Swine Flu Updates and Issues - page 9
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Jun 6, '09Scotland
Critically ill swine flu victim gives birth to baby three months early
Quote from www.dailymail.co.uk
The baby was born almost three months early on Monday at the Royal Alexandra Hospital (RAH) in Paisley, Renfrewshire, and is being looked after in intensive care.
The baby's mother, 38, is still in intensive care at the RAH and is critical but stable.
It is understood the baby does not have swine flu.
An NHS Greater Glasgow and Clyde spokeswoman said: 'The baby was delivered at the Royal Alexandra Hospital on Monday afternoon at 29 weeks gestation.
The mother is one of three people still in intensive care at the RAH.
A man aged 45 is critical but stable, and a 23-year-old woman is stable and improving.
Two hospital doctors are among the latest people confirmed as having swine flu.
Both are doctors at the RAH and are thought to have caught it from patients being treated there, the Scottish Government said.Last edit by indigo girl on Jun 24, '09
Jun 6, '09People already feel 'tricked' by the 'fizzle' of the Swine Flu. It was hyped and hyped, then it so far has turned out not to be as bad as first thought. I agree it can and probably will get worse with the new flu season, but as of now it is not killing thousands. Can it change and do that? Absolutely. But if WHO declares a pandemic now, I think people will be inclined to pooh-pooh it and not take it seriously when it does get worse. WHO loses credibility, and has lost credibility with the public. Is the public right? No. WHO followed their own guidelines pretty well. Maybe their guidelines need to be revised a bit, but on the whole things seemed to progress ok. A full-blown pandemic declaration should probably be reserved for the time when a whole lot of folks have serious illness and their are a lot of deaths. Then people will listen.
Jun 6, '09obama seeks more funds for novel flu fight
there is some very interesting info in this article from cidrap some of which pertains to hcw receiving ppe and antivirals should we need it. most of us realize by now that our workplaces will run out of ppe in a prolonged surge. no facilities have tamiflu allocated for staff at all. that must come from the govt if we are to receive it.
this is a very good summary of what funding is going to be needed. i have reformatted to try to make sense of all the information.
it seems like our public health system will require some major financial support to do the job this winter if the expected surge occurs. they seem to think that it will.
Quote from www.cidrap.umn.edu
president barack obama this week asked congress for another $2 billion in supplemental funds to fight the novel h1n1 influenza epidemic, on top of $2 billion requested a month ago, and also proposed to tap federal economic stimulus funds for up to another $3.1 billion for the same purpose.
in addition, obama proposed to use up to 1% of unspent stimulus funds... that would amount to about $3.1 billion out of the $311 billion...
public health advocates welcomed the administration's new request, but dr. paul jarris, executive director of the association of state and territorial health officials (astho), estimated that a nationwide h1n1 vaccination campaign could cost as much as $15 billion.
... 600 million doses of an h1n1 vaccine—two doses per american—could cost about $6 billion ($10 per dose). administering the vaccine might cost another $15 per dose, or roughly $9 billion, he said.
besides seeking to use some of the stimulus money, the administration is proposing to take money from the bioshield program...at a press briefing yesterday on the h1n1 situation, tfah executive director jeff levi, phd, criticized the proposal to use bioshield money. "the administration proposes to use $2.9 billion from the program to support h1n1 vaccine development," he said. "this means programs for things like anthrax and smallpox will need to be put on hold. this would be robbing peter to pay paul. if we need this money for an h1n1 vaccine, we should appropriate it."
earlier this week, a coalition of groups led by tfah urged the house and senate conferees to adopt the house version of the pandemic funding proposal and add more funds to it.
the coalition's letter to congress said the house's proposed $2.05 billion appropriation for the h1n1 epidemic includes:
$350 million for state and local pandemic preparedness efforts
at least $1.5 billion in flexible funding to the department of health and human services' public health and social services emergency fund, for use to continue building domestic vaccine capacity, replenish and build antiviral stockpiles, and expand
domestic and international disease surveillance
$200 million to support global efforts to track, contain, and slow the spread of a pandemic
the coalition endorsed all of the above items and urged the congressional conferees to consider several other needs it said are not addressed in the current house or senate bill.
