Swine Flu: Being part of the solution not the problem

Swine Flu, or the H1N1 pandemic, is serious. Deadly serious. It is a situation when unfounded skepticism can literally be life-threathening. HDEO thinks its high time we were all part of the solution.

When catastrophes hit the world - killing people, wreaking havoc, and threatening our way of life - the world responds with its entire means. However, when we can predict a crisis, armed with irrefutable scientific evidence, the sceptics often outnumber those willing to respond.

The World Health Organization (WHO) recently announced a change in how it will continue to monitor and report the influenza H1N1 pandemic (commonly called Swine flu). They are no longer quantifying confirmed cases or numbers of affected countries because “further spread … within affected countries and to new countries, is considered inevitable” but also because of the unprecedented speed at which the virus is spreading. Basically, the inevitability of a global pandemic means its pointless to count any more.

Projections and predictions, in blogs and mainstream media, cover both extremes from dismissing the pandemic as hyped to emphasising worst-case scenarios as the best course of action. Very few query what is needed to prevent the worst from happening - or at least to limit its consequences.

May yet mutate

Neither approval nor scepticism can change the reality that the virus is spreading and affecting more people, and may yet mutate into a more severe form that causes a significant increase in mortality.

The uncertainty about if and when this might happen is in the nature of scientific search for truth. The big question that needs answering now is while we hope for the best, what do we do in preparation for the worst, which might come sooner than we know?

So far, two big solutions are suggested - vaccines and antiviral medications.

First doses of vaccine

The first doses of the vaccine can be available in late September and the most optimistic production estimates are at 4.9 billion doses in the following 12 months, a more conservative estimate puts the production capacity at 1 to 2 billion doses per year.

Experts recommend that priority for vaccination be given to health care workers and high-risk groups, but several rich countries already pre-ordered enough vaccine to cover their entire populations. This means that health workers and at-risk groups in less fortunate parts of the world will have to wait until more vaccines are available. So, if you pay you’re OK and developing countries will yet again be stranded without the best means to combat the pandemic.

Tamiflu (Oseltamivir) is the antiviral medicine that H1N1 responds to now, but this can change rapidly and resistant strains are already appearing. Additionally, with only several million doses available and insufficient production capacity, this is another solution that may also be a case of “if you can pay you’re OK”.

Simple steps to reduce risk

So where does that leave those on modest or average incomes, or the billions who live in poverty, with no health infrastructure, and who are not likely to receive vaccines or medicines?

There are some simple solutions that will make it less likely that you will catch the virus or, should you be infected, to pass it to your friends and family.

If you wash your hands regularly, keep a safe distance from people who might be sick, cover your nose and mouth with a tissue or sleeve when you cough or sneeze, and avoid crowded areas, you will be less likely to contract the disease. And, If you did contract influenza, you would be less likely to die from it. This is a fact.

A recent survey in the UK showed that only 37 per cent of those surveyed used prevention measures and fewer than five per cent followed avoidance behaviour to protect themselves from influenza.

Why such complacency? The survey concludes that when people believe a threat is real and trust the advice they are given, they are more likely to follow the recommendations. However, if they believe “that the outbreak had been exaggerated” they are less likely to change.

This is a time when unfounded scepticism could be life threatening.

There is a need to promote a culture of prevention. Only when everyone takes responsibility for spreading the word, when people have the knowledge and determination to protect themselves, their families and their neighbours, will we reach a point where we are likely to make a real difference. Such simple gestures can bring about life-saving change.

The planet will not be saved by superheroes but by each one of its own people. Take H1N1 seriously, and know it is not too late to be prepared.

Swine Flu ain't over till it's over

Right, a factory worker at a mask factory in the Philippines where production has tripled in the last few weeks.

Swine flu (H1N1) is still with us despite the sharp fall off in media interest. Yesterday, I had to watch main news channels for ten minutes or so before the pandemic was mentioned, if at all. One news editor told me he instructed his journalists to ‘give up on swine flu. It’s a story that’s going nowhere’.

I have heard doubts and even criticism expressed from some quarters on ‘scare-mongering’ or ‘crying wolf’. What is it about human nature? Do we really want the ‘proof’ of a lethal pandemic before our eyes till we truly kick into action? Is it not in our DNA make-up to tackle life-threatening events before they happen if we are lucky and wise enough to act early based on clear warning signs?

Deliberately or not the media has contributed to a misperception that the threat has faded. This shows little respect or understanding for the nature of pandemics and could even undo all the good prevention and mitigation work that has taken root in many countries up to now.

A real and present scenario is that the current strain of H1N1 will go underground and reappear with a vengeance during the northern hemisphere’s winter influenza season in a few months time. There are many other equally unappealing scenarios.

It seems now that pigs are basically Petri dishes for the virus and not just direct transmitters. The case in Canada where infected humans passed the virus to pigs and back again proves this. What will be the scenario if this happens in Asia where avian influenza (H5N1) is still very much around. What mutant scenario will we get if these two hook up? 

