Will we see a global influenza pandemic in 2009?

Clarification: only the World Health Organization, via the press, can declare a true global pandemic.

http://www.who.int

So this market says that there will no no flu pandemic in 2009 and the other market is saying that there will be a Swine |Flu pandemic! These are not very healthy markets!!

Pandemic threat level raised to 5: http://news.bbc.co.uk/1/hi/world/americas/8025931.stm
Pandemic 'Imminent'

WSJ 5/2 @ 1011 EDT (http://online.wsj.com/article/SB124126480414780235.html?mod=googlenews_wsj):

'A growing number of cases in Spain, New Zealand and other countries -- where travelers brought the disease home and could be spreading it to others -- means that sustained transmission of the disease is likely to take hold soon in more countries, Scott Dowell, head of the Centers for Disease Control and Prevention international team, said in an interview Friday. That development -- community outbreaks in more than one region of the world -- would fit the World Health Organization's criteria for its highest global alert level, phase 6. "It's going to happen imminently," he said."

"WHO still believes flu pandemic is imminent"

Michael Ryan, WHO Director of Global Alert and Response, said it remained probable that the alert level would be raised from its current level of 5 to the top of the 6-stage scale. "At the present time I would still propose that a pandemic is imminent, because we are seeing the disease spread," Ryan said. "At this point we have to expect that phase 6 will be reached..."

02 May 2009 @ 15:55:36 GMT (http://www.alertnet.org/thenews/newsdesk/L2710434.htm)

"WHO still believes flu pandemic is imminent"

or

"WHO still believes flu pandemic is imminent?!"

;-)

No, Who's on first....

"WHO head indicates full flu pandemic to be declared" (2009-05-04 09:53:10 GMT - http://www.forexpros.com/news/forex-news/update-1-who-head-indicates-full-flu-pandemic-to-be-declared-50884)

"The World Health Organisation is likely to raise its flu alert to the top of its six-point scale and declare a pandemic, its director-general indicated in an interview published on Monday. In remarks setting the scene for another alert increase, but without saying when, WHO chief Margaret Chan warned against over-confidence following a stabilisation in the number of new cases of the H1N1 strain that has proved deadly in Mexico. "Level 6 does not mean, in any way, that we are facing the end of the world. It is important to make this clear because (otherwise) when we announce level 6 it will cause an unnecessary panic," she told Spanish newspaper El Pais."

Does WHO need to declare flu a full pandemic?
Thu May 7 7:27am EDT (http://www.reuters.com/article/newsOne/idUSTRE5462MN20090507)

"The United Nations agency's guidelines state that as soon as the virus starts spreading freely in two regions of the world, its six-point pandemic alert should be raised to the top notch. With infection numbers rising in Europe, public health experts are struggling to decide whether it is worth sounding the full alarm over H1N1, which is treatable with existing drugs and appears less severe than seasonal flu in most cases.

"Under the rules, just one country outside the Americas needs to have a community-level outbreak of the new strain to trigger a Phase 6 designation indicating a global pandemic is under way.

"Some experts believe Britain is especially vulnerable to a community-wide outbreak, given the flu strain is propagating inside some schools. Spain also has a relatively large cluster of infections, with 73 according to the latest WHO tally.

"No one country, however, is likely to want to be seen as tipping the scale toward a pandemic declaration, especially with discontent rising about whether public health experts have exaggerated the risks of the H1N1 strain. That leaves the WHO in a difficult spot, given many disease experts anticipate the new virus could rebound with a vengeance later this year when winter temperatures conducive to the spread of flu return to the populated northern hemisphere."

05/09: For those interested, here are a few excerpts from today's CDC press conference (featuring Dr. Anne Schuchat of the CDC):

--"The virus has moved into the southern hemisphere, where influenza season is just beginning, and could mix with circulating seasonal flu viruses or the H5N1 avian influenza virus to create new strains. 'This is a very unusual circumstance,' Schuchat said."

