Posted: April 28, 2009
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Article SummaryIn the face of a very scary swine flu outbreak spreading from Mexico, the World Health Organization on April 27, 2009 did two things to its index of six pandemic phases: It implemented some changes in phase definitions (long in the works) that – among other effects – made the criteria for Phase 4 more demanding; and in spite of that it finally ratcheted up to Phase 4. Bob Roos of CIDRAP News sent me an email asking for comment on the likely impact of the latter change. His published article used some of what I said about my hope that the shift would signal organizations to trigger their pandemic plans and individuals to launch their own preparations. Here is the whole email I sent him.

Impacts of the WHO Ratchet
from Pandemic Phase 3 to Phase 4

Robert Roos’s CIDRAP News article is also online.

Flu watchers have long understood that the World Health Organization wouldn’t be announcing the next pandemic; it would be confirming it – lagging a day or two behind most experts as it waited for a broader consensus, waited to make sure (or close to sure) before putting its imprimatur on any Phase shift. There has been criticism of the WHO for waiting these past few days, but on the whole the system has worked the way everyone expected it to. Michael Osterholm announced Phase 4 two days before the WHO did. No surprise there.

But it matters a lot that the WHO caught up this evening.

U.S. government officials have been saying for two days now that they’re responding to conditions on the ground, not to any “label” the WHO might decide to apply or not apply. That may be true for the CDC and other U.S. agencies. But it’s not true for health officials in countries without any confirmed cases so far, many of which have written pandemic plans that specify a different response to Phase 4 than to Phase 3. And it’s not true for companies, especially multinational companies, many of which have their own pandemic plans keyed to the WHO stages. Ditto for cities and states with pandemic plans but no local cases; the WHO Phase shift may trigger a response from them as well.

And a lot of smaller companies and smaller communities without pandemic plans have been waiting for a signal to start taking precautionary action. This may be the signal they have been waiting for.

We can only hope it is. Phase 5 will mean a pandemic is virtually assured and probably imminent. Phase 4 – the phase we entered this evening – means we might still dodge the bullet but we’d be wise to assume otherwise, to take action now to diminish the devastation in case a pandemic is around the corner.

We have to hope it’s the signal the U.S. media and the general public have been waiting for too. For ordinary citizens, the U.S. government has so far recommended only hygiene, not preparedness. It has told people to stay home if they’re sick, to cover their coughs, and to wash their hands a lot. It hasn’t told people to stock up on food, water, prescription medicines, and other key supplies. Two years ago HHS Secretary Mike Leavitt was crisscrossing the country with that advice. This weekend and today Acting Secretary Napolitano and Acting CDC Director Besser kept evading questions from journalists about whether that’s still good advice.

In order to avoid frightening the public, the U.S. government has avoided clueing in the public that all of us – not just the feds – need to prepare now for a possible pandemic – both logistically and emotionally.

People have been “watching” the swine flu story. Some have been watching with more intense interest than others – but watching, not preparing, has been just about everybody’s focus. So we are losing precious preparedness time – time to go out and buy supplies before there’s a real emergency, while the shelves are still full and the stores can still replenish; and time to think through what life might be like in a week or two if all schools are closed, most businesses are closed, and many people are very, very sick.

The trick is to do all that preparing while bearing in mind that this swine flu outbreak may very well fizzle. In other words, we must prepare for the worst without committing ourselves to expecting the worst.

The CDC seems to be doing exactly that. But it isn’t telling the public to do that. I hope – I pray – that this evening’s WHO move to Phase 4 isn’t just a signal to governments and companies, but a signal to all of us. If you didn’t do any special pandemic prep over the weekend, the WHO is telling you to find time for some tomorrow.

And here’s the secret of preparedness that fearful government leaders tend to forget: It’s a calming experience to prepare. People who have been working hard not to worry about the pandemic that might be looming, people who have spent today holding back that gathering knot in their guts, will feel more in control after they have taken some concrete steps to get themselves and their family ready. I hope they read tonight’s WHO decision as advice to do that tomorrow.

Copyright © 2009 by Peter M. Sandman

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