One Year Ago

[indigo girl]

A year ago on the blog : Effect Measure

It was a year ago today we put up our first post about swine flu: "The California swine flu cases." I think we were the first blog to notice it, and it began this way:

Late yesterday afternoon a Morbidity and Mortality Weekly Report (MMWR) Dispatch appeared on CDC's website that is unique in my experience. MMWR is usually heavily vetted and edited and nothing gets out of there fast. Indeed, in recent years, nothing at all got out of CDC very fast. And yet here is this Dispatch, with text referring to the same day of issue (April 21), reporting on two young patients with febrile respiratory illnesses, one of whose cases CDC only learned about on April 13, 8 days earlier. April 17 CDC determined that the two children, both from the San Diego, California area, were infected with a swine flu virus of a novel kind. (Effect Measure, April 22, 2009)

It was not at all clear what was happening, but the speed with which these cases were published was a warning flag that it wasn't business as usual.

Then news of the Mexican cases blew things wide open:

Late yesterday we summarized a CDC media briefing about the developing investigation of cases of influenza in California and Texas with a previously unknown flu virus with genetic components from pigs ("swine flu", humans and birds). At the same time reports were surfacing of an especially virulent respiratory disease outbreak in central and southern Mexico that had resulted in 20 deaths and hospitalizations with acute respiratory failure. 137 cases have been reported, including health care workers. When asked yesterday, CDC said they were in close touch with their Mexican counterparts but at that point had no evidence of a connection.

...easy to declare in hindsight that those who knew the most about flu overreacted. If you say it that way it is clearer that the alarmed reaction wasn't because public health authorities didn't know what they were doing but was because they knew more about flu than everyone else. Pandemic flu is always pregnant with possibilities and the ones that deserve the most attention are the ones that are dire. Would you have it any way?

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.

[indigo girl]

Portrait of a Year Old Pandemic

Portrait of a year-old pandemic : Nature News

Declan Butler is a science reporter for the journal, Nature, well known for his early coverage in 2004, of the H5N1, bird flu threat. Here he provides a balanced view on our first year of the current ongoing pandemic of H1N1. The lessons learned are important, and will be used to guide public health response for the next inevitable pandemic, hopefully with these issues either solved or at least prepared for as we know more about what needs to be done.

...the number of life years lost was around a quarter more than usual because the 2009 pandemic deaths were skewed towards younger ages than seasonal flu (see 'Deaths and years of life lost from influenza'). Under a less conservative estimate, based on comparing overall mortality during the pandemic with mortality over the same period in previous years, excess deaths numbered 44,100, surpassing those of a typical flu season. Years of life lost were three to four times higher than a virulent H3N2 season and five times higher than years of life lost to seasonal H1N1 and B viruses-of the same order as the 1968 flu pandemic.

Will there be more waves of infection?

Probably. In past pandemics, infection and illness have come in waves over a period of several years, and later waves are often more severe. "We are in a pandemic period of 2 to 5 years and must continue to keep our guard up," says Lone Simonsen, a flu expert at the Research and Policy for Infectious Disease Dynamics (RAPIDD) programme, a collaboration between the NIH Fogarty International Center and the science and technology directorate of the US Department of Homeland Security.

This winter saw little flu overall in the Northern Hemisphere. Outbreaks of pandemic flu are currently occurring in some of the tropical zones of the Americas, west and east Africa and southeast Asia, in particular Thailand and Singapore, but at low levels. With winter approaching in the Southern Hemisphere, the question of whether a new pandemic wave will hit countries there will soon be answered.

(hat tip Avian Flu Diary)

[oramar]

Was just thinking about that. One week I am reading articles saying what a mild winter flu season it has been, then POW.

[indigo girl]

Coping With Swine Flu Down Under

Coping with swine flu down under last year : Effect Measure

What are we to make of the swine flu pandemic? The only thing I feel confident about is that it will be some time before we really know. A great deal of data and experience was gained in the year since the pandemic H1N1 took everyone by surprise but it will be a while before we can harvest all of it. Meanwhile I can say things were better than we thought they might be and certainly better than everyone's worst fears, but how much better -- better, how bad -- they were we just don't know. It was a very good year for people in my age category (over 65) as for reasons now becoming a bit clearer we were least susceptible. In ordinary flu years we are the most susceptible and we die in large numbers. This last year it was the young most at risk. The numbers of flu deaths overall don't tell the complete story, nor does the fact that many hospitals seemed able to cope. In Australia and New Zealand in the southern hemisphere who got the first full flu season with the virus, they almost didn't cope:

"If we had had any greater activity of that virus we would not have been able to offer that service [to everyone]."

Unlike normal flu seasons, it was predominantly younger people with no underlying symptoms who needed intensive care, Dr Seppelt said.

Wellington Hospital intensive care unit director Peter Hicks said he had "never seen anything like it before where we've had a disease that's so significantly impacted all the intensive care services across the two countries".

New Zealand hospitals had not had to turn people away from intensive care units but "it got close". (Kate Newton, The Dominion Post)

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.