CBS NEWS: Swine Flu Cases Overestimated...Whodathunk?

[H_2_O]

As the mass hysteria subsides...a return to reality:

http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml

[oramar]

This is about what went on early in the outbreak. The title to the thread is misleading. The article is about the CDC's decision to stop collecting data so early in the outbreak. I was a bit shocked by the decision myself. Who was responsible for that decision and why did everyone just fall into it? I think future statisticians are going to be ham strung by lack of data when they try to quantify what was done. I think I know why they did it but it is just a quess. Federal and state labs were being over run with testing. It was becomming really obvious that fundng cuts to public health were a big mistake. They found a way of stopping the public from realizing what was actually happening.

[tewdles, RN]

Am I supposed to feel reassured that H1N1 is not "really" posing a threat to my community or family?

[H_2_O]

You can "feel" whatever you want.

The article just confirms what I had stated in previous threads: Someone (an unknown group of individuals/entity) made the decision to stop testing for swine flu because "99% of tests were coming back positive for swine flu." This was the exact quote given to me by three healthcare professionals from three different states, interestingly enough.

My hypothesis (of about a middle-school level) was that because they stopped testing for swine flu and decided to label EVERYTHING swine flu, numbers of people ACTUALLY INFECTED were most likely grossly inflated.

Of course I was ignored - along with common sense - in favor of mass hysteria.

[HonestRN]

My thinking on this is that the rapid flu test is highly unreliable and as oramar stated in her post that state and federal labs were being overwhelmed by the sheer volume of tests and couldn't possibly keep up. Unless a person is hospitalized or the hospital is a sentinel reporting site the rRT-PCR test to absolutely confirm H1N1 is not being done. I don't think the numbers are grossly overinflated to stir mass hysteria. I think hysteria is happening because of inconsistent information being put out by various media outlets.

Rapid tests vary in their ability to detect flu viruses. Depending on the test used, their ability to detect 2009 H1N1 flu can range from 10% to 70%. This means that some people with a 2009 H1N1 flu infection have had a negative rapid test result. (This situation is called a false negative test result.) Rapid tests appear to be better at detecting flu in children than adults. None of the rapid tests currently approved by the Food and Drug Administration (FDA) are able to distinguish 2009 H1N1 flu from other flu viruses.

http://cdc.gov/h1n1flu/diagnostic_testing_public_qa.htm

However, most people with respiratory illnesses since this spring have not had testing with the rRT-PCR test, which is the only test that can confirm infection specifically with the 2009 H1N1 virus. Tests such as rapid antigen detection assays and diagnoses based on symptoms alone without rRT-PCR testing, cannot specifically determine if a person has 2009 H1N1 influenza.

http://cdc.gov/h1n1flu/vaccination/clinicians_qa.htm

[tewdles, RN]

are you a little irritable about this topic H_2_0?

[indigo girl]

CBS News on swine flu testing: Fail!

A few words about the Reveres since I am posting their commentary with their permission:

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

http://scienceblogs.com/effectmeasure/2009/10/cbs_news_on_swine_flu_testing.php

Most importantly what the CBS article pointed out was that unless you were confirmed positive by testing, you don't know for sure if you have immunity to this novel virus. Because of your lack of assurance, you have a decision to make to vaccinate or not. It's a very big decision if you have kids to protect.

Does it actually matter how many cases of influenza are occurring? Not a whole lot.

What matters most to me, at least is that we are seeing an unusual number of deaths in groups that don't normally die of flu i.e. healthy pregnant women, school age kids, teens, and young adults. And, we saw this in the spring and the summer as well. The fact that there were no prior exisiting conditions for at least a third of these cases is very troubling. And, the fact that they are dead means that they were indeed confirmed cases.

The CBS interpretation of events about the testing is misleading. Read the Reveres full commentary for a better explanation but here is bit of it.

