Thursday, August 27, 2009

Notes from a pandemic

Informative report in Eurosurveillance yesterday from New Zealand summarizing their H1N1 experience to date. A few encouraging signs are that a). the pandemic seems to be slowing down, b). proportion of people needing hospitalization is low, on the order of 0.3%, of whom ~12% require an ICU, and c). the case fatality rate is about 0.005%. All this in the face of an estimated attack rate of 11%. Very encouraging!

So, given what I said yesterday in my post, perhaps we can revise down our estimates for the US. If we were to do that on the back of a napkin, we would see a much less concerning picture of around 33 million infections, ~100,000 hospitalizations, ~12,000 ICU admissions and a little over 1,500 fatalities. Whew! Much better than what either our group or the White House advisers predicted. But is this the right time to recalculate? Maybe not.

Here is why. First, the Southern hemisphere is still in the middle of its flu season, and flu epidemics are known to come in multiple waves, separated by intervals from months to years. So, while the slow-down is encouraging, the fat lady has not yet sung. Second, the New Zealand report notes that the native Maori and Pacific peoples, two socio-economically disadvantaged ethnic groups with marked health disparities, exhibited triple to quintuple the attack and case fatality rates seen in their European counterparts. Given that 47 million people in the US are without routine access to the healthcare system, and racial and ethnic healthcare inequalities are rampant, we remain at high risk for seeing a lot of severe cases. Finally, and most importantly, New Zealand has a comprehensive nation-wide plan for mitigating a pandemic (and it is a much smaller nation than ours). Some of the phases include extensive pre-pandemic planning, improved surveillance, border control aimed at containment, and quarantining active cases if necessary. Our plan, which is actually many different plans, is still evolving and is unlikely to be this comprehensive, uniform or enforceable.

So, while I am encouraged by what is being reported, I am not willing to hang my hat on it yet, and neither should the US Department of Health and Human Services. It is true that we may get lucky this time. But this should serve as our national wake-up call, since in our global village it is only a matter of time until we are faced with a devastating health emergency. Do we really want to rely on luck next time?

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