nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Tuesday, May 5, 2009

H1NA FLU: NO MAJOR CHANGE, SLOW BUT STEADY GROWTH

This will be my last email on this for a while.  You can see the global spread below, and I expect this whole process to motor along on both the national and world-wide level.  There is still no case analysis being released, which is really overdue. (Totals for cases/deaths:  403/1 US, 1124/26 world-wide)

 

Note that the global map has some limitations.  There are countries that are not equipped to test and monitor cases…and unfortunately there are countries who will purposely not report, or report incompletely.  We saw this before with avian flu, where China delayed release of their data for political reasons (hence the sign below in the graphic:  “As reported by national health authorities.”).

 

I’ll come back on the wire if there are new developments

Doc D

 

 

Monday, May 4, 2009

ARE THE THREE LITTLE PIGS, AND OTHER CARTOON SWINE, VULNERABLE TO H1N1?

I can tell from the news reports that the drama is starting to fade.  The media makes a story out of the outbreak, then makes a story out of the story of the outbreak.  Then we get the backlash story that there was no story, and on and on it goes, while we suck it up and the media makes money.

 

Let’s invent a term:  “epidemic fatigue”, n., of or pertaining to an emotional state of being tired of being afraid of a new disease, fed up with being pumped up with fears that the apocalypse has arrived.

 

Back to the real world.  There is still only one death in the US.  I heard one news anchor getting upset about that (a “where’s the beef” kind of reaction).  They clearly want some more trauma and disaster to report.

 

The states with the largest numbers have increases, but nothing dramatic—Texas went up by only one.  New Mexico still at only one, a real puzzle.

 

I heard one of the public health officials, saying they are “working the issue” of analyzing the data on severity, treatment, age, gender, socioeconomic status, concomitant disease.  Typical bureaucratic response.  Is there something else they’re working on that’s taking up their time?  They should be feeding this out broadband…yes, it will be incomplete and can’t be taken as definitive yet, but I don’t care.  I know how to tell when the data set is small, and how to not read too much into anecdotes and few numbers.

 

 

U.S. Human Cases of H1N1 Flu Infection
(As of May 4, 2009, 11:00 AM ET)

States

# of
laboratory
confirmed
cases

Deaths

Alabama

4

 

Arizona

17

 

California

30

 

Colorado

7

 

Connecticut

2

 

Delaware

20

 

Florida

5

 

Idaho

1

 

Illinois

8

 

Indiana

3

 

Iowa

1

 

Kansas

2

 

Kentucky*

1

 

Louisiana

14

 

Maryland

4

 

Massachusetts

6

 

Michigan

2

 

Minnesota

1

 

Missouri

1

 

Nebraska

1

 

Nevada

1

 

New Hampshire

1

 

New Jersey

7

 

New Mexico

1

 

New York

73

 

North Carolina

1

 

Ohio

3

 

Oregon

3

 

Pennsylvania

1

 

Rhode Island

1

 

South Carolina

15

 

Tennessee

1

 

Texas

41

1

Utah

1

 

Virginia

3

 

Wisconsin

3

 

TOTAL (36)

286 cases

1 death

International Human Cases of Swine Flu Infection
See: World Health OrganizationExternal Web Site Policy.

*Case is resident of KY but currently hospitalized

            Recommendations for your personal health and safety haven’t changed.  If you are using a mask, (1) remember that they need to be sealed when worn, handled with care, and discarded when they become moist, and (2) you’re a victim of panic, and need to get a grip.  Outside of healthcare workers taking care of hospitalized flu patients, or family caretakers of an infected person, there’s no need for them.  The risk data is clear; you are much more likely to be killed in an auto accident driving to the grocery store.

 

This outbreak is really unique, because it’s the first time we can see it evolve in real-time.  So many questions I have.  There are these lurches in numbers:  a few days stable, then a small burst.  We see cycles in other epidemic diseases, but the intervals are related to incubation times, or other biological factors that create ups and downs.  Influenza is pretty straight forward: quick exposure, short incubation.  The only thing I can think of right now is that the sudden micro-bursts are due to a single case that exposes a group, an escape from containment that we didn’t know about.  Anyway, there will be books written about this.

 

The WHO is now showing over a thousand cases in 21 countries.  No deaths except in Mexico still.

 

Most of you have probably seen the Pooh and Piglet cartoon.  Thanks to John for “exposing” me to it.  Google it, for a laugh (is this what they call “gallows humor?”).

 

Doc D

Sunday, May 3, 2009

WE'RE GIVING IT BACK TO THE PIGS - IS THAT JUSTICE OR WHAT?

Thirty states are now showing confirmed cases.  States that had not changed much in three days are showing a bump (New York, Texas, Arizona, a couple more), although Massachusetts and Florida dropped by one.  Again, this is what got tested 2-3 days ago.

 

This is like driving by looking in your rearview mirror—with no visual on the traffic that’s around you at the moment.

 

I wonder why New Mexico is only now showing a case.  You would think, that like the other border states, their numbers would be higher and earlier, because of the steady back-and-forth at the border.  New York is explainable:  the miracle of air travel.  Oh well, not everything can be explained right away.

 

Here’s something to think about.  Things aren’t very hospitable right now for a contagious respiratory disease.  People aren’t staying inside in groups because it’s cold outside, the warm weather dries up moist surfaces, etc.  But wait until fall:  this virus could hover out there for many months and come back late in the year when conditions are more favorable.  Or, we could have severe outbreak now, and then another round in the winter.  This happened in 1918.  One prominent theory is that the 1918 pandemic began in the US early in the year, but wasn’t bad, then went overseas with the troops, devastated Europe, then was brought back to the US east coast late in the year, and swept across the nation.

