View Full Version : Worst-Case Scenario for Swine Flu 2.0
Warrior-Mentor
09-05-2009, 10:03
The Real Worst-Case Scenario for Swine Flu 2.0
Thomas P.M. Barnett
Sept 3, 2009
Could a new wave of the H1N1 virus become as crippling to Obama as Katrina was to Bush? An in-depth assessment of the risks to moms and politicians across the country.
The more and more I talk to people around Washington these days — fellow security guys, policy consultants, health-care experts, parents — the more I realize that the next wave of the H1N1 virus ("swine flu," if you must) is going to be a bigger deal than even the mask-wearing paranoiacs at the county fair will let on. And the more I pour over the new H1N1 report released to the White House from President Obama's seriously legitimate science-and-technology advisory council, its worst-case scenario seems even more frightening than the one from Stanley McChrystal that landed on his desk yesterday.
The Obama geek panel's "plausible scenario" suggests an early flu season peaking in the middle of October that could kill 300 percent more people than our usual flu season does. That's ninety thousand people in the next couple months — more than ten times as many Americans as we'll lose in Iraq and Afghanistan in the next couple administrations. Even the council's low-end prediction of thirty thousand would arguably double the usual death count because this won't be your aging grandma succumbing to swine flu; the report rather darkly — and repeatedly — emphasizes fatalities among kids, for whom "the consequences of infection in this epidemic are already known to be far more severe."
Children shouldn't have to die this way.
So the good news? The advisors said they were "deeply impressed" with the administration's decisions to date, describing them as "probably the best effort ever mounted against a pandemic." That's good for my four kids and me, but it's also good for Obama: pro-pig approval ratings, data shows, should help drum up Democratic votes for the mid-terms — or at least help Rahm ram through health-care reform ("never allow a crisis go to waste," Emanuel likes to say).
But even if one vaccination can now perform a two-dose job against H1N1, the new report highlights the virus' second wave arriving too early for widespread vaccination. That means one in every two Americans could plausibly contract this novel flu strain, and that means the political finger-pointing could get nasty. And all this from a "moderate" pandemic.
Inside the Numbers: Is H1N1 the Second Coming of Katrina?
Okay, more good news: H1N1 has a stunningly low death rate, and most young people recover within a few days without requiring medical treatment beyond what a caring mom would instinctively muster. On the other hand, swine flu has a stunningly wide reach, and these kinds of vast infection numbers — even if only a small fraction of cases lead to hospitalization — will swamp the capacity of our nation's health-care infrastructure rather easily.
Sure, the president's science advisors say this fall's flu wave won't be a rerun of the super-deadly 1918 flu (another H1N1 strain, by the way), but it sure as hell won't be a Chicken Little drill like the swine flu of 1976, when a government-distributed vaccine resulted in more panic than prevention. For the no-drama Obama crowd, that sort of swag (scientific wild-ass guess) can't be comforting. Hurricane Katrina killed fewer than two thousand Americans, but it saddled the second Bush administration with a popular perception of sheer incompetence that it never shook off. And with the health-care debate bringing out the big-picture "desperation" vultures in full force, the political stakes for Democrats couldn't be higher.
Just how difficult could things get for moms and Obama alike? Let's drill down on the report's worst-case scenario numbers: Up to half of Americans (or 150 million people) could become infected, with as many as 80 percent of those (120 million) exhibiting symptoms. As many as three-quarters of those with clear symptoms (ninety million) are expected to seek medical attention, and of those, 2 percent (1.8 million) will need hospital care. Of those hospitalized, only about 1-in-5 will require intensive care, and the large majority of those will survive — hence the much Drudged-about estimated ceiling of ninety thousand. The lower ranges of this scenario (not to be confused with any best-case "floor") cut all of those estimates in half, with the death toll cut by two-thirds — or a double-plus-bad flu season (thirty thousand H1N1 cases conceivably on top of the usual, elder-concentrated loss).
Left to its own devices (or unmitigated, in doc-speak), the peak incidence date of October 15 should see no more than 1-in-50 Americans (six million) come down with the flu, but, because of the clustering effect by age, any enterprise that employs or involves concentrated numbers of young adults (read: school) could be temporarily decimated. That, in turn, could trigger some extraordinary measures aimed at "social distancing," like canceling major sporting events, or conducting them sans fans, as Mexico has already done. Then there's the familiar tactic of closing schools, which the World Health Organization is telling countries to consider. But in an education-heavy economy like ours, each week of classes canceled across the country would shave half a percentage point off our GDP, according to the medical journal The Lancet.
No matter how you slice it, swine flu is going to cost America plenty.
Consider what the worst case calls for: six million people infected six-and-a-half weeks from now essentially means we need 450,000 hospital beds — pronto! According to the report, that's asking for seven out of every ten hospital beds that are readily accessible in America today — and asking for it at a time when occupancy rates typically hover at much higher percentages (a standard goal being 85 percent). Conceivably, almost half a million Americans would suddenly be chasing less than one hundred thousand free beds. That means triaging the "worried well" (typically, a vast additional diagnostic burden) from the truly needy, and then reducing that truly needy number down to the available beds. Under normal conditions (or, I guess, in anti-Obamacare propaganda), that's called rationing, with the losers encouraged to accept home-based care (not a bad idea in terms of social distancing, but a burden on families). Of course, in an emergency, you can free up some beds by suspending voluntary admissions, but what about intensive-care beds? The worst-case load prediction is 25 percent higher (seventy-five thousand) than the current U.S. total (sixty thousand), and most intensive-care units are virtually filled up. All the time. And, the report notes, "the number of ICU beds available for pediatric patients is especially limited."
