Page 14 - Smart public health emergency management and ICT implementations - A U4SSC deliverable on city platforms

2 Pre-smart city responses to a pandemic: H1N1 Influenza (Swine flu)

As pandemics are events characterized by a definite time-frame, often determined by availability
of a vaccine and a treatment, it is not unreasonable to wonder whether plans devised during an
outbreak are shelved indefinitely or remain viable. The influenza A virus subtype H1N1 (H1N1)
influenza is a case in point for which evidence can be located. Its source was a virus; there was no
similar data to support specialists, and labs realized the threat early; and people had surveillance
systems and technology to support them. Though briefly examined , it shares several attributes
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with the Covid-19 outbreak. It started in 1997 when the first human infected by the H5N1 avian
influenza was detected. This was followed by several others within a few months and reached 400
in 2009. Public health officials could not validate that it was a pandemic since the influenza was
not transmitted effectively from person to person but from exposure to a live poultry market. The
preparedness period was launched in 1997 in the U.S. for this global public health disaster, which
spread internationally in 2006. It included a CDC plan and the collection of clinical, laboratory and
epidemic data. This crisis was followed by the H1N1 epidemic in 2009, which demanded changes
and alignments to the existing planning. H1N1’s mortality was lower compared to H5N1, while
its symptoms are flu-like that could lead to complications of contracting pneumonia. It affected
mainly the elderly demographic (over 65 years old) and its spread was mainly caused by droplets
expelled from the mouths and noses of infected individuals.

The first cases were detected with influenza-based tests in public health laboratories in the U.S. and
this was considered the first success of the pandemic response. Although the first results could not
recognize the virus subtype and confused it with swine-based viruses, their success was attributed
to the classification of the virus in the influenza category, which assisted in generating public health
alarms within 24 hours globally. The U.S. CDC undertook a complex and comprehensive set of
laboratory, epidemiologic and communications measures to determine the extent and severity of
each incident. The Emergency Operations Centre (EOC) was activated as the central public health
incident management centre. Regional surveillance teams were launched and managed to quickly
collect an increasing amount of data to deduce the extent of the spread and the severity of the
illness. The regionally collected information was valuable to launch a field investigation and to
raise situational awareness in relation to the pandemic. Moreover, the teams tried to determine the
virus transmission process to generate accurate recommendations and to implement appropriate
measures, such as restrictions and lockdowns.

The surveillance system that was launched relied on collecting data on the location, timing and
severity as well as viral characteristics of influenza each season. Important information regarding
the attack rates, the risk factors and the effect of medical and non-pharmaceutical interventions
(school closures, isolation of infected persons etc.) were collected from the 50 U.S. states and six
U.S. territories, analysed and monitored with graphs (e.g., hospitalized curve). Moreover, numerous
cases were investigated, tracked and analysed for the calculation of the reproductive number
and the incubation period (serial interval) for H1N1 infection. In a sensitivity analysis, making use
of previous estimates of the mean serial interval, the reproductive number was estimated to be
between 1.5 and 3.1 (recorded values in Hong Kong were 1.4–1.5 at the start of the local epidemic

4 U4SSC: Smart public health emergency management and ICT implementations