H1N1 pandemic -- progression

[fuji]

So as time goes by we get more data. In Canada specifically H1N1 is killing 1 person in 250 who contracts it, and hospitalizing 1 in 11.

Meanwhle we have only around 3500 to 4500 mechanical ventilators in all of Canada, meaning we will run out if we have a caseload of around 50k people at which point the fatality rate will rise significantly above 1 in 250. Left on its own this would likely eventually result in some 50-100k deaths in Canada.

H1N1 has been primarily killing healthy people between the ages of 5 and 40, and hitting native Canadians and pregnant women especially hard. Meanwhile UW-Madison researchers have concluded that the reason why H1N1 is more virulent than ordinary flu is that it has the ability to infect the lungs, which is unlike ordinary flu, but like the 1918 pandemic.

Final bit of H1N1 news--there have been problems producing the vaccine. Yield from the normal process used by most vendors has been half of the yield they expected, meaning that sufficient quantities of the vaccine may not be on hand when the flu season arrives in November.

We will see--presumably there will at least be enough vaccine to innoculate the hospital workers themselves and keep the bulk of the healthcare system intact. That's important because in past pandemics there have been problems with hospitals having to close just when they are needed most, for lack of sufficient healthy staff.

There have now been 211 deaths in the US up from 37 deaths a month ago. A little lower than the 330 deaths I had predicted a month ago in debate with train based on simple extrapolation of its growth rate--but then again this is Summer, and it's not expected to pick up full steam until Fall.

So where is train? Almost exactly one month ago you were crowing that it had only killed 37 in the US. Now that the deaths have increased six-fold in one month how are you feeling about H1N1? Do you figure it will increase six-fold again and we'll be at 1200-1300 deaths by next month?

The race for the vaccine is on. If the vaccine comes out in time for flu season and we innoculate enough people we could stop this before it gets worse, but left to its own devices, it very clearly is getting a lot worse and quickly.

 

[cyberdoc]

In an effort to shed more light on the subject, I offer the following:

Flu still in it's early stages, from recombinomics.
This is very similar to 1918.
http://www.wpxi.com/video/19313969/index.html

Recombinomics credentials
http://www.recombinomics.com/founder.html

Flu Pandemic Timeline / Event Dynamics
http://www.globalsecurity.org/security/ops/hsc-scen-3_flu-pandemic-timeline.htm

Flu World Tracker
http://flutracker.rhizalabs.com/

Novel H1N1 Flu Situation Update CDC site
http://www.cdc.gov/h1n1flu/update.htm

Cytokine Storm and role in influenza death
http://en.wikipedia.org/wiki/Cytokine_storm

Relenza:
http://www.relenza.com/

Tamiflu
http://www.tamiflu.com/

I am posting this information now, because I anticipate the flu will return to North America in a more virulent form, and I do not anticpate posting very frequently going forward. My advice to terb members is to try to obtain prescriptions for both Relenza and Tamiflu, and fill them now. While Tamiflu is more widely prescribed, there are some reports of initial resistance, so it is best to have a back up. Also try to stock up if possible, on alcohol based hand sanitizer now. For the ladies, try to build up a nest egg cushion/emergency fund, while you can. If the flu is truly virulent, commerce, and virtually all economic activity will cease. People will be too affraid to leave their homes to even consider hobbying.
All the best, Doc

 

[Scarey]

Thanks for the"I just shit my pants " post of the day doc .My wife and I just discussed this the other day.This definitely looks like it could be the little engine that could.

 

[Julius Caesar]

I think once the flu "season" is upon us again it will be a whole new thing.
This is one tough bug.
I am going to initiate a 10 meter zone of exclusion around me!
I have and will continue to stockpile essential items that will keep me away from large concentrations of people with infection.

Thanks Fuji and Cyberdoc.

 

[blopar]

In an effort to shed more light on the subject, I offer the following:

Flu still in it's early stages, from recombinomics.
This is very similar to 1918.
http://www.wpxi.com/video/19313969/index.html

Recombinomics credentials
http://www.recombinomics.com/founder.html

Flu Pandemic Timeline / Event Dynamics
http://www.globalsecurity.org/security/ops/hsc-scen-3_flu-pandemic-timeline.htm

Flu World Tracker
http://flutracker.rhizalabs.com/

Novel H1N1 Flu Situation Update CDC site
http://www.cdc.gov/h1n1flu/update.htm

Cytokine Storm and role in influenza death
http://en.wikipedia.org/wiki/Cytokine_storm

