Tag Archives: pandemic

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Flu Update: Study Confirms Low Mortality Rate

Here is a short summary article clarifying what we already knew–the swine flu mortality is low.

Study Confirms Low Mortality for Swine Flu

By Maggie Fox, Health and Science Editor

Reuters

WASHINGTON

 

One of the most systematic looks yet at the swine flu pandemic confirms that it is at worst only a little more serious than an average flu season and could well be a good deal milder, researchers said on Monday.

They analyzed data from Milwaukee and New York, two U.S. cities that have kept detailed tabs on outbreaks of H1N1, to calculate a likely mortality rate of 0.048 percent.

“That is, about 1 in 2,000 people who had symptoms of pandemic H1N1 infection died,” Dr. Marc Lipsitch of Harvard University and colleagues wrote.

Probably 1.44 percent of patients with H1N1 who were sick enough to have symptoms were hospitalized, and 0.24 percent required intensive care, they added.

The findings, published in PLoS Medicine, a Public Library of Science journal, should be reassuring to public health officials and policymakers who worry that a flu pandemic could kill millions and worsen the global recession.

They do not, however, guarantee that H1N1 will not worsen, or that some other, stronger, strain of flu will not emerge.

“We have estimated … that approximately 1.44 percent of symptomatic pandemic H1N1 patients during the spring in the United States were hospitalized; 0.239 percent required intensive care or mechanical ventilation; and 0.048 percent died,” Lipsitch and colleagues wrote.

LOWER RATES

Using a different method and New York City data only, they said they calculated a much lower death rate of 0.007 percent.

Health experts agree it is impossible to count precisely how many people have been sickened by H1N1, which was declared a pandemic in June.

Few people are tested, tests are inaccurate and many people only have mild illness. So careful projections give a more accurate picture of a pandemic than actual counts of confirmed illnesses and deaths.

Lipsitch specializes in these sorts of calculations and a global estimate he did in September gave similar projections.

One open question is how many people have actually been infected. The U.S. Centers for Disease Control and Prevention estimated in November that number was 22 million Americans.

Lipsitch’s team calculated a potential range of 7,800 to 29,000 deaths.

This compares to seasonal flu, which kills 36,000 people a year and puts 200,000 into the hospital.

“To date, symptomatic attack rates seem to be far lower than 25 percent in both the completed Southern Hemisphere winter epidemic and the autumn epidemic in progress in the United States,” the researchers added in their report, published at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000207.

(Editing by Doina Chiacu)

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Flu Update: More Stats

CDC announced that up to 6 million swine flu cases in last few months! So now looking at the total of deaths worldwide 6051, we are looking at a mortality rate of .001%.  Unfortunately the people that do get sick and who are at risk of serious illness are kids whereas the regular seasonal flu tends to effect babies and old people.  (original article from CDC)

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Flu Update: 1 in 5 Kids had H1N1 (swine) flu this month

An article today points out that it is estimated that 1 in 5 kids in the U.S. contracted swine flu in the month of October, 2009. Now looking at the demographics of the U.S., it is estimated that there are 60 million kids ages 0-14 in the U.S. in 2009.  This means that approximately 1.2 million kids had the H1N1 flu this month.  The total deaths from the H1N1 flu in the U.S. is estimated at 1,164. Therefore the mortality rate in kids in the U.S. can be estimated to be far less than 1% (.00097).

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Flu Update: The H1N1 (Swine Flu) is upon us!

I was stopped by a friend this morning who was concerned about the swine flu because he watched a 60 Minutes special last night about a teenager who died of the swine flu.  The special went into detail about this poor teenager’s suffering and death (or so I was told–I didn’t see the special).

It is time to STOP the presses!  The press/media is making people panic.

The facts:

  • If you have fever, cough, body aches, and/or headache, you have the flu–it is widespread and epidemic
  • 55,781 confirmed cases in U.S. & 1,081 deaths=mortality rate=1.9% NOW these stats are WAY off because those are the confirmed cases meaning cases that have been tested.  There are probably double that many of cases that were tested and were false negatives (had the flu but test was wrong–30-50% of the time!).  There are probably 10 times (at a minimum) more cases of the flu so probable cases of the flu in U.S. likely 500,000 or more so that means the mortality rate is far less than 1%.
  • The problem–those who are dieing are young and healthy.  Regular flu kills 30,000 people per year but they are very old or very young people.  New pandemic flu strains attack the people in their prime.  This is what drives the media to report on the deaths.  We HAVE TO keep it in perspective.
  • The vaccine scare–The H1N1 vaccine was created in the SAME process that the regular seasonal flu vaccine is (they would have mixed the seasonal flu vaccine and the H1N1 vaccine in the SAME shot if they had had the time).  The vaccine is safe (as safe as the regular seasonal flu vaccine.
  • tamiflu–NOT recommended unless person with the flu is immunocompromised otherwise tamiflu is NOT recommended (and it is NOT without it’s own side effects)
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Flu Update

