What to look for in August....

[Jeremy]

Re: What to look for in August....

I have'nt seen any reliable data on hospitalizations by month for the three previous pandemics, but I think we are comparing apples and oranges.

As the famous saying goes, "if you have seen one pandemic, you have seen one pandemic". You just cannot compare the existing Swine Flu virus with any others. It has its own characteristics and future, and it will let us know what that will be in the months ahead.

Well if we are comparing apples to oranges and as you have said "if you have seen one pandemic, you have seen one pandemic" then you really can't go on hospitalization rates for the first wave as a predictor of future events because we have nothing to compare it too.

And while the majority have recovered without medical assistance I believe this also happened in 1918, 1957, and 1968.

 

[wotan]

Re: What to look for in August....

Well if we are comparing apples to oranges and as you have said "if you have seen one pandemic, you have seen one pandemic" then you really can't go on hospitalization rates for the first wave as a predictor of future events because we have nothing to compare it too.

And while the majority have recovered without medical assistance I believe this also happened in 1918, 1957, and 1968.

I have always had a hard time locating info on 1957 and 1968, but my understanding is that vast majority of cases in 1918 had "mild" illnesses and recovered just fine.

 

[Mamabird]

Re: What to look for in August....

Well if we are comparing apples to oranges and as you have said "if you have seen one pandemic, you have seen one pandemic" then you really can't go on hospitalization rates for the first wave as a predictor of future events because we have nothing to compare it too.

And while the majority have recovered without medical assistance I believe this also happened in 1918, 1957, and 1968.

I agree with our inability to use this information as a predictor of future events, that is why it is so frustrating to see posts about how this virus is right on track with 1918. Thus far, this virus is not even on track with the severity of seasonal flu, and for it to get nasty, it needs to change characteristics, i.e. its genetic blueprint.

So, we need to remain vigilant in our monitoring, and the more sequences the better, but the Southern Hemisphere's flu season has not been as bad as many expected. This likely means the virus remains stable and has not yet mutated.

Will we see a lot of illness in the US in the coming months? For sure, because we have little immunity to this new pathogen. Will we see a lot of deaths? Perhaps, but only if the virus materially changes in the coming weeks.

 

[Jeremy]

Re: What to look for in August....

I agree with our inability to use this information as a predictor of future events, that is why it is so frustrating to see posts about how this virus is right on track with 1918.

Personally, I do not see much evidence that we are on an exact track with 1918.

There are certain similiarities, some sudden deaths, attacking the young, it is an H1N1, etc.

And there are a lot of unknowns....both the good and bad news is that we won't have to wait much longer to find out where this is headed. (I have always been a little impatient anyways )

 

[Hogweed]

Re: What to look for in August....

that is why it is so frustrating to see posts about how this virus is right on track with 1918. Thus far, this virus is not even on track with the severity of seasonal flu

Is it not true that most medical authorities said the equivalent of "this virus is not even on track with the severity of seasonal flu" as late as this day August 19th 1918?

 

[Jeremy]

Re: What to look for in August....

Is it not true that most medical authorities said the equivalent of "this virus is not even on track with the severity of seasonal flu" as late as this day August 19th 1918?

I wouldn't say that....the director of DHS said they are expecting a "severe" pandemic.

That would make it much worse than the seasonal flu.

 

[Hogweed]

Re: What to look for in August....

I wouldn't say that....the director of DHS said they are expecting a "severe" pandemic.

That would make it much worse than the seasonal flu.

Although I didn't say it, I was quoting Mamabird and just pointing out that at this stage in 1918 absolutely nobody thought there was anything serious to worry about.

 

[Mamabird]

Re: What to look for in August....

Is it not true that most medical authorities said the equivalent of "this virus is not even on track with the severity of seasonal flu" as late as this day August 19th 1918?

There are archived news articles from early 1918 that say exactly that.

Since most medical authorities had little experience with pandemics or what exactly caused them, they were clueless as to the ugliness that awaited them just a few months later.

 

[Jeremy]

Re: What to look for in August....

Although I didn't say it, I was quoting Mamabird and just pointing out that at this stage in 1918 absolutely nobody thought there was anything serious to worry about.

