In this issue Allam1 raises concern about perceived over-reaction to the emergence of the novel influenza H1N1 strain, stating that the response of the World Health Organization (WHO) and mass media conclusions overestimated and exaggerated the problem, and provoked unnecessary alarm among the general population, rather than transmitting calm and a sense of safety. (see letter, page 862).

His first argument is that the rapid escalation of pandemic phases and communications by WHO gave the impression of an escalation in virulence of the virus rather than simply reflecting an increase in the extent of the spread. The WHO’s pre-specified definitions of pandemic phases are entirely based on the extent of geographic spread and make no reference to severity.2 WHO’s communications at the time of declaring different pandemic phases have consistently emphasised that most cases are mild. On the declaration of phase 6, it was stated that “On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery—often in the absence of any form of medical treatment … we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.”3 This is not consistent with the assertion that …