In the hard-fought business of preventive health you have to base your reasoning on a whole range of scenarios. We do not have the luxury to wait till our scenarios play out, say “Told You So” and head home to wait it out in a bunker.

Now is the time to take action. We don’t need to sit around to see ‘what if’. We are programmed to prevent ‘what if’ and that is a good strategy (and a good investment) even if at times the highly unpredictable out-maneuvers us or evaporates into the ether.

Understandably, Mexico, which has absorbed a lot of media inquiry and its fair share of bad press, is keen to portray a return to pre-outbreak stability. But we are not there yet. All you have to do is look at the figures. The number of confirmed cases has more than doubled around the world since last week, as has the number of countries where swine flu (or H1N1) is now prevalent. In Spain there are some 80 confirmed cases and the UK is not far behind. In all probability these numbers are far higher. Why? Because confirmed cases are based on the capacity of laboratories to diagnose, not on the reality as such.

 Swine Flu about to “take off”

The renowned medics at International SOS had an interview with Professor John Oxford yesterday. He confirmed that, over the last 2 days, the influenza H1N1 virus has been behaving in the UK as predicted by previous mathematical models. That is, the virus is scattered over the country due to multiple introductions. 

In keeping with those models, he expects that the virus will suddenly "take off" in the UK in about 5 weeks. On the issue of severity, Professor Oxford believes that it is likely to get worse, not better. He does not think that it will "peter out". The Professor’s credentials are also worth noting. He is Professor of Virology at St Bartholomew's and the Royal London Hospital, Queen Mary's School  of Medicine and Dentistry, and is Scientific Director of Retroscreen Virology (pictured above, a ballet class in Hong Kong).

Meanwhile, today in Paris, far from the media glare, leaders from more than 30 Red Cross societies from all over the world met to discuss the current influenza outbreak and seek ways to better prepare and respond to the threat of a global pandemic. They were joined by representatives from partner organizations, including UN agencies.

Our Secretary General, Bekele Geleta stated clearly that “it is too early to claim victory over the H1N1 virus and we must remain vigilant, especially in case the virus comes again in a few months with renewed strength. We can never be too prepared to face such a threat.” 

Another colleague, an expert in pandemics and health emergencies said it another way: It ain't over till it's over. So, when it comes to pandemics, its Head Down Eyes Open all the way to the winning vaccine.

/PC

Swine Flu gets a High Five

Whatever your view on Swine flu (which we now officially call H1N1) my reality is that it has taken up all my waking hours (and extended them) over the last week. I haven't had lunch since last Friday and there are journalists following this story with a dedication I have rarely witnessed. What is it that grips the collective imagination to such an extent? The Spanish flu of 1918 / 1919, which laid waste to an impressive 40 million people, is certainly a harrowing lesson of our time but really, how many people truly knew about it last week? (In fact, some accounts claim that as many as 100 million perished).

But how much has our world changed since 1919? How much has our world changed since 1999 for God's sake? Last night, at 22h00 Geneva time the World Health Organization (WHO) raised the global alert to level five. Again, people and journalists (often one and the same) who last week knew little about WHO, never mind phase four or five, are now providing sensational and, sorry to say, hysterical commentary. 

What we really need, in my view at least, is a sense of perspective. At the same time I fully acknowledge we also need people to consider and plan for the worst case scenarios. And this is very much part of our daily modus operandi if truth be told. Disaster preparedness has to consider the gloomiest possibilities, else it will not work.

There is a human need to know the "what if" and the "worst case". If you doubt me just tune in to your nearest tv station and chances are it will be betting on millions of us falling about out of our minds on nature's latest toxic creation a.k.a. swine flu a.ka. H1N1.

Today at 14h Geneva time, we went to the international media to present our plans for scaling up and our sober analysis. Four Red Cross people talking to more than 50 journalists from Geneva's international press corps, including 6 different TV stations. Some even carried live on major news channels like Sky and repeated on a number of other major media afterwards. So, what did we have to say that is so different?

On one side we concur with WHO's analysis about taking the situation seriously - how could you not? On the other hand we feel calm and even confident. Never has the world been so well prepared for a global pandemic. We know that more than 70% of our national Red Cross and Red Crescent societies are already active, contributing to reducing the risk of pandemic in their countries. Next week this figure will most likely be closer to 100%. 

And this is our niche. WHO provides the global guidance if you like, the Science. We, and many other governmental and civil society partners at the national and community level, carry out the much-needed efforts on the ground to drive the message home, coordinate efforts on the ground, deliver protective gear and advice and promote "respiratorial etiquette" (a wonderful phrase which I learned today - basically it means, don't cough in my face and I won't cough in yours).