My bad...looking back at your statement now I see what you were implying...correctly I might add.

 

[sbrooks]

Re: What to look for in August....

We're in the last few days of august,

there have been some quick outbreaks in colleges and schools. While the
weather has been unseasonably cool in parts of the midwest, we have not seen big outbreaks in coastal cities. So far the southern hemisphere
seems to have handled the virus.

I'd say for the moment its been a quiet august......a calm before a storm?

 

[Snowy Owl]

Re: What to look for in August....

When I format this long Military report It had developed a feeling of pandemic dynamics.

These datas set the Perspective,

Disease Pattern just Previous to 1918 Pandemic

Snowy Owl

 

[cozodapo]

Re: What to look for in August....

In August of 1918 a British troop ship docked at Freetown for coaling. A few days later, according to the British Colonial medical officer, absenteeism among the coalers was the first indication that something was wrong. A few days later, the medical officer was reporting a febrile respiratory illness that killed healthy young people within 36 hours.

The profile of the outbreak in Freetown was very similar to those seen in London and New York. It evolved rapidly and was largely over in a month. An estimated 1000 people died in Freetown, and many were buried in a mass grave in the Ascension Town cemetary on Kinsella Road.


The Colonial Medical Officers Report [ The Sierra Leone Royal Gazette. Saturday 9 November 1918 XLIX, No. 1780, p.729-733, ] deals only with the tip of the iceberg. Many people fled the capital, returning to their villages around what was then a Protectorate. This had a drastic impact on rice production the following year, leading to serious food shortages and riots in the capital.

Since Freetown was, and still is a major deep water port, it was a key stop on British and other shipping routes. At the time, much of the traffic was returning soldiers from the war to their respective home country.

Here is an excerpt from a book containing a more detailed historical account of the African situation.

Freetown is also on a major migratory bird flyway and its unique coastal mangrove swamps are a stop off point for hundreds of thousands of migratory birds. See this previous discussion thread.

"In late August 1918 (Roughly August 22nd), the second wave of the Spanish flu struck three port cities at nearly the same time. These cities (Boston, United States; Brest, France; and Freetown, Sierra Leone) all felt the lethalness of this new mutation immediately"

​

Without modern air travel the most logical conclusion, for the reason these three cities could got hit at the same time, is if the virus was already "seeded" or present in these locations.

With 2009 H1N1 already seeded, and the second wave almost upon us, I think we should all be on the lookout for the parallels to 1918. For August may very well be the Witching Hour...

 

[wdcare]

Re: What to look for in August....

A friend's job takes him to numerous medical offices in North Alabama. Today he said the parking lots were all packed. Sick children even with temps of 105F are being sent home with Tylenol and Tamiflu. A child died today in Scottsboro, AL, and 2 others in last few days in Mississippi. Parents must feel frantic!

 

[Rainbow Lake]

Re: What to look for in August....

The most recent WHO update (update 63, 28 Aug 2009, http://www.who.int/csr/don/2009_08_28/en/index.html) shows that Mexico is one of the two places in the world (at least of those brave enough to report it )showing VERY HIGH intensity* levels of acute respiratory disease*.


WHO MAP LINK to INTENSITY* OF ACUTE REPIRATORY DISEASE

* Intensity is an estimate of the proportion of the population with acute respiratory disease covering the spectrum of diseases from influenza-like illness to pneumonia (WHO's definition)

http://gamapserver.who.int/h1n1/inte...opulation.html

I fear that this could be Mexico's SECOND WAVE.

Will the second waves appear in order of first wave infection? Should we be looking at New York, Chicago, etc.for second wave activity?

 

[tesseract]

Re: What to look for in August....

Interesting thread, lots of good viewpoints to make one *think*.

Reading it, I have several thoughts - 1st, in response to this:

The more I think about it, the more I am thinking that it is highly likely that, if we are going to see a 1918 repeat, we will see an increase in reports of "lethal disease" outbreaks that don't seem to look like the current "mild" 2009 H1N1 influzena.

At first most reports will most likely not call it the flu, because it is killing to fast or causing hemorrhagic type symptoms. The tests might not come back positive for 2009 H1N1 because it may have mutated around the tests, which might cause delays reports.

