An influenza pandemic is a global outbreak of a new influenza A virus. Pandemics happen when new (novel) influenza A viruses emerge which are able to infect people easily and spread from person to person in an efficient and sustained way. The United States is NOT currently experiencing an influenza pandemic. There is an ongoing pandemic with a new coronavirus. CDC influenza programs protect pdf icon [1.1 MB, 2 pages, 508] the United States from seasonal influenza and an influenza pandemic, which occurs when a new flu virus emerges that can infect people and spread globally.
- Seasonal Flu vs Pandemic Flu
- Questions and Answers
- Past Pandemics
- Pandemic Intervals Framework
- Influenza Risk Assessment Tool
- Severity Assessment Framework
- Current Situation
- Viruses of Special Concern
- Global Monitoring
CDC works to improve global control and prevention of seasonal and novel influenza, and works to improve influenza pandemic preparedness and response.
In 1997, avian influenza A(H5N1) viruses first spread from poultry directly to infect humans in Hong Kong resulting in the deaths of 6 of 18 infected persons. Concerned about the possibility that this A(H5N1) virus could easily infect humans and eventually spread from person-to-person, the World Health Organization (WHO) and United States government increased pandemic preparedness planning. Since 2000, the world has experienced a pandemic and there have been other instances of novel influenza A viruses infecting people, including avian and swine influenza A viruses. An influenza pandemic could place extraordinary demands on public health and health care systems as well as on essential community services. Preparing for such a threat is an important priority.
In 2005, officials at the United States Department of Health and Human Services (HHS) developed a Pandemic Influenza Plan to coordinate and improve efforts to prevent, control, and respond to A(H5N1) viruses as well as other novel influenza A viruses of animal (e.g. from birds or pigs) with pandemic potential. Although it is impossible to predict when the next pandemic will occur, United States government have developed three tools to guide national, state and local planning and response. These tools align with the World Health Organization’s (WHO) global framework external icon of pandemic phases and risk assessment activities for preparedness, response, and recovery.
National Pandemic Strategy Documents
The following documents guide the United States’ preparedness and response in an influenza pandemic, with the intent of stopping, slowing or otherwise limiting the spread of a pandemic to the United States; limiting the domestic spread of a pandemic, mitigating disease, suffering and death; and sustaining infrastructure and mitigating impact to the economy and the functioning of society.
Don’t panic, but there is another virus out there that could cause a pandemic.
This one is an influenza strain circulating in pigs and their caretakers in China.
It is not currently causing widespread illness, and it may never do so. But it has “all the essential hallmarks of a candidate pandemic virus,” according to the authors of a new study in the Proceedings of the National Academy of Sciences.
“This strain requires very close watching,” said Andrew Pavia, chief of the pediatric infectious diseases division at the University of Utah, who was not involved with the research. “But at present, we just don’t know what the pandemic potential is.”
The new strain contains genes from the flu virus that caused a pandemic in 2009. It infects human cells and spreads easily in lab tests.
The strain has become dominant in Chinese pigs and has infected people. The study’s authors tested workers at 15 hog farms in Hebei and Shandong provinces for the virus, as well as people living nearby. They found that about 10% of the workers and 4% of the locals had been exposed.
‘Good news, bad news’
“There’s good news and bad here,” Pavia said. “I think the bad news is that once again, it looks as if we’re identifying strains of flu that are emerging in populations with the potential to jump to humans.”
However, only a handful of serious cases have been reported.
“The severity remains low. That’s good news,” Pavia said, adding, “there’s no guarantee that it’s going to stay that way.”
Other factors also must change before alarm bells really go off, experts note.
“What is really important for influenza pandemic emergence, as well as for any viral pandemic emergence, is sustained airborne transmission,” said University of Pittsburgh School of Medicine microbiologist and molecular geneticist Seema Lakdawala, who was not part of the research team.
While a few people are getting infected, she said there is no sign now of sustained transmission.
Food animals are a common source of new flu viruses. Birds, pigs and humans can all exchange flu strains. Pigs are especially welcoming environments for influenza viruses to reinvent themselves. Multiple strains can infect one animal, swap genes and emerge as a novel strain.
There is no telling when the right combination of genes will fall into place and produce a virulent, transmissible virus.
A lethal strain called H5N1 first appeared in poultry in Hong Kong in 1997 and resurfaced in 2003. It kills more than half the people it infects. But for reasons scientists do not understand, it has not gone pandemic.
“It’s still a concern. It has caused hundreds of deaths,” said senior scholar Gigi Gronvall at the Johns Hopkins Center for Health Security, who was not involved with the research. “But for whatever reason, even though all eyes were on that, it was this other virus that took off in 2009.”
That year, H1N1 emerged from pigs and sparked a pandemic. Researchers estimate that nearly 300,000 people died from it in the first year.
Since then, health officials have increased efforts to monitor livestock farms and markets for new viruses.
“There’s been a big improvement, but it’s far from complete,” Pavia said. “The challenge is enormous. Influenza circulates among ducks, turkeys, swine – not to mention there are strains that infect everything from horses to dogs. And tracking all of these is an enormous task.”
The effort is understaffed and underfunded, “like so many things in public health,” he said.
And that’s dangerous.
“We’ve seen the consequences of inadequate public health surveillance in the emergence and failure to control COVID-19,” Pavia noted.
Unlike COVID-19, health experts have tools against influenza that might help if the new strain were to launch a new pandemic.
“We know how to test for influenza viruses,” Lakdawala said. Flu antivirals are only partly effective, “but we do at least have antivirals that can limit the severity of disease. We have a number of them. We also have a vaccine platform that is already approved and safe.”
A vaccine could be available in a matter of months.
But there is no way to know whether the newly identified strain will spark a pandemic.
“The more you study flu, the more you realize we just don’t know how to predict that,” Pavia said.
Steve Baragona is an award-winning multimedia journalist covering science, environment and health.
He spent eight years in molecular biology and infectious disease research before deciding that writing about science was more fun than doing it. He graduated from the University of North Carolina at Chapel Hill with a master’s degree in journalism in 2002.
The purpose of this bulletin is to provide general information and resources relating to seasonal or H1N1 flu to health care providers licensed or regulated by Health Regulation at the Minnesota Department of Health.
MDH has developed a web page related to the flu for Long Term Care Providers where important information and updates will be posted. This will include information such as case definitions, vaccinations, testing and treatment, infection control policies and procedures, as well as links to other important information and resources. Providers can subscribe to receive an email when the pages are updated. You can view the page and information on subscribing at: Long-Term Care: Influenza
As additional questions and concerns arise please send them to us via email at: [email protected] or by phone to 651-201-4200. We will answer them as best as we can, keeping in mind that some questions may need to be addressed and resolved on a case by case basis depending on the situation and individual circumstances at the time.
This bulletin addresses the following questions:
- What should I be doing now to prepare and plan for a flu outbreak?
- Who do I contact if I am impacted by an outbreak and need help with addressing shortages of staff, supplies and other resources?
- Where do I obtain general information on infection control procedures during flu?
- Who do I contact about questions related to licensing or CMS regulations?
- Where do I find information about emergency procedures as outlined by the Centers for Medicare and Medicaid Services?
1. What should I be doing now to prepare and plan for a flu outbreak?
Some of the steps you can take now are:
- Educate staff and clients regarding seasonal flu and H1N1. Current H1N1 and flu information can be found at: Influenza (Flu).
- Review and reinforce infection control procedures. Information on infection control in flu outbreak can be found at: Infection Control Guidance for Health Professionals (/divs/idepc/diseases/flu/hcp/ic/index.html [unavailable link] – new link to try: Influenza Information for Health Professionals).
- Encourage staff to obtain seasonal and H1N1 flu vaccinations when available. Encourage staff to develop personal family emergency plans.
- Identify staff roles and determine alternate staff role possibilities.
- Update internal communications plans to reach staff and external communications plans to reach clients and families.
- Determine resources required to continue care/services to home care clients and develop emergency staffing plans for clients that require continued services or cannot be left on their own. Review with clients their personal emergency preparedness plan.
- Identify other similar medical providers within the community and determine if there can be shared resources and or staff.
- Stay in touch with your city or county local public health agency. They will be working with MDH on planning and needs related to flu in your city or county. They are a critical resource in health emergencies.
- Subscribe to Long-term Care Influenza Information on the MDH web to get an e-mail when new long-term care influenza information is posted. You can find that link at: Long-Term Care: Influenza.
Preparation checklists, toolkits, and guidelines that will assist healthcare providers and service organizations in planning for a pandemic outbreak can be found at: http://www.flu.gov/plan/healthcare/index.html [expired link]. Additional emergency planning information and resources are available from the Office of Emergency Preparedness at Emergency Preparedness & Response.