at the top of the list was extra money for vaccinations. the group voiced concern that the $1.5 billion in flexible funds in the house bill would not be nearly enough to buy, distribute, and administer a vaccine and set up electronic systems to track the program and monitors adverse reactions. but the letter did not specify an amount.
the coalition also called for:
a contingency fund for the ongoing h1n1 response by state and local governments, to be used in the case of a public health emergency
$122 million to complete state antiviral stockpiles and extend the shelf life of antivirals that will soon expire; the group said more than 8 million treatment courses are still needed to meet the original stockpile goal of 75 million courses
at least $563 million to help states and localities buy personal protective equipment and antivirals for workers in public health, healthcare, and critical infrastructure operations
in a separate letter this week, astho and the national association of city and county health officials also urged the congressional leaders to adopt the house version of the pandemic funding. the letter said state public health agencies spent more than $80 million on the response to the h1n1 epidemic between apr 21 and may 15.
Jun 9, '09Flu patients clog intensive care
Very early this morning while at work, I began reading these reports on Canada with dismay, but I was too busy and too tired to post.
Notice that they are not going to close the schools.
Quote from www.winnipegfreepress.com
There has been a "surge" in the number of people requiring intensive care in Manitoba hospitals with flu-like illnesses, the province said Monday.
As of Sunday night, there were 26 such people in hospital -- more than half of them aboriginal. All were or had been on ventilators due to influenza or of an influenza-like illness. Eight persons with severe cases required hospitalization in the past week alone.
Joel Kettner, chief provincial public health officer, said Monday "most if not all" of the cases are expected to be confirmed as the new H1N1 influenza.
"I expect that there will be many more confirmed cases of H1N1," he said.
Kettner said the number of severely ill persons with flu-like symptoms is greater than what health officials would normally see in a typical flu season.
And, he said, Manitoba seems to be harder hit than other provinces.
He estimated that perhaps five or 10 per cent of Manitobans have been exposed to H1N1 in the past six weeks.
Kettner said the 26 people on ventilators in hospital are "very ill."
"Some of them have been on ventilators for several weeks... The pattern has been so far that many of these patients have required several weeks of intensive care before they have recovered."
He said that in the first week of June, the rate at which people became severely ill with what is suspected as H1N1 was far higher than it was in April or May.
More than half of those in intensive care are First Nations people ...
Jan Currie, vice-president of the Winnipeg Regional Health Authority, said there are normally 30 to 35 people on ventilators in Winnipeg hospitals at any one time for a variety of reasons. The 26 listed by Kettner are in addition to that, she said. The WRHA has acquired 15 extra ventilators and may defer non-urgent procedures that would normally require ICU care. It is also taking steps to provide enough support in intensive-care units and prioritizing patients for personal care home beds.
Meanwhile, the Public Health Agency of Canada has provided three epidemiologists to Manitoba to help assess the province's cases of flu-like illness.
Kettner said only two of the 26 persons in intensive care are of school age. He said there is no reason to recommend any school be closed due to H1N1, adding this would not stop kids from gathering and potentially spreading the virus.
Jim Wolfe, the federal regional director for First Nations and Inuit Health, said Ottawa is working with the province to ensure there are enough doctors and nurses in First Nations communities to deal with an outbreak.
Jun 9, '09http://www.recombinomics.com/news/06..._critical.html
Quote from www.recombinomics.com
currently, there are 26 people - 23 adults and three children - in intensive care units of manitoba hospitals, using ventilators to aid their strained breathing from flu-related reasons.
it is expected many of them will be confirmed as cases of swine flu, or the h1n1 influenza a virus, manitoba's chief medical officer of health, dr. joel kettner, said at a press conference monday afternoon.
another 25 children are in hospitals with respiratory illnesses and are being tested for swine flu, according to health officials.
typically, at this time of year, there are very few - if any - cases of severe flu, said kettner.
