What happens during a "public health emergency," and what's a "pandemic alert level"?

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April 27 2009 11:41 AM

Pandemic Alert!

What happens during a "public health emergency," and what's a "pandemic alert level"?

Click here to read more from Slate on the swine flu. 

Janet Napolitano. Click image to expand.
Homeland Security Secretary Janet Napolitano 

As the number of reported domestic cases of swine flu climbed to 20 Sunday, the acting secretary of health and human services declared a "public health emergency." Meanwhile, an official at the World Health Organization said it would decide Tuesday whether to raise its pandemic alert level from 3 to 4. What's the significance of these official declarations?

One gives the government more freedom to act; the other merely describes what's going on. Under Section 319 of the Public Health Service Act, the secretary of HHS can declare an emergency in order to free up money, extend reporting deadlines, and generally loosen regulations in order to deal with a pressing public health problem. In practice, that means hospitals can keep patients for longer than usual, Medicare beneficiaries can go out of network to receive treatment, local doctors can be more flexible in prescribing drugs and administering tests, and the government can access emergency funds to pay for treatment efforts.

Public health emergencies are not that uncommon. The flooding in North Dakota in March and April sparked an official emergency declaration, as did Hurricanes Ike and Gustav. A PHE was even declared for the presidential inauguration in order to help Washington, D.C., hospitals prepare to handle a potential influx of patients.

The WHO created the six-level system in 1999 to deliver information quickly to member nations about viral threats. (See the current level here.) Each level corresponds to a different phase of a viral outbreak.  In Phase 1, the virus has been limited to animals; in Phase 2, it has started causing human infections; Phase 3 means there are small clusters of animal-to-human infection. (Both the avian flu virus H5N1 and swine flu virus H1N1 are currently in Phase 3.) The transition to Alert Phase 4 "marks a significant upwards shift in the risk for a pandemic," according to the WHO Web site. However, that "does not necessarily mean that a pandemic is a forgone conclusion." By Phase 6, a global pandemic is under way. (The Centers for Disease Control and Prevention also have a Pandemic Severity Index to measure an outbreak's reach. It ranges from Category 1 through Category 5, depending on how many people are infected. According to that system, the swine flu outbreak merits a Category 1 designation, since it has affected less than 0.1 percent of the population.)

In practice, raising the pandemic alert level to 4 would probably spur more countries to impose travel bans or to start screening people flying in from countries where outbreaks have occurred.

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AP: Fighting the swine flu outbreak


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