Crying WHOlf?

Raising the Pandemic Alert level to 5 shows how crude the WHO system of pandemic threat levels is – one more notch and we’re all dead? Surely not. News media all over the world are obviously featuring the story, but many people will find a Level 5 alert on a 6 point scale unduly alarmist at this stage. More people die in road traffic accidents everyday, but you don’t see that as the top news on CNN or Sky. The WHO pandemic level is a simple measure, and we don’t live in a simple world. The rapid escalation of the alert level could lead to people treating this as another false alarm, like the SARS scare.

The WHO levels go from 1 – animal to animal transmission with no transmission to humans – through transmission to humans, human to human infection in a small community, up to human to human transmission in 2 countries which is where we are now. Level 6 will undoubtedly be declared today or tomorrow when we see human to human transmission in a third country in a different region. As a measure of the spread of a disease, this is pretty clear. In our world, with millions of people flying from pace to place everyday, packed in airborne virus incubators with recirculated air, breathing each others germs for hours, any virus will spread very quickly. One sneeze in a major airport can see 3,000 infected people in 10 different countries 4 hours later. We all know this, and this is all the WHO levels measure.

On this basis, we are at level 6 for hundreds of diseases. Since someone in a third country probably already has a human-to-human case of swine flu, we are in reality probably in a Level 6 Swine Flu Pandemic. The problem is it doesn’t look like a Pandemic. People are dying, but not in great numbers. Right now, for most of us, Swine flu seems less dangrous than crossing the road, and for most of it, it may well stay that way.

The media have added two obvious measures – numbers reported infected and number of deaths. These numbers are still small, and therefore not yet scary at all. Since the numbers are small, they are not very robust – millions of people have a flu, or flu like illness at any given time, but who really has this flu? People who have swine flu have died, but reports come later that some died from other causes. Let’s face it, if you go into hospital with any minor ailment these days, you seem to risk getting something worse which will kill you. Many people will look at these numbers and conclude that it isn’t a serious issue, and after the weekend papers, the media may well lose interest and push the story down the page.

Measures that we are not seeing, and really do need, are things like the rate of infection – 1 person to 10 people to 100 in one country are all small numbers, and especially if they are all in one region. 1 person in one city to 10 people in 10 cities in one country is more serious, but if that is happening, it isn’t being reflected in the WHO index or the media.

As well as knowing how diffuse it is, we really should see better figures on mortality rates. What proportion of people infected are dying, and who are they? How far on was the disease when it was diagnosed among those who later died, and what treatement did they have access to? If one person on a flight from Mexico had H1N1, how many other passengers developed it, and how quickly? This is the sort of detail we need to be able to properly asess risk and decide what level of precautions to take.

I suspect that if you are a fit, well fed, white person in a developed country who takes good supplements and has decent medical care, your risk of dying from swine flu is no worse than that of dying from regular flu. In fact, I’d guess that deaths from all types of flu in the developed world will fall over the next 6 months, because people may take more care. In the developing world, people are at more risk, but they are at risk of dying from simple, treatable illnesses everyday anyway. For people livinng without adequate water or food, in warzones or refugee camps, the daily death rates are already too high, and for many of them, H1N1 may only be a small extra danger.

Without better numbers, we are living in an unreal crisis – indeed, it might not be a crisis at all. Level 6, which is the highest level, should see airports closed and travel bans and schools shut and people all over the world hiding inside, shouldn’t it? Where are the folks in the spacesuits coming to take samples? It doesn’t look like a level 6 pandemic, it doesn’t feel like it, it doesn’t smell like it, and that is because the WHO levels measure one and one one dimension of the threat.

What we need is a ‘dashboard’ that shows rates of infection, mortailty by age and socio-economic level, and by access to medical help, rate of mutation of the virus (so far, apperently, zero) and time to a vaccine. I’m sure there are some other numbers we could meaningfully add in there as well. As a historian, I’m open to suggestions as to which facts are significant – indeed, thinking about this is my job. Right now we are working at a level of analysis equivalent to saying one executed monarch makes a revolution, which is even more simplistic than primary school history. If we expect the people who read only the redtops to take this issue as seriously as it warrants, we first need – quickly – to be clear about how serious it actually is.