the above comments describe the deteriorating situation in manitoba. yesterday, 15 more ventilators were requested as the number of serious swine flu victims grows, media reports indicate hundreds more are sick with mild illness and large numbers of confirmed cases have also been announced in adjacent nunavut (see updated map). patients on ventilators are typically in critical condition, raising concerns of a significant increase in the swine fu death toll in canada.
the sudden jump in serious cases raises concerns that as the virus spreads and cases grow, other communities around the world may face similar episodes.
the serious cases have increase pressure on who to raise the pandemic phase level to 6, signaling the worldwide spread of the virus. although many countries outside of north america are attempting to limit spread through border checks, the virus has already spread worldwide and community spread is largely undetected because resources and testing is concentrated at airports.
as countries focus attention on community spread, the number of confirmed cases will rise dramatically, increasing pandemic concerns.
Jun 9, '09http://crofsblogs.typepad.com/h5n1/2...l-peoples.html
A little ethnic education from crofsblog:
Quote from crofsblogs.typepad.com
I'm a little uncertain about the use of the term "Inuit." The Inuit are an Arctic people, quite distinct from First Nations peoples. (Our current health minister, Leona Aglukkaq, is an Inuk--that's the singular of "Inuit.")
According to PHAC's June 8 update, Nunavut (with an 85% Inuit population) has 25 cases (19 confirmed since June 5), and the Northwest Territories have two.
These numbers are already out of date: CBCnews.ca says today's count in Nunavut is 53, with six hospitalized. The same report also cites Fukuda's worries about Inuit cases.
So something about the Nunavut outbreak may be notably serious. But I'm surprised that Fukuda didn't use a term like "aboriginal." That would include the First Nations cases like those at St. Theresa Point in Manitoba--which are indeed serious, with many band members in hospital on respirators.
Serious H1N1 cases in Canadian Inuits raise concern
Quote from www.cidrap.umn.edu
An official from the World Health Organization (WHO) said today that health experts are closely monitoring novel H1N1 influenza infections in Canada's Inuit populations, following reports that the communities are seeing more than their share of severe cases.
...WHO doesn't know if the trend is linked to socioeconomic factors, genetic factors, or chronic underlying diseases, and commented that Inuit groups were hit hard in some earlier pandemics. Fukuda is the WHO's assistant director-general for health security and the environment.
...health officials in Canada's Nunavut territory today said the number of confirmed novel flu cases has jumped from 25 to 53, with six patients in the hospital, the CBC reported. Nunavut's population is primarily Inuit.
Donald R. Olson, MPH, research director for the International Society for Disease Surveillance, based in New York City, told CIDRAP News that the severe cases in Canada's Inuit populations are puzzling. However, he added that among remote populations, the 1918 pandemic influenza was more severe and didn't follow the age patterns seen in the rest of the world.
"Inuit groups didn't show the same apparent sparing of the elderly, so possibly the older proportion of the population had not been exposed" to previous viruses related to the pandemic strain, he said.
The medical literature tells of "flu orphans" from remote Alaskan villages who survived the 1918-19 pandemic, though their parents and grandparents died, presumably because they had not been exposed to earlier H1-like viruses.
In 2006 at a state summit in Alaska, former US Health and Human Services Secretary Mike Leavitt described the impact of the 1918 pandemic virus on Alaska's native populations. "The Alaska native population in Nome was decimated--176 of the 300 Alaska Natives in the region died," he said in comments posted on the HHS pandemic flu Web site. "The pandemic swept through communities, killing whole villages."
Officials don't know if higher rates of chronic illnesses in today's Inuit populations are playing a role in the high number of severe cases. However, Health Canada reports that when compared to the rest of the nation, First Nations and Inuit people have 1.5 times the rate of heart disease, 3 to 5 times the rate of type 2 diabetes, and 8 to 10 times the rate of tuberculosis infection.
Yesterday, an Australian health expert from Darwin warned that the country's indigenous populations might be at greater risk for novel H1N1 infections.
Besides citing lack of exposure to similar virus and underlying conditions as possible risk factors, experts have also theorized that remote populations might have a genetic predisposition that makes them more susceptible to the virus, Olson said. But he expressed doubt that the factor is playing a role in Canada's current outbreak.