2. Who do I contact if I am impacted by an outbreak and need help with addressing shortages of staff, supplies and other resources?
Contact the Public Health Preparedness or Healthcare Preparedness Consultant in your region. This person can direct you to local public health or other resources. Contact information is available at: Public Health Preparedness Consultants.
3. Where do I obtain general information on infection control procedures during flu?
Information on infection control is available at: Infection Control Guidance for Health Professionals (/divs/idepc/diseases/flu/hcp/ic/index.html [unavailable link] – new link to try: Influenza Information for Health Professionals).
4. Who do I contact about questions related to licensing or CMS regulations?
Call Health Regulation at 651-201-4200 or email your questions to [email protected]
We plan to post the frequently asked questions (FAQ) on the flu web pages for LTC Providers at: Long-Term Care: Influenza. Please check those pages to see if the answer to your question has already been posted.
5. Where do I find information about emergency procedures as outlined by the Centers for Medicare and Medicaid Services?
CMS information specific to H1N1: http://www.cms.hhs.gov/H1N1/ [expired link].
If you have any questions related to this Information Bulletin, please contact:
Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
P.O. Box 64900
St. Paul, Minnesota 55164-0900
Telephone: (651) 201-4200
Email: [email protected]
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An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears in the human population, causes serious human illness, and spreads easily from person to person worldwide.
Because people have little or no immune protection from such new viruses, there can be high levels of illness, death, social disruption, and economic loss. The last major flu pandemic occurred in 1918 and killed as many as 40 million people worldwide, including more than 500,000 in the United States.
The H5N1 avian influenza or “bird flu” covered in the news has not qualified as a pandemic strain of influenza and scientists cannot predict if or when this might happen. However, the virus continues to spread in birds and from birds to some people, so health experts are on high alert.
South Dakota Prepares
South Dakota has developed a pandemic influenza plan that mirrors the U.S. Department of Health and Human Services plan. It was developed by the state Health Department, other state agencies, and health care partners and submitted to the Centers for Disease Control and Prevention in April 2005. It continues to be revised and updated. South Dakota Pandemic Influenza Plan
Flu Terms Defined
Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity and a vaccine is available.
Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available.
Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person.
“Swine flu” was the popular name for the virus which was responsible for a global flu outbreak (called a pandemic) in 2009 to 2010. It’s a type of seasonal flu and is now included in the annual flu vaccine.
The scientific name for swine flu is A/H1N1pdm09. It’s often shortened to “H1N1”.
“Swine flu” pandemic 2009 to 2010
The virus was first identified in Mexico in April 2009. It became known as swine flu because it’s similar to flu viruses that affect pigs.
It spread rapidly from country to country because it was a new type of flu virus that few young people were immune to.
Overall, the outbreak was not as serious as originally predicted, largely because many older people were already immune to it. Most cases in the UK were relatively mild, although there were some serious cases.
The relatively small number of cases that led to serious illness or death were mostly in children and young adults – particularly those with underlying health problems – and pregnant women.
On 10 August 2010, the World Health Organization (WHO) declared the pandemic officially over.
“Swine flu” now
The A/H1N1pdm09 virus is now one of the seasonal flu viruses that circulate each winter. If you’ve had flu in the last few years, there’s a chance it was caused by this virus.
As many people now have some level of immunity to the A/H1N1pdm09 virus, it’s much less of a concern than it was during 2009 to 2010.
The symptoms are the same as other types of common flu. They’re usually mild and pass within 1 to 2 weeks. But as with all types of flu, some people are at higher risk of serious illness, particularly those with underlying health problems.
The regular flu jab will usually protect people who are at a higher risk of becoming severely ill. A vaccine programme for children has also been introduced, which aims to protect children and reduce their ability to infect others.
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Page last reviewed: 02 September 2019
Next review due: 02 September 2022
By Laura Lee Bloor
Reviewed by William C. Shiel Jr., MD, FACP, FACR
What is a pandemic?
The H1N1 swine flu pandemic is another way of saying the H1N1 virus is a global disease outbreak. Pandemics are difficult to predict because several factors influence how destructive it can be. A flu pandemic’s impact depends on
the number of cases;
the virulence, or strength, of the virus;
people’s individual immunities;
the immunity protection people derived from antibodies acquired through seasonal flu infections;
What preparedness plans have been developed for the H1N1 swine flu pandemic?
Millions of doses of flu vaccines have been developed to combat the spread of the H1N1 swine flu pandemic. Some come in the form of a regular flu shot injected subcutaneously and others are the FluMist nasal spray vaccine. Contact your doctor about getting the H1N1 swine flu vaccine.
For those who still contract H1N1 swine flu, the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) may be prescribed. These drugs are most effective when taken within 48 hours of the start of H1N1 flu symptoms. Whether these are prescribed for treatment depends on each individual case; not everyone needs antiviral drugs. People can recover from swine flu without Tamiflu or Relenza.
Who gets the H1N1 swine flu vaccine first?
Everyone should get vaccinated, but a few groups have priority:
Day-care providers and other caregivers of children
Health-care workers and emergency medical personnel
Kids and young adults 6 months to 24 years of age
A few regulations apply to the H1N1 vaccines: The H1N1 nasal spray vaccine is only approved for healthy people 2-49 years of age. Also, the nasal spray is not approved for pregnant women, so they should get the flu shot. The H1N1 nasal spray vaccine is a live vaccine and should not be given to people taking certain medications that suppress the immune response.
How can I help prevent an H1N1 swine flu infection?
To protect yourself from swine flu and other flu viruses, you should
avoid close contact with people who are sick with a fever and/or cough;
try to confine an individual infected with swine flu to a spare bedroom and consider wearing a face mask when you interact with them;
wash your hands frequently and thoroughly with antibacterial soap and water;
use hand sanitizer gels if you can’t wash your hands;
avoid touching your eyes, nose, and mouth unless you’ve just washed your hands;
cover your mouth when you cough or sneeze, and wash your hands as soon as possible;
engage in healthy habits;
Get enough sleep (seven to eight hours a night).
Eat healthy, nutritious meals with lots of fruits and vegetables.
Exercise most days of the week.
How can I prepare for the H1N1 swine flu pandemic?
To minimize the impact a global swine flu pandemic would have on your daily life, you can
store extra supplies of food, water, and nonprescription drugs, such as pain relievers and cough and cold medications;
create a plan to ensure you can get prescriptions;
volunteer in your community to help assist in the event of an emergency;
secure other means of transportation if you use public transportation;
see if you can work from home and do not go into the office in the event that you develop H1N1 swine flu;
What are other examples of pandemics?
Perhaps the most well-known and devastating pandemic is that of human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Another well-known pandemic is the 1918 flu, also known as the Spanish flu, which killed between 40-50 million people.
In 1957, Asian influenza killed 2 million people, and in 1968, Hong Kong influenza killed 1 million people.
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“Current WHO Phase of Pandemic Alert.” World Health Organization. .
DeNoon, Daniel J. “H1N1 Swine Flu Vaccine FAQ.” WebMD. Oct. 1, 2009. .
Hitti, Miranda. “Swine Flu Found in More Countries.” WebMD. Apr. 28, 2009. .
Hitti, Miranda. “Swine Flu: 66 Confirmed U.S. Cases.” WebMD. Apr. 28, 2009. .
“Pandemic Preparedness.” World Health Organization. .
“What Are Epidemics, Pandemics, and Outbreaks?” WebMD. Apr. 28, 2009. .
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- National Center for Biotechnology Information – PubMed Central – Analyses of the 1957 (Asian) influenza pandemic in the United Kingdom and the impact of school closures
- GlobalSecurity.org – Asian flu of 1957
The 1957 outbreak of influenza was first detected in Singapore in February that year. In the months that followed, the outbreak spread to Hong Kong and surrounding regions. By the summer of 1957, it had reached coastal areas of the United States.
The 1957 flu pandemic caused an estimated one million to two million deaths worldwide and is generally considered to have been the least severe of the three influenza pandemics of the 20th century.
The 1957 flu pandemic was caused by influenza H2N2 virus, to which few people had previous exposure. A vaccine was rapidly developed against H2N2, though later assessment showed that more vaccine than usual was needed to produce immunity. H2N2 no longer circulates in humans but is carried by animals. Because of the pandemic potential of H2 viruses, researchers are developing putative H2 vaccines as part of pre-pandemic vaccine planning.
The 1957 flu outbreak was associated with variation in susceptibility and course of influenza illness. Some infected individuals experienced only minor symptoms, whereas others experienced life-threatening complications such as pneumonia. Persons who were unaffected or only mildly affected likely possessed protective antibodies to other, closely related strains of influenza.
