WHAT IS A "PANDEMIC" ANYWAYS ?

In other words, a lot of people [would] have to fall seriously ill, and a lot of them have to die. This, of course, did not happen with the H1N1 flu. Although many people caught the illness, most experienced only mild symptoms. Only a small percentage became seriously ill, and a smaller percentage died.

At the time of the pandemic declaration, nearly 30,000 people in 74 countries had been infected but only 144 people died. The death rate works out to less than 0.5 percent, which is very low. In contrast, the diseases SARS (severe acute respiratory syndrome) had a death rate of about 15 percent -- although SARS was not declared a pandemic because few people got infected.

By changing the pandemic definition, the WHO has made it easier to classify the 2009 flu outbreak as one. This, however, adds fuel to criticisms that the WHO seems overly eager to declare a pandemic."

The World Health Organization's definition of what constitutes a pandemic is too broad, according to an article published this week.

Peter Gross, infectious disease specialist with the Hackensack University Medical Center in New Jersey, has penned an editorial for the British Medical Journal's Clinical Evidence in which he suggests that the WHO's loose definition could lead to false alarms.

The WHO changed their definition last year, Dr. Gross said. Previously, a “shift” in the virus would have to occur, meaning a new subtype of the virus would have to appear in order for a pandemic to be declared. [so there was a change in 2008 too!]

A subtype is represented in the H and N numbers of a flu virus' name, such as H1N1. Another example is avian flu, which is categorized as H5N1 or, technically, as Influenza A/H5N1.

Now, with their recent change, Dr. Gross said the WHO has made the definition too vague. “They said a new animal or human-animal strain could qualify as a pandemic strain. That's too non-specific.” He said neither shifts nor drifts, which are subtle changes in the virus' makeup, are mentioned specifically in the guidelines for declaring a pandemic.

As of this year, the WHO defines a pandemic as occurring “when an animal influenza virus to which most humans have no immunity acquires the ability to cause sustained chains of human-to-human transmission leading to community-wide outbreaks. Such a virus has the potential to spread worldwide, causing a pandemic.”

Dr. Gross says the new definition could lead to false alarms and that “any minor change, any minor drift could be considered a pandemic.”

He also pointed out that, even in a medical dictionary, the definitions for the terms “pandemic” and “epidemic” are not clear, with no guidelines set on the number of people who need to be affected to reach either status, and no specific mortality rate.

In their 2009 Pandemic Influenza Preparedness and Response document, the WHO defined a pandemic as simply “an epidemic on a global scale.”

Dr. Gross said, “H1N1 has been around for most of this century, except for 20 years mid-century, from 1957 to 1976. Nobody knows where it went, but then it re-appeared in '76.”

He said that since 1977, H1N1 has been included in seasonal flu vaccines, along with H3N2.

However, Dr. Gross said the current strain of H1N1 has undergone a significant drift in its makeup, thereby making humans less resistant to it.

“A seasonal flu causes about 36,000 deaths,” he said, referring to statistics in the United States. “The difference with what's going on right now is we have more morbidity and mortality among young children and young adults. Usually, it's the other end of the age-spectrum that's affected.”

The WHO pandemic document includes statistics for the three major pandemics of the 20th century. The worst was the Spanish Flu of 1918-1919, which also targeted young adults and killed 2 to 3 per cent of those who contracted it, worldwide.

“Influenza is different from most other human viruses,” he said. “When you get the measles vaccine, that lasts for a lifetime because the virus is genetically stable.” Influenza, on the other hand, is not as stable because its genetic makeup is split into pieces. If one strain meets another, the pieces mix together. “When it comes out, who knows what it's going to look like?”

“We just need a better definition of all of this,” Dr. Gross said. “It's really kind of amazing after all these years that it's not clearer.”

http://www.theglobeandmail.com/news/national/who-pandemic-definition-may-be-too-broad-report/article1348100/

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'A Whole Industry Is Waiting For A Pandemic'

The world has been gripped with fears of swine flu in recent weeks. In an interview with SPIEGEL, epidemiologist Tom Jefferson speaks about dangerous fear-mongering, misguided, money-driven research and why we should all be washing our hands a lot more often.

SPIEGEL: Mr. Jefferson, the world is living in fear of swine flu. And some predict that, by next winter, one-third of the world's population might be infected. Are you personally worried? Are you and your family taking any precautions?

