Thread by @alexandraphelan, It’s time for a Pandemic thread for #COVID19(prompted by questions from the [...]

It’s time for a Pandemic thread for #COVID19

(prompted by questions from the excellent @MackayIM & @onisillos - thank-you)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌏" title="Earth globe asia-australia" aria-label="Emoji: Earth globe asia-australia">What is a pandemic?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌍" title="Earth globe europe-africa" aria-label="Emoji: Earth globe europe-africa">Are we in a pandemic?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌎" title="Earth globe americas" aria-label="Emoji: Earth globe americas">How do pandemic and PHEIC declarations differ?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌏" title="Earth globe asia-australia" aria-label="Emoji: Earth globe asia-australia">What is the impact of declaring a pandemic?

(1/?)

2. A pandemic refers to the spread of a disease worldwide or over a significant proportion of the world, generally considered to be two or more continents. “Pandemic” is a descriptive term, not a legal term, and specifically describes spread, not severity, of a disease.

3. Spread is more than just cases in a country but transmission. But @WHO pandemic guidance no longer delineates b/w limited/sustained human to human transmission (after H1N1). Rather, WHO uses 4 phases: pandemic is simply “global spread” with severity risk assessed separately.

4. However, a big disclaimer: WHO pandemic guidance (and phases) is based on influenza. #COVID19 may warrant a different approach but the classic definition (above) would arguably still apply as a descriptive term.

Here’s the WHO Pandemic Flu guidance: https://apps.who.int/iris/bitstream/handle/10665/259893/WHO-WHE-IHM-GIP-2017.1-eng.pdf;jsessionid=FF0E44DE342CCEF9F0A31E1EFB14C8E8?sequence=1">https://apps.who.int/iris/bits...

5. Who decides if we& #39;re in a pandemic? @WHO decides if we& #39;re in a pandemic? No doubt some experts believe we& #39;ve already met the pandemic definition for #COVID19. As the lead global health agency, folks likely waiting for WHO DG to make this as a statement of fact first.

6. In contrast, PHEIC is a legal declaration the DG makes under IHR: an extraordinary event posing public health risk through int& #39;l spread & requires coordinated international response. A PHEIC doesn& #39;t require an outbreak be a pandemic (but a pandemic is likely already a PHEIC)

7a. What is the impact of a pandemic declaration?
(international law)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌏" title="Earth globe asia-australia" aria-label="Emoji: Earth globe asia-australia">IHR - no additional powers in a pandemic: it’s all about that PHEIC.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌍" title="Earth globe europe-africa" aria-label="Emoji: Earth globe europe-africa"> For flu, relevant for distributing vaccines & antivirals under PIP Framework. But there& #39;s no PIP Framework equivalent for #COVID19.

7b. What is the impact of a pandemic declaration?
(national law - varies country to country)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📚" title="Books" aria-label="Emoji: Books"> regulatory and funding agencies may have laws that depend on a pandemic declaration.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📚" title="Books" aria-label="Emoji: Books">Some contracts (e.g. insurance especially) may have clauses trigger on a pandemic.

8. Are we in a pandemic? I think we are incredibly close:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔺" title="Up-pointing red triangle" aria-label="Emoji: Up-pointing red triangle">more than incidental local transmission in Asia (China, South Korea, Japan, Singapore, Hong Kong, Iran) & Europe (Italy).

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔺" title="Up-pointing red triangle" aria-label="Emoji: Up-pointing red triangle"> assume some undetected spread occurring globally.

But, I think we are still on the cusp.

8. Are we in a pandemic? I think we are incredibly close:https://abs.twimg.com/emoji/v2/... draggable=

more than incidental local transmission in Asia (China, South Korea, Japan, Singapore, Hong Kong, Iran) & Europe (Italy).https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔺" title="Up-pointing red triangle" aria-label="Emoji: Up-pointing red triangle"> assume some undetected spread occurring globally. But, I think we are still on the cusp." title="8. Are we in a pandemic? I think we are incredibly close:https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔺" title="Up-pointing red triangle" aria-label="Emoji: Up-pointing red triangle">more than incidental local transmission in Asia (China, South Korea, Japan, Singapore, Hong Kong, Iran) & Europe (Italy).https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔺" title="Up-pointing red triangle" aria-label="Emoji: Up-pointing red triangle"> assume some undetected spread occurring globally. But, I think we are still on the cusp." class="img-responsive" style="max-width:100%;"/>

9. So what would I do if I were DG? Focus on a “pandemic” can be distracting.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="➖" title="Heavy minus sign" aria-label="Emoji: Heavy minus sign">If facts meet definition, delaying could undermine trust.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="➕" title="Heavy plus sign" aria-label="Emoji: Heavy plus sign">Declaring could shift global response to both containment & mitigation & must be coupled w a tool to help countries assess their own risk

10. I& #39;d watch next 7 days v. closely for transmission in a new country or signif.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow"> in Iran, Jordan or Italy. If so, separate to "pandemic", I& #39;d convene Emergency Committee to advise on mods to the PHEIC Temp Recs to help all countries esp. countries w weak health systems. END

[sidebar citation for classical definition].
This is from Gordis, Epidemiology (6th edition) and shows you the high-level and descriptive nature of the term "pandemic" from an epi perspective.

And also, Porter, A dictionary of epidemiology, 5th edition. (2008) defines pandemic similarly, but without specific geographic criteria: "An epidemic occurring worldwide or over a very wide area, crossing international boundaries, and usually affecting a large number of people"

For some brilliant answers on the public health communication perspective of a pandemic, this is an excellent piece: https://virologydownunder.com/past-time-to-tell-the-public-it-will-probably-go-pandemic-and-we-should-all-prepare-now/">https://virologydownunder.com/past-time...

Past Time to Tell the Public: “It Will Probably Go Pandemic, and We Should All Prepare Now”

by Jody Lanard and Peter M. Sandman NOTE FROM IAN: The expert risk communication team of Lanard and Sandman has given me permission to post their very well-considered reply to my question of them just

https://virologydownunder.com/past-time-to-tell-the-public-it-will-probably-go-pandemic-and-we-should-all-prepare-now/

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