WHO upgrades Alert level to 5 ... what next?

Current level of influenza pandemic alert raised from phase 4 to 5

29 April 2009

Following discussions and further assessment of all currently available information, Dr Margaret Chan, WHO's Director-General has raised the current level of influenza pandemic alert from phase 4 to 5.

She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

The full text of her statement is below, but what does this mean and what is likely to happen next?

In what was an expected move Dr Chan of the World Health Organisation in moving to a Level 5 Alert has signalled to all governments that the current Novel A(H1N1) is likely to become a pandemic. As the Continuity Forum had predicted the impact of air travel has contracted the usual timeline for the progression through the various WHO alert levels. By escalating the Alert Level Dr Chan is ensuring that the opportunity for early intervention is maximised that could prove to be significant in the long term implications for this new and novel virus and its impact.

The worlds media is now full of commentary on the outbreak and the Pandemic is being discussed on news screens and in the press extensively. There is some reasoned debate, but the attention being given is heightening fears for most people.

Since the outbreak was first reported on the international stage, just 6 days ago, the virus has spread with now 14 countries having suspected cases. At this time it appears that most of the cases were contracted in Mexico. As matters progress and the infection spreads more will be come clear, but at this time the biggest issue is the unknowns.

What are the unknowns?

The virus is suspected of an incubation period of 4-7 days, so at this time we do not know how far or how many people have been infected.

For those that have been infected we do not know just how infectious the illness is in its early stages.

People do not have immunity to this new virus, but the severity of its effects are not yet understood. The death rate in Mexico does not match the international experience and WHO are investigating the reasons for this. It may be that the outbreak was more established than first thought or that there were complications that increased the fatalities in Mexico.

Antiviral drugs such as Relenza and Tamiflu appear to be effective, at this time in the treatment of the illness, if given early enough. What is unknown is how long it'll take for a new vaccine to be developed. There is though good news here, the virus is of a strain that we have some experience of and this could well accelerate the development of a preventative vaccine.

It is unknown how the virus may mutate further as it expands around the globe, this may change the effects mitigating its effect, or potentially increasing it.

Governments are better prepared than ever before to cope with a Pandemic , stockpiled drugs including both Antibiotics and Antivirals are available and the strategic planning is well established. However, without the details needed above it is very difficult to predict what the effects will be in our communities and the experts and politicians need to manage the situation carefully to avoid causing undue concern whilst at the same time ensuring appropriate measures are taken to contain and treat the effects of the outbreak.

Even if the Alert level does increase to to 6, which is highly likely, its impact will depend entirely on the clinical factors outlined above. If the virus is relatively mild then whilst those infected will be poorly for a week or two the effect would be entirely manageable. However, if the virus is more severe or it undergoes further mutation then the situation could change dramatically.

In the modelling undertaken on pandemics generally infection rates, the severity of symptoms and the fatality rates all play a vital role in scaling the effect on our health and it is important to remember our economies.

Doubtless, should a full scale pandemic develop, most people will have serious concerns surrounding work and the normal activities of life. It is though vital to remember that for the overwhelming majority of people infected they will recover in a week or so and that many may not even contract the illness. Those that suffer more serious infection or develop complications will likely be a tiny percentage and whilst very concerning this perspective should be remembered.
What does need to be done though is the preparation to maintain business activity through this period. Organisations need to to consider immediately how they are going to manage the coming months as there is a real risk of staff shortages and changes in the patterns of customer behaviours.

Staff will have concerns over travel, infection in the workplace and perhaps how social care of infected family will be viewed. These issues need to be reviewed and decided on now, remember though we are in a fluid situation and these decisions need to be constantly updated as more becomes known.

Generally speaking, emphasis should be focused on maintaining core services or activities and this may mean training some staff to provide cover for others within the organisation, effectively expanding the pool of resources available to cope with the personnel strains a Pandemic may cause. Staff absence needs to be accommodated and remember that once the threat passes, you will still need the people, be sensitive and reasonable to the circumstances of the individuals involved.

Make your policies clear and take the opportunity to use or develop flexi or distance working models, if possible. Ensure that the security of your IT systems is up to the task and be very careful on any activity involving money transfer or confidential data being devolved to homeworkers without insuring their systems integrity. Ensure your infrastructure has the bandwidth to cope. Consider alternatives to home connections and look at creating separate working teams to minimise the potential for cross infections.

Look very closely at your business and try to assess how your sector is likely to be affected and build these considerations into your planning. Be proactive and creative, speak with your key customers and suppliers customers and understand what their situation and needs. By opening lines of communication with partners you are likely to find more solutions than problems, building better relationships, understanding and resilience that will give you a solid foundation that will be significant in dealing with issues as they arise.

Don't forget to involve others in your community, Local Authorities, the NHS and bodies like the Continuity Forum can all help you understand the situation as it develops and give guidance that should assist.

Specific areas of activity that we would recommend urgent action is taken on immediately are as follows:


Statement by WHO Director General, Dr Margaret Chan 

Ladies and gentlemen,

Based on assessment of all available information, and following several expert consultations, I have decided to raise the current level of influenza pandemic alert from phase 4 to phase 5.

On the positive side, the world is better prepared for an influenza pandemic than at any time in history.

Preparedness measures undertaken because of the threat from H5N1 avian influenza were an investment, and we are now benefitting from this investment.

For the first time in history, we can track the evolution of a pandemic in real-time.
I thank countries who are making the results of their investigations publicly available. This helps us understand the disease.

I am impressed by the work being done by affected countries as they deal with the current outbreaks.

I also want to thank the governments of the USA and Canada for their support to WHO, and to Mexico.

Let me remind you. New diseases are, by definition, poorly understood. Influenza viruses are notorious for their rapid mutation and unpredictable behaviour.

WHO and health authorities in affected countries will not have all the answers immediately, but we will get them.

WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels.
The results of these ongoing assessments will be issued as public health advice, and made publicly available.

All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.
At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

I have reached out to donor countries, to UNITAID, to the GAVI Alliance, the World Bank and others to mobilize resources.

I have reached out to companies manufacturing antiviral drugs to assess capacity and all options for ramping up production.

I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine.

The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?

It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. We need to continue to monitor the evolution of the situation to get the specific information and data we need to answer this question.

From past experience, we also know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries.

No matter what the situation is, the international community should treat this as a window of opportunity to ramp up preparedness and response.

Above all, this is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic.

As I have said, we do not have all the answers right now, but we will get them.

Thank you.

  • Consider limiting international travel
  • Identify critical staff roles; ensure there is cover in place and appropriately trained
  • Liaise with critical partners to join up planning and business priorities
  • Ensure BCM plans are up to date
  • Ensure Hygiene resources and protocols are in place
  • Detail and share organisation policies on staff absence
  • Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world.


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Thank you

The Continuity Forum Team

The Continuity Forum can help and advise your organisation please mail us here Pandemic Support