It has been a real professional pleasure for me this week to be part of our crisis team, gearing itself up to support the global response of the international Red Cross. I have had the pleasure to work closely with some hugely experienced colleagues like Dr. Pierre Duplessis, our human influenza expert. Pierre is the former head of the Canadian Red Cross and has spearheaded our program to combat Avian flu over the last few years. A good guy to have in your corner, pandemic or not.

The situation has also provided an opportunity to reconnect with a former colleague, Marco Jimenez, in Mexico city, who has volunteered to report back for us and provide photographs so we can keep our worldwide network informed and provide some authentic images and stories to the world's media. 

When I worked in Sudan, Marco was my handler in Geneva and plenty of sparks flew. That was 5 years ago or so and now our roles are somewhat switched - and this time we were hooked up through facebook. 

There is no doubt that we are in a serious situation but we need to address it calmly, reassured in the knowledge that we have never been so well prepared. We have never had such early warning and early action. As far as I know all cases (more or less) have originated in Mexico and no more than a few dozen confirmed elsewhere. If we fail to prepare we prepare to fail - this is a truism and this is our thinking right now. And its Roy Keane's motto - and your a braver person than me if you take issue with his philosophy.

WHO is right when it advises that we are beyond containment. But we are absolutely not beyond mitigation and organizations such as the Red Cross will certainly make a massive difference in reducing the impact. Let's go about our business cooly and calmy, confident in our capacities to make a difference. Confident in knowing that we have learned some positive lessons from recent pandemic scares. Confident in our own common sense. Perspective is a good ally in such sensationalistic times.  

Btw; for the latest updates on H1N1 around the world, I highly recommend the Veratect twitter feed - the first with the latest for my money: http://twitter.com/veratect

/PC

Outbreak of Swine Flu grips the world

I have been in crisis mode all weekend and today. Busy providing support and guidance to our global membership and operations on how to communicate about the emergency of the so-called swine flu in Mexico. As I write, cases are now confirmed in the US, Canada, New Zealand and Spain with many other reported cases from around the world.

We can also imagine that surveillance and monitoring capacities in developing countries will mean that alot of swine flu cases may go undetected. It has been a very interesting experience working closely with our health experts, liasing with the World Health Organization (WHO), all in an attempt to get our messaging right and to provide good support to our member Red Cross and Red Crescent around the world.

At the start of such a potential pandemic it is generally advised to exercise caution in your public communication and not to contribute to any destabilizing over-reaction or panic due to sensational messages. At times like this it is usually advisable to stick to the science and leave the hyperbole to the tabloids.

At times like this it is also gratifying to see how crucial and effective organizations such as WHO and CDC are in providing the knowledge and direction for a global response to what is in reality a potentially severe and life-threthening pandemic which will be extremely difficult to stop.

This is the gist of our public communication issued first thing today in Geneva - alot more expected on this topic which has truly gripped the media and public's imagination.

IFRC: Swine flu outbreak is “a situation of immediate and serious concern”
27 April 2009

The confirmed Swine Flu outbreak in Mexico, and the reported cases in the United States, Canada, Brazil, The United Kingdom, France, Spain, Israel, Australia and New Zealand, is a situation of serious concern for the International Federation of Red Cross and Red Crescent Societies (IFRC). The IFRC shares the World Health Organization’s analysis that there is a potential for swine flu to develop into a global pandemic affecting a much larger geographical area of the world.

“This is a situation of immediate and serious concern,” says Bekele Geleta, Secretary General of the IFRC, “Our national Red Cross and Red Crescent societies, supported by IFRC health specialists, and working closely with their governments at the national level, are on full global alert. We will spare no resources in tackling this threat full on.”

In Mexico, the most affected country so far, Mexican Red Cross put its volunteers from 486 local branches in high alert, working closely with the authorities to limit the spread of the disease.

The worldwide network of Red Cross and Red Crescent has invested heavily in recent years in pandemic preparedness and provides a solid foundation at the community level to expedite critical alerts and actions. This is a key contribution to a well coordinated response at the local level that is in line with global priorities as well as existing practices and recommendations at the national level.

In addition, the IFRC has the ability to swiftly mobilize well-trained volunteers based in communities at risk which is a vital capability when dealing with pandemic threats. “At this moment in time we are on full alert” according to Dominique Praplan, head of the IFRC’s health department in Geneva, “and are preparing for all eventualities”.

“The best case scenario right now would be for national level epidemics to be managed which would lessen the likelihood of a widespread global pandemic. The worst case scenario is for the epidemic to develop into a severe, potentially life-threatening pandemic. If this transpires,” says Praplan, “the IFRC will apply the full vigour and commitment of its resources and expertise to join a global effort”.

If the threat of pandemics is to be effectively reduced it requires the international community to work in partnership. The IFRC works in close coordination with the World Health Organization, other United Nations agencies and with the International Committee of the Red Cross (ICRC) at regional and global levels, to ensure a complementary approach.

/PC