1957 flu pandemic, also called Asian flu pandemic of 1957 or Asian flu of 1957, outbreak of influenza that was first identified in February 1957 in East Asia and that subsequently spread to countries worldwide. The 1957 flu pandemic was the second major influenza pandemic to occur in the 20th century; it followed the influenza pandemic of 1918–19 and preceded the 1968 flu pandemic. The 1957 flu outbreak caused an estimated one million to two million deaths worldwide and is generally considered to have been the least severe of the three influenza pandemics of the 20th century.
The 1957 outbreak was caused by a virus known as influenza A subtype H2N2. Research has indicated that this virus was a reassortant (mixed species) strain, originating from strains of avian influenza and human influenza viruses. In the 1960s the human H2N2 strain underwent a series of minor genetic modifications, a process known as antigenic drift. These slight modifications produced periodic epidemics. After 10 years of evolution, the 1957 flu virus disappeared, having been replaced through antigenic shift by a new influenza A subtype, H3N2, which gave rise to the 1968 flu pandemic.
In the first months of the 1957 flu pandemic, the virus spread throughout China and surrounding regions. By midsummer it had reached the United States, where it appears to have initially infected relatively few people. Several months later, however, numerous cases of infection were reported, especially in young children, the elderly, and pregnant women. This upsurge in cases was the result of a second pandemic wave of illness that struck the Northern Hemisphere in November 1957. At that time the pandemic was also already widespread in the United Kingdom. By December a total of some 3,550 deaths had been reported in England and Wales. The second wave was particularly devastating, and by March 1958 an estimated 69,800 deaths had occurred in the United States.
Similar to the 1968 flu pandemic, the 1957 outbreak was associated with variation in susceptibility and course of illness. Whereas some infected individuals experienced only minor symptoms, such as cough and mild fever, others experienced life-threatening complications such as pneumonia. Those persons who were unaffected by the virus were believed to have possessed protective antibodies to other, closely related strains of influenza. The rapid development of a vaccine against the H2N2 virus and the availability of antibiotics to treat secondary infections limited the spread and mortality of the pandemic.
A pandemic is a global disease outbreak. A flu pandemic occurs when a new virus emerges and people have little or no immunity to the virus.
Austin/Travis County Health and Human Services Department (ATCHHSD) has the following personnel and other resources to assist in disaster response:
- Disease Control and Prevention: epidemiologists, physicians, veterinarians, infection control practitioners, registered nurses, experienced disease investigators, data entry/analysis, and other professional staff
- Environmental Health: sanitarians, toxicologists, and other environmental technicians
- Planning and Regulations: staff with expertise in state/federal laws; hospital licensing expertise
- Immunization: nurses, pharmacists, and experienced disease investigators
- Emergency Medical Services (EMS): staff with expertise in facilitating emergency medical system response and trauma systems
- Public Health Laboratories: microbiologists, laboratory technicians and other staff; laboratory testing facilities
- Health Alert Network
- Stress management and Crisis Counseling: Critical Incident Stress Management (CISM) trained personnel, social workers, psychologists, crisis counselors, and other professional staff
Austin/Travis County Health and Human Services Department conducts syndromic surveillance for respiratory illness or ILI (a variety of syndromic surveillance systems are currently used or under implementation).
ATCHHSD will have an inventory of the following services and/or items:
A potential clue to fighting a future pandemic.
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I n September 2009, the H1N1 swine flu had arrived in Portugal, Spain, and the UK, so France braced itself for cases.
Indeed, the number of people in France with respiratory symptoms soon increased. But they did not seem to have H1N1. France registered only sporadic positive tests for the new swine flu for most of that September and the first half of October. When H1N1 finally took hold in France, it was much later in the fall than expected. And that got scientists thinking: Why?
A flurry of papers since then have narrowed in on a beguiling hypothesis: The pandemic flu was deflected by the common cold.
For many people, COVID-19 has revealed, in terrifying detail, the bizarre nature of viruses. Beneath the surface of our daily lives is a constantly shifting ecology of pathogens that often behave in unexpected ways. In France in 2009, infections by rhinoviruses, which usually cause colds, were spiking when H1N1 was expected to arrive, and when they petered out, the pandemic flu took off. Since then, studies have found that instances in which people have two viruses at once are rarer than chance alone would predict. That suggests that having one protects you from the other, at least for a while — somehow.
During the COVID-19 pandemic, cases of many other respiratory infections have plummeted. This is likely a result of social distancing protocols, but it’s also possible that viral interference, the phenomenon of viruses affecting each other, may be involved. This insight could offer a head start on fighting future pandemics. With a deeper understanding of our viral ecology, what if, someday, we could use viruses against each other?
In recent years scientists have developed a much more sophisticated picture of what bacteria do to us and for us. They’ve been exploring how our health is shaped by the mix of beneficial and dangerous bacteria in our microbiomes. Now viruses may merit a reexamination as well.
The idea that viruses might interfere with each other is old — as old as vaccination. Edward Jenner, the English doctor who helped develop the practice of inoculating against smallpox in the 18th century, noticed it. Inoculation involved infecting a person with the milder cowpox virus. But if the patient had herpes, then it did not work as well. It was as if having two active infections at once altered how the immune system responded.
Over the next two centuries, scientists reported more and more situations in which it was clear that infections didn’t operate in a vacuum. One 1950 review article even called it a “well-known fact” that having one virus could inhibit the growth of another.
The topic is not frequently discussed these days, though. Viral interference that protects people can be difficult to study and is generally overlooked, says Stacey Schultz-Cherry, an infectious disease researcher at St. Jude’s Hospital in Memphis, Tenn. That’s because, she explains, situations in which simultaneous infections cause a worse prognosis are so much better known. The flu, for instance, is notorious for opening the door to bacterial pneumonia. Small studies from the beginning of the pandemic suggest having both the flu and COVID-19 is worse than having either alone.
But the worst-case scenarios might mask something profound about what often happens as our immune systems encounter viruses all day, every day, says Michael Mina, an epidemiologist at Harvard Medical School and Brigham and Women’s Hospital. “Viral infections may actually protect people from other viral infections — or bacterial infections — by stimulating immune responses, by keeping our innate immune system on its toes all the time, with these constant little pushes and nudges,” he says. “They are like training for us,” he suggests.
Adaptive immune defenses target specific pathogens, and these are what protect us after we’ve been vaccinated. But innate immunity is more all-purpose. After studying the H1N1 flu, Ellen Foxman, an immunologist at the Yale School of Medicine, and colleagues released a paper in October suggesting that once the innate immune system is activated by one pathogen, the body can repel another invader.
To model what might have been happening during the swine flu pandemic, the researchers grew human airway tissue in the lab and infected it with rhinovirus. Then, three days later, they gave it the H1N1 flu. They were intrigued to see that the flu virus just fizzled out, and they determined that the rhinovirus had switched on a number of genes that produce innate immune proteins. Suspecting that molecular messengers called interferons had flipped those switches, they treated the tissues with a drug that blocked interferons and ran the experiment again. “Lo and behold, the influenza grows just fine,” says Foxman. Interferons produced to fight the rhinovirus had been beating back the flu.
A number of viruses trigger the interferon response, and it’s possible that any of them could make the body put up stiff resistance to a new infection for some period of time. For instance, the team didn’t test whether having the flu first would stop a rhinovirus in its tracks, but it’s plausible, says Foxman. That might explain why flus and colds have alternating peaks every year. There are a lot of reasons why one virus might take center stage over others, including human behavior, school schedules, and climate. “But you really wonder if viral interference is one missing piece of that equation,” Foxman says.
In the current pandemic, the same questions are at play. While social distancing and masks are reducing the incidence of seasonal flu, perhaps the prevalence of COVID-19 is cutting it down further. Or, says Schultz-Cherry, maybe the flu would have slowed down COVID-19. They’re questions that can only be answered with further research, but they are worth asking.
Because the new research demonstrates how one infection can stop another, it hints at the possibility of unusual new therapies somewhere down the road. One can imagine viruses engineered to provoke just enough of a response to protect us against more dangerous things for, say, the next week — a benign infection to block an immediate threat. On a more practical level, says Schultz-Cherry, a protective interferon response might someday be generated in just the right places in the body by something like a nasal mist. For people at high risk, interference might provide a shield.
On the larger scale, these immune responses are the result of eons of coevolution between humans and viruses. Is it possible that after our long dance with these self-replicating snippets of genetic code, there are viruses that do us more good than harm? Mina suspects that medical research’s focus on the negative outcomes of viral infections may have blinded us to that reality.
“We miss these beautiful interactions that probably, evolutionarily, are completely working for and with us as humans, and not against us,” he continued. “The microbiome is a great example. . . . We saw bacteria everywhere and thought, maybe they’re good. Turns out they’re essential.”