The reason we know that the virus popped up all over the place at the same time in 1918 is because researchers scowered news articles and were able to put together the puzzle after the fact based on the symptoms and news reports.

I think for the next 6-8 weeks we should be even more suspect about "lethal disease" outbreaks than we have been.

Because the simple fact is, right now people have been hearing about this "mild" flu so the symptoms of a 1918 type repeat will not look anything like the "mild" flu so it most likely will be missed at first.

You wrote this almost a month ago - yet it reminded me of what happened to a young teen here in Mississippi last week:

http://www.vicksburgpost.com/articles/2009/08/29/news/doc4a98ad075cb1b872931274.txt

From that article:

Wesley, of 35 Round Alley, began to complain of not feeling well Aug. 21, said his grandfather, Wesley Brown. He was taken to a clinic Monday, and returned to school Tuesday. He also went to football practice that afternoon, but the family took him to River Region Medical Center?s emergency room Tuesday night. Wesley was treated for sinus drainage and given a prescription for Zyrtex, an antihistamine, said his aunt, Mary Wyatt. X-rays or lab tests were not done, Wyatt said.

Still not feeling well Wednesday, Wesley stayed home. Wyatt made an appointment for him to see a doctor at the Street Clinic Thursday morning.

On the way to the doctor, Wesley said he could not see and was very weak. He was taken in a wheelchair to a small examining room, where Wyatt said she became concerned that he was not breathing. She called clinic staffers, who placed Wesley on the floor and began ?pushing on his chest. There was blood everywhere,? coming from his mouth and nose, she said.


Wesley died around 9:30 a.m. in a small waiting room detached from the main waiting area, his grandfather said.

As of yesterday, the State Coroner's office said that preliminary testing had come back negative for H1N1, but that CDC would do further testing. I hope this is just some weird case - and not indicative of what you described several weeks ago!


2.) Also, the last two weeks of August in Mississippi has seen a huge uptick in the number of ILI cases. For example, as of 8/18, the Mississippi Healthy Schools site had 149 reported ILI. 10 days later, on 8/28, that number had increased to 2092. K-12 here in Mississippi started back on 8/10.

Most of the Universities here started back the next week - 8/17. MSU had 6 ILI cases on 8/18. Last week those numbers began swinging up - 100 on Wednesday, 200 on Thursday and 300 on Friday. Other colleges are reporting cases now as well (I have two teens on college campuses in Mississippi - neither are at MSU, but both are reporting 'swine' flu at their respective campuses). My oldest, is at Southern Miss - which reported as of last week 2 confirmed cases, 10 ILI...my son says it's more like 50 though now.

Also in Mississippi - 2 Teens and 1 child have died from ILI in the past month. 2 are confirmed H1N1. The third one is the one in the article above - no confirmation as of yet.

Just thought this was interesting considering the title of this thread.....

 

[tesseract]

Re: What to look for in August....

Also, I'd love some input from some of you on those "36,000 - 60,000" a year numbers we've heard so much about.

I am a numbers person as well. Helps me to 'see' the picture. So I started doing some research on this. I found the data breakdown - by age and coding - for 2002 and for 2005. Very interesting indeed.

Here's 2002:

http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_05.pdf

Go to page 31 of this pdf. This reports the influenza deaths from 2002 - this is for the ENTIRE COUNTRY:

Influenza . . . . . . . . . . . . . . . . . . . . . . . . .
All Ages: 727
Under 1: 7
1-4 Years: 5
5-14 years: 12
15-24 Years: 7
25-34 Years: 4
35-44 Years: 8
45-54 Years: 17
55-64 Years:30
65-754 Years: 56
75 - 84 Years: 177
85 and over: 404

Besides the obvious fact that 90% of the deaths are older than 65...that total is a lot smaller than 36,000. Of course, the Pneumonia total is much higher!

So look at the codes. The coding definitions are here: http://apps.who.int/classifications/apps/icd/icd10online/

J10-J11 are for Influenza

J12 - J18 are for Pneumonia - most interestingly, J12 specifically states: Viral pneumonia, not elsewhere classified; Includes: bronchopneumonia due to viruses other than influenza viruses; Excludes Influenza
J13 - J17 are very specific (not Influenza) and J18 is the catch all.

