The Statement of Health Secretary Francisco T. Duque III on WHO Declaration of Pandemic Alert Level 6
On June 11, 2009, Director-General Margaret Chan of the World Health Organization declared that the "world is now at the start of the 2009 Influenza Pandemic" after raising the Pandemic Alert Level for the novel Influenza A virus from Level 5 to Level 6.
This means that the new A(H1N1) virus has now spread and caused sustained community level outbreaks in at least one or two countries in two WHO Regions. It has initially affected US and Mexico (North America) which are the epicenters of this pandemic and has shown a fast and steadily increasing number of cases particularly in the United Kingdom (Europe), Chile and Argentina (Latin America) as well as Australia, Japan and China (Western Pacific Region) which show that the virus is contagious and easily transmissible from person to person.
To date, there are nearly 30,000 confirmed cases of A (H1N1) from 74 countries and this is expected to increase further in the coming days and months. This is because of the nature of the virus to be an efficient spreader of disease and also because of unrestricted travel within and across national borders.
Thus, WHO has already alerted all of its member states that further spread is inevitable and governments will do well by preparing their health systems to treat and manage an increasing number of patients.
It needs to be emphasized however that the current grading of a pandemic by WHO focuses on the geographic spread of the virus and not on its virulence or its capability to cause deaths or severe disease.
Thus far, WHO says that "the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment." This is the same picture that we are seeing in all of the nearly 100 cases we have documented in the Philippines, all of which were mild with some infections resolving even without antiviral treatment.
The novel influenza A virus has caused 144 deaths out of the total reported 28,774 cases globally. This translates to a case fatality rate of 0.5%. In the country, it is fortunate that we have not had any deaths nor any severe manifestation of A (H1N1) though our cases are increasing because we expect this with aggressive surveillance, good reporting and intensive contact tracing.
To put it in perspective, the number of deaths due to A (H1N1) is few compared with deaths from other diseases with pandemic potential such as SARS and avian flu which kill about half of their victims. In the country, more people die from dengue with a case fatality rate of anywhere between 1-2%.
WHO has thus assessed the current pandemic as having "moderate severity" because 1) most patients recover and survive without hospitalization or medical care, 2) Levels of severe illness from A (H1N1) appear similar to levels seen during local seasonal influenza periods, and 3) most countries' health systems have been able to cope with the number of people seeking and requiring care.
As the Pandemic Alert Level has been raised to the highest alert level globally and as we foresee more cases to appear in the coming weeks, the Department of Health will soon be shifting toward a strategy of mitigation, particularly in localities where there are indications of community level transmission. To date, we stress that we still do not have community level transmission in the Philippines.
With mitigation, the government will be recommending to localities and areas concerned to now focus on taking care of the sick, providing guidance for people to protect themselves and their families, and monitoring the outbreak. I have already called for a Task Force Meeting which will be held tomorrow to ensure that there will be a smooth transition to this new policy.
The DOH is also heeding the general recommendations the WHO with regard to the announcement of Pandemic Alert Level 6: 1) No border closure as it will not be possible to stop it at said points of entry; 2) No restriction of travel as people who are infected may not show symptoms so they cannot be identified from others who are not infected; 3) Greater emphasis on providing care with a decreased emphasis on stopping the spread of the virus.
As WHO has repeatedly emphasized, the goal in any pandemic is to save as many lives, reduce deaths and severe illness and minimize the impact of the pandemic on society.
Although majority of cases due to a (H1N1) have so far been mild, this picture might change from country to country depending on so many factors that is not limited to the innate nature of the virus. Our ability to overcome the challenge posed by A (H1N1) or any pandemic threat will depend largely on the efficiency and effectiveness of our systems to respond.
Thus I call on all relevant agencies and all local governments to closely monitor the situation and to coordinate very closely with the Department of Health to be vigilant about unusual and increasing cases of flu-like illnesses throughout the country. Report them immediately to the Department of Health. Also, ensure the readiness of your hospitals and your health workers to manage the minority of cases which will experience complications and thus require hospitalization or higher level of care.
For the public, again I emphasize early and appropriate health seeking behavior. For those with only mild symptoms, supportive care at home consisting of fluids, bed rest, vitamins and antipyretics should be enough for most cases. If you have progressive symptoms and preexisting conditions (i.e diabetes, asthma, COPD, heart disease, pregnant, immunocompromised, HIV, TB, malnutrition, extremes of age), then immediately seek medical care.
The Department of Health will continue to closely monitor the situation and inform the media and the public of any development as they unfold. We are updating our strategies and continually improving our national pandemic preparedness and response plan on a weekly and sometimes, daily basis to adapt to changes in the local and global situation. We call on everyone's sobriety, cooperation and understanding as together our nation faces this unique and extraordinary challenge.