Data Collection
The International Health Regulations (IHR) 2005 - which have been adopted by most countries ? includes an undertaking to setup an internal monitoring system for notifiable infectious diseases. It also requires that the state provide the WHO with a single point of contact through which it can communicate information about occurrences within its boarders. This is an excellent advance ? over the previous more ad hoc systems - and should have been the basis for a coordinated pandemic data collection system.
Since H5N1 concentrated the minds of the world?s governments on the dangers of a pandemic almost all nations have developed some kind of pandemic plan. While the plans should be sufficiently broad to accommodate a wide range of scenarios based on different causative agents flu was always the most likely suspect and has a know propensity for waves with concentrated localised peaks which put enormous strain on healthcare systems. It should also have been fairly obvious that some kind of standardised real-time reporting system was going to be needed if we were going to be able to watch these waves and assess where resources should be concentrated and if there was any change in disease pattern. The system could also help in gauging the efficacy of treatment regimes.
Data collection has been a mess. While a lack of resources make it difficult for low income countries to collect this information poor coordination among the wealthy nations is less forgivable. There has been a reasonable amount of data collection but the numbers are of little value because they lack any standardisation and are, consequently, not comparable. Any logical system would have lead to a WHO mediated agreement on some lowest common denominator of comparable numbers with the option, for the likes of G8 countries, to opt in to submitting more detailed information. This should have included estimates for each of total ILI, pandemic infection, pandemic hospitalisation & pandemic deaths. In Europe we supposedly have a unified data collection source through the ECDC but if you look at its daily briefings they all have the same format with table1 showing four columns for ?Hospitalisation? and ?in ICU? plus their cumulative totals. Despite this having been produced on a daily basis for months there is no data in any of the boxes from Germany, Italy or Spain. Of the 31 countries listed only the Norwegians, Dutch, French and Irish have ticked every box. This is not esoteric data or tricky to estimate, if some one gets as far as being hospitalised or given an ICU bed one would expect a G8 country to be able to count them and report same to the body overseeing data collection.
In the US although a single ? albeit large ? country we have had different data collection by State, different reporting practices to the CDC and changes over time so earlier data is not directly comparable to later data. Needless to say neither of these systems produces comparable data nor can what has been learnt from the Southern Hemisphere be easily compared to the experiences in the north. If the virus were to undergo a change that affected either virulence or transmissibility then there is little chance of our realising it in time to do anything useful about it.
Communication
You can not effectively communicate the state of the pandemic to the public if you do not have the data on which to formulate what you are going to say. It is impossible to get this part right if you have not first planned for all I have discussed under ?Data Collection?. There are a few prerequisites, firstly some level of trust between those giving the message and the public. This can not be built instantly if it does not already exist and there are few countries (actually I can?t think of any) where the public trust their government to tell them the truth. It is best then to try and get the message from the scientists not the politicians ? and to prevent the later from scripting it. On the whole this has been done surprisingly well with the exception of going to Phase 6 - which was botched. Phase 6 should have been declared much earlier in line with the existing ? and widely understood ? definition of a pandemic. It was not hard to explain that this was a measure of spread not virulence and if the WHO was bowing to political pressure then it has been weakened by it ? more backbone please DG. Where problems have arisen they have related to not working hard enough to educate journalists ? and through them the public ? on the limitation of the data. Again we are back to those numbers. The papers are going to write sensational and ?human interest stories? - there is no way to stop this ? and in a pandemic this means deaths. Without easily absorbed data to explain how frequently, or infrequently, this occurs there is bound to be a false sense of severity. In a non pandemic flu season there are plenty of deaths but they only make it to the obituaries column.
Communication has not been as poor as Data Collection but both were foreseeable and could have been handled better. Maybe next time.
We have been very lucky ? so far ? in that the disease has not been particularly severe, in most cases, and was kind enough to appear at the end of the Northern Hemisphere flu season. Most of the world?s population live in the north and it could not have been kinder in its timing to give us the longest possible time to get our antiquated vaccine production system up to speed.
The question is what are we going to take away from this experience?
There is a danger one camp may draw the conclusion the last few years have seen far too much pandemic hype and when it came it really was not such a big deal. I hope the lesson drawn is just how lucky we were that it was not more virulent.
A sober analysis after it is all over will, I believe, show that the shift in age profile seen in this, and previous pandemics, and the occurrence of a small number of very severe cases is inevitable and a result of poor immune regulation in the face of a novel threat with some stealth capability. As the symptoms are quite specific so are the required medical interventions and we will count ourselves lucky that, in those countries with advanced health care systems, the surge capacity for ICU beds with mechanical ventilation were not severely exceeded. Off course most of the world was not so lucky and there will, I regret, be many deaths that have not so far been counted. Had the virulence been anything even remotely 1918 like ? let alone H5N1 like ? our advance medical technology would have been relatively unimportant as few would have actually received its benefits.
It is not over yet and these are only some first thought which I hope others will add to.
Edit:
Embedded a few links to posts in other threads in which I have covered some topics in greater detail.
