Further Spread is Inevitable
And so pronounced the WHO today in their release entitled “Pandemic (H1N1) 2009 briefing note 3 – Changes in reporting requirements for pandemic (H1N1) 2009 virus infection” (16 July 2009). The document went on to say “The 2009 influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks.” I personally found that last sentence to be sobering and really tells the story of contagious diseases in the modern age.
No Longer Counting Noses
In this announcement the WHO stated it would no longer be released cases numbers by country any longer as it is now not practical or feasible to have meaningful numbers. “The increasing number of cases in many countries with sustained community transmission is making it extremely difficult, if not impossible, for countries to try and confirm them through laboratory testing. Moreover, the counting of individual cases is now no longer essential in such countries for monitoring either the level or nature of the risk posed by the pandemic virus or to guide implementation of the most appropriate response measures.”
Monitoring Still Necessary
This pandemic has been characterized, to date, by the mildness of symptoms in the overwhelming majority of patients, who usually recover, even without medical treatment, within a week of the onset of symptoms. However, there is still an ongoing need in all countries to closely monitor:
- Unusual events, such as clusters of cases of severe or fatal pandemic (H1N1) 2009 virus infection
- Clusters of respiratory illness requiring hospitalization
- Unexplained or unusual clinical patterns associated with serious or fatal cases.Other potential signals of change in the currently prevailing pattern include unexpected, unusual or notable changes in patterns of transmission. Signals to be vigilant for include spikes in rates of absenteeism from schools or workplaces, or a more severe disease pattern, as suggested by, for example, a surge in emergency department visits.
- Indications that health services are having difficulty coping with cases mean that such systems are under stress but they may also be a signal of increasing cases or a more severe clinical picture.
The Rationale for No Longer Testing
A strategy that concentrates on the detection, laboratory confirmation and investigation of all cases, including those with mild illness, is extremely resource-intensive. In some countries, this strategy is absorbing most national laboratory and response capacity, leaving little capacity for the monitoring and investigation of severe cases and other exceptional events.
For all of these reasons, WHO will no longer issue the global tables showing the numbers of confirmed cases for all countries.