How to Respond: Influenza Pandemic Preparedness
Influenza pandemics - global outbreaks of a novel influenza virus - have been unknown to mankind until 1918. Since then, five influenza pandemics have occurred, including the newest one, the COVID-19 pandemic. As these outbreaks become more frequent, it is essential for us to know how to respond effectively and efficiently. Quick response to a novel influenza virus, including COVID-19, is essential to slowing spread. Looking back at the 2009 H1N1 pandemic, we can see something incredible - the detection and response was almost immediate. A few days prior to April 15th, a 10-year-old boy in California was taken to an outpatient clinic with a suspected respiratory illness. He was treated and tested to determine the virus causing his illness. His test came back negative for the known human influenza strains (H1N1, H3N2, and H5N1) so per protocol, the San Diego County Health Department was notified and his un-subtypable sample was sent to the CDC for further Analysis. It was at the CDC on April 15th, that it was discovered that he was infected with a H1N1 swine influenza, later called 2009 H1N1.
Within a week of this, the CDC notified the World Health Organization of the potential threat and began to work on a candidate vaccine virus. Two days later the gene sequence was available, four days after that, detection test kits were available, and again, a few days later, those kits were shipped around the US and world.
The swift action taken to contain and prevent the spread of this virus lead to the prevention of many deaths, and extreme overburdening of healthcare systems.
Looking at the timeline of the Covid-19 Pandemic, things moved much slower. It wasn’t until December 27th that a doctor from Hubei Provincial Hospital of Integrated Chinese and Western Medicine told China’s health authorities that the disease was caused by a new coronavirus. By then, more than 180 people had already been infected. In 2019, Chinese authorities identified at least 266 infected people who had been under medical surveillance. But it was not until December 31st of that year that the World Health Organization was notified of the epidemic.
In order to know how to respond to a pandemic, it is important to evaluate the effectiveness of past events, and see what went right and wrong. That said, here are some aspects of the 2009 H1N1 pandemic response that lead to such amazing control of the outbreak from its early stages.
3 Takeaways from the H1N1 Pandemic Response
1. We were actively preparing for an influenza pandemic.
In 2005, the Department of Health and Human Services published the Pandemic Influenza Plan that provided a blueprint for national influenza pandemic preparedness. It included instructions on surveillance, laboratory diagnostics, healthcare planning, vaccine distribution, and more. Additionally, they called for increased preparedness and funding for pandemic response within state and local health departments.
By 2008, 89% of health departments who responded to a NACCHO health profile survey had developed and updated pandemic influenza preparedness plans and 86% participated in drills.
Later that year, the CDC spent $24 million to fund projects in state and local public health departments that could improve influenza pandemic preparedness.
2. Surveillance was occurring regularly.
Because of all of the preparation noted above, protocol was already in place to quickly identify a novel virus. Samples from Influenza cases were regularly subtyped, so non-normal subtypes were rapidly identified within the population. The protocol to immediately send such samples from state health departments to the CDC helped raise awareness of any potential public health concerns.
3. The WHO was quickly notified.
The WHO was notified 3 days after the novel 2009 H1N1 virus was identified. This helped prepare the global community for potential infections and outbreaks, as well as increase visibility of any potential issues.
The rapid identification of and response to the novel H1N1 virus were crucial to its containment and control. With consistent surveillance, verified protocols, and quick notification, the effects of emerging viruses and potential pandemics can be reduced. Let us continue to learn from our past and prepare for a better future!
While it is easy to point fingers during times of trouble, we must remember that that is not constructive. In a pandemic we are all responsible for the outcome and must all deal with the effects. So let’s work together to improve pandemic preparation for all nations and put the greater good over notions of liability.
Sources:
National Pandemic Influenza Plans | Pandemic Influenza (Flu)
Press Release - CDC Awards $24 Million for Pandemic Influenza Preparedness Projects
Swine Influenza A (H1N1) Infection in Two Children --- Southern California, March--April 2009
2009 H1N1 Pandemic Timeline | Pandemic Influenza (Flu)
China’s first confirmed Covid-19 case traced back to November 17
1st known case of coronavirus traced back to November in China
Moderna Reports First Quarter 2020 Financial Results and Provides Business Updates
Pandemic Basics | Pandemic Influenza (Flu)
2009 H1N1 Pandemic (H1N1pdm09 virus) | Pandemic Influenza (Flu)