Don't even get me started on how tightly we staff our hospitals today, or the scary fact that barely one-third of U.S. medical workers typically get a flu shot every year. Little wonder that Dr. Harold Varmus, medical superstar and co-chair of the president's council, warned that H1N1's second wave will "stress every aspect of our health system."
The Fallout: As Goes the Flu, So Goes Obamacare?
How all this affects Obama's push for health-care reform is anyone's guess right now — and, I guarantee you, every pundit's favorite after Labor Day. The president's speech to a joint session of Congress should provide more of a sense of how he'll spin the swine into the legislative mix, but his instinct — if only to get them to wash their hands and cover their sneezes — is clearly to strike the fear of God into his constituency, at least in the short term (The height of this global pandemic is less than seven weeks away!).
In political terms, emphasizing worst-case projections sets up the White House to claim a convincing victory after the fact, while simultaneously noting all the system's vulnerabilities — hence the compelling need for reform. Far from being his Katrina, H1N1 could prove to be Obama's congressional vote-grab — if he plays his cards right (and keeps his germaphobe vice-president — not to mention the out-in-the-tumbleweeds former one — away from microphones). Beginning on page 45 of the report (the PDF of which is all worth reading), there's a long section on the challenges of data collection and management during this crisis, with not-so-subtle calls to avoid waiting for new policies amidst the rise of a pandemic. If that doesn't sound like a winning argument for electronic medical records, I don't know what does.
For now, unfortunately, we just can't be certain how bad a hand we're being dealt here. With SARS and avian flu, the higher death rates were often fueled by "cytokine storms" triggered by the virus within previously hardy individuals. These potentially fatal immune-system overreactions (when signaling chemicals [cytokines] are over-stimulated) usually occur in young adults, meaning their bodies fight back so hard that vital organs (typically the lungs) are damaged catastrophically. Thankfully, there's no solid evidence we'll see this year's version of H1N1 triggering large numbers of such cases, but it's one of the many reasons why this report came with the authors' caveat that "features of 2009-H1N1's next wave cannot be accurately predicted."
What we can predict this fall is an issue — finally, a real issue, of importance to public good and public policy — that goes beyond the partisan (and wing-nut) chatter to really test our mettle. And while your kid will try to fight back in his middle-school classroom with that hardened immune system, the president will have a lot more than germs to battle.
http://www.esquire.com/the-side/war-room/swine-flu-death-090309
Warrior-Mentor, Thank you for the time you have spent giving us a insight that many don't see, being outside the belt way.
I agree with you that in a few weeks the POTUS is going to have a hand full of shit to deal with., but not as much as each of us American that need to live in this challenging time in our county.
Our training and wit, is going to help us get thought the next many weeks.
AL
:munchin
Thank you, Sir.
I never thought I'd be glad to be "not young."
Saturation
09-09-2009, 20:31
And then it hits close to home... 33 year old aquaintance's death confirmed today as H1N1.
And then it hits close to home... 33 year old aquaintance's death confirmed today as H1N1.
Any idea of what their health status was prior to H1N1 infection?
It's going around here in Charleston, SC now.
My wife's office has had people out with flu-like symptoms, one of which was tested and confirmed as H1N1. Anyone with symptoms is now ordered to stay home. Now she is heading to the doc today with sore throat, runny nose, and body aches.
One person where I work has a child with confirmed H1N1, but his kids are home schooled so they didn't get it from school. Maybe mom or dad, maybe church, who knows.
I'm not afraid for myself, but I have a 6 month old son. :(
Update: Wife is confirmed NOT swine flu, not regular flu, just a virus.
Rice University has 147 cases of flu with 40+ confirmed Swine flu. It is also beginning in our school district. Second hand info, but I was told doctors aren't sending off samples anymore because of the time involved and the large number of cases. They are treating them all as Swine Flu.
A guy here in my office had it a couple weeks ago. He stayed home for a week, got over it, and is back to work just fine. He said the worst part was a very sore throat that made it hard to swallow. Otherwise, it was very much like the normal flu.
A He said the worst part was a very sore throat that made it hard to swallow. Otherwise, it was very much like the normal flu.
Same with my stepmom, she said the sore throat was the worst she's ever had. Took her about 2 weeks to get to feeling better.
Saturation
09-12-2009, 16:40
Haven't been here for a few days so late reply.
The prior question about previous health of the 33 year old that died- she was pretty healthy with the exception of being overweight.
Reading the follow up posts I was disturbed to see the sore throat mentioned because in a similar thread her at ps there was the contrast between the flu and cold. Sore throat was listed under cold not flu. :confused:
Source is here (http://www.foxnews.com/politics/2009/10/24/obama-declares-hn-flu-national-emergency/).President Obama signed a proclamation declaring the H1N1 influenza a national emergency, giving doctors and medical facilities greater leeway in responding to the flu pandemic.
Obama signed the declaration late Friday, which the White House said allows medical treatment facilities to better handle a surge in flu patients by waiving federal requirements on a case-by-case basis.
"The foundation of our national approach to the H1N1 flu has been preparedness at all levels -- personal, business, and government -- and this proclamation helps that effort by advancing our overall response capability," the White House said in a statement.
In the proclamation, Obama said the pandemic keeps evolving, the rates of illness are rising rapidly in many areas and there's a potential "to overburden health care resources."
Because of vaccine production delays, the government has backed off initial, optimistic estimates that as many as 120 million doses would be available by mid-October. As of Wednesday, only 11 million doses had been shipped to health departments, doctor's offices and other providers, according to the federal Centers for Disease Control and Prevention.
The government now hopes to have about 50 million doses of vaccine for the so-called swine flu out by mid-November and 150 million in December.
The flu virus has to be grown in chicken eggs, and the yield hasn't been as high as was initially hoped, officials explained.
H1N1 is more widespread now than it's ever been. Health authorities say almost 100 children have died from the flu, and 46 states now have widespread flu activity.