So how many of the deaths in 2002 were coded J18? Also, I wish I could what months these occurred?

Here is the data for 2005:

http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf - go to page 33

 

[Farmer]

Re: What to look for in August....

Also, I'd love some input from some of you on those "36,000 - 60,000" a year numbers we've heard so much about.

I am a numbers person as well. Helps me to 'see' the picture. So I started doing some research on this. I found the data breakdown - by age and coding - for 2002 and for 2005. Very interesting indeed.

Here's 2002:

http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_05.pdf

Go to page 31 of this pdf. This reports the influenza deaths from 2002 - this is for the ENTIRE COUNTRY:

Influenza . . . . . . . . . . . . . . . . . . . . . . . . .
All Ages: 727
Under 1: 7
1-4 Years: 5
5-14 years: 12
15-24 Years: 7
25-34 Years: 4
35-44 Years: 8
45-54 Years: 17
55-64 Years:30
65-754 Years: 56
75 - 84 Years: 177
85 and over: 404

Besides the obvious fact that 90% of the deaths are older than 65...that total is a lot smaller than 36,000. Of course, the Pneumonia total is much higher!

So look at the codes. The coding definitions are here: http://apps.who.int/classifications/apps/icd/icd10online/

J10-J11 are for Influenza

J12 - J18 are for Pneumonia - most interestingly, J12 specifically states: Viral pneumonia, not elsewhere classified; Includes: bronchopneumonia due to viruses other than influenza viruses; Excludes Influenza
J13 - J17 are very specific (not Influenza) and J18 is the catch all.

So how many of the deaths in 2002 were coded J18? Also, I wish I could what months these occurred?

Here is the data for 2005:

http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf - go to page 33

tesseract,

The 36,000 estimate is drawn from this 2003 JAMA article: http://jama.ama-assn.org/cgi/content/full/289/2/179

 

[Niko]

Re: What to look for in August....

tesseract,

The 36,000 estimate is drawn from this 2003 JAMA article: http://jama.ama-assn.org/cgi/content/full/289/2/179

Per CDC (http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm)

What are flu-related deaths?

Flu-related deaths are deaths that occur in people for whom influenza infection was likely a contributor to the cause of death, but not necessarily the primary cause of death.


...which is precisely why it is so misleading for news reports to throw out the 36,000 number when reporting on young healthy people dying from flu.

 

[Science Teacher]

Re: What to look for in August....

September begins fairly quietly.
Watch for increasing numbers of H1N1 clusters, mostly in school children.
Watch as it spreads from the children into the families then stretches far out into the community.
Watch as this disease grows deadlier; fatalities increase.
Watch as hospitals become overwhelmed.

Watch, hope, pray and most of all, be prepared in your homes.

 

[tesseract]

Re: What to look for in August....

Thanks Farmer - but I cannot read the article. I now do see where you have part of the article posted on page 2 of this thread.

The conclusion posted is:
"Influenza viruses and RSV, respectively, were associated with annual means (SD) of 8097 (3084) and 2707 (196) underlying pneumonia and influenza deaths, 36 155 (11 055) and 11 321 (668) underlying respiratory and circulatory deaths, and 51 203 (15 081) and 17 358 (1086) all-cause deaths."

So, the analysis was that influenza was a leading factor.

Niko - thanks for the input regarding contributing versus primary. That was how I interpreted the National Vital Stats data. The ICD coding specifically separates Influenza and Pneumonia - noteworthy is that the coding for Influenza does not exclude Pneumonia, but is still tracked separately. Is it because the Pneumonia coded deaths (all but one of those do exclude Influenza) may have Influenza (J18) as a contributing factor, but not primary? There must be some reason to track those separately and very detailed at the sub code level. I guess one could also suggest that not all Pneumonia deaths tested positive for flu, but that doesn't necessarily mean flu didn't contribute (i.e., at time of testing, flu wasn't present, but doesn't the patient didn't have it before time of testing, right?)

I agree with your point about young healthy patients! ETA: I remember reading an article yesterday where an ICU doctor who had been treating H1N1 patients made a comment about how he was amazed at their (medical staff) inability to oxygenate these patients - and that he had never seen anything like that before.