Veronique Greenwood is a writer whose work has appeared in The New York Times, The Atlantic, and National Geographic, among other publications.
Oklahoma has supported the creation of plans to coordinate responses with all partners. The purpose is to ensure people and organizations not accustomed to preparing are aware of, and understand, the actions and priorities of the state when responding to these potential risks.
TPRS has created templates to assist our partners in creating their own plans so they may also prepare for their response. Each County Health Department created their specific plan in partnership with the Oklahoma State Department of Health. This partnership allows for county explicit responses in the event of a Pandemic Influenza occurrence. The County Pandemic Influenza Plan summarizes the responsibilities of each county’s nine essential components to an influenza pandemic.
The nine components are:
- Command, Control, and Management
- Surveillance and Laboratory Diagnosis
- Delivery of Vaccine
- Acquisition and Delivery of Antiviral Medications
- Health Systems and Emergency Response
- Community Disease Control and Prevention
- Infection Control
- Clinical Guidelines
- Risk Communication
Just as each county has a template for the County Pandemic Influenza Plan set in place; each participating tribe also has designed a Pandemic Influenza Plan. Each tribe’s plan may differ from tribe to tribe but the tribes have the same common goals and factors. Click on the following links to view an example of a County Pandemic Influenza template and the assessment tool (1.8 MB) used by the tribes to design their Tribal Pandemic Influenza plans.
Antibodies against the common flu blunt bird flu’s effects on mice, but how to enhance the protection in people is unclear
- By JR Minkel on February 12, 2007
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The vaccine caused the mice to create antibodies against neuraminidase, a flu protein that lets newly born virus particles escape from infected cells. The researchers also found signs that some humans carry similar antibodies. “It’s hard to prove but my gut feeling would be, if people had high enough levels of this antibody, there certainly would be a reduction in severity” from H5N1 infection, says virologist Richard Webby of St. Jude Children’s Research Hospital in Memphis, Tenn., whose group performed the research. “But that’s the million dollar question: How much of this antibody do you have to have?”
Researchers name flu viruses based on the type of hemagglutinin (HA) and neuraminidase (NA) proteins they containhence the numbers after “H” and “N” in H5N1. Flu vaccines are designed to prevent infection by eliciting antibodies against HA, which the virus uses to break into cells lining the airways.
But experts have speculated that antibodies against one type of neuraminidase could provide protection against multiple flu viruses sharing the same NA type. Some studies suggest, for example, that the 1968 H3N2 flu pandemic, which killed 1 million people worldwide, was less severe than it might have been because of neuraminidase antibodies left over from the 1957 H2N2 pandemic, which killed twice as many people.
Neuraminidase antibodies would not prevent a person from getting sick with the flu, because they do not stop the virus from infecting cells. To see if they would suffice to make H5N1 infection less severe, Webby and his co-workers injected mice with DNA for the neuraminidase gene from human H1N1, one of three flu subtypes covered by this winter’s flu shot. Next they infected the mice with avian H5N1. After two weeks, five out of 10 of these mice survived, but none of the control mice lived.
The researchers also looked at blood serum samples from human volunteers. Of 38 samples, 31 contained antibodies against H1N1 neuraminidase, presumably from past infections or vaccinations. In test tubes, seven of the serum samples inhibited the activity of neuraminidase from H5N1.
The results are “very intriguing” but “it is premature to conclude that immunity induced by the [H1N1] virus will provide significant protection from illness associated with avian influenza H5N1,” caution Laura Gillim-Ross and Kanta Subbarao of the National Institute of Allergy and Infectious Disease in an editorial accompanying the report, published online February 12 by PLoS Medicine. They note that with less than 300 confirmed human cases of H5N1 infection, researchers would be hard pressed to determine the amount of antibodies needed to confer protection.
“There’s no doubt we’ve got to focus on hemagglutinin” for developing pandemic flu vaccines, Webby says. The amount of neuraminidase in seasonal flu shots, he says, is unknown and likely varies from batch to batch.
M ore than six months after the World Health Organization declared COVID-19 a pandemic, as scientific understanding of the novel coronavirus continues to evolve, one question remains decidedly unanswered. How will this pandemic come to an end?
Current scientific understanding is that only a vaccine will put an end to this pandemic, but how we get there remains to be seen. It seems safe to say, however, that some day, somehow, it will end. After all, other viral pandemics have. Take, for example, the flu pandemic of 1918-1919.
That pandemic was the deadliest in the 20th century; it infected about 500 million people and killed at least 50 million, including 675,000 in the United States. And, while scientific knowledge of viruses and vaccine development has advanced significantly since then, the uncertainty felt around the world today would have been familiar a century ago.
Even after that virus died out, it would be years before scientists better understood what happened, and some mystery still remains. Here’s what we do know: in order for a pandemic to end, the disease in question has to reach a point at which it is unable to successfully find enough hosts to catch it and then spread it.
In the case of the 1918 pandemic, the world at first believed that the spread had been stopped by the spring of 1919, but it spiked again in early 1920. As with other flu strains, this flu may have become more active in the winter months because people were spending more time indoors in closer proximity to one another, and because artificial heat and fires dry out skin, and the cracks in the skin in the nose and mouth provide “great entry points for the virus,” explains Howard Markel, physician and director of the Center for the History of Medicine at the University of Michigan.
Flu “does tend to go quiet when the cold weather regresses, but no one knows why,” Markel says.
But, by the middle of 1920, that deadly strain of flu had in fact faded enough that the pandemic was over in many places, even though there was no dramatic or memorable declaration that the end had come.
“The end of the pandemic occurred because the virus circulated around the globe, infecting enough people that the world population no longer had enough susceptible people in order for the strain to become a pandemic once again,” says medical historian J. Alexander Navarro, Markel’s colleague and the Assistant Director of the Center for the History of Medicine. “When you get enough people who get immunity, the infection will slowly die out because it’s harder for the virus to find new susceptible hosts.”
Eventually, with “fewer susceptible people out and about and mingling,” Navarro says, there was nowhere for the virus to go —the “herd immunity” being talked about today. By the end of the pandemic, a whopping third of the world’s population had caught the virus. (At the moment, about half a percent of the global population is known to have been infected with the novel coronavirus.)
The end of the 1918 pandemic wasn’t, however, just the result of so many people catching it that immunity became widespread. Social distancing was also key. Public health advice on curbing the spread of the virus was eerily similar to that of today: citizens were encouraged to stay healthy through campaigns promoting mask-wearing, frequent hand-washing, quarantining and isolating of patients, and the closure of schools, public spaces and non-essential businesses—all steps designed to cut off routes for the virus’ spread.
In fact, a study that Markel and Navarro co-authored, published in the Journal of the American Medical Association in 2007, found that U.S. cities that implemented more than one of these aforementioned control measures earlier and kept them in place longer had better, less deadly outcomes than cities that implemented fewer of these control measures and did not do so until later.
Public health officials took all of these measures despite not knowing for sure whether they were dealing with a virus or a bacterial infection; the research that proved influenza comes from a virus and not a bacterium didn’t come out until the 1930s. It wasn’t until 2005 that articles in Science and Nature capped off a nearly decade-long process of mapping the genome of the flu strain that caused the 1918 pandemic.
A century later, the world is facing another pandemic caused by a virus, though of a different sort. COVID-19 is caused by a novel coronavirus, not influenza, so scientists are still learning how it behaves. While flu is more active in the winter—and, as Markel points out, the 1918 flu died out in a way “we would expect now” of seasonal flu—COVID-19 was active in the U.S. over the summer. Doctors expect the COVID-19 pandemic won’t really end until there’s both a vaccine and a certain level of exposure in the global population. “We’re not certain,” Markel says, “but we’re pretty darn sure.”
And yet, in the meantime, people can help the effort to limit the impact of the pandemic. A century ago, being proactive about public health saved lives—and it can do so again today.
A book about the 1918 flu pandemic spurred the government to action.
George W. Bush paved way for global pandemic planning
In the summer of 2005, President George W. Bush was on vacation at his ranch in Crawford, Texas, when he began flipping through an advance reading copy of a new book about the 1918 flu pandemic. He couldn’t put it down.
When he returned to Washington, he called his top homeland security adviser into the Oval Office and gave her the galley of historian John M. Barry’s “The Great Influenza,” which told the chilling tale of the mysterious plague that “would kill more people than the outbreak of any other disease in human history.”
“You’ve got to read this,” Fran Townsend remembers the president telling her. “He said, ‘Look, this happens every 100 years. We need a national strategy.'”
Thus was born the nation’s most comprehensive pandemic plan — a playbook that included diagrams for a global early warning system, funding to develop new, rapid vaccine technology, and a robust national stockpile of critical supplies, such as face masks and ventilators, Townsend said.