Worldwide, more than 5,000 people have reportedly died from swine flu since it emerged this year and developed into a global epidemic, the World Health Organization said Friday. Since most countries have stopped counting individual swine flu cases, the figure is considered an underestimate.
The flu has infected millions of Americans and killed nearly 100 children in the U.S. The chief of the Centers for Disease Control and Prevention said Friday that over a thousand people have died as a result, with 46 states reporting widespread H1N1 activity.
"Since the beginning of the pandemic, we've seen more than 1,000 deaths and 20,000 hospitalizations," said Dr. Thomas Frieden, head of the CDC. "We expect it to occur in waves, but we can't predict when those waves will happen."
The Associated Press contributed to this report.It is interesting that the declaration came late in the day on a Friday.
I'm terrifically encouraged by the fact that the president took such bold action months ago. Source is here (http://www.whitehouse.gov/the_press_office/WEEKLY-ADDRESS-President-Obama-Outlines-Government-Actions-to-Address-the-2009-H1N1-Flu/).EMBARGOED UNTIL 6:00 AM ET, SATURDAY, May 2, 2009
WEEKLY ADDRESS: President Obama Outlines Government Actions to Address the 2009 H1N1 Flu
Over the last week, my administration has taken several precautions to address the challenge posed by the 2009 H1N1 flu virus. Today, I’d like to take a few minutes to explain why.
This is a new strain of the flu virus, and because we haven’t developed an immunity to it, it has more potential to cause us harm. Unlike the various strains of animal flu that have emerged in the past, it’s a flu that is spreading from human to human. This creates the potential for a pandemic, which is why we are acting quickly and aggressively.
This H1N1 flu has had its biggest impact in Mexico, where it has claimed a number of lives and infected hundreds more. Thus far, the strain in this country that has infected people in at least nineteen states has not been as potent or as deadly. We cannot know for certain why that is, which is why we are taking all necessary precautions in the event that the virus does turn into something worse.
This is also why the Centers for Disease Control has recommended that schools and child care facilities with confirmed cases of the virus close for up to fourteen days. It is why we urge employers to allow infected employees to take as many sick days as necessary. If more schools are forced to close, we’ve also recommended that both parents and businesses think about contingency plans if children do have to stay home. We have asked every American to take the same steps you would take to prevent any other flu: keep your hands washed; cover your mouth when you cough; stay home from work if you’re sick; and keep your children home from school if they’re sick. And the White House has launched pages in Facebook, MySpace and Twitter to support the ongoing efforts by the CDC to update the public as quickly and effectively as possible.
As our scientists and researchers learn more information about this virus every day, the guidance we offer will likely change. What will not change is the fact that we’ll be making every recommendation based on the best science possible.
We will also continue investing in every resource necessary to treat this virus and prevent a wider outbreak. The good news is that the current strain of H1N1 can be defeated by a course of antiviral treatment that we already have on hand. We began this week with 50 million courses of this treatment in the Strategic National Stockpile. Over the course of the last few days, we have delivered one-quarter of that stockpile to states so that they are prepared to treat anyone who is infected with this virus. We then purchased an additional thirteen million treatments to refill our strategic stockpile.
Out of an abundance of caution, I have also asked Congress for $1.5 billion if it is needed to purchase additional antivirals, emergency equipment, and the development of a vaccine that can prevent this virus as we prepare for the next flu season in the fall.
The Recovery Act that Congress enacted in February also included expansions of community health centers, a dramatic increase in the training of health care workers and nurses, and $300 million for the development and deployment of vaccines – all of which will help us meet this threat. If I had a TARDIS, I'd go back a year and cast my vote for this guy. I really would.:rolleyes:
Surf n Turf
10-24-2009, 19:17
It is interesting that the declaration came late in the day on a Friday.
I'm terrifically encouraged by the fact that the president took such bold action months ago. If I had a TARDIS, I'd go back a year and cast my vote for this guy. I really would.:rolleyes:
Sigaba,
Your HEALTH CARE dollars at work.
Lots of people wish they could re-vote. :D
SnT
I know one person age 29 who had a confirmed case of H1N1 and he got to do a self quarantine at home.
My daughter had a high fever for 4 days, the following Monday when she returned they had 6 kids in class, the rest were out sick and the school had a total of 80 out. And based on the emails going around, none of the parents had their kids tested they just kept them home and returned them to school after they were without fever for 24 hours. No one died.
So is this a convenient emergency or is it a true emergency?
We are losing 1 kid a week as opposed to 2/yr. Our clinic visits for Flu symptoms are 8 times higher than normal, and we are admitting 200-300 per week to the local hospitals when our record for seasonal flu hospitalizations in one week was 65. All this being said it appears that our medical system is able to handle it so far. Who knows what will happen next month.
I'd like to hear what Mugwump thinks.
Trying to figure out if getting one of these H1N1 shots is the best idea. I see the lines of folks in the DC area waiting as if their going to buy U-2 tickets. Camping out, just waiting for riots to break out. Like watching Soylent Green! About 25%+ of the kids in school in the small town here have some sort of flu...swine or whatever. No hospital close, just a shorthanded clinic.
My daughter in Austin is 7-mos pregnant and she's scared to get the shot. Thoughts anybody? Risk the shot or risk the flu?
Obama is trying to get his healthcare bill passed.
The economy is getting worse.
Berry is in the news daily.
Pig flu is in the news daily.
People are wondering what he is going to do about the war.
My vote is it is a convenient emergency. Now my question is wasn't there some bill passed a few years ago that in case of emergency the president gets some emergency powers?
1976 National Emergencies Act (50 U.S.C. 1601–1651)
I lean towards BS for all the reasons you mentioned and because all the doctors and other medical staff I have spoken to have said it is a 'Flu' plain and simple. A few will die as with any flu, but the vast majority will just get sick and recover.
