26 April 2009

Sunday 10:30pm

Canada confirms 6 cases of swine flu, NYC 8 cases and Ohio 1 case as US Declares Public Health Emergency during televised White House Press Briefing Sunday<= o:p>

The World Health Organization (WHO) held another (daily) swine flu press conference on Sunday and in the transcript was noted to maintain its pandemic alert phase at 3. The next meeting was scheduled for = this Tuesday, in part again to consider the rapidly evolving situation in Mexico= , as well as the USA (20 confirmed cases), and Canada (6 cases). Dr. Fukuda was quoted speaking for = the WHO in Geneva. He noted that of 51 specimens from 51 patients in Mexico, 16 had tested positive in the national reference lab in Winnipeg. The clinical condition of the= se 16 patients was not discussed, nor how many of these 16, if any, overlapped wi= th the 7 swine influenza A (H1N1)-positive tests from patients in Mexico = tested at the US CDC Atlanta.

The WHO also posted on their website a diagram and updat= ed text definitions for each of the WHO pandemic phases 1-6, with 6 being a gl= obal epidemic or “pandemic”, a condition not yet documented to exist. There appears to be quite reasonable grounds, however, for the WHO Expert Advisory Committee to continue to meet often to address whether to elevate = the pandemic phase to 4, if community-level outbreaks due to SUSTAINED person-to-person spread are proven to exist in Mexico already. IF a second n= ation (e.g., the USA or Canada) in the same WHO region (e.g., of t= he Americas) were also to have proven community-level outbreaks with this novel flu virus then the criteria would appear to have been met for Phase 5.

Can= ada repo= rted late in the day 6 lab-confirmed cases of the same “swine flu”. = Nova Scotia had 4 cases, at least some of whom had = an epidemiological link (“epi-link”) to recent travel in Mexico.= British Columbia= had two lab-confirmed cases.

At 12:30= pm the White House held a special televised press conference to address the evolving swine flu situation and responses. A total of 20 cases were confir= med in the USA: 8 in NY Ci= ty, 7 in California, 2 in Texas, 2 in Kansas, and 1 in Ohio. The Director of the Department of Homeland Security (DHS), Ms. Janet Napolitano, was introduced as a speaker = and identified as the person in charge of the overall federal response to this outbreak. The Acting Director= of the CDC, Richard Besser, MD, was also introduced as a speaker at the press conference and addressed the medical and public health issues. <= /span>

This swine flu outbreak was designated as a Public Health Emergency by the US Government. Thus, specific results can follow, from a l= egal and government perspective. For example, it was announced that the US woul= d release 25% of the 50 million treatment courses of oseltamivir (Tamiflu) held in the Strategic National Stockpile (SNS). A potential result of this US declaration is the ability= to invoke the legal framework for Emergency Use Authorization (EUA) for public health countermeasures against this novel influenza outbreak.

One can anticipate that the important data from Mexico = will be available soon regarding laboratory diagnostic results of persons who have = died, as well as persons who are ill and/or have recovered, as well as persons wi= th asymptomatic infection with this novel virus. This data will allow a more accurate initial determination of the critically important case-fatality ra= te (CFR), and modeling of the severity of this epidemic and resultant scale of public health responses.

Daniel R. Lucey, MD, MPH

EROne Institutes, Washington Hospital Center

Adjunct Professor of Microbiology and Immunology

Geo= rgetown University Medical Center, Washington, D.C= .=

Website for this posting: www.BePast.org (requires Internet Explorer)

e-mail: DRL23@Georgetown.edu