  • A very detailed article came out last week in the New England Journal of Medicine outlining the origins of the swine flu.  They have found that the swine flu is a 4th generation virus from the 1918 strain.  We are in a 90 year pandemic era all originating from 1918 strain, and finally,  “it appears that successive pandemics and pandemic-like events generally appear to be decreasing in severity over time. They say this is probably due to medical and public health advances.”
  • Another article points out that Tamiflu is not all that great and that rushing to be seen at the doctor’s office has contributed to the spread of this virus:

“The most puzzling, and most consistent, point of information in these algorithms was a recommendation to treat virtually everyone with antiviral medicines. The departments of health recommended that patients with even mild URI symptoms and virtually any history of any medical problem, or common contact with anyone who has a medical problem, be prescribed anti-influenza drugs.

On what evidence did the NYC DOH recommend prescription-only antiviral medications for all? Cochrane and other large-scale reviews show that oseltamivir and zanamivir reduce influenza symptoms by roughly one half day to a day compared to placebo, though only when given <48 hours after the illness begins. Unfortunately, the medicines frequently seem to add nausea, vomiting, or diarrhea, and cost roughly $100 per prescription. They also only work for those with test-confirmed influenza. The simple use of NSAIDs, it would seem, could rival these agents for symptom control, and without the side effects or cost.

With such a tepid, selective, symptom-only impact, and at such considerable expense, why use them? I asked my local infectious disease specialists this question. Treatment, they said, may reduce complications such as death, pneumonia, or hospitalization.

I looked further. Interestingly, despite the fact that 10,000-20,000 people typically die each year in the U.S. from influenza, antivirals have never been shown to decrease either mortality or critical illness. As for other complications, one meta-analysis of ten trials suggested small reductions in pneumonia and a 1% reduction in hospitalization. But the meta-analysis was retrospective, it used only cherry-picked secondary outcomes, and the studies were hand-selected from a Roche database. And yet this remains the only combined data ever to report any significant benefit on complications. Two much larger reviews have since concluded that the drugs have no appreciable effect on the use of relief medications or subsequent need for antibiotics. “

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Flu Update: What we know and what we don’t

“Influenza virus has only eight genes. The molecular structure of the most important proteins they code for is known in intimate detail. The coming and going of its epidemics have been studied by statisticians continually since the 1840s. But predicting pandemics remains a fools’ game. It falls into the category of Alvin Weinberg’s ‘trans-science’ – a question of fact that can be stated in the language of science but is unanswerable by it. Weinberg’s examples focused on the impossibility of predicting the probability of extremely improbable events. There have only been three influenza pandemics in the last century: in 1918, 1957 and 1964. The uncertainty is massively amplified by evolution – the random and frequent genetic mutations and the swapping of genes between bird, pig and human viruses….” read more from this great summary…

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Flu Update: Mortality and Morbidity of Swine Flu

Summary:

Mortality rate (as I suspected) based on true Mexico numbers is less than 1% (11932 cases with 42 deaths).

Age most affected remains 5-40 years old

Overall this is a mild illness but hope and pray that a second wave doesn’t occur or is just as mild.  I am hopeful that gov et al will start production of vaccine for this fall.

Questions?

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Flu Update

It appears that even though this virus is affecting young people that they mortality rate in Mexico was tied to poverty and delay in care, and as I have always said, it is also related to unreported number of cases.

The CDC has told schools not to close likely because of the mild illnesses the virus is causing.

There are now 2 reported deaths due to the virus in the U.S., but it turns out that both were in young people who had chronic medical conditions.

Finally, the move to level 6 by officials would not come as a surprise.  If you look at the definition of pandemic, it is a new, highly infectious agent that has crossed all geographic boundaries (don’t quote me on that just check CDC or WHO website).  Calling it a full blown pandemic only means that it has spread globally, it is about geography not how virulant/dangerous/deadly the virus is.