 

There’s a great book, called Flu : The Story Of The Great Influenza Pandemic by Gina Kolata.  Superb reading.  There was a PBS documentary on it that was great.  The website has maps and a timeline.  Well worth a look.  You can find it here:  http://www.pbs.org/wgbh/amex/influenza/.

 

Still only the one death in Texas.

 

 

 

States

# of
laboratory
confirmed
cases

Deaths

Alabama

1

 

Arizona

18

 

California

26

 

Colorado

4

 

Connecticut

2

 

Delaware

10

 

Florida

3

 

Illinois

3

 

Indiana

3

 

Iowa

1

 

Kansas

2

 

Kentucky*

1

 

Massachusetts

7

 

Michigan

2

 

Minnesota

1

 

Missouri

1

 

Nebraska

1

 

Nevada

1

 

New Hampshire

1

 

New Jersey

7

 

New Mexico

1

 

New York

63

 

Ohio

3

 

Rhode Island

1

 

South Carolina

15

 

Tennessee

1

 

Texas

40

1

Utah

1

 

Virginia

3

 

Wisconsin

3

 

TOTAL (30)

226 cases

1 death

*Case is resident of KY but currently hospitalized in GA.

            As of about 4 hours ago, the World Health Organization is reporting 898 cases of influenza A (H1N1) infection from 18 countries.  Of these, 506 are from Mexico, of which 19 were deaths.  I think I would restrict travel to and from Northern Mexico, they just have a ton of the disease, but the WHO is not recommending that.  They’re just saying it’s “prudent” for sick people to delay international travel.  Well, thanks a lot, from those of us who AREN’T sick yet.

 

Canada on 2 May reported the identification of the A(H1N1) virus in a swine herd in Alberta. It is highly probable that the pigs were exposed to the virus from a Canadian farm worker recently returned from Mexico, who had exhibited flu-like symptoms and had contact with the pigs.

So, we’re getting back at the pigs.  I doubt their death rate will be as low, since they will probably be “sacrificed.”  And we all know what that euphemism means.

I want to see our government organizations giving more analysis on the cases:  age range, young or old, male-female mix, occupational risk comparison, what percentage get very ill as opposed to acutely ill, etc.  Why aren’t we seeing this?

Doc D

 

 

 

Saturday, May 2, 2009

INFLUENZA: IS ISOLATION AND CONTAINMENT WORKING?

Confirmed case update as of two hours ago.  Note that Texas, and New York have remained substantially unchanged for the last three days.  California took a jump; recall that there is a delay from testing to test results (more on this below).  If this goes on for a few more days, then one might argue that containment is having some impact.  However, there are additional states reporting new cases.  This is a demonstration of just how contagious a respiratory virus can be. 

Procedures in each state may vary:  things like measures to reduce exposure by closing public activities, and how fast and thorough they are in containing exposure through isolating a case, are up to the states.  So we can’t tell whether any of these new reportings will propagate.

The World Health Organization, which doesn’t have the highest reputation (because, like the UN they get used for political purposes), is showing confirmed small numbers of cases in 23 countries.  A few of these countries have well-organized public health response procedures, but others are less so—they are the weak points.

A word about testing.  Specimens are screened for Influenza A, and then undergo more specific testing for H1N1 (swine flu).  A confirmed case has to pass specific testing:  that is, be positive for RT-PCR (the swine flu test panel).  A probable case is just positive for Influenza A generally (a less specific test), but negative  for H1 and H3 of the RT-PCR (swine flu panel).  A suspected case is someone with flu-like symptoms, who may have had some potential exposure (but no test results).  The table below shows only confirmed.

This is why the news reports seem so different.  They report a lot of stuff, some of which won’t be confirmed; on the other hand they get info much quicker…so it’s difficult to tease out what’s important.

 

U.S. Human Cases of H1N1 Flu Infection
(As of May 2, 2009, 11:00 AM ET)

States

# of
laboratory
confirmed
cases

Deaths

Arizona

4

 

California

24

 

Colorado

2

 

Connecticut

1

 

Delaware

4

 

Florida

2

 

Illinois

3

 

Indiana

3

 

Kansas

2

 

Kentucky*

1

 

Massachusetts

8

 

Michigan

2

 

Minnesota

1

 

Missouri

1

 

Nevada

1

 

New Jersey

7

 

New York

50

 

Ohio

1

 

South Carolina

13

 

Texas

28

1

Virginia

2

 

TOTAL (21)

160 cases

1 death

International Human Cases of Swine Flu Infection
See: World Health OrganizationExternal Web Site Policy.

*Case is resident of KY but currently hospitalized in GA.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I thought it might be interesting to show the retrospective information on when the confirmed cases actually began.  Note that this is onset.  That the first case goes back quite a ways is not unusual.  I see that all the time.  There’s a level of awareness that has to be reached before a doctor, or a patient, or a health department, says “wait, isn’t there a pattern developing here?”

 

FIGURE. Confirmed human cases of swine-origin influenza A (H1N1) infection with known dates of illness onset* --- United States, April 27, 2009

The figure shows the number of confirmed human cases of swine-origin influenza A (H1N1) infection with known dates of illness onset in the United States as of April 27, 2009. Onset dates were available for 25 of the 64 confirmed cases.

One case each had onset on March 28 and 30, April 4, 5, 6 and 11. Two cases had onset on April 12. One case had onset on April 15, 19, 20, and 21. Five cases had onset on April 22. Four cases had onset on April 23. Three cases had onset on April 24, and one case had onset on April 25.

 

 

 

Doc D

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