Relenza:
http://www.relenza.com/

Tamiflu
http://www.tamiflu.com/

I am posting this information now, because I anticipate the flu will return to North America in a more virulent form, and I do not anticpate posting very frequently going forward. My advice to terb members is to try to obtain prescriptions for both Relenza and Tamiflu, and fill them now. While Tamiflu is more widely prescribed, there are some reports of initial resistance, so it is best to have a back up. Also try to stock up if possible, on alcohol based hand sanitizer now. For the ladies, try to build up a nest egg cushion/emergency fund, while you can. If the flu is truly virulent, commerce, and virtually all economic activity will cease. People will be too affraid to leave their homes to even consider hobbying.
All the best, Doc

How can one get a prescription for Relenza or Tamiflu? I am assuming that you can't just ask your doctor. Or, can you?

Is a doctor more likely to prescribe this if you have certain other symptoms or ailments? (eg. asthma, cardiac issues, etc)?

 

[cyberdoc]

Yes, and Yes but quite frankly there is no reason why your doctor should deny you the prescription.

 

[Anynym]

It's tough to interpret some of the data.

First, let's consider the assumed total infection rate. The Pandemic experts seem to expect about 30-40% of the population to become infected, max. (according to the Pandemic Preparedness Plans). These won't all be infected at the same time, so we're probably looking at more people being unemployed at a time than will be sick at the same time.

Then let's look at the mortality rate assumptions. Right now in Canada, death rates from H1N1 have a number of factors to consider, including: (1) complicating health factors contributing to death, (2) "typical" influenza death rates, (3) reported versus actual rates of H1N1 infection.

For the last, it is important to note that in Ontario, only "clusters" are being looked at for possible H1N1 infection: actual infection rates can be presumed to be severely underreported. But deaths are being looked at for possible H1N1 complications, so the number of attributable deaths are probably close. This tends to severely inflate the apparent death rate from the flu.

But here's the trick: if deaths from flu in an average year are largely among those with complicating health factors, how many more deaths will there be from H1N1? The "regular" strains and the H1N1 will be targeting the same population, so it's difficult to say that we need to worry a lot more about H1N1 than we do about flu season every year.

 

[wetnose]

But here's the trick: if deaths from flu in an average year are largely among those with complicating health factors, how many more deaths will there be from H1N1? The "regular" strains and the H1N1 will be targeting the same population, so it's difficult to say that we need to worry a lot more about H1N1 than we do about flu season every year.

That's all fine and good for a public health perspective...all that needs to happen is for IT to hit YOU and stats/rates/etc won't matter a whit.

 

[fuji]

The Pandemic experts seem to expect about 30-40% of the population to become infected, max.

...

(2) "typical" influenza death rates, (3) reported versus actual rates of H1N1 infection.

Note that (2) and (3) are irrelevant because what they are predicting is a 30-40% reported infection rate, so far as I understand it. Maybe I'm wrong. What that actually means is an infection rate nearer 100% but only 30-40% of the cases becoming serious enough that people seek treatment. Many of the rest will be infected but get such a mild case that they don't even know they're sick, or think it's a minor cold.

Since the 1 in 250 number and 1 in 11 number are versus the reported cases you can assume that those ratios will hold for the 30-40% as well as it is apples to apples.

The "regular" strains and the H1N1 will be targeting the same population, so it's difficult to say that we need to worry a lot more about H1N1 than we do about flu season every year.

That's not quite true. H1N1 is targetting a very different population than regular flu. Regular flu kills primarily the old and the sick. H1N1 has been killing for the most part otherwise healthy people.

The above of course is if NOTHING is done to stop the spread of H1N1--its natural progression would eventually be nearly a 100% infection rate as few/no people have immunity. (People born before 1918 appear to have some immunity.)

In reality though that won't happen because WHO has in fact declared a pandemic alert and the health agencies have moved into high gear to respond. In particular some number of people will be vaccinated and as the vaccine reaches more and more people the spread of the virus will be slowed--at some point so many people are immune that the virus has no vector to reach those who aren't immune and the pandemic burns out.

Eventually enough people will be vaccinated that H1N1 does not actually reach the rest who have not yet been infected or vaccinated. How much of the population gets it by that time depends on a simple race: How quickly can we produce vaccine, versus how quickly the virus spreads.

This is especially true if the vaccine is applied sensibly--to the people who are most likely to spread it, such as school children, hospital workers, and people whose jobs bring them into contact with lots of people.

