Watching the Pandemic Evolve in Utah

oramar · Jun 17, 2009

Our nephew and his family lives in Utah. My grand niece just graduated from high school AND finished 2 1/2 years of chemo for leukemia at the same time. God please take care of her.

indigo girl · Jun 17, 2009

http://www.sltrib.com/news/ci_12603135

Six Salt Lake County residents now have died after testing positive for H1N1 swine flu and nearly 100 have been hospitalized with the novel strain. The past four deaths have occurred in the past week, as hospitals in the valley report being inundated with patients with flu-like symptoms and doctors race to understand more about the new virus.
Nathan Dean, chief of pulmonary critical care at Intermountain Medical Center in Murray and LDS Hospital in Salt Lake City, said about one patient a day has been admitted to the intensive care unit for the past three weeks.Most ICU patients have been overweight, he said, which is puzzling: Their weight isn't causing other health conditions that the federal government says puts people at higher risk of severe influenza complications, such as cardiovascular disease or diabetes, he said.
"I really don't consider being overweight a disease, at least in the patients we're seeing," Dean said. "It's not like they're so [obese] they've gone into heart failure. Somehow, the disease is striking them."
About a fourth of the ICU flu patients have suffered from an inflamed airway, exacerbated by conditions like asthma or emphysema. Nationally, asthma is the most common condition causing hospitalizations.
Other patients end up in the ICU suffering from adult respiratory distress syndrome (ARDS) or septic shock, he said. ARDS is a lung condition that leads to low oxygen levels in the blood, which can harm organs, according to the U.S. Department of Health and Human Services. And while septic shock, which can lead to low blood pressure and organ failure, is normally associated with bacterial infections, doctors aren't seeing such infections with flu patients.
"The virus itself seems to be initiating the septic shock cascade," said Dean, who said the virus reminds him of hantavirus, which is transmitted through rodent urine, droppings or saliva, and can cause acute respiratory distress.
The Centers for Disease Control and Prevention recommend giving antiviral medications only to hospitalized patients and patients with underlying health conditions that put them at higher risk of complications. Doctors should also consider prophylactically treating people who live with flu patients and are at high risk of complications, the CDC says.
But Dean and others say people who have had symptoms of the flu, including a fever, cough, body aches and fatigue, for less than 48 hours should seek medications. "Why not use something you know works?" Dean said.

oramar · Jun 17, 2009

http://www.sltrib.com/news/ci_12603135

This is the first time I heard it was going into ARDS.

indigo girl · Jun 18, 2009

Are we talking about cytokine storm?

http://www.sltrib.com/news/ci_12607907

Two more Utahns have died after testing positive for the H1N1 swine flu, including the first death reported outside Salt Lake County. A Davis County man and a Salt Lake County woman, both between the ages of 25 and 50, died Saturday, bringing the state's total to eight. Five deaths have also occurred among adults in the same age range, and a child under 18 has also died.
Utah has "one of, if not the most, active outbreaks in the country," state epidemiologist Robert Rolfs said Wednesday. And it's not clear why.
» H1N1 is continuing to spread during the summer, when seasonal flu is dormant.» Even if the spread dies down this summer, history shows pandemics return in a more severe form in the fall and winter. "A lot of what we're concerned about is its potential," Rolfs said.
Another challenge around the corner: When the vaccine now in development becomes available, there won't be enough for everyone. "It will have to be prioritized," he said. Federal officials are still figuring out who should get the upcoming vaccine, which would be distributed through public clinics, not private doctors, to ensure the approved populations get it, Rolfs said.
He said people will need two doses, in addition to a seasonal flu shot. And officials will have to maintain public confidence in the vaccine when those inoculated report side effects, he said. In 1976, a mass vaccination against a different swine flu led to reports of people being paralyzed, even as the outbreak never materialized.
Rolfs said there is an "emerging belief" that inoculating school-aged children will limit the transmission in the general population. Health and Human Services Secretary Kathleen Sebelius told the Associated Press she has urged school superintendents to prepare to use their schools as shot clinics if the government decides to mass vaccinate.
Federal officials will decide who should get the vaccine based in part on how the novel virus behaves in the Southern Hemisphere this summer, where the flu season is just starting, she said.
The state health department reported Wednesday that 129 flu patients have been hospitalized. That's 39 more than the last time hospitalizations were reported on Thursday. Four have been among health care workers and 11 patients were pregnant. By comparison, 255 Utahns have been hospitalized for seasonal flu since the end of September.
One theory about why Utah seems to be suffering more from H1N1 is the state's younger population. Older people who have been exposed to several flus appear to have antibodies that help protect them, according to the Centers for Disease Control and Prevention.
Nathan Dean, chief of pulmonary critical care at Intermountain Medical Center in Murray and LDS Hospital in Salt Lake City, also hypothesizes that younger patients are having an "overreaction" to the virus, triggering a "vigorous inflammation response" that can cause septic shock and adult respiratory distress syndrome, which lands them in the hospital.
Local health departments are no longer reporting whether the patients who die have underlying health conditions that would have put them at higher risk for complications. Rolfs said that is because it risks breaching patient confidentiality and it can be seen as blaming the victim. Plus, many Utahns have the risk factors: being pregnant or obese, having asthma or diabetes, he noted.

