Who's Ready if Swine Flu Pandemic Comes Knocking
By Andy Coghlan, Linda Geddes & Rachel Nowak, New Scientist Magazine
Doomsday visions of curfews, sealed borders, travel bans and scuffles over food are a long way from materializing in the current crisis regarding swine flu.
But if the World Health Organization declares a pandemic, countries could bring in draconian measures to isolate and treat infection, prevent further spread and keep societies functioning.
In late April, the global threat level rose to 4 on a 6-point scale, escalating the WHO strategy to prevent further spread of the virus beyond Mexico, where the epidemic originated.
During the first three phases, the WHO expects governments simply to be prepared for an epidemic and to minimize risk -- by monitoring farms closely for emergence of new flu strains, for example. From 4 and up, the key goal is to isolate regions of infection from infection-free areas.
Tougher measures, such as declaring a state of emergency, would only be possible if the WHO declares a full phase-6 pandemic.
However, investigations by New Scientist suggest that global preparedness for a pandemic is extremely patchy.
Unsurprisingly, poorer countries are least prepared, but even in richer regions there are serious gaps: A survey in 2007 of 30 European nations found that, on average, countries had in place only half of the measures expected by the WHO. The biggest gap was in preparedness to keep society functioning beyond its health system, to ensure continued provision of electricity, transport, banking, food and policing.
"Multisectoral planning is the vital thing," says co-author of the survey, Sandra Mounier-Jack of the London School of Hygiene and Tropical Medicine (LSHTM). Of the 30 nations, only 12 had such plans.
The best prepared countries, including Germany, France and the United Kingdom, had plans in place to ensure key workers would keep industries and services going. Most also met the WHO demand for simulations and drills.
Preparedness is also high in Southeast Asian countries and Australasia
Officials in these regions contacted by New Scientist had conducted drills, for example, and all had thermosurveillance machines available for airports to spot fever in travelers. Many had learned lessons from the SARS outbreak of 2003.
In Africa, however, just 35 out of 53 countries have pandemic plans, and of these, "most lack a coherent strategic approach," says Paul Coker of LSHTM, who evaluated the plans of African countries in 2007.
Moreover, he says, for the majority of African countries the emphasis has been on strengthening detection and containment of bird flu in animals, not on handling a human flu pandemic.
As southern-hemisphere countries are now entering their flu season -- when some flu viruses spread more easily -- they may be particularly vulnerable if the Mexican swine flu turns pandemic.
In developing countries already struggling with the toll of HIV, TB and malaria, "an influenza pandemic would represent a profound challenge to already overstretched health systems," Coker warns.
CASE STUDY: LESSONS FROM SARS
Hong Kong was at the center of the SARS outbreak in 2003 and so may be better prepared than many countries for a flu pandemic. Hong Kong's evaluation of its SARS response found inadequacies in contingency planning, particularly in infection control.
Lessons incorporated into Hong Kong's pandemic plans include:
-- Having trained infection control staff and an infection control committee in every hospital
-- Ordering the immediate detention at a hospital of anyone arriving with flu-like symptoms after traveling through a region with lab-confirmed outbreaks in the past seven days
-- Additional beds and a dedicated wing in one of its major hospitals
-- Setting up a system for exchanging vital information with its neighbors
-- Expanding its flu research labs
Wayne Marasco is no doubt the only Harvard medical researcher who abandoned a successful construction firm, Waymar Roofing and Siding, to become an immunologist. The man with the unorthodox history recently made a striking discovery: a human antibody that attacks a newfound vulnerability in flu viruses.
Swine Flu: How Can We Prepare For a Killer Autumn Wave
By Debora MacKenzie, New Scientist Magazine
Is the world ready for a killer, autumn wave of swine flu? Flu pandemics historically come in waves, often getting worse as they go. The 1918 flu started with a mild wave in March, followed by a deadly second wave later in the year. What's now keeping health officials awake at night is the possibility that a more virulent version will come roaring back and kill millions.
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