Trying to figure out if getting one of these H1N1 shots is the best idea. I see the lines of folks in the DC area waiting as if their going to buy U-2 tickets. Camping out, just waiting for riots to break out. Like watching Soylent Green! About 25%+ of the kids in school in the small town here have some sort of flu...swine or whatever. No hospital close, just a shorthanded clinic.
My daughter in Austin is 7-mos pregnant and she's scared to get the shot. Thoughts anybody? Risk the shot or risk the flu?
My wife, the careful one in the family, who works in a hospital said tonight that there are too many risks.
We are losing 1 kid a week as opposed to 2/yr. Our clinic visits for Flu symptoms are 8 times higher than normal, and we are admitting 200-300 per week to the local hospitals when our record for seasonal flu hospitalizations in one week was 65. All this being said it appears that our medical system is able to handle it so far. Who knows what will happen next month.
I'd like to hear what Mugwump thinks.
My daughter had only 6 students in her class a couple weeks ago. Obviously there is something going around. But one could debate that the increase in visits and admissions might be related to the MSM and .GOV saturation on H1N1 which has gone on for the past several months.
The Reaper
10-24-2009, 22:36
Our son had flu like symptoms and went to the Doctor's office last Monday. According to my lovely bride, the Doc told her during the appointment that it was H1N1, sent him home with a script for Tamiflu and some cold meds and said that when the fever broke and he no longer had a cough, he could return to school in 24 hours.
He was back in school on Friday.
On Thursday evening, our daughter developed similar symptoms, and missed school Friday. She also had hives, which we were unable to diagnose, so I put her on Benadryl. We were prepping for an ER visit last night after the hives merged into almost total coverage, we administered one last dose of Benadryl and waited. As of tonight, she seems mostly recovered and fever/cough is gone, along with almost all of the hives.
Not sure if this was really H1N1 or not, frankly, I hope it was and they now have some immunity to future strains.
The wife has been asymptomatic, I had a nasty cold relapse, but went to work regardless. I was never as bad as the kids seemed to be though, so I may be next.
Hope that everything works out okay for everyone here. I thinkl the "get it early, get treated while resources are available, and get it over" plan with may not have been a bad idea.
Hey, I thought the POTUS promised part of our vaccine supply to the 3rd world. Could that be where part of it has gone?
TR
While clinic visits could easily reflect the growing concern of H1N1, pediatric deaths and hospital admissions are NOT consumer driven figures. You can't walk down to the ICU and check yourself in unless you really need it.
When the average seasonal flu season has 50-60 pediatric deaths per year and you see that many in the first 6 weeks, it's difficult to call it "just a flu." This may not be 1918 Pt 2, but we won't know for a few more months.
I too hope everyone here comes out well, my family has dodged H1N1 twice in the last 10 days.
Our son had flu like symptoms and went to the Doctor's office last Monday. According to my lovely bride, the Doc told her during the appointment that it was H1N1, sent him home with a script for Tamiflu and some cold meds and said that when the fever broke and he no longer had a cough, he could return to school in 24 hours.
He was back in school on Friday.
On Thursday evening, our daughter developed similar symptoms, and missed school Friday. She also had hives, which we were unable to diagnose, so I put her on Benadryl. We were prepping for an ER visit last night after the hives merged into almost total coverage, we administered one last dose of Benadryl and waited. As of tonight, she seems mostly recovered and fever/cough is gone, along with almost all of the hives.
Not sure if this was really H1N1 or not, frankly, I hope it was and they now have some immunity to future strains.
The wife has been asymptomatic, I had a nasty cold relapse, but went to work regardless. I was never as bad as the kids seemed to be though, so I may be next.
Hope that everything works out okay for everyone here. I thinkl the "get it early, get treated while resources are available, and get it over" plan with may not have been a bad idea.
Hey, I thought the POTUS promised part of our vaccine supply to the 3rd world. Could that be where part of it has gone?
TR
Could be coincidence, but my daughter also developed hives some months ago. We suppressed them with Benadryl. She's never had hives until that period. All three of us (me, wife, daughter) were sick with the flu, right around the time the locals here started reporting a few H1N1 cases.
I wasn't going to post about this any more but I'll make an exception in this case. I am no a doctor. I am not a nurse.
Rash accompanied by fever is a symptom of H1N1 that is present in between 5% and 10% of patients less than 24 years old. Its presence is a cause for concern and increases the odds that your child will quickly become seriously ill. Note that I said 'increases the odds.' I didn't say they'd die. I didn't say they will end up in ICU. I didn't say they'd end up in the hospital. It indicates a more serious than usual case. Many of the kids who die in ICU present with a rash. I cannot say how many. Watch the news. I have no idea if she'll write an article but put a Google alert on Helen Branswell anyway. Remember that ARDS is an immune over-reaction in the cytokine cascade process and an erythematous macular rash (what's being described in this thread) is common in autoimmune response.
In children emergency warning signs that need urgent medical attention include:
Fever with a rash
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
And yes, I know rash is not on the list on your ER/clinic/school nurse's wall, or in the CDC bulletin, and your doctor/nurse/neighbor said it's all a bunch of hooey, and if it's not one thing it's another, and that everyone you know has gotten better.
Brush Okie/Paslode, I think you are wrong. Declaring an emergency is a necessary step in freeing up logistical pathways, nothing more.
Lanyard, I think you are correct. Locally, we have had student athletes aged 13-17 succumb to this flu and there would have been more in the absence of heroic treatment measures. Right now the medical system is keeping up although we are seeing emergency bypass being declared and the slack is slowly being taken up in ventilator capacity. We are in the second week of the official flu season.
I will not express an opinion regarding vaccine use.