The effort was intense over the ensuing three years, including exercises where cabinet officials gamed out their responses, but it was not sustained. Large swaths of the ambitious plan were either not fully realized or entirely shelved as other priorities and crises took hold.
But elements of that effort have formed the foundation for the national response to the coronavirus pandemic underway right now.
“Despite politics, despite changes, when a crisis hits, you pull what you’ve got off the shelf and work from there,” Townsend said.
When Bush first told his aides he wanted to focus on the potential of a global pandemic, many of them harbored doubts.
“My reaction was — I’m buried. I’m dealing with counterterrorism. Hurricane season. Wildfires. I’m like, ‘What?'” Townsend said. “He said to me, ‘It may not happen on our watch, but the nation needs the plan.'”
Over the ensuing months, cabinet officials got behind the idea. Most of them had governed through the Sept. 11 terror attacks, so events considered unlikely but highly-impactful had a certain resonance.
“There was a realization that it’s no longer fantastical to raise scenarios about planes falling from the sky, or anthrax arriving in the mail,” said Tom Bossert, who worked in the Bush White House and went on to serve as a homeland security adviser in the Trump administration. “It was not a novel. It was the world we were living.”
According to Bossert, who is now an ABC News contributor, Bush did not just insist on preparation for a pandemic. He was obsessed with it.
“He was completely taken by the reality that that was going to happen,” Bossert said.
Tune into ABC at 1 p.m. ET and ABC News Live at 4 p.m. ET every weekday for special coverage of the novel coronavirus with the full ABC News team, including the latest news, context and analysis.
In a November 2005 speech at the National Institutes of Health, Bush laid out proposals in granular detail — describing with stunning prescience how a pandemic in the United States would unfold. Among those in the audience was Dr. Anthony Fauci, the leader of the current crisis response, who was then and still is now the director of the National Institute of Allergy and Infectious Diseases.
“A pandemic is a lot like a forest fire,” Bush said at the time. “If caught early it might be extinguished with limited damage. If allowed to smolder, undetected, it can grow to an inferno that can spread quickly beyond our ability to control it.”
The president recognized that an outbreak was a different kind of disaster than the ones the federal government had been designed to address.
“To respond to a pandemic, we need medical personnel and adequate supplies of equipment,” Bush said. “In a pandemic, everything from syringes to hospital beds, respirators masks and protective equipment would be in short supply.”
Bush told the gathered scientists that they would need to develop a vaccine in record time.
“If a pandemic strikes, our country must have a surge capacity in place that will allow us to bring a new vaccine on line quickly and manufacture enough to immunize every American against the pandemic strain,” he said.
Pandemic Flu Preparedness
what is pandemic influenza?
Pandemic influenza, or flu, is a global outbreak of disease in humans that occurs when these conditions are met:
- A new strain of influenza virus not seen before in people
- The virus can cause severe illness in people
- The virus spreads easily from person to person
Influenza pandemics usually spread quickly around the world, resulting in unusually high number of illnesses and deaths. Such pandemics occurred in 1918, 1957, 1968 and in 2009 with the novel H1N1 strain of influenza.
Because people have not been infected with a similar virus in the past, most or all people will not have any natural immunity (protection) to a new pandemic virus. A pandemic influenza vaccine (flu shot) will not be immediately available. It first must be developed, tested and manufactured. This process could take months.
The Vermont Department of Health’s pandemic preparedness efforts include tracking the number of flu cases that occur in communities, as well as working with other government agencies, communities, hospitals, health care providers, and first responders to address and respond to the complex issues that the state faces during a pandemic.
There are a number of things that you can do to prepare yourself and those around you. It is important to think about the challenges that you might face, especially if a pandemic is severe. Go through a planning checklist to ensure that you plan for the impact of a flu pandemic on you, your family, or your business.
There are steps individuals and families can take to prepare for a pandemic:
- Keep a supply of food and medicines on hand in case you have to stay at home.
- Think about how you would care for people in your family who have special needs if support services are not available.
- Decide who will take care of children if schools are closed.
- Cover your mouth when you cough or sneeze.
- Wash your hands often and well.
- Stay at home and away from others when you are sick.
The deadly third wave of the 1918 flu shows what can happen when society prematurely returns to pre-pandemic life, a medical historian cautions.
Picture the United States struggling to deal with a deadly pandemic.
State and local officials enact a slate of social-distancing measures, gathering bans, closure orders and mask mandates in an effort to stem the tide of cases and deaths.
The public responds with widespread compliance mixed with more than a hint of grumbling, pushback and even outright defiance. As the days turn into weeks turn into months, the strictures become harder to tolerate.
Clergy bemoan church closures while offices, factories and in some cases even saloons are allowed to remain open.
Many citizens refuse to don face masks while in public, some complaining that they’re uncomfortable and others arguing that the government has no right to infringe on their civil liberties.
As familiar as it all may sound in 2021, these are real descriptions of the U.S. during the deadly 1918 influenza pandemic. In my research as a historian of medicine, I’ve seen again and again the many ways our current pandemic has mirrored the one experienced by our forebears a century ago.
As the COVID-19 pandemic enters its second year, many people want to know when life will go back to how it was before the coronavirus. History, of course, isn’t an exact template for what the future holds. But the way Americans emerged from the earlier pandemic could suggest what post-pandemic life will be like this time around.
Sick and tired, ready for pandemic’s end
Like COVID-19, the 1918 influenza pandemic hit hard and fast, going from a handful of reported cases in a few cities to a nationwide outbreak within a few weeks. Many communities issued several rounds of various closure orders – corresponding to the ebbs and flows of their epidemics – in an attempt to keep the disease in check.
These social-distancing orders worked to reduce cases and deaths. Just as today, however, they often proved difficult to maintain. By the late autumn, just weeks after the social-distancing orders went into effect, the pandemic seemed to be coming to an end as the number of new infections declined.
People clamored to return to their normal lives. Businesses pressed officials to be allowed to reopen. Believing the pandemic was over, state and local authorities began rescinding public health edicts. The nation turned its efforts to addressing the devastation influenza had wrought.
For the friends, families and co-workers of the hundreds of thousands of Americans who had died, post-pandemic life was filled with sadness and grief. Many of those still recovering from their bouts with the malady required support and care as they recuperated.
At a time when there was no federal or state safety net, charitable organizations sprang into action to provide resources for families who had lost their breadwinners, or to take in the countless children left orphaned by the disease.
For the vast majority of Americans, though, life after the pandemic seemed to be a headlong rush to normalcy. Starved for weeks of their nights on the town, sporting events, religious services, classroom interactions and family gatherings, many were eager to return to their old lives.
Taking their cues from officials who had – somewhat prematurely – declared an end to the pandemic, Americans overwhelmingly hurried to return to their pre-pandemic routines. They packed into movie theaters and dance halls, crowded in stores and shops, and gathered with friends and family.
Officials had warned the nation that cases and deaths likely would continue for months to come. The burden of public health, however, now rested not on policy but rather on individual responsibility.
Predictably, the pandemic wore on, stretching into a third deadly wave that lasted through the spring of 1919, with a fourth wave hitting in the winter of 1920. Some officials blamed the resurgence on careless Americans. Others downplayed the new cases or turned their attention to more routine public health matters, including other diseases, restaurant inspections and sanitation.
Despite the persistence of the pandemic, influenza quickly became old news. Once a regular feature of front pages, reportage rapidly dwindled to small, sporadic clippings buried in the backs of the nation’s newspapers. The nation carried on, inured to the toll the pandemic had taken and the deaths yet to come. People were largely unwilling to return to socially and economically disruptive public health measures.
No matter the era, aspects of daily life go on even during a pandemic. Chicago History Museum/Archive Photos via Getty Images
It’s hard to hang in there
Our predecessors might be forgiven for not staying the course longer. First, the nation was eager to celebrate the recent end of World War I, an event that perhaps loomed larger in the lives of Americans than even the pandemic.
Second, death from disease was a much larger part of life in the early 20th century, and scourges such as diphtheria, measles, tuberculosis, typhoid, whooping cough, scarlet fever and pneumonia each routinely killed tens of thousands of Americans every year. Moreover, neither the cause nor the epidemiology of influenza was well understood, and many experts remained unconvinced that social distancing measures had any measurable impact.
Finally, there were no effective flu vaccines to rescue the world from the ravages of the disease. In fact, the influenza virus would not be discovered for another 15 years, and a safe and effective vaccine was not available for the general population until 1945. Given the limited information they had and the tools at their disposal, Americans perhaps endured the public health restrictions for as long as they reasonably could.
A century later, and a year into the COVID-19 pandemic, it is understandable that people now are all too eager to return to their old lives. The end of this pandemic inevitably will come, as it has with every previous one humankind has experienced.