It is clear that CDC is saying to the state epidemiologists they are sorry they did not run the Q&As about stopping testing by them , not the decision to stop testing. Contrary to this article, I heard throughout this period that the pressure on CDC to stop the testing was coming from the states, not the other way around. It's no secret that state health departments are hard pressed to keep their heads above water financially and are short staffed all around. Expensive swine flu testing was something they couldn't afford. The burden to do the testing was on the states, not CDC, but as long as CDC recommended it, states couldn't easily stop on their own, especially if neighboring states were still testing. The reason for stopping was confusing (and CBS News shows themselves confused) and bound to be controversial. In effect, CDC decided to take the bullet for state health departments. And CBS News obligingly pulled the trigger.

Is it flu or is it something else? The likelihood increases with the circumtances:

CBS's own investigation found that in all 50 states, prior to stopping testing in July, lab-confirmed cases showed that most specimens were not influenza. As I noted, since other viruses cause ILI during non-flu season this isn't too surprising. What was surprising was the amount of influenza there was at a time when we expect to see very little. Now that flu season is here, the chances that an ILI is truly influenza (causally defined) is much greater. And frankly, there is no possibility of testing all ILI cases for swine flu. There will be millions of cases of ILI and they can't all be tested and most won't even be seen by anyone. Moreover, during the period of the CBS "study" many people were having specimens taken that would not ordinarily have seen a doctor. The data they looked at were from all 50 states (and we don't know what data it was or what they counted or whether they even calculated things correctly) and were mostly cases that were not epidemiologically linked.

This last is important. CBS News cites an outbreak of 250 cases at Georgetown University as an example where no testing was done so it isn't certain this was a flu outbreak. Admittedly, it could have been adenovirus or respiratory syncytial virus or a bunch of other things. But when something like this happens in the setting of a pandemic, the odds are that it was influenza. More importantly, data on the number of positive specimens for all the people of Georgia over a several month period three months prior is not the same as 250 cases among students who were in contact with each other and that occurred over a few weeks. And think about the alternative? Nothing prevented Georgetown University from testing all those cases. Nothing except that it would have been infeasible and the resources weren't available, that's all. And it wouldn't have changed how they were treated, except perhaps to delay treatment.

[H_2_O]

are you a little irritable about this topic H_2_0?

Irritable? No, just quite satisfied in the fact my earlier assumption was correct.

[tewdles, RN]

so...self satisfaction translates into a little snippy on a forum...ok...good to know

[blondy2061h, MSN, RN]

Massive tamiflu resistance in 3...2...

Everyone being put on tamiflu is what's driving me nuts. I guess it's CYA medicine as usual.

[llg, PhD, RN]

Our ED (in a children's hospital) is being over-run by kids with "flu-like illnesses" who are really quite sick -- sicker than kids usually are with influenza. We've had a couple of local schools where huge percentages of the kids and teachers have "flu-like illnesses."

I have never been one to panic, or to support mass hysteria about it ... but it is obvious that this bug is different from the typical seasonal flu we have all gotten used to over the years. More kids are getting sick -- and those who get it are sicker than is usual. I've also know several adults who have been extremely sick with a flu-like illness in the last 2 months -- sicker than they have been in years.

Hysteria is not a good response to the situation -- but we do need to get the public to pay attention to this and take steps to alleviate the situation before we literally run out of resources to care for these very sick children. That means getting immunizations, staying home if sick, wearing masks if appropriate, etc. And the only way we can get the public to cooperate is to get the information out there which inevitably stirs up a little hyper-reaction in some people. It's hard to get everyone on the same page, reacting the same way, to information that is evolving as a situation unfolds.

That's normal

[NBmomto2]

I actually work as a pediatric nurse in Canada, and I saw first hand this week how a DR. admitted a pediatric pt. (with flu like symptoms) with a diagnosis of H1N1, before any swabbing was done. I did the swabbing once he was admitted to the unit. We had to fight with admitting office to actually get the diagnosis changed, which was done. This child came in afebrile, with just a little bit of a stuffy nose.He ended up staying for 2 days, even though he didn't need to, and we discharged him only to find out a few hours later that the test was positive for H1N1.

But...this proved to me that the numbers (which are not that high to begin with), I'm seeing of people admitted to the hospital with H1N1 are grossly exaggerated.

I suspect I'll see more of it in the days and weeks to come.