Edited to add: I can say this...even if a child has one of the emergency warning signs (such as rash) and becomes hospitalized the odds of a happy outcome remain good.
I still believe Obama declared the emergency for political reasons. He has everything to gain and nothing to loose.
That is my basis for my opinion as well. When you have advisors like Rahm spouting to 'Never let a crisis go to waste' it doesn't help the situation. And based on the last 10 months they Obama & Co have a track record of making a mountain out of a mole hill.
So is this a convenient emergency or is it a true emergency?My vote is it is a convenient emergency. Now my question is wasn't there some bill passed a few years ago that in case of emergency the president gets some emergency powers?Brush Okie/Paslode, I think you are wrong. Declaring an emergency is a necessary step in freeing up logistical pathways, nothing more.I still believe Obama declared the emergency for political reasons. He has everything to gain and nothing to loose. If the virus scare turns out to be a dud he can claim it was due to his actions. If it kills off half the US he can say he acted early and saved the other half by doing so. The added benefit of taking the spotlight off hit other inept actions is a bonus. Just my opinion. While I agree that the proclamation addresses logistical issues in the treatment of H1N1, the timing of the proclamation strikes me as yet another example of the president's unique brand of political cynicism. (Which is why I posted the president's proclamation here and not here (http://professionalsoldiers.com/forums/showthread.php?t=10148).) How many times have we seen this administration go on a media offensive when the prospects for success are high and/or the "blame" for failure can be placed at the feet of the GOP, Bush the Younger, or circumstances that the president "inherited"?
By releasing the proclamation at the end of a weekly media cycle, the president gets to have it both ways. He takes an important and necessary step to advance the nation's struggle against H1N1 and he manages to deflect, at least for the time being, a variation of a question the Democrats and others dogged Bush the Younger some years ago: "You knew this was coming, so why aren't the vaccinations ready?"
On another topic.I wasn't going to post about this any more but I'll make an exception in this case. I am no a doctor. I am not a nurse.Mugwump, IMO your contributions important. Your expertise, writing style, and temperament inspire confidence.
Just my $0.02.
Mugwump, IMO your contributions important. Your expertise, writing style, and temperament inspire confidence.
I agree. I appreciate your thoughts and postings.
PedOncoDoc
10-25-2009, 16:25
I wasn't going to post about this any more but I'll make an exception in this case. I am no a doctor. I am not a nurse.
Rash accompanied by fever is a symptom of H1N1 that is present in between 5% and 10% of patients less than 24 years old. Its presence is a cause for concern and increases the odds that your child will quickly become seriously ill. Note that I said 'increases the odds.' I didn't say they'd die. I didn't say they will end up in ICU. I didn't say they'd end up in the hospital. It indicates a more serious than usual case. Many of the kids who die in ICU present with a rash. I cannot say how many. Watch the news. I have no idea if she'll write an article but put a Google alert on Helen Branswell anyway. Remember that ARDS is an immune over-reaction in the cytokine cascade process and an erythematous macular rash (what's being described in this thread) is common in autoimmune response.
In children emergency warning signs that need urgent medical attention include:
Fever with a rash
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
And yes, I know rash is not on the list on your ER/clinic/school nurse's wall, or in the CDC bulletin, and your doctor/nurse/neighbor said it's all a bunch of hooey, and if it's not one thing it's another, and that everyone you know has gotten better.
Brush Okie/Paslode, I think you are wrong. Declaring an emergency is a necessary step in freeing up logistical pathways, nothing more.
Lanyard, I think you are correct. Locally, we have had student athletes aged 13-17 succumb to this flu and there would have been more in the absence of heroic treatment measures. Right now the medical system is keeping up although we are seeing emergency bypass being declared and the slack is slowly being taken up in ventilator capacity. We are in the second week of the official flu season.
I will not express an opinion regarding vaccine use.
Edited to add: I can say this...even if a child has one of the emergency warning signs (such as rash) and becomes hospitalized the odds of a happy outcome remain good.
Good thoughts above.
Generalized rash typically is not a concern - especially in pediatrics. Sometimes it is the only thing that accompanies a fever to signify that the infection causing the fever is viral. Why some feel it might be a harbinger of a rougher course of illness is that if it presents in the first 24-48 hours of illness it may suggest a higher level of generlized inflammation - which can also be present in the lungs (i.e. ARDS).
The H1N1 flu is just another flu virus that is going around at this time on top of the typical inlfluenza - this always leads to panic and a lot of media coverage. H1N1 tends to be spread quite easily which also doesn't help things.
For most people, they wil get the symptoms, the symptoms will be aty their peak from days 3-5 of illness then they will peter out over the next 7-10 days. A cough may persist afterwards, but typically is harmless.
Just as with the normal flu, the people who are at greatest risk are the elderly and the young. Concerning medical history portending to a rougher illness course include former preterm/premature infants, people with asthma/COPD/emphysema or other lung conditions and people with compromised immune systems such as patients undergoing chemotherapy or with advanced HIV infection.
I've seen to many obese people have a rough time with the flu and have several friends who have lost young adult family to flu complications with no other risk factors than obesity.
The most important things are typically common sense items: good hand washing practices, not sharing drinks, and avoidance of sick people whenever possible. This is why there has been such a push for people staying home when they are ill.
Regading vaccinations, I tnd to leave it up to the individual, but IMHO the potential harm of the vaccine is outweighed by the risk of infection for high risk groups like mentioned above.
Thaty's my $.02.
Red Flag 1
10-25-2009, 17:02
Good thoughts above.
Generalized rash typically is not a concern - especially in pediatrics. Sometimes it is the only thing that accompanies a fever to signify that the infection causing the fever is viral. Why some feel it might be a harbinger of a rougher course of illness is that if it presents in the first 24-48 hours of illness it may suggest a higher level of generlized inflammation - which can also be present in the lungs (i.e. ARDS).