The signals coming out of Canada are worrying, he said. "The less developed world may have a terrible experience with this, though there is a lot of coughing and sneezing in the rest of the world," Olson said.
Danuta Skowronski, MD, a physician and epidemiologist at the University of British Columbia, told CIDRAP News that over the past few years, circulation of seasonal H1N1 viruses in North America has been patchy, and people in remote communities are likely to have had less exposure to the viruses than have people living in urban settings.
There's still much that researchers don't know about possible cross-protection against the novel H1N1 virus from exposure to previous H1N1 strains, she said. Though researchers have identified antibody markers and determined that seasonal vaccination offers little protection, they still haven't gauged the cell-mediated response--which can offer protection during severe infections--afforded by exposure to previous H1N1 strains, Skowronski added.
Public health officials will also be looking for environmental factors that might be contributing to the infections in the First Nations and Inuit groups, she said. For example, large numbers of people living in one household may have greater exposure to the virus. "This all needs to be assessed, because we're picking up possible signals of concern," Skowronski said.
Jun 9, '09"Two hospital doctors are among the latest people confirmed as having swine flu.
Both are doctors at the RAH and are thought to have caught it from patients being treated there, the Scottish Government said." quote from indigogirl's quote in her post.
I wonder if those doctors wore masks and/or had the patients wear their "respirator" type masks.......Last edit by lamazeteacher on Jun 9, '09 : Reason: typo
Jun 10, '09mexico
Quote from crofsblogs.typepad.com
health ministers from 40 nations and senior officials from the world health organization (who) will gather in mexico's caribbean resort of cancun early next month to discuss influenza a/h1n1, the health ministry said on tuesday.
the meeting, slated for july 1-3, aims to share the best practice in tackling the disease, which has infected 26,563 people across 73 nations, including 140 deaths, the ministry said in a statement.
who director-general margaret chan and pan-american health organization director mirta roses are expected to attend the gathering.
participating countries will be those which have been suffering from a/h1n1 flu in recent weeks, though the meeting is also open to other nations that are interested in the outbreak, the ministry said.
if i were running any country on the planet, however poor, i'd find the money to send my best people to cancun.
interesting. the cfr of the 1918 pandemic was supposedly 2%. what are they saying here?
Quote from crofsblogs.typepad.com
h1n1 is still a problem in mexico:
two schools closed in tabasco state due to h1n1.
new outbreak of flu in a jalisco state school.
mexico announces an international meeting on influenza.
a school in gustavo a. madero district has reopened after an outbreak has come under control.
as of monday night, the health secretariat announced that since april 29 when the epidemic began, it has recorded 6,241 cases of h1n1, with 108 deaths. those deaths represent 1.7% of all cases, of whom 51.9% were females and 48.1% males, and 71.3% were between 20 and 54 years old.
as well, 37% of the fatal cases also suffered metabolic diseases such as obesity and diabetes mellitus, 18.5% cardiovascular diseases, 13% "tabaquismo" (tobacco addiction?), 8.3% respiratory problems, and the rest suffered from infectious diseases, autoimmune diseases, and cancers.
that sounds as if no one died outright of h1n1, and it calls into question the theory that mexicans of aboriginal ancestry may have been genetically vulnerable to this new virus. but i may not have translated the report properly, and it may not be accurate in any case.
a very detailed study of mexico's cases and deaths should be a major priority for the immediate future.
Jun 10, '09Swine flu: are we there, yet?
Yes, let's gone on with it.
Quote from scienceblogs.comThe 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.
