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.
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.
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.
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.
I thought I was a cynic. But, I have learned a lot while reading this thread. Though, none of what I've learned is really related to pandemic flu. I am now somewhat less naive. I regret that small loss of innocence.
"pp should avoid heavily populated crowds" quote from Silver girl
VP Biden is known for speaking his mind before figuring out the consequences for himself, since his viewpoints didn't mirror those announced by CDC and WHO (although they did say that later). While no one really thought he was wrong about what he said, the view taken by politicians, is that he should be sure of the policies made by official agencies, before issuing his own to the public. Stepping on toes of those in charge is a faux pas, the risk for which most politicians avoid.
Well, I knew the facts before he spoke his mind, and I'd been recommending the same thing for a few days - but then I have no political position to uphold.
I thought I was a cynic. But, I have learned a lot while reading this thread. Though, none of what I've learned is really related to pandemic flu. I am now somewhat less naive. I regret that small loss of innocence.
I am sorry for that loss, and it's probably bigger than it seems. When the White House holds its press conference on Swine Flu, it might be somewhat harder to hear it in exactly the same way. Political decisions really can make things worse.
It would be helpful to hear something more realistic like what is proposed in the link below. This whole article is mostly about containment which was not the strategy in the US but still is elsewhere. It is only the last part of the article that I have highlighted because it is exactly the type of communication that the public does need from govt.
For the U.S. population of 300 million, we should be planning for 100-150 million swine flu cases, of which we have experienced roughly one million so far.
Few governments anywhere in the world are working hard to give their people an accurate impression of how pervasive swine flu is expected to be.
When we talk to friends and acquaintances, we sometimes probe for this understanding. Almost invariably, it's not there. Most of the people we talk to get it that swine flu isn't over; they think it has receded from the northern hemisphere for the summer but is expected to return in the fall.
But since almost every swine flu news story they've ever seen or heard featured some small tally of confirmed cases (local, statewide, national, international), they grossly underestimate the actual number of cases so far. And since no news story they've ever seen or heard has explained that pandemics spread like geometric progressions (maybe even fractally), they picture it returning in the fall pretty much the way they think it was this spring, with cases by the handful, not by the busload. Even those who understand that pandemic H1N1 might turn more virulent haven't quite absorbed that, virulence aside, H1N1 is expected to get much, much, much more prevalent.
And that's in the United States, where swine flu was confirmed first, where it has been confirmed most often, and where the government has been candid about the fact of community transmission from Day One.
So we still see many headlines like this one, from a June 20 article in a western New York State newspaper: "More Swine Flu Cases Possible in Tompkins County."
And we still see passages like this one, from a June 18 article in a Minnesota newspaper:
Do not panic.
Do prepare and be thinking about how your family and business might deal with a seriously threatening local H1N1 flu outbreak.
It's not here yet, thank goodness. It might not come.
That wonderful second paragraph, caught between those two awful paragraphs!
One of the most important things for people to know about the swine flu pandemic is that it's just starting. It may or may not get a lot worse in terms of virulence, but it almost certainly will get a lot worse in terms of pervasiveness.
So how bad is it to go through a pandemic that infects one-third to one-half of the population over a couple of years? After all, the ordinary seasonal flu is estimated to infect 5 to 20 percent of the U.S. population every year, most of them in the winter - and we get through that without much fuss.
Nobody has the answer to that key question. Nobody even knows whether the pandemic toll will come on top of the seasonal flu toll, or whether pandemic H1N1 will crowd out one or both of the two seasonal influenza A viruses that currently circulate every winter. Nobody has any real idea what the population burden of influenza will be for the next couple of years, but it is likely to be much greater than average.
Will it get bad enough to overwhelm healthcare facilities? Nobody knows. But hospitals in cities like Rochester (New York) and Winnipeg (Manitoba) have already reported being overwhelmed by the comparatively few severe swine flu cases they have faced so far.
Will it get bad enough to shut down factories, schools, and essential services due to absenteeism? Again, nobody knows. But some local ambulance companies have already reported limited service because of swine flu absenteeism. And today's just-in-time supply chains are fragile. If too many coal miners or railroad employees call in sick with the swine flu at the same time, coal-fired power plants could run out of fuel and major cities could go dark. If the factories in developing countries that manufacture surgical masks and generic drugs can't operate or can't ship, U.S. hospitals and pharmacies could find themselves with empty shelves. These are just "tip of the iceberg" examples of possible supply chain problems in our globalized just-in-time economy.
It's hard to find this kind of information in the mainstream media. Official sources aren't stressing it, and most journalists aren't looking for it. (Readers who think the media invariably sensationalize risk might pause to consider this.)
There are exceptions. On June 22, a New Zealand Ministry of Health official speculated that up to half the country's population could be infected over the next few months. The same day, an official from the Philippines Department of Health speculated that 90 million Filipinos - 25 percent of the population - might get swine flu over an unknown time frame.
These are two rare examples of officials quoted in the mainstream media of their countries, trying to tell people what to expect during the pandemic of 2009, based on knowledge from the pandemics of 1918, 1957, and 1968. Few other officials have done likewise, and few other mainstream media have picked up these sorts of numbers.
How many deaths do these sorts of numbers imply? Let's speculate that the current virus will turn out roughly as virulent as the seasonal flu - no worse, but no better. Mortality from the seasonal flu is thought to be around 0.1 percent, one death for every thousand cases.