--"We think this virus is in most of the United States," Schuchat said. "The individual numbers are likely to be a very great underestimate."

--"More Americans are seeing doctors for influenza-like illnesses at a time of year when such visits are usually on the decline."

--"It would be futile to try to stop the virus in the United States because it was only identified after person-to-person transmission had taken place for weeks before it was identified. 'Our indications are that it is still accelerating,' Schuchat said. Mexican officials have said outbreaks there are on the wane but Schuchat disagreed. 'In some parts of that country they may see a decline,' she said. But fresh outbreaks were occurring in other parts, she said."

--"'This particular virus has all of the hallmarks that we look for with a possible pandemic,' Schuchat said. It's a new strain capable of spreading easily and killing people."

-----------------------

In other flu news:

--Thailand reported its first case of A/H1N1 today. That comes on the heels of Japan and Australia, which both confirmed their first cases yesterday.

--There was a death in Costa Rica from the swine flu announced today, making that country the fourth with a confirmed fatality from the virus.

--Nearly 4,400 cases of the virus are now confirmed in 29 countries on five continents, with the EU the hardest hit after North America. That number is up 4,500% in the past two weeks.

--Cases in the U.S. continue to grow; the virus has been confirmed by the CDC in 43 states, and probable cases are awaiting confirmation in at least four others.

Stay tuned...

05/11 A/H1N12 Update:

--The CDC says that the number of cases is growing too quickly to count, and that there are many more cases than have been reported. "I think the cases we’re confirming are the tip of the iceberg,” said Dr. Anne Schuchat of the CDC. (http://www.msnbc.msn.com/id/30398682/)

--This year's virus is, according to epidemiologists, a bit more dangerous than the one that caused the last pandemic (in 1968). Those same scientists also speculate that somewhere in the vicinity of 32,000 people already had the virus in Mexico before the end of April when the global community became aware of it. (http://www.alertnet.org/thenews/newsdesk/N11538600.htm)

--In a normal year, about 10% of the population gets sick with the seasonal flu; scientists project that this virus--which is "substantially more transmissible" than seasonal flu "clearly has pandemic potential", and may eventually infect two to three times the average number (http://www.timesonline.co.uk/tol/tools_and_services/mobile_times/swine_flu/article6269046.ece)

--The WHO says that the virus has "potential" for pandemic. "Most cases in Europe, Asia and South America are linked to travelers bringing the virus home with them, but there is a possibility the disease will become established there too," said WHO's flu chief Keiji Fukuda. (http://www.pr-inside.com/who-potential-for-swine-flu-spread-r1244908.htm)

--Worldwide, the number of confirmed cases of the flu "nearly doubled" over this past weekend. (http://www.un.org/apps/news/story.asp?NewsID=30761&Cr=+flu+&Cr1=)

--In La Gloria, Mexico, where the virus was first found running rampant, reasearchers believe the virus was transmitted there over 14 to 73 generations. That is, one person infected another, who infected another, and so on, up to 73 times. (http://www.alertnet.org/thenews/newsdesk/N11538600.htm)

--So far, at least, A/H1N1 is spreading at a more or less logarithmic pace, doubling in the number of confirmed cases roughly every four or five days. If the current rate of sperad were kept up, there'd be more than one million cases somewhere around the last few days of June. (http://en.wikipedia.org/wiki/File:Influenza-2009-cases-logarithmic.png)

11 May 2009 -- As of 06:00 GMT, 11 May 2009, 30 countries have officially reported 4694 cases of influenza A(H1N1) infection.

Mexico has reported 1626 laboratory confirmed human cases of infection, including 48 deaths. The United States has reported 2532 laboratory confirmed human cases, including three deaths. Canada has reported 284 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

Related links


Map of the spread of Infuenza A(H1N1): number of laboratory confirmed cases and deaths [jpg 435kb]
As of 06:00 GMT, 11 May 2009

Influenza A(H1N1) web site
Daily updates will be posted on this site.



