Hazardous WHO Phase Daze

Commentary



Recombinomics Commentary 17:54
May 26, 2009

The W.H.O., starting in April, quickly raised its alert level to 4 and then 5 as the virus spread in North America. But even as the virus infected people in Britain, Spain and Japan, the agency did not go to Level 6, which signifies spread to a new continent. Dr. Fukuda argued that there was still no proof of "community spread," meaning beyond travelers, schools and contacts.

The above comment, as well as similar remarks by WHO officials and other government agencies, range from delusional to deliberate distortions with regard to the current phase 6 pandemic. The constant rewriting of the phase system to avoid calling a phase 6 pandemic a phase 6 pandemic does significant harm in the monitoring of the pandemic, as well as raising public awareness of the seriousness of the evolution and spread of swine H1N1.

An earlier revision moved the definition of sustained transmission from phase 6 to phase 4. Since sustained transmission will quickly spread worldwide, the revision simply delayed the inevitable, by defining phase 5 as sustained transmission in a region and phase 6 as worldwide sustained transmission.

However, it was clear when the first swine H1N1 cases in California were confirmed, that the escalation to a phase 6 definition would happen in the near term. The first two cases were over 100 miles apart and had no linkage, indicating sustained transmission was happening in southern California, and the associated reports of H1N1 in Mexico further supported the view that phase six was inevitable and near term.

Expanded testing in the US identified cases throughout the country, which was also found in Canada and Mexico (see updated map). The sequences of these isolates were virtually identical, which again supported sustained worldwide transmission. This view was further supported by the detection of similar cases identified at airport checks worldwide, couple with community spread discovered in association with tracing of airport cases. These cases of community transmission in Europe and Asia left no doubt that the pandemic was spreading worldwide (see updated map), but most countries continue to focus on airport checks, even though H1N1 was clearly spreading in the community.

The WHO position and phase 5 designation continues to focus efforts away from the real problem of community spread, and hopeless programs focused on international travelers. Although the airport checks can help identify countries which are spreading the virus, such as those in North America, including countries denying infections, such as the Dominican Republic.

These denials of cases, or cases in the community, allow the virus to silently spread and evolve.

The spread of a swine H1N1 in a human population at the current levels ahs not been reported since the 1918 pandemic. Since the swine virus is now efficiently transmitted in a human host, it will continue to adapt and will likely cause significantly more fatal cases, as was seen in 1918. However, this evolution is being largely ignored because countries are focusing efforts on airport checks, while ignoring/denying community spread. However, the community spread will lead to the emergence of new variants, which will be largely missed because of the misplaced emphasis.

When the new variants are identified, they will have established a strong foothold and will spread rapidly, once again avoiding belated containment efforts. The establishment will speed the spread, which will also impact vaccine efforts, because the identification of the emergent strain will happen well after the spread has accelerated.

Thus, the efforts of WHO to deny phase 6, and misplaced surveillance efforts which target international travel, will accelerate the emergence of variants, which will increase the likelihood that containment and vaccine efforts will fail.