Listening to yesterday's press briefing with WHO's Dr. Keiji Fukuda...several things seemed clear to me. The first is that everyone, WHO included, thinks a pandemic is well underway. Second, WHO's efforts to explain why they are not making it "official" by going to phase 6 are becoming increasingly awkward and the explanations manifestly tortured. Essentially what Fukuda said was that WHO was waiting for its member nations to signal they knew it was a pandemic and then WHO would say it was a pandemic. It was reminiscent of the cries of one of the principals of the revolution of 1848 as he chased the mob into Paris's Jardin du Luxembourg: "I'm their leader! I must follow them!" Third, despite Fukuda's calm and measured tone, there was an undercurrent of worry. The severity of the not-yet-called-a-pandemic pandemic is now being termed "moderate" (which seems accurate to me). Fukuda explicitly declined to characterize it as "mild." He also called attention to reports of "disproportionate numbers of serious cases occurring" in Canada's First Nation (indigenous) community.
As Fukuda points out, influenza took a heavy toll in isolated and disadvantaged communities in earlier pandemics. This is part of a picture of a well transmitted novel influenza virus, circulating out of season and hitting younger age groups differentially, just what one expects from a pandemic strain based on past experience.
The on-again-now-off-again inclusion of severity as a criterion for a pandemic is currently being spun as a descriptor to give member nation's the best information on the nature of the pandemic they are dealing with. I think that's a sensible attitude, and I don't fault WHO. The politics of any intergovernmental agency, especially in the UN system, produce a difficult and treacherous landscape to negotiate. If you've never seen it close up, it's hard to appreciate the labyrinthine and counter-to-common sense ways of the international community. This is not the UN's fault and certainly not WHO's. It is the system they (and we) are forced to work within, as mandated by the nations of the world. If the space program becomes robust enough, someday you may be able to opt out for another planet. Until then, it's no use complaining.
Meanwhile we now have the long predicted influenza pandemic. It's neither so scary nor so benign that we can afford to either hide under the bed or ignore it. What we must do is roll up our sleeves and manage the consequences.
Jun 10, '09The only thing that I find surprising about the demographic BELOW, is the absence of a large number of cases in African countries. There may be under reporting there, in India, and Sweden, and in Russia and its subsidiaries. New Zealand nurses have reported many more cases, at allnurses.com THIS IS THE PICTURE OF A PANDEMIC!
Jun 10, '09Bingo! You have made an excellent point, lamaze. The African cases are conspicuous by their absence, aren't they?
No doubt the cases are there. The reasons why we are not seeing them? Lack of resources for testing, and lack of motivation for testing ILI most likely. Most of those countries are not going to isolate mild illnesses, assuming that it stays mild, that is.
The First Nation experience in northern Canada might be repeated in Africa as well. Cases are being reported in Egypt, btw but you probably mean the rest of the continent, I am guessing.
The Egyptians are clearly motivated to test. Remember this is the country where in an excess of caution and misguided zeal, they slaughtered thousands of pigs. Fear is a great motivator. Why are they so afraid?
Egypt is the one country with the most cases of bird flu, H5N1 outside of Indonesia. There have been this year alone, 29 cases of H5N1 since January, mostly in kids. Does it mean that only kids are catching it? Probably not! It is endemic in the bird population and the humans are likely passing it around quietly. Kids get diagnosed because parents have been taught to report symptoms, and they want to safeguard their kids. Most recent cases have been mild. It is not always mild as we well know. Most adults with bird flu have died, and that is a fact.
Now, with two different type A influenzas circulating in the same country, Egypt may be a potential breeding ground for a future more virulent form of swine/bird flu if these two viruses co-infect the same hosts, and exchange genetic material. Egypt is well aware of this threat. They are considering all sorts of ways to stop swine flu from spreading. Will they be successful? That will be interesting to see.
Quote from www.google.comhttp://crofsblogs.typepad.com/h5n1/2...1n1-cases.html
...Two more people in Egypt have tested positive for swine flu bringing the total number of those infected in the country to 10, the spokesman for the Health Ministry said Wednesday.
Abdel Rahman Shahine said that the two new cases had recently returned from the United States. One is an Egyptian citizen who has now been hospitalized in Alexandria, while the other - a foreigner-is in a hospital in Cairo.
He did not disclose the nationality of the foreigner.
A student dorm of the American University in Cairo has been placed under quarantine through June 15 after seven Americans, six students and one faculty member, were diagnosed with swine flu on Saturday.