If we have anything to learn from the history of the 1918 influenza pandemic, as well as our experience thus far with COVID-19, however, it is that a premature return to pre-pandemic life risks more cases and more deaths.
And today’s Americans have significant advantages over those of a century ago. We have a much better understanding of virology and epidemiology. We know that social distancing and masking work to help save lives. Most critically, we have multiple safe and effective vaccines that are being deployed, with the pace of vaccinations increasingly weekly.
Sticking with all these coronavirus-fighting factors or easing off on them could mean the difference between a new disease surge and a quicker end to the pandemic. COVID-19 is much more transmissible than influenza, and several troubling SARS-CoV-2 variants are already spreading around the globe. The deadly third wave of influenza in 1919 shows what can happen when people prematurely relax their guard.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Evidence Service to support the COVID-19 response
The age affected structure doesn’t fit with pandemic theory
Carl Heneghan, Tom Jefferson
“It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.”
― Sir Arthur Conan Doyle, Sherlock Holmes
Pandemic, as the definition goes, is the worldwide spread of a new disease. Most of the historical analysis point to those in younger age groups being disproportionately affected in a pandemic. As opposed to seasonal outbreaks where older people are more likely to be affected.
In this current pandemic, the age structure of those most affected reveals a tension between whether COVID-19 is operating more like a seasonal viral effect or is similar in its effect to previous pandemics
The US Centre for Disease and Control Prevention (CDC) estimated that 150, 000 to 575,000 people died from (H1N1) pandemic virus infection in the first year of the outbreak.
80% of the virus-related deaths were estimated to occur in those 60 years. More than 50% of all deaths were people > 80 years or older.
The data support the theory that the current epidemic is a late seasonal effect in the Northern Hemisphere on the back of a mild ILI season. The age structure of those most affected does not fit the evidence from previous pandemics.
The outbreak does, however, fit with the WHO’s definition of a Pandemic. This definition does not help explain the age structure of those most affected, and how this differs from that of seasonal outbreaks. The definition of a pandemic remains elusive.
Learn about Canada’s planning for pandemic flu, including detecting and monitoring, vaccines, and antiviral drugs.
On this page:
- Detecting and monitoring
- Antiviral drugs
The systems and processes that Canada has in place during yearly seasonal flu epidemics give us a strong foundation for responding to a flu pandemic. There are also many flu experts across Canada who can be called on to give governments and organizations advice during a flu pandemic.
The federal, provincial and territorial governments have pandemic plans in place, as well as many local municipalities, Indigenous communities, health care facilities, and businesses. These plans have been adjusted based on Canada’s experience during the last flu pandemic in 2009.
Detecting and monitoring
Each year, we monitor influenza activity using the surveillance system called FluWatch. All across Canada, we collect information from health care professionals and laboratories, including the National Microbiology Laboratory, on the type of influenza infecting people in Canada.
This will help us to quickly detect if there is unusual activity or a new strain circulating in Canada.
Canada also works along with other countries to watch for and share information about flu viruses world-wide. For information about new flu viruses that are currently being monitored, see Emerging Respiratory Pathogens.
Vaccination is the most effective way to prevent illness and death from pandemic flu. Canada has a contract with a domestic manufacturer to produce enough pandemic flu vaccine for everyone living in Canada if needed. Canada also arranges for another source of pandemic flu vaccine in case it is needed.
A pandemic flu vaccine can only be produced once the pandemic flu virus emerges. The seasonal flu vaccine, which protects people against yearly seasonal flu epidemics, is not expected to protect against pandemic flu.
During a flu pandemic, each province and territory will have a plan for distributing the vaccine to people living in their jurisdiction.
Antiviral drugs can be given to people when they are sick with the flu to:
- shorten the length of illness
- reduce flu complications
It is important that antivirals be started as soon as possible once a person gets sick with pandemic flu. Each province and territory holds a stockpile of antiviral drugs which they will distribute in a flu pandemic. A stockpile is a good way to make sure that antiviral drugs are available quickly for people who may need them at the time of a pandemic.
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Just over 100 years ago, a new strain of influenza infected a third of the world’s population — but within just three years, the threat of this deadly flu had all but passed.
This was a time before modern medical care and even before humans understood what viruses were. So what’s changed since then?
It’s a question plenty of you have asked in recent months: how do pandemics end? And how will the one we’re currently living through end?
Three ingredients for a pandemic
An infectious agent needs three conditions to cause a pandemic, says virologist Kirsty Short from the University of Queensland:
- 1. It needs to cause disease in humans
- 2. It needs to be highly transmissible
- 3. We need to have no pre-existing immunity to it
“For example, we live with MERS today,” says Dr Short, referring to Middle Eastern respiratory syndrome, a coronavirus that is related to the one that causes COVID-19.
“It hasn’t caused a pandemic yet because it’s not highly transmissible from person to person.
“In contrast, the seasonal coronaviruses that we get, probably at one point were a pandemic, and they’ve just become these seasonal colds that we don’t really care about because we’ve evolved immunity to them.”
Stay up-to-date on the coronavirus outbreak
In terms of the three ingredients that make a pandemic, when it comes to COVID-19 there’s not much we can do to stop the coronavirus from infecting us, because that’s based on the biology of the virus and us as humans.
With physical distancing and masks, we are somewhat able to pull that second lever of not allowing the virus to transmit as much.
But the big thing that stops a virus becoming a pandemic — that is, a large-scale outbreak affecting multiple countries or continents — is the third factor: immunity.
“Herd immunity can be achieved through natural infection or vaccination,” Dr Short says.
Swine flu: From pandemic to seasonal flu
When swine flu struck in April 2009, it was different enough from previous influenza virus strains to spread at a pandemic rate.
Around 10 per cent of the world’s population caught the virus. Then, about six months into the pandemic, a vaccine was available.
By the following year, the swine flu had become a seasonal flu virus — still circulating, but not at pandemic levels.
“You had a sufficient amount of the population that either had immunity to it, because they’d had the vaccine or had immunity to it because they had had the virus,” Dr Short says.
“That then meant that if they got infected, they were less likely to transmit, it was less likely to be severe.
“The virus didn’t go away. But the next year, in 2010, the virus was still there, but there was enough pre-existing immunity to its 2009 ancestor that it wasn’t a pandemic.”
A pandemic without a vaccine
But what about the 1918 flu pandemic? It’s the big historical pandemic many have compared COVID-19 to, so how did it end in the absence of a vaccine?
The same ingredient changed, Dr Short says: herd immunity. But without a vaccine it took longer to do so than with the 2009 swine flu pandemic.
“In 1918, there was no vaccine. The virus just went around unchecked. And the pandemic continued in some places until 1921,” she says.
“What happened then is that there was enough herd immunity or pre-existing immunity that it actually became the seasonal flu strain.
“That 1918 virus remained the seasonal flu strain until 1958, when it was replaced by an H2N2 strain, the Asian flu pandemic.”
But achieving herd immunity in the absence of a vaccine came at enormous cost: tens of millions of people died worldwide.
Coronavirus questions answered
Breaking down the latest news and research to understand how the world is living through an epidemic, this is the ABC’s Coronacast podcast.
For the past century, the 1918 flu pandemic was considered a worst-case scenario because it was both highly infectious and clinically severe, says medical historian Peter Hobbins from Artefact Heritage Services.
“Our pandemic planning for the last century has very much relied on that scenario. [and] a lot of that pandemic planning has come into play this year,” says Dr Hobbins, who also holds an honorary position at University of Sydney’s department of history.
“It’s been interesting to see that because of the very nature of COVID, we’ve ultimately had to rely on measures that were very similar to those used in 1919.
“Despite all the advances in our health care system, ambulances, intensive care units, antiviral drugs, supportive care, epidemiology, global surveillance systems, all of those developments we’ve seen in the last hundred years, ultimately we’ve still had to fall back on the sorts of measures that we saw were effective in 1918 and 19, including good nursing care for victims, quarantine, social isolation and basic measures like masks and sanitation.
“Sometimes what we know from the past still turns out to be the most effective response that we have.”
How and when will this pandemic end?
The promise of a vaccine for COVID-19 is inching closer to reality, with some candidate vaccines already approaching the last big hurdle in the clinical trial process. There’s also multiple treatments for the disease being trialled and refined.
But it’s not like a switch will flip and the pandemic will end the moment a vaccine is available, Dr Short says.
“There’s not going to come a day where we say, ‘OK, on [this date], this will no longer be a problem’. It’s going to be a continuum,” Dr Short says.
“What we should eventually see is that once we get vaccines out, the number of cases will go down. On top of that, therapies will improve and the mortality rate will go down.
“It’ll end with a fizzle instead of a bang.”
And even with the best therapies and vaccines in the world, this virus is almost certainly going to be with us forever, even after the pandemic phase has passed.
