Pandemic Semantics
ScienceInsider reports that the World Health Organization is couching its language so carefully that at a press briefing yesterday, a spokesperson said it is now “really very close” to calling the international H1N1 influenza outbreak a “pandemic.” At issue is the need to communicate disease risk without triggering unnecessary panic. The WHO pandemic alert system designed in 2003 relies upon geography, defining “pandemic” as sustained community-level spread of a disease in two WHO global regions. But critics of the system point out that it fails to account for severity, which Jon Cohen reports “is tricky to define as it includes everything from the virulence of a particular influenza strain to the vulnerability of a particular population and its ability to respond.”
The public health experts at Effect Measure have been following the discussion over what to call the world-wide epidemic, and interpreted the WHO press briefing like this: “everyone, WHO included, thinks a pandemic is well underway.” But they look to deeds, not dictionaries for solutions to an outbreak that has infected a reported 27,737 people worldwide:
Meanwhile we now have the long predicted influenza pandemic. It’s neither so scary nor so benign that we can afford to either hide under the bed or ignore it. What we must do is roll up our sleeves and manage the consequences.
The question of what the word “pandemic” means has gotten so entangled in the media coverage of the outbreak that The New York Times yesterday dug into the history of the term, revealing that the public health community hasn’t yet agreed on how to define it:
The word implies the rapid spread of an infectious disease to many countries in different regions, hitting each with more or less the same severity. But in fact, severity varies — not all people are infected at the same time, and not every country need be affected.
And there can be many other factors, including the numbers and percentages of people falling ill and dying; a population’s vulnerability to the disease, based on previous rates of infection; and the quality of health care facilities and disease monitoring systems.
Not least is that scientists do not know precisely how pandemics arise, what fuels them, why they vary in their lethality, why some occur in waves and why they stop.
Complicating matters further is the fact that the term gets applied to health problems like obesity and heart disease—very different from the international influenza outbreak.
Instead of tweaking the current alert system, the Effect Measure editors recommend an “up-to-date information” system. Sharing data in real time on the Internet would be helpful not just for national health systems, but would also allow media outlets to spend more time and effort looking at what is happening, rather than having to worry so much about what to call it. Fortunately, the Obama administration understands the issue clearly and has requested nearly $12 billion in additional funds to handle the ongoing outbreak, which has infected 13,217 people and killed 27 in the United States.
Image: CDC
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