WHO: Latest Satement on H1N1 Swine Flu Level 6

Dr Margaret Chan
Director-General of the World Health Organization

Ladies and gentlemen,

In late April, WHO announced the emergence of a novel (to us) influenza A virus.

This particular H1N1 strain has not circulated previously in humans (recently). The virus is entirely new (to us).

The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries. (You do the maths?)

This is only part of the picture. With few exceptions, countries with large numbers of cases are those with good surveillance and testing procedures in place. (If you don't look for trouble you will not find it but it will find you, eventually)

Spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission. Further spread is considered inevitable. (We haven't a clue what's happening)

I have conferred with leading influenza experts, virologists, and public health officials. In line with procedures set out in the International Health Regulations, I have sought guidance and advice from an Emergency Committee established for this purpose. (We are lost for ideas and further confused by the geeks)

On the basis of available evidence, and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met. (WE are covering our ass)

I have therefore decided to raise the level of influenza pandemic alert from phase 5 to phase 6. (Reluctantly, after strong demands from the global community)

The world is now at the start of the 2009 influenza pandemic.

We are in the earliest days of the pandemic. The virus is spreading under a close and careful watch. (We are but spectators watching it go on)

No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness. (We know where to hide, how quick to run and have many ass covering methods)

We have a head start. This places us in a strong position. But it also creates a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty. (We are in headless chicken mode)

Thanks to close monitoring, thorough investigations, and frank reporting from countries, we have some early snapshots depicting spread of the virus and the range of illness it can cause. (Everyone is sending us scarey pictures)

We know, too, that this early, patchy picture can change very quickly. The virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time. (We haven't a clue what to do now that heavy handed bureaucracy doesn't work)

Globally, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity. As we know from experience, severity can vary, depending on many factors, from one country to another. (We hope its not too bad for a bit but don't quite believe it will stay that way)

On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment. (See its not a problem really, if you ignore the poor and the dying)

Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections. (Fingers crossed it doesn't affect any of us)

We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years. (So that's ok then for us oldies)

In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia. (As opposed to the less deadly pneumonias)

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years. (Again with the young people remark and the 'greys' shall inherit the earth, is it? Our time has come around again? Don't think so)

This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people. (Its natures way)

Many, though not all, severe cases have occurred in people with underlying chronic conditions. Based on limited, preliminary data, conditions most frequently seen include respiratory diseases, notably asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity. (This we understand!)

At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people. (Now you're just getting annoying, broken record )

Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups. (Are you going to list all the young groups and sectors, I hope not)

Finally, and perhaps of greatest concern, we do not know how this virus will behave under conditions typically found in the developing world. To date, the vast majority of cases have been detected and investigated in comparatively well-off countries. (Can it be spread through designer label changing rooms, Starbuck lattes, BMW steering wheels and IKEA's catalogue?)

Let me underscore two of many reasons for this concern. First, more than 99% of maternal deaths, which are a marker of poor quality care during pregnancy and childbirth, occurs in the developing world. (Cause we count them and gieve over them. We don't just bury them and move on because its a fact of life in poverty)

Second, around 85% of the burden of chronic diseases is concentrated in low- and middle-income countries. (God bless the old and rich, for they shall survive again)

Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems. (God bless the poor, it is their destiny to suffer)

Ladies and gentlemen, (You're not winning any friends here)

A characteristic feature of pandemics is their rapid spread to all parts of the world. In the previous century, this spread has typically taken around 6 to 9 months, even during times when most international travel was by ship or rail. (It goes where people go)

Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection. (We've only just begun to fight. It will not be over by Xmas)

Guidance on specific protective and precautionary measures has been sent to ministries of health in all countries. Countries with no or only a few cases should remain vigilant. (If you ain't got it yet, just wait, it's coming your way)

Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities. (You know what you have and you can't cure it, so attend to the sick and dying as best you can)

WHO has been in close dialogue with influenza vaccine manufacturers. I understand that production of vaccines for seasonal influenza will be completed soon, and that full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come. (Pharma companies are happy to flood the market with as much useless vaccine as you are willing to pay for and by the way, because of the urgency the price has gone up enormously)

Pending the availability of vaccines, several non-pharmaceutical interventions can confer some protection. (We don't currently have any effective vaccines and wont have for months, by which time the pandemic will have burned itself out)

WHO continues to recommend no restrictions on travel and no border closures. (We cannot enforce or control it anyway)

Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection. (Shit happens)

We are all in this together, and we will all get through this, together. (Except the one's who die of neglect and insufficient measures being taken, allegedly)

Thank you. (Now run for your life, except the old and rich. You're gonna be just fine. Pass the good port in any storm!)