# 3309
Yesterday Margaret Chan, Director-General of the World Health Organization – announced: “we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity in countries with good health infrastructure and adequate resources.”
She added that in less developed countries, “we are wise to anticipate a bleaker picture.”
For those already convinced by mainstream media that H1N1, even if it becomes a pandemic, will be a non-event – this may come as a bit of a surprise.
After all, we’ve heard report after report from news sources and pundits that this virus is `mild’, `rarely lethal’, and that it may not even qualify as a pandemic strain.
How does this become a `moderate’ pandemic, or worse?
It helps if we define our terms, based not on Stephen King’s The Stand, but on the HHS’s scale of pandemic severity.
The concept of mild, moderate, and severe pandemics is nothing new, it is something that scientists and public health officials have considered all along.
After all, the 1968 pandemic was `mild’, and 1957 could probably be best described as `moderate’. We have to go all the way back to 1918 to find a `severe’ pandemic.
Granted, the press - and by extension, the general public – seems to have difficulty with the idea that pandemics come in all sizes, shapes, and flavors. To many, a pandemic means death on a massive scale.
But even in the horrific 1918 Spanish Flu, here in the United States, less than 1 person in 150 died (globally, it was closer to 1 in 50).
A terrible toll, yes. But not quite what most people probably envision.
To put things in perspective, each year seasonal influenza claims between 30,000 and 40,000 American lives.
Or roughly 1 person out of every 10,000.
And it is against this backdrop that we must compare pandemic scenarios, not the fertile imagination of horror novel authors.
The last influenza pandemic to grip the world began in 1968, and over the course of a couple of years it claimed roughly a million lives. By just about all measures, it was a `mild pandemic’.
Globally, it killed about 1 person in 3,000. Here in the United States, that number was more like 1 in 6,000 (roughly 33,000 deaths).
In comparison, the 1957 pandemic was `moderate’, with estimates of global deaths running between 2 million and 4 million, and about 70,000 deaths in the United States.
Globally that meant the 1957 virus killed about 1 in 1400 (assuming 2 million deaths), and in the US, about 1 in 2400.
Or roughly 4 times the normal number of deaths.
By the HHS’s definition, a `moderate’ pandemic (Category 2 or 3) could be expected to claim somewhere between 100,000 and 900,000 American lives.
Or anywhere from 1 in 3,000 to just over 1 in 300 lives. Globally, the mortality rate for a `moderate’ pandemic would likely be higher.
Developing countries with little access to antibiotics, antivirals, vaccines or even rudimentary medical care, would obviously see a far greater impact than wealthier nations.
Of course, the costs of a pandemic cannot be measured by the number of deaths alone.
There are economic impacts, societal impacts, and perhaps most visible of all, the impact on the health care delivery systems around the world.
Hospitals, most of which have precious little surge capacity, would be stretched to the limit and beyond by even a mild pandemic.
During a `normal’ flu year, 200,000 Americans are hospitalized due to influenza-related illnesses. During a `mild’ pandemic, the number needing hospitalization could easily triple. . . or more.
Waits for triage, and treatment, at emergency rooms, clinics, and doctor’s offices would increase. Some facilities would be overwhelmed.
Hospital beds could become a scarce commodity, elective surgeries could be delayed, and if the demand for ventilators exceeds the supply, some flu and non-flu patients could easily die because the life saving resources they needed were unavailable.
It is unclear how well hospitals would cope with that kind of surge.
A simple, but realistic, example of the kinds of collateral damage that can be brought on by even a `mild’ or `moderate’ pandemic.
While there are some who seem intent on downplaying the H1N1 threat, simply because the virus hasn’t lived up to their preconceived image of a pandemic, the people who will have actually have to deal with the outfall from this looming global epidemic are far less sanguine.
When it is your job to protect the health and safety of the public, it doesn’t take a 1918-level pandemic to ruin your entire day.
