The third component of our preparation for optimally deploying standard care in a pandemic is being able to change our approach quickly as new knowledge emerges. In the so-called Spanish infl uenza pandemic of 1918-19, the unfamiliar clinical course meant that infl uenza was not even considered when the fi rst cases appeared (8) , and expectations had to be revised concerning who was most vulnerable and at what stage in their clinical course they were most at risk. Therefore, healthcare professionals must develop and test the public health infrastructure to capture patient factors associated with outcome and treatment response during a pandemic and feed this information back into clinical practice rapidly and reliably, as occurred during the epidemic of severe acute respiratory syndrome (9) . International collaboration will be important for sharing this work (10) and developing useful tools early in a pandemic. Having recognized the risk for pandemic infl uenza, we must now complement the research into novel infl uenza treatments by addressing our knowledge gap on how best to use our resources to deliver optimal clinical care in the management of infl uenza guided by effective clinical surveillance. 