The H1N1 flu is just another flu virus that is going around at this time on top of the typical inlfluenza - this always leads to panic and a lot of media coverage. H1N1 tends to be spread quite easily which also doesn't help things.
For most people, they wil get the symptoms, the symptoms will be aty their peak from days 3-5 of illness then they will peter out over the next 7-10 days. A cough may persist afterwards, but typically is harmless.
Just as with the normal flu, the people who are at greatest risk are the elderly and the young. Concerning medical history portending to a rougher illness course include former preterm/premature infants, people with asthma/COPD/emphysema or other lung conditions and people with compromised immune systems such as patients undergoing chemotherapy or with advanced HIV infection.
I've seen to many obese people have a rough time with the flu and have several friends who have lost young adult family to flu complications with no other risk factors than obesity.
The most important things are typically common sense items: good hand washing practices, not sharing drinks, and avoidance of sick people whenever possible. This is why there has been such a push for people staying home when they are ill.
Regading vaccinations, I tnd to leave it up to the individual, but IMHO the potential harm of the vaccine is outweighed by the risk of infection for high risk groups like mentioned above.
Thaty's my $.02.
Like to learn of your thoughts re: obesity in this issue. Is this regarding the general population, our the peds population?
Prevention can include immunization. IMHO, care in hand washing is pretty key. Droplet borne infections are what they are. For the most part, folks generally try to avoid sneezing/coughing in the face of others. Folks on the other end of the sneeze/cough generally recognize the risk. As you well know, there is another key....
Our hands do our work, they touch nearly everything around us. We then bring what ever we touch to our faces, and then inoculate ourselves , via nasal, oral ,and conjunctival mucosa, with what ever is on our hands. SA, attention to detail, and frequent hand washing is important, as you have pointed out. Our young ones simply do not have the SA to recognize the hand to face risk. That having been said, our youngsters seem to be at the greatest risk.
As a Peds guy, I would value your insight in the risk/benefit ratio in immunization for our wee ones. Would also like to learn of your thoughts in prescribing Tamaflu, etc, for the wee ones; can the hepatic, GI systems tolerate such agents?
RF 1
Monsoon65
10-25-2009, 17:23
On Wed night (21 Oct), my wife said that she had a tight feeling in her chest. By Thursday night, she had a bad cough, fatigue, and fever. I told her to get to the docs ASAP, since she could be considered "high risk" due to her having a miscarriage on 7 Oct (whole other story. Freakin' Oct 2009 sucks!).
Doc said she had "the flu", didn't test due to most cases being H1N1. Tamiflu being restricted to people with previous cases of asthma, lung issues, etc. They gave her a script for Robitussin with codeine to suppress the cough.
She's been home since then, and things aren't getting any worse (or better). Just the cough, body aches and fever at night. We're treating with OTC stuff, rest, fluids.
So far, I'm good to go. My wife hopes I don't get it, since I'm a huge whiner when I get sick. :D
Source is here (http://www.nytimes.com/2009/10/26/health/26H1N1.html?_r=1&ref=us&pagewanted=print).October 26, 2009
H1N1 Is Still Spreading Globally
By JACKIE CALMES and DONALD G. McNEIL Jr.
WASHINGTON — President Barack Obama has declared the swine flu outbreak a national emergency, allowing hospitals and local governments to speedily set up alternate sites for treatment and triage of any surge of patients, the White House said.
The declaration Saturday did not signify any unanticipated worsening in the United States of the H1N1 outbreak, officials said. It seemed likely, however, to increase concerns, disruptions and at times, panicky reactions, to a disease now affecting most parts of the world.
At some vaccination sites people have stood in line through the night; hundreds have been turned away. On Chicago’s North Side, Mary Kate Merna, 28, a teacher, arrived too late. “I thought I’d be a priority, being nine months pregnant,” she said. “You hear it’s a national emergency and it scares you.”
On Sunday, swine flu reached high into the sporting world, delaying a key French soccer match in Marseille. The game between rivals Paris Saint-Germain and the Olympique de Marseille was postponed after a third player on the Paris team was diagnosed with the H1N1 virus. The cancellation was announced hours before the match at the 60,000-seat Stade Velodrome.
The disease continued to spread rapidly in parts of the Northern Hemisphere, though it has slowed in much of the Southern Hemisphere. Worldwide, the swine flu has claimed nearly 5,000 lives, according to the World Health Organization. U.S. officials say more than 1,000 Americans have died because of it.
Morocco recently closed schools for the first time, when 10 students contracted the flu. Turkey reported its first fatal case of H1N1, that of a 29-year-old in Ankara. Iceland had its first swine-flu death last week. Mongolia and Rwanda reported their first cases.
Thousands of Americans have lined up for vaccinations, even as federal officials acknowledged that their ambitious vaccination program has gotten off to a slow start. Only 16 million doses of the vaccine are available now, and about 30 million were expected by the end of the month. Some states have requested 10 times the amount allotted.
Flu activity — virtually all of it the swine flu — is now widespread in 46 states, a level equaling the peak of a typical winter flu season. Millions of people in the United States have had swine flu either in the first wave in the spring or the current wave.
Amid growing fears, traditional Halloween parties, school events and birthday parties have been canceled. Reactions have at times bordered on the panicky.
U.S. officials sought to calm undue fears, emphasizing that Mr. Obama’s emergency declaration was largely an administrative move, clearing the way for hospitals in danger of being overwhelmed with swine flu patients to execute disaster plans that include transferring patients to satellite facilities or other hospitals. The officials said it had nothing to do with vaccine shortages.
New York State last week suspended a vaccination requirement for health workers, citing a vaccine shortage, and urged children and pregnant women to get shots first. Other vaccination programs across the country have reported long lines — some people have arrived with camping supplies to spend the night — and short supplies.