The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (2, comprising 1 in China, Hong Kong Special Administrative Region, and 1 in mainland China), Colombia (3), Denmark (1), El Salvador (4), France (13), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (15), Poland (1), Portugal (1), Republic of Korea (3), Spain (95), Sweden (2), Switzerland (1) and the United Kingdom (47).

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.

Further information on the situation will be available on the WHO web site on a regular basis.

05/12: Professor Neil Ferguson of the World Health Organization (WHO) said today that a study just completed by a group of scientists at London's Imperial College hints that A/H1N1 possess "full pandemic potential", and will "likely spread around the world in the next six to nine months." (Or, in the breathless headline screaming from The Sun, "Swine flu will 'rip through globe!'")

http://news.sky.com/skynews/Home/World-News/Swine-Flu-First-In-Depth-Study-Of-H1N1-Says-One-Third-Of-World-Could-Be-Infected/Article/200905215280099?lpos=World_News_First_Home_Article_Teaser_Region_4&lid=ARTICLE_15280099_Swine_Flu%3A_First_In-Depth_Study_Of_H1N1_Says_One_Third_Of_World_Could_Be_Infected
http://www.redorbit.com/news/health/1686994/london_study_maintains_flu_has_full_pandemic_potential/
http://www.thesun.co.uk/sol/homepage/news/article2424699.ece

Place your bets... :-|

5/13 Influenza A(H1N1) - update 27 (from WHO website http://www.who.int/csr/don/2009_05_13/en/index.html

13 May 2009 -- As of 06:00 GMT, 13 May 2009, 33 countries have officially reported 5728 cases of influenza A(H1N1) infection.

Mexico has reported 2059 laboratory confirmed human cases of infection, including 56 deaths. The United States has reported 3009 laboratory confirmed human cases, including three deaths. Canada has reported 358 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (3, comprising 1 in China, Hong Kong Special Administrative Region, and 2 in mainland China), Colombia (6), Cuba (1), Denmark (1), El Salvador (4), Finland (2), France (13), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (98), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (68).

Update 29 (from WHO website http://www.who.int/csr/don/2009_05_15/en/index.html)

As of 6:00 GMT, 15 May 2009, 34 countries have officially reported 7520 cases of influenza A(H1N1) infection.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Belgium (1), Brazil (8), China (4), Colombia (10), Cuba (3), Denmark (1), El Salvador (4), Finland (2), France (14), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (40), Poland (1), Portugal (1), Republic of Korea (3), Spain (100), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (71).

Sorry - plus this to Update 29

Mexico has reported 2446 laboratory confirmed human cases of infection, including 60 deaths. The United States has reported 4298 laboratory confirmed human cases, including three deaths. Canada has reported 449 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

You're a little low, jeopardy; as of today's update, the CDC says the U.S. has 4,714 cases and five deaths. (And this evening, the CDC estimated that the flu is more widespread than thought; they say there are probably 100,000 cases in just the U.S. alone.)

yeah - WHO and CDC are probably operating off different databases ... the WHO numbers are from the WHO website out of Geneva, I believe. I'd tend to trust the CDC numbers - also, those WHO numbers are as of 6:00 a.m. GMT, and the CDC numbers are later.

It's obviously a quickly moving target, and while difficult to keep up accurately, the over-all trend is unmistakable ...

Update 30 (from WHO website http://www.who.int/csr/don/2009_05_16/en/index.html)

As of 07:00 GMT, 16 May 2009, 36 countries have officially reported 8451 cases of influenza A(H1N1) infection.

Mexico has reported 2895 laboratory confirmed human cases of infection, including 66 deaths. The United States has reported 4714 laboratory confirmed human cases, including four deaths. Canada has reported 496 laboratory confirmed human cases, including one death. Costa Rica has reported nine laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Belgium (2), Brazil (8), China (4), Colombia (11), Cuba (3), Denmark (1), Ecuador (1), El Salvador (4), Finland (2), France (14), Germany (14), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (9), Norway (2), Panama (43), Peru (1), Poland (1), Portugal (1), Republic of Korea (3), Spain (100), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (78).