“To eliminate a virus from the human population is incredibly difficult. We’ve only ever done it with one human pathogen, and that’s smallpox,” Dr Short says.
“To do that, you need a global vaccination strategy. On top of that, you need a vaccine that provides essentially 100 per cent protection against the virus and against any mutations the virus might throw up. And no animal reservoir. That’s a pretty tall order.”
While the pandemic has been hugely disruptive, Dr Short says it’s also been a reminder that, despite our technological and medical advancements, we’re still vulnerable to disease and need to be on our guard.
“If I could go back in time and just cancel the pandemic, I’m not sure I would,” she says.
“I would cancel the deaths. But I think this was really important for the world to go through, because I think it’s taught us a really valuable lesson that we are not invincible.
“If we can remember what we’ve learnt during this process, as a species, we’re going to be better prepared for the future.”
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An influenza pandemic occurs when a novel and highly contagious strain of the influenza virus emerges, affecting populations around the world. Many experts consider influenza pandemics to be inevitable, yet no one knows when the next one will occur. The most recent influenza pandemic in the United States was the 2009 H1N1 pandemic. Before that, there were a total of three influenza pandemics in the 20 th century (1918, 1957, and 1968).
Florida’s geographic and demographic characteristics make it particularly vulnerable to importation and spread of infectious diseases, including influenza. Nearly one third of Florida’s population resides in urban/suburban areas of 3 southeastern counties, including large populations of immigrants. Florida’s two Interstate road systems bring in thousands of tourists each year.
The Department of Health has estimated that an influenza pandemic could result in Florida of up to 10 million persons infected, with 5 million chronically ill. An estimated 3 million persons may require outpatient care with an additional 71,000 hospitalizations and up to 18,000 deaths. Demands on health care services under these conditions would overwhelm the state’s delivery system. Shifts in human and material resources that are normally executed during other natural disasters will not be possible since outbreaks are expected to occur simultaneously throughout much of the U.S.
It is expected that effective preventive and therapeutic measures – including vaccines and antiviral agents – will be in short supply, as may some antibiotics used for treatment of secondary infections. Existing medical facilities may be quickly overwhelmed, requiring the use of non-traditional medical settings. Healthcare workers and other first responders will likely be at even higher risk of exposure and illness than the general population, further impeding the care of victims. In addition, communications systems are likely to be overwhelmed.
An influenza pandemic preparedness plan has been developed to ensure that Florida is prepared to implement an effective response before the next pandemic arrives. Florida has been participating with a number of other states in an initiative to develop state influenza pandemic plans, following guidance from the Centers for Disease Control and Prevention, with funding from the Council for State and Territorial Epidemiologists. The purpose of this plan is to provide a guide for the Florida Department of Health (DOH) and other state and local agencies on detecting and responding to an influenza pandemic. The plan describes disease surveillance, emergency management, vaccine delivery, laboratory and communications activities, as well as how multiple agencies should work together to respond to such an event.
Related Links for Pandemic Flu Planning
NEW YORK (AP) — February is usually the peak of flu season, with doctors’ offices and hospitals packed with suffering patients. But not this year.
Flu has virtually disappeared from the U.S., with reports coming in at far lower levels than anything seen in decades.
Experts say that measures put in place to fend off the coronavirus — mask wearing, social distancing and virtual schooling — were a big factor in preventing a “twindemic” of flu and COVID-19. A push to get more people vaccinated against flu probably helped, too, as did fewer people traveling, they say.
Another possible explanation: The coronavirus has essentially muscled aside flu and other bugs that are more common in the fall and winter. Scientists don’t fully understand the mechanism behind that, but it would be consistent with patterns seen when certain flu strains predominate over others, said Dr. Arnold Monto, a flu expert at the University of Michigan.
Nationally, “this is the lowest flu season we’ve had on record,” according to a surveillance system that is about 25 years old, said Lynnette Brammer of the U.S. Centers for Disease Control and Prevention.
Hospitals say the usual steady stream of flu-stricken patients never materialized.
At Maine Medical Center in Portland, the state’s largest hospital, “I have seen zero documented flu cases this winter,” said Dr. Nate Mick, the head of the emergency department.
Ditto in Oregon’s capital city, where the outpatient respiratory clinics affiliated with Salem Hospital have not seen any confirmed flu cases.
“It’s beautiful,” said the health system’s Dr. Michelle Rasmussen.
The numbers are astonishing considering flu has long been the nation’s biggest infectious disease threat. In recent years, it has been blamed for 600,000 to 800,000 annual hospitalizations and 50,000 to 60,000 deaths.
Across the globe, flu activity has been at very low levels in China, Europe and elsewhere in the Northern Hemisphere. And that follows reports of little flu in South Africa, Australia and other countries during the Southern Hemisphere’s winter months of May through August.
The story of course has been different with coronavirus, which has killed more than 500,000 people in the United States. COVID-19 cases and deaths reached new heights in December and January, before beginning a recent decline.
Flu-related hospitalizations, however, are a small fraction of where they would stand during even a very mild season, said Brammer, who oversees the CDC’s tracking of the virus.
Flu death data for the whole U.S. population is hard to compile quickly, but CDC officials keep a running count of deaths of children. One pediatric flu death has been reported so far this season, compared with 92 reported at the same point in last year’s flu season.
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- – China approves two more COVID-19 vaccines for wider use
“Many parents will tell you that this year their kids have been as healthy as they’ve ever been, because they’re not swimming in the germ pool at school or day care the same way they were in prior years,” Mick said.
Some doctors say they have even stopped sending specimens for testing, because they don’t think flu is present. Nevertheless, many labs are using a CDC-developed “multiplex test” that checks specimens for both the coronavirus and flu, Brammer said.
More than 190 million flu vaccine doses were distributed this season, but the number of infections is so low that it’s difficult for CDC to do its annual calculation of how well the vaccine is working, Brammer said. There’s simply not enough data, she said.
That also is challenging the planning of next season’s flu vaccine. Such work usually starts with checking which flu strains are circulating around the world and predicting which of them will likely predominate in the year ahead.
“But there’s not a lot of (flu) viruses to look at,” Brammer said.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Kristina Duda, BSN, RN, CPN, has been working in healthcare since 2002. She specializes in pediatrics and disease and infection prevention.
Anju Goel, MD, MPH, is a board-certified physician who specializes in public health, communicable disease, diabetes, and health policy.
You may read about or hear in the news that there is a flu epidemic occurring, but do you know what that means? How do public health officials determine that flu levels are high enough to declare an epidemic? And how does it differ from a pandemic?
What is a Flu Epidemic?
Although the word “epidemic” sounds scary, it isn’t uncommon for the flu to reach epidemic levels. In fact, seasonal flu epidemics happen almost every year.
An epidemic is a rise in the number of cases of disease beyond what is normally expected in a specific geographic area. The increase in cases is sudden, the disease stays contained to a specific geographic area—like a city or region—and doesn’t spread across countries and continents. It may not even spread across an entire state.
Each week, the Centers for Disease Control and Prevention (CDC) compares the percentage of flu-related deaths to an epidemic threshold value. If this number exceeds the threshold, the CDC declares the flu to be at epidemic levels. When the percentage of flu deaths drops below the threshold, the epidemic is over.
What is a Flu Pandemic?
Flu pandemics happen when a new strain of the flu A virus appears. A new viral strain quickly spreads because most people aren’t immune and a vaccine that offers immediate protection isn’t widely available. As a result, it spreads across several countries around the world, causing widespread illness.
The World Health Organization (WHO) says the following conditions can lead to a flu pandemic:
- The virus is able to infect humans
- The virus is able to spread easily from human to human
- The virus must cause serious illness or death in humans
While flu pandemics are rare, they do occur periodically. There have been four flu pandemics since the beginning of the 20th century, the most severe being the Spanish flu of 1918:
- 1918 Spanish flu pandemic: Killed approximately 675,000 in the U.S.
- 1957-1958 Asian flu pandemic: Caused an estimated 116,000 U.S. deaths
- 1968 Hong Kong flu pandemic: Linked to around 100,000 deaths in the U.S.
- 2009 H1N1 flu pandemic: Responsible for an estimated 12,469 U.S. deaths
Just like with an epidemic, a flu pandemic is over when the number of cases is no longer above a defined threshold. However, the virus can continue to circulate in humans even after the pandemic is over. Take the 2009 H1N1 flu pandemic: Even though WHO declared an end to this pandemic in 2010, H1N1 continues to circulate as a seasonal flu virus, causing illness and hospitalization worldwide every year.
A new flu strain can cause a pandemic, with high rates of infection worldwide because no vaccine is available and people have not been exposed or developed immunity to it, and. An existing flu strain may cause an epidemic if it spreads among more people than usual in a specific geographic region, but it is not expected to spread worldwide in higher numbers than usual because most people are already immune, and a vaccine is available.