indigo girl · Jun 19, 2009

Utah health officials won't immediately report flu deaths

http://www.sltrib.com/news/ci_12623865

Well, this is sure something to think about...

Is anyone else feeling a little uncomfortable with this lack of transparency? I do not buy this "complacency" cover story at all.

This is better for who? I really doubt that anyone could get complacent about the untimely deaths of so many young people epecially when it's happening in our own country!!

Not to worry though, if a "whole bunch at once" should die over the weekend, they'll be sure to let us know...

And, if they no longer have to report if the patients have underlying health conditions, then no one is going to know about those that don't, will they?

I get it!

Health officials don't plan to release any more daily death tallies of Utah's H1N1 swine flu victims -- but that won't necessarily mean people aren't continuing to die after testing positive for the novel flu strain.
It's up to the state's 12 local health departments to decide how they report flu deaths. So far, the fatalities have been announced as they are confirmed, with a total of eight -- six in the past week -- since the outbreak started more than a month ago.
But that is changing to just once-a-week announcements: A compilation of deaths and hospitalizations will be put out by the Utah Department of Health on Wednesdays.
The change comes on the heels of a decision to no longer report whether flu victims had underlying health problems that put them at greater risk for serious complications.
An unusual number of deaths may spur an earlier release, officials said. But state health department spokesman Tom Hudachko said a routine daily death report "dilutes" the public health message.
"What we don't want is for the public to start to tune us out, because once that happens we'll have a significant challenge to overcome in the event that things get worse," he said in an e-mail.
The Salt Lake Valley Health Department...agrees.
"That's probably what we'll be doing," said Gary Edwards, executive director of the county health department. "It's better to have a message that focuses on what the public health concerns are, not just the fatality as it occurs," he said. "
Utah is thought to have one of the nation's most active outbreaks, with emergency rooms filled with patients reporting flu-like symptoms and one hospital reporting that it admits one flu patient to the intensive care unit a day.
"If there were a whole bunch of deaths over a weekend, of course we would probably release that information," said Salt Lake Valley Health Department spokeswoman Pam Davenport.

RedWeasel, RN · Jun 21, 2009

(bear with me it is late and I am getting frustrated) This is getting ridiculous. The CDC NEEDS to come out with guidelines, NOW, for the entire country.

1) anyone presenting with a flu like symptom, placed in isolation-no questions-or sent home for 7 days, or wear a mask around others-. They don't have to be tested really-just assume they have it to protect others. I hate to think they won't keep reporting cases because it just tells me they think hiding data will keep public from panicking. Well, I am panicking because they aren't being, as you say, transparent. I want specifics.

2) anyone while in the hospital who acquires a flu-like illness, despite a uti or whatever, needs to be considered as contagious and placed on isolation with gown, gloves, mask, and even face shield if suctioning or close to a coughing patient.

3) Last year with the flu (regular old kind) when patients tested positive they had to stay in their rooms - could not leave them while inpatient. This was when the flu shot had not been accurate enought to cover that strain.

