The Pandemic That Wasn’t

PALO ALTO – Last June, the United Nations’ World Health Organization, responding to an outbreak of the H1N1 virus, or swine flu, boosted the pandemic alert to the highest level, Phase 6, meaning that a pandemic was under way – the first time in 41 years that the organization had taken that declared step. But the outbreak appears to have ended less like the rogue wild boar that WHO bureaucrats predicted and more like a roasted pork tenderloin with apples and sage.

In fact, the WHO repeatedly violated Sherlock Holmes’ warning, “It is a capital mistake to theorize before you have all the evidence.” And the pandemic alert was doubly strange, given that ordinary seasonal flu sweeps the world annually, is invariably far more lethal than the currently circulating low-virulence H1N1, and certainly meets the WHO’s definition of a pandemic: infections over a wide geographic area and affecting a large proportion of the population.

Ironically, the appearance of the H1N1 flu during the past nine months might be thought of as a net public-health benefit, because it appears to have suppressed, or at least supplanted, the far more virulent and lethal seasonal flu strains. During the second week of January, 3.7% of Americans tested positive for the seasonal flu, compared to 11.5% during the same week in 2009. The official death toll worldwide from H1N1 is under 14,000, while seasonal flu kills about 36,000 on average in the United States and hundreds of thousands elsewhere.

Most flu and public-health experts consider the WHO to have been overly alarmist. The decision in April 2009 to raise the pandemic flu threat to the penultimate level, Phase 5 (“Pandemic Imminent”), already raced far ahead of the accumulated data, so the Phase 6 declaration in June revealed the organization’s paradigm to be fundamentally flawed. A warning system based solely on how widely a virus has spread, but that does not consider the nature and severity of the illness it causes, would classify as “pandemics” not only seasonal flu, but also the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis, for example. (The WHO has never explained why these obvious examples do not meet their criteria.)