I hope this will burn itself out and continue to be a mild virus, but officials are concerned that this is just the first wave.  Hopefully if there is a second wave, it is in the fall and a vaccine will provide some immunity.

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Flu Update

This is a great review of our current situation. This strain so far seems to be similar to seasonal varieties in fact maybe even more mild seeing as the seasonal flu kills 1,000’s of people every year.  The mortality rate in Mexico vs. U.S. et al remains unaccounted for although likely will find it is just a matter of not having all the numbers of patients who got the flu but recovered without testing.

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Flu Update

So the swine flu is continuing to spread.  The concerns continue to be:

  1. The mortality rate 
  2. The age of the victims.

The WHO has stated that the initial mortality numbers from Mexico were not correct so they have been dramatically adjusted.  The mortality rate seems to be confirmed at 19 of 506 cases in Mexico or a rate of 3%, and if you use the suspected numbers the mortality rate is less than 2%.  This still seems high to me, and I continue to suspect that the mortality rate is lower but we just don’t have all the data.

The age of the people contracting the disease seems to be young.  In the U.S. the average age has been 17.  I did read today that there were at least 4 deaths in Mexico over age 60, but the most accurate numbers are probably from the MMWR.

The Associated Press said yesterday:

“Epidemiologist Pablo Kuri, an adviser to Mexico’s health secretary, gave a brief survey of the 16 confirmed swine flu fatalities in that country to The Associated Press. They include four males and 12 females. Three children died — a 9-year-old girl, a 12-year-old girl and a 13-year-old boy. Four were older than 60, the oldest 68.

The other nine fatalities were between 21 and 39 — unusual ages for people to die of the flu, because they tend to have stronger immune systems.

People sickened in the U.S. range in age from 1 to 81, but most are younger than 20, according to the U.S. Centers for Disease Control and Prevention.”

Associated Press said today: “Mexican Health Secretary Jose Angel Cordova said the virus that has killed 19 people in Mexico and sickened at least 506 apparently peaked here between April 23 and April 28. A drastic nationwide shutdown appears to have helped prevent the outbreak from becoming more serious, he said.

“The evolution of the epidemic is now in its declining phase,” Cordova declared.

He said officials would decide Monday whether to extend the shutdown or allow schools and businesses to reopen on Wednesday.

Pablo Kuri, an epidemiologist advising Cordova, told The Associated Press on Sunday that tests have confirmed a swine flu death in Mexico City on April 11, two days earlier than what had been believed to be the first death.

He also said there have been no deaths among health care workers treating swine flu patients in Mexico, an indication that the virus may not be as contagious or virulent as initially feared.”

We must continue to pray that the mortality numbers will be comparable to the seasonal flu (<1%) and that deaths will not be in the prime of life.

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Flu Update: Fear not!

Here is a great challenge for those of us anxious Christians:  Faith and Healing: H1N1

“…And what of people of faith? This may be the time that we care called not simply to pray for healing, but to be vehicles of it. It may be our turn to embrace the leper. It may be a lot of things. It is time for us to be a calming presence around those around us so that fear does not carry the day. Remember that God’s messengers in Scripture always greet their mortal hosts with these words, “Fear not!”

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Flu Update: Much uncertainty still remains

Associated Press most current review of Q and A regarding the flu

The L.A. Times yesterday (April 30, 2009) has a very encouraging article pointing out that the genetic sequence of this flu has been studied and appears to be less worrisome than previous thought.

Another encouraging summary from a layperson’s blog that I am hopeful is going to be the scenerio that pans out in the end.  It seems that I am finding more ‘no big deal’ articles than worry ones.  I think that the truth lies somewhere in between.

Hand washing is key.  Some report that the flu spreads more from contact than from the air:

“2.4 Evidence for the Mode of Influenza Transmission 

 Organisms, especially respiratory viruses expelled in large droplets, remain viable in droplets that settle on objects in the immediate environment of the patient.  Both influenza A and B viruses have been shown to survive on hard, non-porous surfaces for 24-48 hours, on cloth paper and tissue for 8-12 hours and on hands for 5 minutes8.  The virus survives better at the low relative humidity encountered during winter in temperate zones.  Contact with respiratory secretions and large droplets, appears to account for most transmissions of influenza.  In a report of an outbreak in a nursing home, the pattern of spread was suggestive of contact rather than airborne transmission because patients who were tube fed or required frequent suctioning had higher infection rates than those who did not require such care.  Whether or not influenza is naturally transmitted by the airborne route is controversial.  An outbreak of influenza on an airliner has been attributed to airborne spread; however, large droplet spread could have been responsible because the passengers were crowded together and moved about for several hours in a small, grounded airplane9.   Although experimental airborne transmission of influenza A virus to mice has been reported, there is no evidence of such transmission in humans.”