Tom Jefferson: I wash my hands very often -- and it's not all because of swine flu. That's probably the most effective precaution there is against all respiratory viruses, and the majority of gastrointestinal viruses and germs as well.

Jefferson: The WHO and public health officials, virologists and the pharmaceutical companies. They've built this machine around the impending pandemic. And there's a lot of money involved, and influence, and careers, and entire institutions! And all it took was one of these influenza viruses to mutate to start the machine grinding.

The President's Council of Advisors on Science and Technology issued an alarming report on swine flu last week. A typical front-page article about it began, "Swine flu could infect half the U.S. population this fall and winter, hospitalizing up to 1.8 million people and causing as many as 90,000 deaths."

But the council's "plausible scenario" involving those alarming figures is based on three main assumptions, and all three are highly suspect.

First, the report says that "based on past pandemics," a sharp increase in infections "is likely ... starting in September and peaking in October." That's important, because the first shipments of vaccine aren't expected until mid-October.

The problem is that swine flu isn't comparable to those past pandemics. As I wrote in June, it's only called a pandemic because the World Health Organization changed its definition of the term so that "enormous numbers of deaths and illness" are no longer required.

Furthermore, true pandemics have been severe because the viruses involved were alien to our immune systems. But H1N1 virus, of which swine flu is a variety, "has been circulating every year since 1977," noted Peter Palese of Mount Sinai School of Medicine in New York, a member of the president's council. It's consistently part of the seasonal-flu vaccine. The swine flu variety is different in some ways, but this is "something our immune systems have seen before," Palese said.

In fact, older people seem especially protected, apparently from exposure to a strain that circulated before 1957. That helps explain why swine flu disproportionately afflicts younger people.

Palese, who is none too happy with the council's report, calls an October peak "highly hypothetical." James Chin, a professor at the University of California, Berkeley, and former WHO epidemiologist, is even more skeptical. "Just six weeks from now, about a quarter of the U.S. population will have to have been infected, or close to an average of two million infections per day," he noted. It took almost five months for the flu to reach an estimated two million infections.

Faulty figures

A second suspect assumption in the report is that, in the absence of a vaccine, swine flu will infect vastly more Americans - 30 to 50 percent of the population - than seasonal flu does. Why? "Because most of the population lacks significant immunity to a new pandemic strain," says the report. Once again, this overstates the newness of the virus.

The report's third dubious assumption is that the rate of death from swine flu "appears to be similar to" that of seasonal flu. There's no source for this claim in the report, so I contacted Dr. Harold Varmus, president of Memorial Sloan-Kettering Cancer Center in New York and a co-chairman of the president's council. In an e-mail, he cited figures from the British government and two journals, BMJ and Eurosurveillance.

The U.K. figures were described as a worst-case scenario. The rates reported by BMJ came from the United States, Mexico, and three other areas; the high end was from Mexico, the U.S. rate was far lower, and those from the other areas were lower still. Portraying them as a range for the United States, as the council report did, is misleading. Finally, the figures attributed to Eurosurveillance come from four different sets of data. Three of these have maximum death rates far below the council's minimum, and the fourth barely exceeds the council's minimum estimate.

Worried well

On the other hand, comparing current U.S. swine flu deaths (about 550) to the number of estimated infections (two million) suggests that the virus is far less lethal than seasonal flu. A new New York City estimate suggests seasonal flu is 10 to 40 times more deadly.

Chin noted that Australia is having its flu season now. But with swine flu cases having peaked in July, and with no swine-flu vaccine, the government is reporting a flu epidemic not discernibly worse than in recent years. Indeed, swine flu "appears to be replacing the current seasonal H1N1 virus," meaning there could be fewer deaths. Chin told me, "My bet is that the coming [U.S.] season will not be too severe - at or below that of a usual flu season."

The only realistic aspect of the scenario put forward by the council is that emergency facilities could be swamped. But rather than with truly sick people, it will be with the mildly ill and the worried well - as happened during the media fright fest last spring. This time, much of the panic will be due to the council's self-fulfilling prophecy

Michael Fumento is director of the Independent Journalism Project, where he specializes in health and science issues.
He can be contacted at fumento@pobox.com