We will start vaccinating people in November so we SHOULD be able to put a big dent in the spread of H1N1 and hopefully stop it before it infects most of the population.

 

[fuji]

227 kids at summer camp infected with H1N1:

http://www.parentcentral.ca/parent/article/666668

 

[cyberdoc]

WHO release

http://www.who.int/csr/disease/swineflu/notes/h1n1_vaccine_20090713/en/index.html

 

[fuji]

Some good news:

"Canadians will have a better chance of getting vaccinated against the pandemic influenza than people in many other countries, including the United States and Britain, thanks to nearly a decade of planning for the disease's arrival. "

Canada has a contract with GlaxoSmithKleine to provide every Canadian with a vaccine, from a facility in Canada.

The US only has vaccine contracts to cover about 20% of the population.

 

[train]

FUJI

Are we still on with the bet ? You donate $100 to Princess Margaret if I win and I will donate $100 to a charity of your choice in you win.

The bet being that the deaths in Canada will be less than 1,000 in 2009. This represents less than 1/3 the number of annual deaths from seasonal flu (3,000 to 3,500). I'm taking the under. So far the vast majority of deaths from both flus are cases with significant medical factors in addition to the flu.

PS the July 6 WHO update stated 25 deaths in Canada ( there are probably a few more now) out of 7983 reported cases or a rate of 0.003 or 0.3%, although statistics are a bit meaningless as only a small portion of non-hospitalized flu cases are now being tested to determine which type of flu is involved.

 

[Anynym]

Note that (2) and (3) are irrelevant because what they are predicting is a 30-40% reported infection rate, so far as I understand it. Maybe I'm wrong. What that actually means is an infection rate nearer 100% but only 30-40% of the cases becoming serious enough that people seek treatment. Many of the rest will be infected but get such a mild case that they don't even know they're sick, or think it's a minor cold.

No. You might want to read the Pandemic Preparedness guides, or even read what I wrote, and you will learn that what they predict is a 30-40% infection rate. Exactly as I said.

That's not quite true. H1N1 is targetting a very different population than regular flu. Regular flu kills primarily the old and the sick. H1N1 has been killing for the most part otherwise healthy people.

Again, no. H1N1 has only rarely resulted in death for otherwise healthy people. The vast majority of lives it has taken are from people who had other health complications.

 

[Gyaos]

I heard it's impossible to get the Type A Influenza H1N1 virus from a handjob.

Gyaos Baltar

 

[Anynym]

PS the July 6 WHO update stated 25 deaths in Canada ( there are probably a few more now) out of 7983 reported cases or a rate of 0.003 or 0.3%, although statistics are a bit meaningless as only a small portion of non-hospitalized flu cases are now being tested to determine which type of flu is involved.

For the most current data, you may wish to consult the Public Health Agency of Canada website on H1N1 Surveillance. Current number of deaths stands at 45, Canada-wide, as of July 15.

 

[Anynym]

I heard it's impossible to get the Type A Influenza H1N1 virus from a handjob.

Gyaos Baltar

And I heard that I won the lottery.

Always be careful to separate fact from rumour.

 

[train]

For the most current data, you may wish to consult the Public Health Agency of Canada website on H1N1 Surveillance. Current number of deaths stands at 45, Canada-wide, as of July 15.

If you want in on the bet you are more than welcome. It's a bit silly on my part really as I'm basically giving 3 to 1 odds just to underscore a point. I should have just said this desease will not kill more than the seasonal flu. However having made the offer I stand by it.

I'm not trying to make light of the people that have died from it either. I am annoyed, however, at forced prioritizing of healthcare resources through politics and media hysteria. There are so many deseases that are killing more frequently and horribly that get significantly less attention.

 

[fuji]

Are we still on with the bet ? You donate $100 to Princess Margaret if I win and I will donate $100 to a charity of your choice in you win.

Only if we don't have widespread vaccination. If Canada takes delivery of a lot of vaccine in November and starts a widespread programme of vaccinating key populations, like school children, hospital workers, etc., then I would expect a significant slowdown in the infection rate.

If the vaccine is not available until January then sure we will see more deaths than that.

 

[fuji]

Again, no. H1N1 has only rarely resulted in death for otherwise healthy people. The vast majority of lives it has taken are from people who had other health complications.

Citation? Only 35% of those hospitalized have had an underlying medical condition.

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090717/flu_folo_090717/20090717?hub=TopStories

What happens to those people when there are not enough ventilators and hospital beds? Does the mortality rate stay down there at 0.3% or do some of the people who fail to receive proper hospital care die?