And finally, here is a good summary article about the theories concerning why Mexico seems to have such a high mortality rate: Answer–unreported cases are probably MUCH higher so the 6% number is much lower?

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Flu Update

Map of Flu Cases

5 Things you need to Know

Health Experts Answer Swine Flu Questions

Prevention can help:  If coughing, stay home and your family stay home.  Coughing is the way this thing is spread.  Hand washing helps because the droplets get on hands and we humans like to touch our mucus membranes–eyes, face, mouth etc…-so wash hands.

Good News:  Mortality rate may be less than previously assumed?

  • mortality rate in Mexico seems to have slowed: total is 152 & health officials have speculated that tens of thousands may have contracted it so this puts the mortality rate from 6-10% to 1% or less.  Still too early to know.  This article gives a more accurate picture of the shear number of cases in Mexico AND that it probably has been around for months–as early as February.
  • U.S. confirmed is at 91 and 1 death which again means that there could be tenfold more unconfirmed cases again pointing to the mortality rate being at the worst 1% if 1/91 rate continues…
  • The other concern has been that it is killing 25-45 year olds, but we still haven’t seen the numbers to know for sure.  The first U.S. death was in a baby from Mexico, and unfortunately, the baby was in the age range that we typically see being most effected by the flu–under 2 and over 65.
  • Here is a reassuring article putting potential ‘worst case scenerio’ stats together to point out that even if this were as bad as the ‘Spanish’ flu of 1918….
Pray and wait.
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Flu Update

Question #1: Why is the mortality rate so high in Mexico?

Ans: There are many theories but no clear answers (yet), but the good news is that it appears that the death rate is slowing and the total cases are slowing as well in Mexico.

I would rank the theories in their most likely order:

1. not enough data and we will find that there were/are a lot more cases so the mortality rate is falsely elevated

2. virus changed minutely/just enough to make itself less lethal but more contagious

3. differences in population–worse health, bad air polution, delay in going to seek medical attention, genetic differences, more herd immunity in U.S.–many of us might think: “Mexico is so poor and their health system must be worse than ours.”  One of my partners assurred me that Mexico Cities healthcare system is very clean and modern so that theory is probably not accurate.

4. Some other infection–some speculate that there is another supra-infection or co-infection that is making the death rate higher in Mexico.

Question #2: Are the deaths highest in the young–25-45 age range in Mexico?

Ans: Again, no data has been available, but some rumors and speculations that that is the case.  If that is true, experts worry that may mean we are dealing with a flu strain like the 1918 strain which was very bad.

Some more links:

Global Map

Daily Update for Emergency Physicians

Daily update from CDC

Incidental notes:

I worked 10 hours last night in the Emergency Department, and we were testing for the flu on EVERYBODY that had any symptoms at all suggestive of the flu–all were negative.  I would think that we would start to see cases if this thing is going to spread like most epidemics do…More to follow….

Also one of my partners is interviewing today a researcher who has created a vaccine (tested only on animals but seems to work) that is non-typable.  This means that this vaccine would work on ANY strain of the flu…WOW…for more details look for his interview on his website.


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Flu: What are the true numbers?

Mexico:  86 confirmed deaths (only 20 of which have been confirmed to have the swine flu); 1400 confirmed cases

These numbers are concerning.  I will make an educated guess that most of the 86 deaths are from the flu but there are 1,000’s of unconfirmed cases to go with the 1400 confirmed cases.  For example, in New York approximately 100 kids came down with flu symptoms, but the health department only tested 8–all of which were positive for the swine flu.  This means that there are a lot of people with this flu that are unconfirmed cases.  I am hopeful that when the dust/stats settle, we will find that the Mexico numbers are more likely 80 dead out of 8000 (I hope or just wishful thinking)–which is a 1% mortality rate rather than the 6-8% mortality currently being reported there.

Now why are we not seeing any mortalities (yet)?  Is it just too few cases? Or has the flu changed? Or is there some kind of herd immunity from exposure to prior flu vaccines etc.?

Any thoughts???