David Levine, head of the Montreal Health and Social Services Agency, told the Gazette newspaper that he hoped to see 75 percent of the city’s population vaccinated within two months, “to create a mass immunity so the virus has nowhere to go.” But supplies there are still short.
Top American flu experts insist that the U.S. shortages are temporary, and local, and that there will be a surplus of vaccine by early next year. That would allow the government to donate tens of millions of doses to poor countries, as it has promised to do.
Although the Paris-Marseille cancellation was the biggest sporting casualty of the flu so far, the disease has hit teams from the professional ranks down through youth leagues.
The flu has hit Cleveland professional sports hard. Nearly one-third the Cavaliers’ 20 basketball players were out ill last week. A dozen members of the Browns football team missed some practice.
Since last winter’s more isolated cases, the expectation that the virus would return with a vengeance has posed a test of the Obama administration. Officials are mindful that the previous administration’s failure to better prepare for and respond to Hurricane Katrina in 2005 left doubts that dogged President George W. Bush to the end of his term.
In Washington, Senator Mitch McConnell of Kentucky, the minority leader, said on Sunday that if the administration requested additional flu-fighting resources from Congress, “I know we’d be happy to provide it on a totally bipartisan basis,” he told ABC’s “This Week.”
Jackie Calmes reported from Washington, and Donald G. McNeil Jr. from New York. Brian Knowlton in Washington, Crystal Yednak in Chicago and Holli Chmela in Fairfax, Va., contributed reporting.
Because of an editing error, a previous version of this article misstated the number of Paris Saint-German soccer players who have contracted swine flu.If the New York Times is going to keep producing pieces like this, they may as well set up shop in Chatsworth, CA.
__________________________________________________ _
* Thomas Harris, Hannibal, (ISBN-13: 9780385299299).
PedOncoDoc
10-26-2009, 06:43
Like to learn of your thoughts re: obesity in this issue. Is this regarding the general population, our the peds population?
Prevention can include immunization. IMHO, care in hand washing is pretty key. Droplet borne infections are what they are. For the most part, folks generally try to avoid sneezing/coughing in the face of others. Folks on the other end of the sneeze/cough generally recognize the risk. As you well know, there is another key....
Our hands do our work, they touch nearly everything around us. We then bring what ever we touch to our faces, and then inoculate ourselves , via nasal, oral ,and conjunctival mucosa, with what ever is on our hands. SA, attention to detail, and frequent hand washing is important, as you have pointed out. Our young ones simply do not have the SA to recognize the hand to face risk. That having been said, our youngsters seem to be at the greatest risk.
As a Peds guy, I would value your insight in the risk/benefit ratio in immunization for our wee ones. Would also like to learn of your thoughts in prescribing Tamaflu, etc, for the wee ones; can the hepatic, GI systems tolerate such agents?
RF 1
A little known fact outside of the medical field is that obesity IS a sytemic inflammatory process. I'm no hard-scientist but I believe this is why they tend to do worse with flu virus. You add a fairly bad viral infection on top of baseline inflammation from obesity and you end up with ARDS (severe inflammation with fluid buildup in the lungs - pumonary edema). This applies to all obese people, but tends to be a bit rougher starting in the late 20's - probably from end-organ damage/dysfunction.
As far as little ones are conncerned, Tamiflu treatment dosages are recommended down to <3 months of age, but no prophylaxis dosage is recommended until >3 months, so provided it's not being rationed, anyone of any age can get it.
Everyone has their own personal feelings on vaccines. I am personally for everyone getting the vaccine who can, especially in 6 months to 5 years of age range and >60 years (out of my AO, but still a good idea). Mass immunity (herd immunity in epidemiology circles) help protect the most vulnerable. It is not offered for children under 6 months, so close care givers should probably consider vaccination to help protect the children. I also recommend the injection not the nasal spray for all high risk patients because there is a slight chance of getting the actual disease from the nasal spray for people with suppressed/compromised immune systems. The likelihood of an adverse reaction from the vaccine is quite low, and the media focuses on any reaction because i sells papers. Most people will get a slight fever and some swelling at the injection sight AT WORST (signs of the body's response to the vaccine). It is an exceedingly rare event that someone gets Guillain-Barre' (ascending paralysis) or dyskinesia - both are frightening, but typically are short-lived.
I also forgot to mention in my previous post that anyone caring for a high-risk person should consider vaccination to help protect the at-risk person.
Again, all IMHO. Hope this helps.
Good thoughts above.
<snip>
Just as with the normal flu, the people who are at greatest risk are the elderly and the young. Concerning medical history portending to a rougher illness course include former preterm/premature infants, people with asthma/COPD/emphysema or other lung conditions and people with compromised immune systems such as patients undergoing chemotherapy or with advanced HIV infection.
<snip>
About 40% of those admitted to ICU in the southern hemisphere had no underlying conditions and were in atypical age groups, i.e. young adults. The same pattern is being repeated now in the US. Those over 55 year are actually less likely to face a serious course of this disease.
While this flu is expected to eventually settle into the typical epidemiological pattern that you describe for 'seasonal' flu, it is not there yet. Why the first few waves of a new flu seem to disproportionally attack the young and healthy is one of the many mysteries that surround the virus, and many researchers are working to find an answer.
I agree that it's bad juju to be in the 60% of flu victims with significant underlying conditions. Thanks for the insight on obesity, your hypothesis makes perfect sense.
Regarding the rash: the observation of the rash-ICU link is empirical. Someone reviewed histories, went "Huh?" and passed the word. They went "huh" also. Data was pooled. Apparently the observation has met statistical confidence limits. Sort of like finding that half of the ICU patients are left handed when random distribution says 10%. I don't know anything about it beyond that.
