Pandemic – What now? (Public Health)

Yesterday I threw out a sampling of the stories I’ve read in the last day or so about the WHO decision to declare a pandemic. Today I will be more editorial and get into what it means, from my point of view.

In a post a couple of weeks back I gave my thoughts on some of the controversy the WHO was dealing with at the time, the “will they or won’t they” declare the H1N1 outbreak officially a pandemic. At the time the main problem the WHO was faced with was the fact that they had crafted a pandemic alert system that was based solely on the spread of illness. Their system didn’t take severity into account. My take was that the people developing the system had done so either consciously or subconsciously based on H5N1, with its high case fatality ratio. The pieces I have read that are critical of the decision to declare a pandemic have focused in on this point. They have pointed to the 145 deaths and argued that we can’t be in a pandemic because pandemics come with so many dead and dying that the social order will break down.

This is a beast of our own making.

I have been in public health, working on pandemic preparedness, so I know just how hard it was to get people who weren’t epidemiologists or other public health professionals to take the potential impact of a pandemic seriously. I also know how much easier it is to make the point that preparedness is important by focusing on the worst case scenarios – not only in pandemics but in everything (the category 5 hurricane, the 9.5 earthquake). Add these two together and you have the common impression that a PANDEMIC (the catastrophic type we talked about as opposed to the textbook definition) is an illness on such a massive scale that society itself will fall apart.

Now that we’re facing a pandemic that doesn’t meet that criteria the skeptics are proven right. Or at least, so they will argue.

As is often the case, if you prepared for the disaster that hits you, your preparations look wasted. The easiest time to judge preparedness efforts is when they fail. If done right, proper preparation can leave you wondering if you overestimated the threat in the first place. Personally, I think that we have mostly done the right things when it comes to pandemic preparedness:

• Education – While this could have been done better, the publicity over pandemic preparedness efforts, the risk, the chaos in the streets stories on the nightly news all served to make the public aware of what a pandemic could be. I doubt that it motivated many to actually prepare their own households to shelter in place, but at least the basic, Pandemic 101 part of things was done before the first outbreak.
• Planning – The Federal government and agencies, states, and localities all have plans in place. Many of them are draft, many have unwarranted assumptions, and most have holes that you could drive an SNS delivery truck through, but they exist. People at all levels have thought about some of the tough questions and while they may not have answered them at least they are aware the questions exist.

Was declaring a pandemic the fear-mongering that some have claimed? a political action to justify the money (and there’s been a lot of it) invested? I don’t believe so. I would argue that many of the people involved would probably be happier if the declaration hadn’t been made. We have no higher level to go to, there is no 11 on this amplifier. But the system is what it is, and changing it now would just continue to elicit complaints from other people that the lack of a declaration was politically motivated to avoid embarrassment or other reasons.

So what now? We continue on as we have, monitoring the situation. If it stays as mild as it has been then in a few months time when the WHO determines that the pandemic has passed we sit down and rewrite the guidance to include some sort of severity scale along with the geographic one. If it doesn’t remain mild, if it kicks into high gear as the cool weather returns to the northern hemisphere, we batten down the hatches and ride it out.

Either way, there will undoubtedly be plenty of material for reviewing and investigating when it’s all said and done.

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