We suffer cultural amnesia about pandemics, since
1918, the world has experienced three additional pandemics, in 1957, 1968, and
most recently in 2009. These pandemics were less severe and caused considerably
lower mortality rates than the 1918 pandemic. The 1957 H2N2
pandemic and the 1968 H3N2 pandemic each resulted in an estimated 1 million
global deaths, while the 2009 H1N1 pandemic resulted in fewer than 0.3 million
deaths in its first year. Earlier this century
the CDC wrote The Deadliest Flu: The Complete Story of the Discovery and
Reconstruction of the 1918 “could a high severity pandemic on the scale of 1918
could occur in modern times?”
They answer the question with a qualified yes “Many
experts think so”, and they go on to say that “If a severe pandemic,
such as occurred in 1918 happened today, it would still likely overwhelm health
care infrastructure, both in the United States and across the world. Hospitals
and doctors’ offices would struggle to meet demand from the number of patients
requiring care. Such an event would require significant increases in the
manufacture, distribution and supply of medications, products and life-saving
medical equipment, such as mechanical ventilators. Businesses and schools would
struggle to function, and even basic services like trash pickup and waste
removal could be impacted.” Sound familiar, it should this is our world today.
When considering the potential
for a modern-era high severity pandemic, it is important; however, to reflect and
recognize that there are a number of ways that global preparations for the next
pandemic still warrant improvement.
As part of WHO’s International
Health Regulations (IHR), countries must notify WHO within 24 hours of any case
of human infection caused by a novel influenza A virus subtype. This requirement is designed to help quickly identify emerging viruses with pandemic
potential.
Since 2010, CDC has used its Influenza
Risk Assessment Tool (IRAT) to evaluate and score emerging novel influenza A
viruses and other viruses of potential public health concern. The score
provided by the IRAT answers two questions: 1) What is the risk that a virus
that is novel in humans could result in sustained human to human transmission?
and: 2) What is the potential for the virus to substantially impact public
health if it does gain the ability to spread efficiently from person to person?
Results from the IRAT have helped public health experts target pandemic
preparedness resources against the greatest disease threats and to prioritize
the selection of candidate vaccine viruses and the development of pre-pandemic
vaccines against emergent viruses with the greatest potential to cause a severe
pandemic.
When pre-pandemic vaccines are
made, they are stored in the Strategic National Stockpile, along with
facemasks, antiviral drugs and other materials that can be used in case of a
pandemic.
In the United States, the
Department of Health and Human Services (HHS) maintains a national Pandemic
Influenza Plan and this plan was updated in 2017, but the Republicans
disbanded the plan in 2018. The World Health Organization (WHO) has published
instructions for countries to use in developing their own national pandemic
plans, as well as a checklist for pandemic influenza risk and impact management.
So, the plans were in place and everything was in place, in theory, to stop or
slow down a pandemic. But as the poet Robbie Burns said in his poem “To a Mouse”
“The best-laid schemes of mice and men, Go often askew, And leave us nothing
but grief and pain, For promised joy!”
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