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.
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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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