How Bad Is It Going To Get?

  1. Categorically Speaking

    The question is, how bad is this going to get, anyway? The answer is, no one knows yet.

    First, a few definitons are needed to understand the discussion more easily. CFR stands for case fatality ratio. It is the number of cases ending in death divided by the number of cases, usually expressed as a percentage or as the number of deaths per 1000 cases. Attack rate is the percentage of people infected during a prescribed period of time.

    By all means, please follow the link for an excellent analysis of what is known so far. And, when you are done, please check this link on the current situation in Argentina and Chile where the flu season is not yet at its peak.

    https://allnurses.com/pandemic-flu-f...es-403123.html

    http://afludiary.blogspot.com/2009/0...-speaking.html

    Quote from afludiary.blogspot.com

    The assumption is that in a pandemic (any category), 30% of the population would fall ill.

    That is an estimate, based on the data we have from the pandemics of the 20th century. In the UK, the government's SAG (Science Advisory Group) has suggested that number could go as high as 50%.

    ...a 30% attack rate has been deemed reasonable by many planners. This is roughly 3 times the number of people normally stricken in a year by influenza. Which means that a virus with the same virulence as seasonal flu would have 3 times the impact, based simply on the increased number of people infected.

    Three times higher absenteeism, three times as many hospitalized, and likely, three times the number of deaths. And many of those deaths will involve children and young adults.

    The greatest impact would probably be felt in the health care field, where a tripling of emergency room visits, hospital admissions, and the need for ventilators or ICU beds would constitute an enormous challenge.
  2. Visit indigo girl profile page

    About indigo girl

    Joined: Mar '06; Posts: 5,909; Likes: 1,741
    visiting nurse; from US
    Specialty: Too many to list

    23 Comments

  3. by   RedWeasel
    I am going to ask a dumb question and ramble on about it till I get to the point. Do you think it is possible a milder h1n1 was going around in feb march of 2008? My brother and mom did not get the flu then. I and many of my coworkers did. This is when it was reported the vaccine that year did not cover much of the flus going around-but people who had the shot in Nov didn't get sick till Feb-long after the flu had been circulating (why then and not all winter-it hit our floor in a week and crippled us)-could it actually have mutated into an h1n1 or 'something' but researchers had assumed it just had missed something in the shot rather than a new mutated flu? (no probably not they know what they are doing-but many of us didn't get tested then-we went on s/s-and those who were tested were only tested to discover they had an influenza A)-so couldn't it be possible that it was already here? I don't think anyone on our floor yet has had the flu yet-maybe we all had it last year!). I believe the authorities said it was an influenza A strain that was 'missed' in the shot last year. I suppose it isn't possible - but it makes me wonder if this h1n1 was subtly in the middle of changing and that is what many of us came down with. My mom and brother have had the flu this week (was not confirmed by testing - but it had every s/s). I have not gotten it. It just makes me wonder....I know they test these things but maybe somehow it was in the middle of jumping or mutating then. In my professional opinion I know it wasn't but I just can't see how I haven't gotten it unless maybe, somehow I already have SOME immunity. Again I know I don't but then my mind starts going into creative 'what if' mode--have to remind myself the science doesn't lie! Like I said, dumb question. Sorry. Maybe I am coming down with :zzzzzit now-not thinking clearly!
  4. by   Katnip
    I've known for some time they've been predicting a 30% attack rate for a pandemic, though that was even before H1N1 arrived on the scene. If they're going to base the estimate now on the current number of cases, I don't see how they can realisitically do so if they aren't testing people with milder symptoms anymore. Or maybe I'm looking at it all wrong?
  5. by   RedWeasel
    Quote from Katnip
    I've known for some time they've been predicting a 30% attack rate for a pandemic, though that was even before H1N1 arrived on the scene. If they're going to base the estimate now on the current number of cases, I don't see how they can realisitically do so if they aren't testing people with milder symptoms anymore. Or maybe I'm looking at it all wrong?