World Health Organization May Raise Alert Level as Swine Flu Cases Leap in Japan - "The number of swine flu cases in Japan soared over the weekend, raising the likelihood that the World Health Organization will soon have to raise its pandemic alert level to 6, the highest level."

http://www.nytimes.com/2009/05/18/world/asia/18flu.html

can we have some clarification at the top of the page? There is so much writing subsequently, that we cant all go through it..

That's funny, ken. :) This one was pretty prescient; the market was created more then 6 months ago, long before the global swine flu thingy was even a microscopic dot in some sow's nostril...

Another headline: "WHO To Declare Phase 6 On Swine Flu" (http://canadafreepress.com/index.php/article/11185)

Talk about moving the goal line: the World Health Organization had previously been stating--nearly ad nauseum--that in order to declare H1N1 a pandemic, they had only to see sustained human-to-human transmission in a WHO region apart from the Americas, and the severity of the flu wasn't even a factor. Well, that has happened, of course, with Japan now reporting nearly 300 cases after seeing its first case just last Friday. Until Monday, that was enough to cause WHO to raise the alert level.

Almost.

But then on Monday, many nations pleaded with WHO to not raise the level, as it would be bad for tourism, bad for business, and bad for the economy as a whole. And today in Geneva, the head of the WHO, said the following: "For Phase 5 to Phase 6 I need to satisfy myself that this is a global phenomenon...I [need to] see more signals coming from the virus itself or the spread of the disease, including severity." She's reportedly going to be "...looking for signs of sustained spread in the Southern Hemisphere first".

Upshot? The pandemic call will almost certainly come...though it may not happen for some time. These markets may yet be open for a while...

(It's also come to the attention of WHO that some nations have been intentionally underreporting their case numbres as a way to hold onto tourism dollars. Whether that will be a factor is anyone's guess.)

(P.S. - I posted this on the big three H1N1 markets this morning, so you'll likely see it again.)

WHO's hesitance to raise the pandemic alert level to 6 is more political than scientific, practical, or semantic.

"...[While] the situation in Japan now seems to satisfy the WHO's current definition for phase.", the WHO's Margaret Chan put forward a new reason for hesitating to declare a pandemic. "One of the things we're not seeing is the same spread in the Southern Hemisphere that we've seen in [Mexico, the U.S., and Canada]," she said, according to Agence France-Press.

Politics, politics. Always politics. :-)

http://www.npr.org/templates/story/story.php?storyId=104384015

Here's an article that sums up the political bent of the hesitancy nicely: http://www.nature.com/news/2009/090521/full/news.2009.501.html

OK ... so .... what happens to this and the other s/flu questions if WHO changes the definition of Stage 6 (pandemic)?

Void and start over?

This market's a little different from the other major swine flu markets in that, as it was presciently created before H1N1 reared its ugly viral head, there's no requirement that WHO be the arbiter of whether or not a pandemic exists. In other words, even if WHO caves to governments and chooses not to call H1N1 a pandemic, enough health professionals and journalists calling it one would likely be enough to let this settle as 'Yes". (And, in fact, there have been numerous epidemiologists and virologists already quoted as saying that H1N1 is nearly pandemic, if not already so, and it's safe to say there'll be many more in the weeks and months to come.)

sql> "...even if WHO caves to governments and chooses not to call H1N1 a pandemic, enough health professionals and journalists calling it one would likely be enough to let this settle as 'Yes"."

Sorry -

Clarification: only the World Health Organization, via the press, can declare a true global pandemic.
(comment #1 from the market creator

Hmmm...you'd think that after 6 months, that comment would have been put into the market's settlement details. :-)

That phrase is a trifle contradictory now (as well as a redundancy with "global pandemic"): WHO is the group caving into pressure to not call the current (near) pandemic a pandemic...

