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Ten days that brought world to the brink of pandemic

Published on 04/05/2009

Geneva — The World Health Organisation was poised a step away from declaring a global flu pandemic on Sunday, following a ten day frenzy that began with the emergence of a dangerous new flu virus in Mexico.

While Mexico was still at the core of the swine flu epidemic, the WHO’s eye was also cast on other continents.

They hold one key to averting the first pandemic of the 21st century by containing cases found among returning travellers and stopping A(H1N1) influenza reaching their wider population.

The other is in the hands of health teams in Mexico that are trying to track down the exact source of the new A(H1N1) influenza and to unravel the mystery of its cocktail of swine, bird and human components.

The global alert currently stands at phase five — signalling that a pandemic is imminent — while phase six would mean a pandemic, or global spread detected on another continent, was underway.

"At this point we have to expect that phase six will be reached, we have to hope it is not reached," said Mike Ryan, World Health Organisation Director of Global Alert and Response.

Authorities in Europe, Asia and the Middle East have imposed quarantines to stop it spreading from ill holidaymakers and business people returning from Mexico.

"I think the next few days will tell," Ryan said late Saturday.

Mexico’s Health Minister Jose Angel Cordova admitted that the virus was "not so aggressive" as first feared and pointed to signs that it was stabilising as the capital stayed indoors on Saturday.

But the WHO was still urging caution this weekend even as the backlog of laboratory tests to confirm or deny Mexican cases was being unwound.

"History has told us that viruses are unpredictable," Ryan pointed out.

Despite that caution, the tension was palpably dropping with the gradual discovery that, for the moment, the impact of the virus on most of its victims was not much more severe than seasonal flu strains.

"Phase six describes geographic spread of the disease, not severity," Ryan underlined.

Swine flu, and its potentially destructive human and economic cost, first erupted on the world headlines thanks to an initially benign announcement by a WHO spokeswoman on April 24 during a regular UN media briefing.

Referring to "swine flu cases that have broken out in the United States and Mexico," WHO spokeswoman Fadela Chaib highlighted "unusual end of season influenza activity began to be noticed at the end of March, peaking in April."

That included "some 800 suspected cases with flu-like illness, with 57 deaths in the Mexico City area," she added, prompting questions about what swine flu was.

Hours earlier the WHO’s round-the-clock emergency operations room mobilised, officials said, and the Mexican health minister was shutting down schools in Mexico City and advising people to avoid the subway.

Within a day, WHO Director General Margaret Chan had rushed back from an official trip to Washington to seek guidance from an emergency panel of independent scientists.

She put the 193 member states on alert phase three for swine flu, saying that it had pandemic potential.

The UN health agency is still trying to piece together the chain of events amid accusations that there was a slow response.

After a series of isolated reports on pneumonia or respiratory illnesses, the WHO ultimately set its alert mechanism rolling after being tipped off about a new flu virus by the US Centers for Disease Control by April 23.

But reports indicate that first suspicions arose in Mexico with a peak of intense flu-like illnesses in mid-March, when the influenza season there is normally waning with the onset of hot weather.

With more cases appearing in the United States and Canada, as well as in Mexico, the WHO raised its alert level to four out of six, to mark human to human transmission. No country was out of reach, it warned.

With the benefit of those alerts, the first cases were detected in travellers from Mexico in Spain, in Britain and in Israel during the week.

Students at a school in New York were infected by classmates who had been to Mexico, and wider transmission became apparent in the United States as well as south of the border.

That prompted the WHO’s chief to raise the alert level to five on April 29, denoting that a pandemic is imminent.

Countries activated their pandemic preparedness plans, deploying stocks of millions of antiviral treatment courses and setting up containment measures.

Meanwhile scientists identified the seed virus, allowing them to determine that a vaccine against A(H1N1) could be produced relatively easily within months, according to a WHO specialist.

By late Saturday, 16 countries on three continents had officially reported 658 laboratory confirmed cases of swine flu infection, according to the WHO.

They included 397 confirmed cases from Mexico and 16 deaths there, as well as 159 cases in the United States and one death — a Mexican child who had been brought across the border for treatment.

Mexico later announced the number of deaths from the flu had risen to 19 and confirmed infections to 454.