    Exactly! How can they estimate? Also how can we prevent it from spreading to HCWs if we DON'T test our patients? I mean if that is how it is going to be (doctors just throwing us all under a bus so they don't have to deal with an influx of phone calls with results etc-'well the treatment won't change-why test?' they say--well so we can isolate them that is why!) - if we aren't going to positively ID those with flu, we need to hear from the CDC LOUD AND CLEAR that they recommend we place them on isolation without doctors orders or test results-"PER pandemic guidelines." This is an emergency situation-desperate times call for desperate measures. Better yet, don't test the patients because false negatives are common and we should be instructed from the CDC during a pandemic flu to place anyone with any influenza s/s on isolation so that we cover our bases. False negatives would put us and other patients at risk. CDC should require isolation for any suspected flu for the seven days needed-despite the results of a nasal swab. I figure just place people on isolation across the board. And if we DO test them and they are negative we need to be told to continue with isolation anyway. Sorry I am too wordy!
  6. by   indigo girl
    Swine Flu - The Worst Is Yet to Come

    http://www.scottmcpherson.net/journa...t-to-come.html

    Scott McPherson is the Chief Information Officer [CIO] of the Florida House of Representatives. By all means, read his full commentary at the link above.

    Quote from www.scottmcpherson.net

    More people died in this country last week from swine flu than died in all of April and May combined.

    Same thing happened last week.

    Deaths in this country are doubling every week.

    It is spreading deeper into corners and pockets of America where it was not before.

    The Muscular Dystrophy Association has cancelled every single one of its MDA kids' summer camps, coast-to-coast. Other organizations are following suit.

    The average age of a dead American from swine influenza is 37.

    The CDC is telling us this virus is moving faster than the 1957 or 1968 pandemics did. Understandable, with quick, easy air travel and interstate highways. But so far, it is not moving with the ease of seasonal flu. So far.


    A moderate pandemic would also nest 2009's swine H1 pandemic into high Category 1 or low Category 2 status on the US charts. As you have seen from the charts I have published before, the case fatality rate from a Category 1 pandemic is up to 90,000 deaths. A Category 2 pandemic is anywhere from 90,000 to 450,000 deaths.


    The case fatality rate from swine H1 is currently .0045, or .45%. That means that for every 2000 people who get sick from swine H1, 9 will die. Extrapolating this rate out over the probable three pandemic waves, we could see as many as 400,000 Americans die from swine H1.


    There, first time in print. Unchecked, and at the current rate of fatality, some 400,000 US residents could die. And most of them would be under age 50.
  7. by   Woodenpug
    I'm not sure what is the point here. Both WHO and CDC are responding aggressively to the pandemic. CDC has released 25% of the strategic national stockpile. By all means, read for yourself http://www.cdc.gov/flu/weekly/.
    Over reacting, would simply use resources that likely will be needed later.
    Complete information, reasonable precautions and information for health care providers can be found at http://www.cdc.gov/h1n1flu/update.htm. By all means, read for yourself and follow the links.
    I thought it was morbidity rate not attack rate. But Attack does sound better.
    Last edit by Woodenpug on Jun 30, '09 : Reason: typos
  8. by   RedWeasel
    Well, CDC and WHO it appears is keeping the info on their site, but I just don't see how relevant it is if it isn't out there for the public to see. I still get blank looks from coworkers when a patient has s/s of flu and I want them to ask the doctor for a swab test. They think everything (I exagerrate a bit) is a UTI. I also know that when the USA switched over to digital TV they had commercials, crawls at the bottom of very popular shows to alert them. During a PANdemic I would explect the government to do no less than that for us. I could give a fig about the TV-I do care about my family. GET the info out there, now before it is too late. Remember how they wanted us to prepare a disaster kit back in 2001 +? They should be advocating we prepare for flu-with meds, food, fluids on hand if an entire family is struck with it at the same time. But I see your point
  9. by   RedWeasel
    My point, I forgot to mention, is that I get so upset when I am watching the local news and they mention recalls on products. Instead of telling the public about it they say, "For info please go to our website." Why even bring it up if you aren't going to tell us on tv? Not everyone has a computer-so not everyone will go to the CDC site. If the govt wanted us to have the info they would put it in our laps and they have not. Instead they belittle the VP for saying pp should avoid heavily populated crowds. THAT tells me right there they don't want to incite panick,- therefore they tout this all as a mild flu in an indirect way. In order to keep the economy going. They certainly don't want pp to avoid movies, dinners, etc at this time. How many of your coworkers or family know that multi organ failure and viral pneumonia have caused h1n1 deaths? That would get me to wash my hands more. Info is power-not panick.
  10. by   indigo girl
    Quote from Woodenpug
    I'm not sure what is the point here. Both WHO and CDC are responding aggressively to the pandemic. CDC has released 25% of the strategic national stockpile. By all means, read for yourself http://www.cdc.gov/flu/weekly/.
    Over reacting, would simply use resources that likely will be needed later.
    Complete information, reasonable precautions and information for health care providers can be found at http://www.cdc.gov/h1n1flu/update.htm. By all means, read for yourself and follow the links.
    I thought it was morbidity rate not attack rate. But Attack does sound better.
    Regarding the Scott McPherson commentary, I can't speak for Scott, of course but I am thinking that he is saying that with the coming of our fall/winter flu season, that there will be an increase in morbidity simply due to the increased number of cases over and above what we would normally see in that time period. More cases, means more deaths. His opinion is that there will be many more. He also said that the true number of deaths in the US, may be far higher than what is currently being reported. This may be a reasonable assumption because death certificates are not likely to say that someone died of swine flu when they had other conditions that were complicated by the flu.