The International Health Regulations (IHR) 2005 - which have been adopted by most countries ? includes an undertaking to setup an internal monitoring system for notifiable infectious diseases. It also requires that the state provide the WHO with a single point of contact through which it can communicate information about occurrences within its boarders. This is an excellent advance ? over the previous more ad hoc systems - and should have been the basis for a coordinated pandemic data collection system.
Since H5N1 concentrated the minds of the world?s governments on the dangers of a pandemic almost all nations have developed some kind of pandemic plan. While the plans should be sufficiently broad to accommodate a wide range of scenarios based on different causative agents flu was always the most likely suspect and has a know propensity for waves with concentrated localised peaks which put enormous strain on healthcare systems. It should also have been fairly obvious that some kind of standardised real-time reporting system was going to be needed if we were going to be able to watch these waves and assess where resources should be concentrated and if there was any change in disease pattern. The system could also help in gauging the efficacy of treatment regimes.
Data collection has been a mess. While a lack of resources make it difficult for low income countries to collect this information poor coordination among the wealthy nations is less forgivable. There has been a reasonable amount of data collection but the numbers are of little value because they lack any standardisation and are, consequently, not comparable. Any logical system would have lead to a WHO mediated agreement on some lowest common denominator of comparable numbers with the option, for the likes of G8 countries, to opt in to submitting more detailed information. This should have included estimates for each of total ILI, pandemic infection, pandemic hospitalisation & pandemic deaths. In Europe we supposedly have a unified data collection source through the ECDC but if you look at its daily briefings they all have the same format with table1 showing four columns for ?Hospitalisation? and ?in ICU? plus their cumulative totals. Despite this having been produced on a daily basis for months there is no data in any of the boxes from Germany, Italy or Spain. Of the 31 countries listed only the Norwegians, Dutch, French and Irish have ticked every box. This is not esoteric data or tricky to estimate, if some one gets as far as being hospitalised or given an ICU bed one would expect a G8 country to be able to count them and report same to the body overseeing data collection.
In the US although a single ? albeit large ? country we have had different data collection by State, different reporting practices to the CDC and changes over time so earlier data is not directly comparable to later data. Needless to say neither of these systems produces comparable data nor can what has been learnt from the Southern Hemisphere be easily compared to the experiences in the north. If the virus were to undergo a change that affected either virulence or transmissibility then there is little chance of our realising it in time to do anything useful about it.
Communication
You can not effectively communicate the state of the pandemic to the public if you do not have the data on which to formulate what you are going to say. It is impossible to get this part right if you have not first planned for all I have discussed under ?Data Collection?. There are a few prerequisites, firstly some level of trust between those giving the message and the public. This can not be built instantly if it does not already exist and there are few countries (actually I can?t think of any) where the public trust their government to tell them the truth. It is best then to try and get the message from the scientists not the politicians ? and to prevent the later from scripting it. On the whole this has been done surprisingly well with the exception of going to Phase 6 - which was botched. Phase 6 should have been declared much earlier in line with the existing ? and widely understood ? definition of a pandemic. It was not hard to explain that this was a measure of spread not virulence and if the WHO was bowing to political pressure then it has been weakened by it ? more backbone please DG. Where problems have arisen they have related to not working hard enough to educate journalists ? and through them the public ? on the limitation of the data. Again we are back to those numbers. The papers are going to write sensational and ?human interest stories? - there is no way to stop this ? and in a pandemic this means deaths. Without easily absorbed data to explain how frequently, or infrequently, this occurs there is bound to be a false sense of severity. In a non pandemic flu season there are plenty of deaths but they only make it to the obituaries column.
Communication has not been as poor as Data Collection but both were foreseeable and could have been handled better. Maybe next time.
We have been very lucky ? so far ? in that the disease has not been particularly severe, in most cases, and was kind enough to appear at the end of the Northern Hemisphere flu season. Most of the world?s population live in the north and it could not have been kinder in its timing to give us the longest possible time to get our antiquated vaccine production system up to speed.
The question is what are we going to take away from this experience?
There is a danger one camp may draw the conclusion the last few years have seen far too much pandemic hype and when it came it really was not such a big deal. I hope the lesson drawn is just how lucky we were that it was not more virulent.
A sober analysis after it is all over will, I believe, show that the shift in age profile seen in this, and previous pandemics, and the occurrence of a small number of very severe cases is inevitable and a result of poor immune regulation in the face of a novel threat with some stealth capability. As the symptoms are quite specific so are the required medical interventions and we will count ourselves lucky that, in those countries with advanced health care systems, the surge capacity for ICU beds with mechanical ventilation were not severely exceeded. Off course most of the world was not so lucky and there will, I regret, be many deaths that have not so far been counted. Had the virulence been anything even remotely 1918 like ? let alone H5N1 like ? our advance medical technology would have been relatively unimportant as few would have actually received its benefits.
It is not over yet and these are only some first thought which I hope others will add to.
Edit:
Embedded a few links to posts in other threads in which I have covered some topics in greater detail.
Last edited:
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