- There are different levels of disease, based on how widespread it is and how often it occurs within a community.
- A pandemic is an epidemic (a sudden increase in the number of cases of a disease) that’s spread over several countries or continents. It usually affects a large number of people.
- The World Health Organization (WHO) has said we’re not yet in a pandemic, but it’s possible that will change.
The last couple of months have seen the COVID-19 crisis grow into a worldwide emergency, but the Centers for Disease Control and Prevention (CDC) report it’s still too early to declare COVID-19 a worldwide pandemic.
“We are taking and will continue to take aggressive action to reduce the impact of this virus, that it will have on the communities in the U.S. We are working with state, local, and territorial health departments to ready our public health workforce to respond to local cases and the possibility this outbreak could become a pandemic,” said Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, in a
But what is a “pandemic,” and what are the implications?
Levels of disease
According to the CDC, there are different levels of disease, based on how widespread it is and how often it occurs within a community.
The first level is called “endemic.” This is the amount of disease usually present in a community; the constant presence or usual occurrence of a disease or infectious agent in a population. It’s also referred to as the “baseline level” of a disease.
An “epidemic” is a sudden increase in the number of cases of a disease above the endemic level for that area.
However, the term “outbreak,” although having the same definition as epidemic, is typically when the disease occurs in a relatively small area.
Finally, a “pandemic” is an epidemic that’s spread over several countries or continents. It usually affects a large number of people.
“A pandemic is person-to-person spread of a disease causing significant illness and death on an exceptionally broad worldwide scale. As opposed to an epidemic, which would be the spread of a disease to an area such as a community, nation, or portions of the world, as well as tending to be a non-exceptional occurrence,” Dr. Charles Bailey, medical director of infection prevention at St. Joseph Hospital in Orange County, California, told Healthline.
Common source or propagated outbreaks?
The
Disease outbreaks can come from a “common source,” like when a group of people with food poisoning all ate at the same restaurant.
Then there’s a “propagated outbreak.” This occurs when a disease is passed from one person to another. It can result from person-to-person contact, sharing needles, or as in the case of Lyme disease, by deer ticks.
“So, it’s not enough to say that somebody that was in, for example, Hubei province has COVID-19, and then they travel somewhere else or somebody who was staying with them goes back to their home country and they’re found to have it,” said Dr. Carl Fichtenbaum of the division of infectious diseases at the University of Cincinnati College of Medicine.
He explains that that doesn’t make it a pandemic. What makes a difference is when you start to have people, such as within Italy or South Korea, “who are transmitting it to other people in that area.”
He emphasizes that it typically starts out with family members.
Last pandemic was the 2009 H1N1 influenza
“Currently, as reported, there are 79,553 people infected and about 2,628 deaths in 29 countries. The WHO will need input from multiple health partners across the world prior to deeming this a pandemic,” said Dr. Vidya Mony, FAAP, associate hospital epidemiologist of infection prevention at Santa Clara Valley Medical Center.
Mony points out that the last pandemic was the 2009 H1N1 influenza pandemic, and neither SARS, MERS, nor Ebola qualified as a pandemic despite differing severity, case counts, and death rates.
“As always, we will await guidance from CDC, WHO as to our next steps. But, as a hospital system, it is important that we prepare ourselves for this potential,” Mony said. “The most important aspect is that everyone remains calm and has an emergency preparedness plan in the event of a pandemic.”
New diseases arise unexpectedly, with severe consequences
Just over 100 years ago, an incredibly
It’s been largely forgotten, but the Spanish flu of 1918 ultimately infected between 25 to 30 percent of the world population and killed an estimated 40 million people.
Fichtenbaum believes the government is taking COVID-19 seriously.
“I think that the preparedness in the United States is starting to change already, and I think we’re starting to see those directives. We’re seeing language coming from the Centers for Disease Control and Prevention showing that they’re starting to think about what happens if we have epidemic levels of COVID-19 and how do we contain its spread and protect people,” he said. “And so very much like some of the early discussions with the Ebola virus, we’re now starting to see this, so the interest is very high.”
What could happen in a pandemic situation?
Fichtenbaum says that part of the U.S. strategy would be for healthcare facilities in each city, and each locale, to begin planning:
- where they’ll care for people with the virus
- who would be tested
- what would be the criteria they use to decide what actions to take
He added, “Of course, this time of year, is very much complicated by influenza, which is virtually indistinguishable from a clinical perspective, so you’d have to be testing people for COVID-19 as well as influenza and also quarantining people so that you could contain the spread of it.”
“It’s a matter of time, but I think that it’s only days or weeks from the World Health Organization calling this [COVID-19] a pandemic,” Fichtenbaum said.
The bottom line
A pandemic involves local people transmitting an infection that affects a significant portion of the population. The CDC hasn’t determined that the situation with COVID-19 meets those criteria — yet.
New diseases have regularly appeared and caused widespread sickness, disruption, and deaths. COVID-19 is one of a long line of health challenges the world has had to deal with.
The United States is preparing to deal with a potential pandemic situation, and experts say it’s only a matter of time before the WHO declares COVID-19 a global pandemic.
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