    Scott was not writing just about the attack rates. He was commenting on what has already happened so far. It is a fact that more people died in this country last week from swine flu than died in all of April and May combined, and that the same thing happened the week before that.

    I would not label him as overreacting just because he has a different view point about what the numbers of cases and deaths are going to be. Opinions are just opinions. We've all got one.

    I did not read anything in his commentary that could be taken as bashing the the CDC or WHO or suggesting use of any additional resources that will be needed later. He just had a differing viewpoint about the numbers. At any rate, most of us would agree that the CDC and WHO are doing a fine job.

    We have been been providing links all along in the pandemic flu forum to the information about the release of 1/4 of the strategic stockpile, as well as links to the CDC information for healthcare providers. Many of us have been providing updates by both agencies as well since this all started in April.

    Scott's opinion that we are going to be slammed in the fall has been voiced by others on these flu threads as well.
  11. by   Woodenpug
    "I did not read anything in his commentary that could be taken as bashing the the CDC or WHO or suggesting use of any additional resources that will be needed later. He just had a differing viewpoint about the numbers. At any rate, most of us would agree that the CDC and WHO are doing a fine job."

    I did not write that he was overreacting. I would like to correct that now. The article was an example of a desire to create more concern for a problem than is needed.

    I did not write any statement suggesting that he was bashing the CDC or WHO. I still do not believe he was bashing either the CDC or WHO.

    The CDC and WHO agree with him that no one knows what are the actual numbers.

    I still applaud your use of attack verses morbidity. It's just got that sound to it.
  12. by   indigo girl
    There is a justifiable reason for concern.

    The CDC and WHO are doing their jobs. They monitor, do investigations, and make recommendations as part of what they do. But they are not present at the local level. Saying that CDC and WHO have it all covered so we don't have to think about this anymore is not realistic. We have a real responsibility to our local communties, and to our own families to be informed about all of the issues as this pandemic situation plays out. We can't just pass this off to the CDC and the WHO. The CDC has been saying since 2006 that preparation begins at the local community level. We need to know what that means, and what the local issues are going to be.

    All of us are very much aware that our hospitals have an ongoing problem during the regular flu season. Handling surge is a hugh issue. Planning for an expected increase in flu cases this fall over and above what we would normally see in a regular flu season, is going to be a tremendous challenge. Swine flu is 1/3 more transmissible than seasonal flu. Yes, there are going to be many more cases, and many more deaths. This is not an over reaction. This is reality.

    Is everything handled? Of course, it isn't. I can easily think of a few things that are not.

    Do any of our nursing homes have N95 masks? No, hardly any of them do, and they will have major staffing issues. No one is giving serious consideration to protecting staff and patients in those mostly privately owned nursing homes. Money is an issue, therefore no N95 masks have been procured.

    What about the treatment of swine flu cases that test negative with the rapid flu tests? Are you aware that people are getting sent away from ERs despite having contact with positive cases or having flu symptoms only to die later? We have documented many of these cases in these flu threads. They are only diagnosed when they have to be admitted to ICU or at autopsy when the more definitive testing gets done. Is this really happening? Absolutely, yes it is. Is the CDC handling this? No! Indvidual state health departments have differing guidelines about point of care testing for flu, and the adminstration of Tamiflu. For example, Nevada decided in the last few days that rapid flu testing was too unreliable. Should individuals know about this? I would think so, but they don't because they are relying on media coverage, and believe that CDC is handling everything. If I take a sick family member in because are really sick, and they test negative for swine flu with the rapid test, I am going to have some serious complaints with the facts to back them up.

    The CDC issued guidelines for pregnant HCW doing patient care. Are the hospitals following them? No. Are the staff aware of these guidelines. No, and if they are not aware they can't complain about it either. This is a local issue.

    Any other issues that WHO and CDC are not going to take care of for us? You bet, but no one is going to even know if those of us that are aware don't say anything about it. I like to look at a variety of information even if I don't agree with it. I have learned after over 3 1/2 years of pandemic influenza research, that I don't know it all.
    Last edit by indigo girl on Jul 1, '09
  13. by   Woodenpug
    Unless I misunderstand, I would like to respectfully disagree with indigo girl.