From today\'s WSJ - http://online.wsj.com/article/SB124346642019860251.html\\r
\\n\\r
\\nOver the next several months, the new H1N1 flu virus is likely to continue to spread around the world, reaching into the southern hemisphere along with winter, then possibly staging a resurgence in the northern hemisphere come fall.\\r
\\n\\r
\\nHundreds of thousands of people could fall sick, and some will die. Public health officials will scramble to minimize the damage, as governments and drug makers continue to invest millions of dollars in a potential vaccine.\\r
\\n\\r
\\nYet the public, after an initial spasm of fear and concern, has turned its attention away from a strain that seems less serious than first advertised. The complacency is increasing the challenge for health officials who are trying to track and limit the spread of a disease that can still make people seriously ill even if it isn\'t deadly for most.\\r
\\n\\r
\\nAs of Wednesday, the virus had sickened at least 13,398 people in 48 countries from Argentina to the U.S., and 95 people have died, according to the World Health Organization. In the U.S., 7,927 probable and confirmed cases in 47 states and the District of Columbia have been reported to the Centers for Disease Control and Prevention, with at least 11 dead. Officials believe thousands more -- at least 100,000 in the U.S. -- have had the virus, but weren\'t tested or sick enough to visit a doctor.

I had written several days ago speculating as to what change(s) in WHO\'s Pandemic Alert Level might be forthcoming. (WHO says in \"a week or two\" they\'ll make any such changes after comsulting a large number of high-level epidemiologists and virologists.) One of the schemas I talked about was maintaining the current six-phase program, but subdividing one or more phases--especially Phase 6, aka \"The Pandemic Phase\"--into smaller and more logical chunks.\\r
\\n\\r
\\nAt the time I wrote that, I wasn\'t aware of the US CDCs \"Pandemic Severity Index\", which--as it turns out--was pretty much exactly what I had in mind. This index--the PSI--breaks down pandemics into five distinct categories based on CFR (case fatality rate), along with the number of projected US deaths:\\r
\\n\\r
\\nCategory 1 Pandemic: CFR < 0.1% / Projected deaths: < 90,000 (yellow)\\r
\\nCategory 2 Pandemic: CFR 0.1% - < 0.5% / Projected deaths: 90,000 - < 450,000 (orange)\\r
\\nCategory 3 Pandemic: CFR 0.5% - < 1.0% / Projected deaths: 450,000 - < 900,000 (red)\\r
\\nCategory 4 Pandemic: CFR 1.0% 0 < 2.0% / Projected deaths: 900,000 - < 1,800,000 (purple)\\r
\\nCategory 5 Pandemic: CFR >= 2.0% / Projected deaths: >= 1,800,000 (black)\\r
\\n\\r
\\nBased on current projections, the H1N1 outbreak would be classified as a Category 2 pandemic. Seasonal flu is a yearly Category 1 pandemic (really), the 1957 and 1968 pandemics were Category 2, and 1918 was a Category 5. (The US has had no Category 3 or 4 pandemics in the past 110 years.)\\r
\\n\\r
\\nThe question is, then, will WHO adopt a similar scheme? That is, will they indeed keep their six-level system but subdivide Phase 6? If they decide to do so a week or so from now, they would likely call a pandemic fairly quickly, given the rapid spread of the virus in the Southern Hemisphere.\\r
\\n\\r
\\nIt\'ll be interesting to watch. (Here\'s a great article from the New England Journal of Medicine*: http://content.nejm.org/cgi/content/full/NEJMp0904380 And you can read about the PSI here: http://www.pandemicflu.gov/plan/community/community_mitigation.pdf) (PDF)\\r
\\n\\r
\\n* - That 1918 flu was a doozy; note the part where it\'s stated that the number of reported cases doubled every three days. Yikes!\\r
\\n\\r
\\nP.S. - I\'m cross-posting this on the three big H1N1 markets.