4) Explain to public through commercials (anyone see a commercial for the digital switchover for TV? Yeah, just like that-innundate us with them) these guidelines and need to stay home for the 7 days or whatever, and to explain what happens to people and that it isn't 'just the flu'. 'Just the flu' is half a population immune because they had a shot, which leaves the other 50 percent or so to spread it amongst themselves. No one has immunity now to h1n1. Those who never get flu shots can't rest on their laurels expecting those who did get shots to pick up the slack to eliminate their risk of getting it-because they didn't get a shot (did that make sense? prob not). Instead of only 50% of population to normally look out for, everyone is a vector.

5) no it won't prevent all flus, but it gives us HCWs some control over an unknown. ISOLATION people. Isolation. :) I need to go to bed. I hope I can delete this.....

indigo girl · Jun 25, 2009

http://www.deseretnews.com/article/705312630/2-more-Utahns-die-from-H1N1-flu.html?pg=1

This still seems like a lot of deaths...

"The public remains our most important partner as we respond to this developing pandemic," said Dr. David Sundwall, health department executive director. "One thing we can be sure of is that this virus will continue to change over time and we want to make sure Utahns don't let their guard down in terms of protecting themselves and others."
Officials continue to monitor any changes in the severity of illness that those who contract the virus are experiencing. They are concerned that it may become more virulent in the fall and spread more widely as cold weather begins. If that happens, Utahns may be asked to take additional steps to limit its spread.
"Families should begin preparing for what they would need if they are asked to spend a week away from school, work or other activities. Now is the time to update, or create, your emergency stockpile. Items like food, water, tissue, sanitizers, over-the-counter medications and prescription medications are all useful items to have on hand in the event you become ill and are confined to your home," officials said in a press release.
The Centers for Disease Control and Prevention is now estimating the virus will be a Category 2, which means it has the following characteristics:
Case fatality ratio of 0.1 percent to less than 0.5 percent.
Between 90,000 and 450,000 deaths in the U.S. (compared with estimated 36,000 deaths during a typical influenza season).
Excess death rate of between 30 to less than 150 per 100,000 people.

(hat tip flutrackers/thebes}

indigo girl · Jun 30, 2009

http://www.abc4.com/content/news/slc/story/Possible-swine-flu-outbreak-at-assisted-living/4qIRKplC80Gm9tuLVUGnxQ.cspx

This is exactly what I would expect to see in a nursing home or assisted living facility. The staff getting infected first, and then some of the patients. The staff is younger and this swine flu likes young victims. Now, it will be interesting to see what happens next there. Will other patients get sick or mostly staff? Do the sick residents have other health challenges?

What are the chances that this facility has any N95 masks? I would say slim to none unless the they are ordered to provide them.

They are really going to let employees have 7 days of sick leave? This could get very interesting if any other staff get sick also.

The Salt Lake Valley Health Department learned Monday of a possible, new outbreak of the H1N1 virus commonly called swine flu. Alta Ridge Assisted Living, 1360 East 9400 South, Sandy, reported that several people have “flu like” symptoms. Of those, rapid tests found that four are type “A” influenza. Swine Flu is a type “A” influenza. However, further testing at the state lab is necessary to determine if it is indeed H1N1.
What’s interesting about the possible outbreak is this: Of the four possible cases, three are employees and only one is a resident. Conventional wisdom says that the elderly are most at risk of infectious disease. But Dr. Dagmar Vitek of the health department says this does not appear to be the case with swine flu. “We don't know at this point why the older population is being spared,” Dr Vitek explains. “But we're seeing that the novel influenza circulates among the younger group. Most affected are somewhere between 5 and 30 -- that's the age group that's being affected the most."
That infection profile has been documented around the world. And it could now be playing out in the assisted living facility as well.
Even so, Dr. Vitek and facility managers are taking no chances. Here are precautions already being put in place:
1) Sick residents isolated.
2) Masks worn by both sick residents and employees who work with them.
3) Sick employees ordered home.
Dr. Vitek admits sick leave is a hardship; still it is necessary to prevent further spread. “I know for some facilities it is really difficult when 30% of staff is ill. But the recommendation is that they should stay home for at least 7 days."
Dr. Vitek and her staff will also recommend that those who are showing symptoms be treated with anti-viral medication.