    CDC′s Mission
    Is to collaborate to create the expertise, information, and tools that people and communities need to protect their health - through health promotion, prevention of disease, injury and disability, and preparedness for new health threats. From http://www.cdc.gov/about/

    "We responded to the H1N1 outbreak from the outset with the presumption that a pandemic was likely, so this decision comes as no surprise. We acted aggressively to stay ahead of the virus as it spread across the country. Now our challenge is to prepare for a possible return in the fall," said Secretary Napolitano. From http://www.cdc.gov/h1n1flu/statement061109.htm

    "There will be increased discussion and planning with school officials, faith organizations, community organizations, the business community, on how to address flu when it comes back in the fall and winter." Tom Friedan, director CDC from http://www.cdc.gov/media/transcripts/2009/t090611.htm

    "Before this Novel H1N1 virus was recognized, of course the U.S. government and our partners at state and local levels were actively working on preparedness plans for just such an eventuality and they did involve things like procurement and stockpiling through our strategic national stockpile of antivirals and personal protective equipment like masks, and exercises where we would practice how would we move them around and state and local exercises to figure out how would we further distribute them, and we really tried to get as ready as we could." Assistant Surgeon General, Dr. Anne Schuchat also from http://www.cdc.gov/media/transcripts/2009/t090611.htm

    I also like to read from many sources. I limit my research to primary and peer reviewed sources. The above is, of course, selections from my reading.

    Indio girl's post was well written and a pleasure to read. (I am sincere in my admiration for the quality of her post.) I apologize if anyone is offended by my poorly written post.
  14. by   indigo girl
    Nothing to apologize for, Woodenpug. It is clear that we are misunderstanding each other at least some of the time. I think I see where you are coming from. I am sure that you mean well, and that you are looking for the truth about what is happening just as much as I am. I am just more willing to look in places that you are not.

    I am thinking that perhaps our disagreement is more about whether or not the national pandemic planning is actually being implemented, or is it just looking good on paper, and talked about in press conferences. The issues I addressed in my last post are local ones. I am waiting to see what happens, and I will try to keep an open mind about it though I am worried about these things, and a whole lot more. When the pandemic plans of the various states were drawn up around 2006, I used to compare them and wonder how they would ever do some of what they said. They had a curious lack of detail. And now here we are three years later...

    I just wanted to comment about the use of peer reviewed research and primary sources. I use them also when they appear, of course. But I am also very open to looking at such sources as translations from foreign media done by the flu forums (or the truly horrible ones that I do myself). I find them to be very valuable. I am looking to fill in the gaps of information that is missing in the official reports by the WHO and CDC.

    If we only look at what govt is telling us, or only at peer reviewed research, we are going to know only what they choose to tell us. This just isn't enough for me.

    Research takes some time, and we are in the middle of a pandemic... We have been seeing some great research being pre-published on the internet, (and it's peer reviewed). These have been fast tracked in record time because we needed to know this stuff yesterday! That's actually amazing. They are even releasing viral sequences though not all of them, and not the ones that we might be most interested in...

    I read the flu forums, and find them to be an extraordinary resource. Those folks are really on top of things. They were already tracking what was happening in Mexico and had figured out that the California cases were the same disease way ahead of any announcement by CDC and WHO. It is very time consuming to read them, but so worth it. The two links below were my very first introduction to the information on swine flu, and it was thanks to flutrackers.com that I even knew about this.

    https://allnurses.com/pandemic-flu-f...32-page10.html
    (see post #96)

    https://allnurses.com/pandemic-flu-f...32-page11.html
    (see posts #102 and 104)



    Now when it comes to the press conferences of the WHO or CDC, I have to admit, I am listening closely for what they are not telling us. I am reading the media reports including the foreign press the same way, and scrutinizing them to find out what the issues are.

    And, I am also very willing to read informed opinions and commentary that I might not always agree with. I am willing to look at their extrapolations because they just might be correct. I have found this to be true by being willing to be open to what they are saying. Of course, I am familiar with the knowledge level, and the views of the people whose work I am posting. These folks are extremely informed about influenza or I won't use post their commentary at all. I find that reading a wide variety in this way helps me to see the bigger picture, and think about issues that I might not have been able to see otherwise. I don't ever regret anything that I have used.

    Because of my time spent studying H5N1, I learned that disease outbreaks always lead to political decisions that have economic consequences. I am looking for transparency from govt sources for that reason. It is not always there.

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