05/28: WHO chief Dr. Margaret Chan said today the world is moving closer and closer to a pandemic. \"We need to look at whether or not the criteria for phase 6 is met,\" she said.\\r
\\n\\r
\\nhttp://news.xinhuanet.com/english/2009-05/29/content_11451166.htm

06/02: Here's some interesting news: according to the well-respected Bloomberg, WHO plans to change the pandemic alert level to Phase 6 sometime in the next two weeks.

"The Geneva-based agency, sometime in the next 10 days, will declare the first flu pandemic in 41 years, said the people, who spoke on condition of anonymity because the WHO’s deliberations are private. WHO is using the time before the announcement to help member states prepare...Following yesterday’s discussion, [WHO Director Dr. Margaret] Chan is considering changes that would allow the agency to describe the situation as pandemic phase 6a, leaving the WHO two more levels -- b for moderate and c for severe -- if a more deadly bug emerges, according to the people familiar with the organization."

http://www.bloomberg.com/apps/news?pid=20601087&sid=aT9sIzRoUnNo&refer=home

Australia is now officially reporting "sustained community spread" of H1N1 - technically, that should be sufficient to meet the WHO criteria for an official "pandemic" announcement

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jun0309australia.html

The World Health Organization said Tuesday a spike in swine flu cases in Australia may push it to finally announce the first flu pandemic in 41 years. It also expressed concern about an unusual rise in severe illness from the disease in Canada.

"On the surface of it, I think we are in phase 6," or a pandemic, said Margaret Chan, WHO's director-general. Chan said it was important to verify the reports that the virus is becoming established outside North America before declaring a pandemic. "The decision to make a phase 6 announcement is a heavy responsibility, a responsibility that I will take very seriously, and I need to be convinced that I have indisputable evidence," she said. [She] said she will hold a conference call with governments Wednesday in order to verify some of the reports she has received before making a formal announcement. "Once I get indisputable evidence, I will make the announcement," she told reporters in Geneva.

http://www.google.com/hostednews/ap/article/ALeqM5jTkkEKE5LtPih_5Jcc-3MpD0gOYQD98NDCQ80
---------------------------

So: Australia's case load has exploded to more than 1,000; Chile's has more than doubled in just two days to nearly 1,000 itself; the EU announced 184 new cases today (including a number of cases with patients who had no known exposure to anyone with A/H1N1), its biggest one-day increase in cases since the outbreak began; cases in the Southern Hemisphere are growing at a more rapid rate than cases in the Northern Hermisphere, a good sign that the disease has taken hold; today the WHO's assistant director stated at a news conference that "we are really very close" to declaring a pandemic; and now the director herself has stated that she's only waiting on "indisputable evidence" to make the call...and there's a lot of such evidence.

IOW: the call may come as early as tomorrow (06/10) or Thursday (06/11).

It certainly looks as though tomorrow (06/11) is most likely the day the pandemic alert level will be raised. Dr. Margaret Chan--director of the WHO-- talked with health officials from several of the hardest hit nations today, and has called an emergency meeting of the WHO's influenza experts committee for 10:00 GMT tomorrow. Dr. Chan previously met with that committee before raising the pandemic alert level to phases 3, 4, and the current 5.

06/11: WHO director Dr. Margaret Chan is holding a press conference at 6:00 PM Geneva time (noon EDT) today at which she will almost certainly announce a move to Phase 6 and officially declare A/H1N1 a pandemic.

http://www.thaindian.com/newsportal/health1/who-concludes-emergency-meeting-pandemic-declaration-expected_100203728.html

Done http://news.yahoo.com/s/ap/20090611/ap_on_he_me/un_un_swine_flu;_ylt=AgoEhcGGv5gRWoFeKtTesjus0NUE;_ylu=X3oDMTJnZmI5ZHMwBGFzc2V0A2FwLzIwMDkwNjExL3VuX3VuX3N3aW5lX2ZsdQRjcG9zAzIEcG9zAzcEc2VjA3luX3RvcF9zdG9yeQRzbGsDd2hvc3dpbmVmbHVw