'Very close to knowing' if swine flu at pandemic level: WHO

The World Health Organization is moving closer to declaring a pandemic of swine flu but wants to avoid the excessive panic surrounding such a declaration, the agency's top flu expert said Tuesday.

"One critical issue is we do not want people to 'over-panic' if they hear we are in a pandemic situation," Keiji Fukuda, acting WHO assistant director-general, told a news conference in Geneva.

WHO wants to prevent people from burdening emergency rooms unnecessarily, and give countries time to prepare guidelines on treating more patients if a pandemic is declared.

The agency also does not want countries to respond with actions that aren't needed, such as shunning pork or restricting travel.

WHO is concerned about the sustained spread of the H1N1 virus in countries such as Australia, which had 1,051 cases as of Tuesday, mostly in the southern state of Victoria. Health officials noted what is called "community spread," meaning random cases that can't be traced back to the first infected person. There also reports of community spread in Chile, where there are 411 cases.

To move its pandemic alert from the current Phase 5 to Phase 6 or a full-blown pandemic, the agency is looking for confirmed community spread in a region outside of North America, where the outbreak began.

Moving to Phase 6 does not mean the situation is more severe or that people are getting seriously sick in higher numbers, Fukuda stressed, noting the agency still considers the impact on countries to be "relatively moderate."

Looking for 'indisputable evidence' of pandemic

Since the outbreak first appeared in Mexico in May, the number of swine flu cases has increased to 26,563 in 73 countries and the number of deaths worldwide has reached 140, Fukuda announced.

"We are getting really very close to knowing that we are in a pandemic situation," Fukuda said.

"On the surface of it, I think we are in phase 6," agreed Margaret Chan, WHO's director-general.

Chan said she would hold a conference call with governments on Wednesday to verify reports of community spread. 

"Once I get indisputable evidence, I will make the announcement," Chan told reporters in Geneva.

WHO worried about Canada's aboriginal communities

Fukuda noted the situation in Canada's Inuit communities is of "concern."

As of Monday, Canada had 2,446 confirmed cases. Of these, the more severe cases are disproportionately concentrated among people from northern and aboriginal communities, as well as among those with underlying health conditions. There have been three deaths linked to swine flu in Canada so far.

"Up in Canada, we know that there are reports of infections occurring in Inuit communities, with a disproportionate number of serious cases occurring," Fukuda said. "So these are observations of concern to us."

In Manitoba, for example, 26 people were in intensive care for swine flu as of Sunday night, and more than half were of aboriginal descent.

On Tuesday, the number of cases in Nunavut doubled from 25 to 53. So far, the Yukon has one confirmed case and the Northwest Territories has two.

In some areas of Nunavut, half of those hospitalized are Inuit, Fukuda said, noting Inuit populations were also severely hit in previous pandemics of other illnesses.

It's not clear what factors might be causing more severe cases in northern and aboriginal communities.

Possibilities include:

• Genetics.
• Underlying chronic diseases such as Type 2 diabetes.
• Poverty and poor living conditions like overcrowded housing and lack of running water.

WHO is concerned that vulnerable populations in South America and Africa could also be hit hard.  

There are no major changes in the virus itself. The majority of infections worldwide have been in people younger than 60, Fukuda said.

Seasonal influenza normally wanes in the Northern Hemisphere during the summer, but flu activity continues.