Tag Archives: swine flu

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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

  • 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

It has been awhile since I updated the swine flu so here is a summary:

  • There have been over 1 million cases in the U.S.!
  • The mortality rate is similar or lower than typical influenza (about 0.4%)–so DO NOT WORRY if you or your kids get it unless you have shortness of breath, can’t keep anything down, or any major concerns that are alarming–most get symptoms like a common cold
  • The only worry is if a second wave hits and the swine flu mutates to a strain that is more lethal…therefore it is important to get a vaccine or if you come down with the flu then you will have immunity or partial immunity to the next wave
  • Looks like the vaccine may be delayed unfortunately
  • If you go to your doctor and they decide to test you for the flu be aware that the test for the flu can often be falsely negative.
  • Here is a great blog resource that seems to post accurate information
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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: 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???