a concerted, nationwide public awareness campaign to help people recognize symptoms and to maintain a safe distance from possibly infected people. This public campaign may take the form of posters as well as commercials and will be designed to alert the public to the growing danger as well as to dispel rumors and misperceptions.
The campaign will also inform the public that basic health-care services may be reprioritized to deal with the growing epidemic. The ready supply of basic commodities such as bottled water and baby formula may dwindle in areas. During this period, officials may set up fever clinics or ambulance response hotlines.
The government may begin closing schools, discouraging mass gatherings, and requesting that non-essential workers stay home. Health officials will probably recommend that all persons entering the country defer travel to where the outbreak has occurred. According to WHO, strict enforcement of travel restrictions would be impractical. However, the public would most likely avoid affected areas voluntarily, provided they are fully aware of the associated risks. At this point, the population of ill and thus quarantined individuals may be growing. If the influenza virus in question is particularly lethal, such as the H5N1 “bird flu” strain, the death toll could mount steadily in places where mass vaccinations failed for one reason or another. In that event, health-care workers would implement corpsemanagement procedures to safely, if somewhat unceremoniously, destroy infected human remains.
Phase six represents a fully evolved pandemic situation. The government of the affected county or counties may implement emergency powers. The media campaign will now focus on achieving public support for national response and contingency measures, such as rationing and curfews, and preparing the public for the imminent onset of pandemic activity. Health-care workers would evaluate vaccine stockpiles and vaccine effectiveness, as well as mortuary capacity. Officials would make a concerted effort to assuage public fears and address public grief. People who had come in contact with the virus, even if not presenting symptoms, would be advised to avoid entering unaffected areas.
As with any large-scale disaster, once an influenza outbreak evolves into a pandemic, the time for strategy and planning will have passed. The response of health-care workers and individuals to warning signals will largely determine the pandemic’s level of destruction. In developed nations, according to the U.S. Centers for Disease Control, a fully evolved pandemic will result in 134 to 233 million outpatient hospital visits and 1.5 to 5.2 million hospital admissions, as well as billions of dollars of revenue and GDP loss. But developing nations, with infrastructures already straining to serve their growing, impoverished populations, will pay the heaviest price. The fact that the UN’s death toll estimates are so broad-5 to 150 million potential casualties from a global pandemic-underscores the need for proper preparation today.
Source: WHO Global Influenza Preparedness Plan. World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland. Telephone +41 22/791-3111. Web site http://www.who.int/csr/disease/influenza/inforesources/en .
Originally published in THE FUTURIST, January-February 2006