A 12-year Egyptian-American girl returning from the United States was diagnosed with flu on June 2. She has since recovered.
Travellers arriving in Egypt are photographed, their body temperature scanned and addresses taken in case there is a need to follow up with them.
I see from translations at flutrackers.com that the Gulf of Suez Petroleum Company has just announced 9 cases as well. Really, there are probably many that are not diagnosed yet. Yes, this is going to be one country to watch in the next month.
They are considering closing the subway or limiting its use to slow down spread. I did not even know that they had a subway. They must mean in Cairo.Last edit by indigo girl on Jun 10, '09
Jun 10, '09China
Yes, that would be 111 confirmed cases which probably means ten times that suspected. And, if anyone really believes that there are only 111 cases in all of China, I have a bridge to sell you in Brooklyn...
Quote from news.xinhuanet.com
The Chinese mainland reported 10 new confirmed A/H1N1 flu cases Wednesday, bringing the total number to 111.
There have been no reports of deaths from A/H1N1 flu on the Chinese mainland, the Ministry of Health said.
According to the Ministry of Health, 29 confirmed A/H1N1 flu cases have been reported in Beijing, 27 in Guangdong, 18 in Fujian,13 in Shanghai, 10 in Sichuan, four in Hubei, three in Shandong, two each in Zhejiang and Hunan, and one each in Shanxi, Henan and Tianjin.
Of the 111 cases, 58 have been discharged from hospital, the ministry said.
Jun 10, '09By Thursday evening, we'll be in first official flu pandemic in 41 years
Scott, such an optimist, you are. Well, just maybe they will get around to it by tomorrow night. As for panic, that you are right about. No whisper of concern from most places as most people do not get that the WHO has now decided that what was first called "mild" is not so mild anymore. Their description is now "moderate" and that could change as we go along.
How the disease progresses through the developing world may well shape the way history will decribe what happened in 2009.
Quote from www.scottmcpherson.netScott MacPherson is the Chief Information Officer of the Florida House of Representatives.
WHO set to declare Phase Six at emergency meeting in Geneva.
Finally. Tomorrow, Thursday, June 11, 2009, the World Health Organization is expected to relent and finally declare what the world already knows; namely, that we are in the beginning of the first honest-to-God flu pandemic since the 1968 Hong Kong H3N2 influenza pandemic.
Dr. Margaret Chan, the head of the WHO, has been working with nations to make sure a move to Phase Six does not create some sort of bureaucratic nightmare. Also, there has been concern that a move to officially declare a pandemic would provoke some sort of panic.
I think the WHO is seriously underestimating the ability of the world's population to filter that news and absorb it quietly, without panic and without fanfare. The world already suspects that we are in panflu status; telling them they are correct will do far more to reassure people there is no coverup going on than to maintain a Phase Five status that is clearly obsolete.
There have been numerous articles regarding the collective inability of the world's animal health and public health professionals to look for the obvious (hogs) when doing their disease surveillance, and instead become preoccupied with avian flu that is still a threat, just not THE threat right now.
I mention Wisconsin because that state has been a veritable incubator of swine flu. At last count, some 2,200 cases of human swine H1 infection were reported to the CDC. This outpaces California, Texas, Illinois, New York and Florida.
What is fascinating is when you look back at the dispersion of the 1946-49 maybe-pandemic of H1N1. the first big area to be impacted by that epidemic was: The western and central Great Lakes states. That would include Wisconsin and Illinois. If you add up their swine H1 exposure, those two states account for nearly one-third of all US confirmed swine H1 cases. One-third. And the last time I looked, neither state borders Mexico, previously considered to be Ground Zero in all this.
I say "previously considered" because someone needs to formulate a theory as to why Wisconsin is the nation's swine flu capital, while not producing a single human death (so far) from the virus. Why is 2009's flu pattern mimicking that of 1946-48's? Somebody get a study going on that one, pronto.
I'll have more on that later. For now, rest assured that by evening drive tomorrow, and thus on the network news shows, we will be at Phase Six. And Americans, at least, will go on about their business.