So if pandemic H1N1 ends up infecting one-third of the world's 6.7 billion people and killing 0.1 percent of those it infects, we can expect 2.2 million swine flu deaths in all, worldwide. WHO has recorded 263 of those deaths so far.
Based on the same assumptions, the U.S. can expect 100,000 of its 300 million people to die from pandemic H1N1. That's about three times as many as die from the seasonal flu every year - and it will be mostly young people, not mostly the elderly. The CDC has recorded 127 of those 100,000 deaths so far.
That's what we probably face if swine flu remains "mild." Swine flu risk communicators should be helping people visualize these things, vividly, so we can all start preparing - emotionally, cognitively, and logistically.
The original source of this article is very slow loading for some reason so I am using the flutracker post of it as it does contain the full text.
What they did in the UK might be interpretated as poor risk communication. They went from containment as if it was really possible to telling people the numbers with nothing in between that I could see. So, yes they are going to be in shock...
Over 100,000 cases per day? Holy cow!
They are going to have a vaccine available by next month? That seems awfully quick.
Health Secretary warns Commons that more than 100,000 new cases could be reported each day by the end of August.
The number of swine flu cases could reach more than 100,000 per day in the UK by the end of next month, Health Secretary Andy Burnham has warned.
The UK has moved past the stage of containing the flu outbreak and into the "treatment phase", Mr Burnham said. "We have reached the next stage in management of the disease."
"The national focus will be on treating the increasing numbers affected by swine flu," he added. "We will move to this treatment phase across the UK with immediate effect."
There are now 7,447 laboratory-confirmed cases in the UK, he told the Commons on Thursday. About one-seventh of the total is in Scotland.
Mr Burnham said that last week saw several hundred new swine flu cases.
He added: "We have now signed contracts to secure enough vaccine for the whole population."
The first will become available next month, with 60 million doses available by the end of the year.
Predicting the huge daily rise in new cases, Mr Burnham said: "Cases are doubling every week and on this trend we could see over 100,000 cases per day by the end of August."
Efforts to trace people who have been in contact with swine flu cases will stop and schools will not need to close when hit by the virus, unless particular circumstances make it necessary.
Scottish Health Secretary Nicola Sturgeon, at a news conference in Edinburgh, said: "In recent weeks we have, as expected, seen a significant increase in the number of cases of pandemic flu throughout the UK.
"Given the number of cases, and the evidence of community transmission, we believe now is the right time to move to the treatment phase of dealing with the pandemic.
"It simply means that we are seeing a rise in the number of cases and are adapting our approach to dealing with these.
"I would again reiterate that the risk to the general public remains low. Fortunately, the vast majority of people who get this virus experience only mild symptoms."
On Wednesday, the Scottish Government said the number of cases have surged to 1,217 overall, including two deaths.
I am shocked once again. The new numbers are out from the CDC. Two states next to us are at 3166 and 5866 I think-and our state? Still at 92-it has been 92 for the last month I think. Seriously. That tells me how much they care about us-they aren't even testing us. I know it. Which means-not thinking about it-which means we will be exposed as HCWs to the virus since they aren't being isolated. I am almost furious. 92 pffffft!!! I know lots of people are getting sick, but not tested. Fine if they go home from work and stay there, but if in our hospital, I want protected. EEEjits
Please be part of the solution, and write to your Governor and other government representatives about your state health department's neglect, in regard to the reporting of all cases of patients with "flu-like symptoms", with or without test results. Since so many false negative results occurred, it isn't necessary to test people with flu-like symptoms. IT IS NECESSARY TO REPORT CASES WITHOUT TESTING, to the public health department in each county.
Send copies of your letter to hospital infection control nurses and committees, newspapers in your state, and to WHO!
Yeah, I already got info from our county health dept on THursday and sent a few questions and observations. Yeah, if anything, they will know we are paying attention. I guess I don't care if we test really. I just want to isolate those with s/s. But it looks weird to have the exact same number for the last month.
Yeah, I already got info from our county health dept on THursday and sent a few questions and observations. Yeah, if anything, they will know we are paying attention. I guess I don't care if we test really. I just want to isolate those with s/s. But it looks weird to have the exact same number for the last month.
It's definitely weird that the number didn't change. Either someone hasn't got their "ear to the ground", or no one has been assigned to maintain stats. If I wasn't getting reports (theoretically, as the statistician for the PHD) from hospitals, doctors' offices and Public Health clinics, I'd be calling them to find out why........
Those with s/s may be going to work in order to stay employed, as the only earner in the family. It's hard to disguise coughing, though. Going to get medical care for the uninsured may be so prohibitively expensive, that they bear their illness at home, without going for care early enough to be effectively treated with Tamiflu. Those are the ones at greatest danger of having extensive resp. complications and possibly death!
This is the report from the USA's Communicable Disease Center (CDC) for this week
"During week 25 (June 21-27, 2009), influenza activity decreased in the United States, however, there were still higher levels of influenza-like illness than is normal for this time of year. "
It seems to be more active in the southern hemisphere, with South America and Africa (below the equator) having their seasonal turn with the flu.
indigo girl
5,173 Posts
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-forum/pandemic-awareness-preparation-361932-page10.html
(see post #96)
https://allnurses.com/pandemic-flu-forum/pandemic-awareness-preparation-361932-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.