Differences Between a Flu Epidemic and a Flu Pandemic
A seasonal flu epidemic is usually caused by an existing flu strain that increases in a certain geographic area. A pandemic flu virus is a new flu strain that hasn’t circulated for a long time, if ever. Because of this, humans have little to no immunity against the virus and it spreads quickly and globally, causing widespread sickness and deaths.
Happens every year, usually in winter
Caused by flu viruses that are similar to those already affecting people
Specific to one city, region, or country
Vaccine available at the beginning of flu season
Causes an average of between 12,000 and 52,000 deaths each year in the U.S.
Infants and elderly most at-risk for serious complications
Rarely happens (only four times since 1918)
Caused by a new flu virus that people have not been exposed to before
Vaccine not available in the early stages of a pandemic
Number of deaths can be significantly higher. The Spanish flu of 1918 caused approximately 675,000 deaths in the U.S.
Healthy people at-risk for serious complications
A Word From Verywell
Flu vaccines are the best way to protect people during flu epidemics and pandemics. Seasonal flu vaccines are available every year before the flu season. These vaccines only protect against epidemic-causing flu viruses. Vaccines against pandemic flu strains typically aren’t available in the early stages of a pandemic.
Regardless of the epidemic status, the flu is a serious illness that everyone should take steps to avoid. By properly washing your hands, covering your nose and mouth when coughing or sneezing, and disinfecting hard surfaces, you can keep yourself and your family healthy throughout the flu season.
Hemagglutinin (HA) is a protein on the surface of the influenza virus that attaches to receptors on host cells. A new study shows how antibodies that target conserved, stable portions of HA, shown in the colored portions here, were highly effective at fighting the virus. (Credit: Guthmiller, et al)
A new study from the University of Chicago and Scripps Research Institute shows that during the last great pandemic — 2009’s H1N1 influenza pandemic — people developed strong, effective immune responses to stable, conserved parts of the virus. This suggests a strategy for developing universal flu vaccines that are designed to generate those same responses, instead of targeting parts of the virus that tend to evolve rapidly and require a new vaccine every year.
Influenza is an elusive and frustrating target for vaccines. There are two main types of flu virus that can infect humans, which evolve rapidly from season to season. When developing seasonal flu vaccines, health officials try to anticipate the predominant variation of the virus that will circulate that year. These predictions are often slightly off. Sometimes new, unexpected variants emerge, which means the vaccine may not be very effective. To avoid this, the ultimate goal of many flu researchers is to develop a universal vaccine that can account for any virus strain or variation in a given year, or even longer.
The new study, published June 2 in Science Translational Medicine, was led by UChicago immunologists Jenna Guthmiller, PhD, and Patrick Wilson, PhD, along with structural biologists Julianna Han, PhD, and Andrew Ward, PhD, from Scripps Research Institute. They studied the immune responses of people who were first exposed to the 2009 H1N1 pandemic flu virus, either from infection or a vaccine.
The researchers saw that the immune systems of these people recalled memory B cells from their childhood that produced broadly neutralizing antibodies against highly conserved parts on the head of a protein called hemagglutinin (HA) — a virus surface protein that attaches to receptors on host cells. These antibody responses were very effective at combatting the virus, and because they targeted conserved parts of the HA protein — meaning they don’t change very often — they could provide an enticing target for a vaccine to generate those same robust immune responses.
That’s the exciting thing about this study. Not only have we found these broadly neutralizing antibodies, but now we know of a way to actually induce them.
In a separate 2020 study, Guthmiller and colleagues found so-called polyreactive antibodies that can bind to several conserved sites on the flu virus. Now, the new study reveals more details about the conditions that can recall the same strong immune responses as this first exposure.
“That’s the exciting thing about this study,” Guthmilller said. “Not only have we found these broadly neutralizing antibodies, but now we know of a way to actually induce them.”
The only problem is that on subsequent encounters with the virus or a vaccine, the body doesn’t generate those same super-effective antibodies. Instead, for reasons that are unclear, the immune system tends to target newer variations on the virus. That may be effective at the time, but isn’t very helpful down the road when another, slightly different version of influenza comes along.
“When people encounter that virus a second or third time, their antibody response is pretty much completely dominated by antibodies against those more variable parts of the virus,” Guthmiller said. “So that’s the uphill battle that we continue to face with this.”
The trick to getting around this is to design a vaccine that recreates that initial encounter with H1N1, using a version of the HA protein that keeps the conserved, powerful antibody-inducing components, and replaces the variable parts with other molecules that won’t distract the immune system.
“Structural studies were essential to delineate the conserved areas on the HA protein,” said Han, who was co-first author of the new study and received her doctorate from the Committee on Microbiology at UChicago. “Now these data can be used to fine-tune vaccine targets.”
In roughly the past century, two of the four flu pandemics have been caused by H1N1 influenza, including the 1918 Spanish flu pandemic that killed as many as 100 million people. Yet the findings of this study are reassuring in the fight against possible future pandemics caused by other H1 viruses.
Just knowing that we actually have the immune toolkit ready to protect ourselves is encouraging. Now it’s just a matter of getting the right vaccine to do that.
“The odds of there being another pandemic within our lifetime caused by an H1 virus is quite high,” Guthmiller said. “Just knowing that we actually have the immune toolkit ready to protect ourselves is encouraging. Now it’s just a matter of getting the right vaccine to do that.”
Britain’s highly rated disease preparation failed on coronavirus – possibly because ministers followed a plan for flu
Did the UK government prepare for the wrong kind of pandemic? Composite: Guardian Design Team/Getty Images/Alamy/Reuters
Did the UK government prepare for the wrong kind of pandemic? Composite: Guardian Design Team/Getty Images/Alamy/Reuters
First published on Thu 21 May 2020 09.51 BST
When the coronavirus struck, the British government repeatedly said it was among the best-prepared countries in the world – with some justification. As recently as October, an international review of pandemic planning ranked the UK the second best prepared country in the world (behind the US).
Two months on, any breezy confidence has evaporated. The government is facing growing complaints over a series of policy missteps that critics say are responsible for the worst death toll in Europe.
How did a country that supposedly had one of the best pandemic plans in the world end up suffering one of the worst outbreaks?
A review of official documents and interviews with politicians, national security advisers and experts in risk management suggests one answer may be that ministers stuck closely to the recommendations of a well-honed plan for a different disease: the flu.
The origin of the UK’s strategy for a catastrophic influenza pandemic was a tractor blockade at a Cheshire oil refinery in September 2000. Several dozen farmers, angry about the cost of fuel, blockaded the Stanlow oil refinery and refused to leave until the Labour government agreed to a reduction in duty.
The 2000 refinery blockade led civil servants to fear that civil emergencies could bring down a country. Photograph: Ian Hodgson/Reuters
The blockade began on a Friday. By Wednesday, the UK was on the brink of collapse. Copycat groups obstructed other fuel depots. Enormous tailbacks of panic-buying motorists stretched out of petrol stations and down motorways. Fire engines and ambulances were days away from running dry, and NHS trusts faced cancelling elective surgeries. One supermarket started rationing.
The protests ended and ministers later agreed to freeze fuel duty. But according to politicians and civil servants in government at that time, the shock of the fuel crisis sparked a realisation at the highest levels of Whitehall that civil emergencies could bring down a country.
“For a few days, a few hundred protesting people outside fuel depots brought the country to a halt,” said Sir Peter Ricketts, a diplomat and later David Cameron’s national security adviser. “The shock of suddenly finding the country stopped because of a few fuel depots being blockaded was a real wake-up call.”
Within just the following year, the UK suffered more fuel protests, floods, foot-and-mouth disease, and the aftermath of September 11. Tony Blair’s government decided a completely new approach to civil emergencies was required, and established a revised and expanded civil contingencies secretariat in the Cabinet Office, backed by new legislation.
The ambition was “to create something which was better suited to the way in which the UK is run”, said Bruce Mann, the director of the unit from 2004 to 2010. Civil contingency planning would cascade downwards through tiers of government, he said, all the way from Whitehall to networks of local emergency response groups.
Mann’s unit dealt with a “relentless” series of civil emergencies during his six years in charge, including periodic outbreaks of infectious disease, endless fuel supply crises including the explosion at the Buncefield fuel refinery, bird flu scares, and the aftermath of terrorist atrocities both domestic and overseas, including the 7 July 2005 bombings.
But the team also had a second responsibility: predicting entirely new risks and anticipating how the government might respond. Within its first year the unit drew up the national risk register, a comprehensive catalogue of all the civil emergencies that could conceivably strike the UK, which continues to be updated annually. At the top of the list – then and now – was an influenza pandemic.