Everyone has their own personal feelings on vaccines. I am personally for everyone getting the vaccine who can, especially in 6 months to 5 years of age range and >60 years (out of my AO, but still a good idea). Mass immunity (herd immunity in epidemiology circles) help protect the most vulnerable. It is not offered for children under 6 months, so close care givers should probably consider vaccination to help protect the children. I also recommend the injection not the nasal spray for all high risk patients because there is a slight chance of getting the actual disease from the nasal spray for people with suppressed/compromised immune systems. The likelihood of an adverse reaction from the vaccine is quite low, and the media focuses on any reaction because i sells papers. Most people will get a slight fever and some swelling at the injection sight AT WORST (signs of the body's response to the vaccine). It is an exceedingly rare event that someone gets Guillain-Barre' (ascending paralysis) or dyskinesia - both are frightening, but typically are short-lived.
I also forgot to mention in my previous post that anyone caring for a high-risk person should consider vaccination to help protect the at-risk person.
Again, all IMHO. Hope this helps.
Thanks, Doctor. Wise words.
PedOncoDoc
10-26-2009, 09:57
About 40% of those admitted to ICU in the southern hemisphere had no underlying conditions and were in atypical age groups, i.e. young adults. The same pattern is being repeated now in the US. Those over 55 year are actually less likely to face a serious course of this disease.
While this flu is expected to eventually settle into the typical epidemiological pattern that you describe for 'seasonal' flu, it is not there yet. Why the first few waves of a new flu seem to disproportionally attack the young and healthy is one of the many mysteries that surround the virus, and many researchers are working to find an answer.
I agree that it's bad juju to be in the 60% of flu victims with significant underlying conditions. Thanks for the insight on obesity, your hypothesis makes perfect sense.
Regarding the rash: the observation of the rash-ICU link is empirical. Someone reviewed histories, went "Huh?" and passed the word. They went "huh" also. Data was pooled. Apparently the observation has met statistical confidence limits. Sort of like finding that half of the ICU patients are left handed when random distribution says 10%. I don't know anything about it beyond that.
"Huh?" is right. Regarding the souther hemisphere data - I'd like to see a list of nations the data was pooled from. The access/utilization of basic health care and sanitation standards in many of the nations south of the equator make it hard to use as a standard for comparison/anticipation of H1N1 in the US. It is interesting, however. Do you have the data for the "typical" influenza season to compare H1N1 to "typical" influenza in these countries? I'd like to be able to compare those 2 internally before trying to extrapolate the info internationally, especially here or where standards of living and health care access/utilization are relatively high.
I have a theory on why the young typically get infected at a higher frequency than the old - kids are in schools where they get exposed to EVERYTHING and then bring it home to their parents. The young adults are also in the workforce and tend to participate in the social/night scene giving them a large number of high-traffic areas which increase the odds of exposure to infectious agents. The same exposure is typically not seen in the elderly, especially those out of the workforce.
"Huh?" is right. Regarding the souther hemisphere data - I'd like to see a list of nations the data was pooled from. The access/utilization of basic health care and sanitation standards in many of the nations south of the equator make it hard to use as a standard for comparison/anticipation of H1N1 in the US. It is interesting, however. Do you have the data for the "typical" influenza season to compare H1N1 to "typical" influenza in these countries? I'd like to be able to compare those 2 internally before trying to extrapolate the info internationally, especially here or where standards of living and health care access/utilization are relatively high.
I have a theory on why the young typically get infected at a higher frequency than the old - kids are in schools where they get exposed to EVERYTHING and then bring it home to their parents. The young adults are also in the workforce and tend to participate in the social/night scene giving them a large number of high-traffic areas which increase the odds of exposure to infectious agents. The same exposure is typically not seen in the elderly, especially those out of the workforce.
I am referring specifically to Australia and New Zealand so I feel it's apples-apples. Some reports include Argentinian data but I don't trust their denominators and therefore find their conclusions suspect. I'm afraid I don't have time to dig up the data, there's some presented in another thread and you can find 'pure' A/NZ epidemiology discussed on the Internets. There's an Australian paper on the use of extracorporeal membrane oxygenation in young adult H1N1 patients that includes a discussion of epidemiological distribution of seasonal vs H1N1 flu.
The skewed target population -- young adults -- is pretty much the hallmark of pandemic flu. There are many theories floating around but most center on an exaggerated immune response leading to cytokine storm and ARDS.
I'm going to bow out now. Good luck all.
frostfire
10-26-2009, 13:22
I also recommend the injection not the nasal spray for all high risk patients because there is a slight chance of getting the actual disease from the nasal spray for people with suppressed/compromised immune systems.
Again, all IMHO. Hope this helps.
How so, Doc?
In my limited understanding, immunocompromised pt is susceptible to infection/disease through all routes of drug delivery. Additionally, the vaccine goes through nasal mucosa and capillary vessels underneath, ending in the blood circulation as well. Thank you for the education.
PedOncoDoc
10-26-2009, 13:54
How so, Doc?
In my limited understanding, immunocompromised pt is susceptible to infection/disease through all routes of drug delivery. Additionally, the vaccine goes through nasal mucosa and capillary vessels underneath, ending in the blood circulation as well. Thank you for the education.
The reason the injection is safer for immunocompromised patients is that there is no live virus in the injectable vaccine. The nasal spray is live attenuated virus. No live virus = no chance for viral infection.
Took the Hubby to Las Vegas a couple of weeks ago for our 7 year anniversary. Get back on Monday, Tuesday he isn't feeling too well. Wednesday he goes to the flight doc after I drive him bonkers about going. Doc tells him he has the flu, didn't say what kind, just the flu, as well as an Upper Respitory Infection. Put him on a Z-pac , musinex, and cough medicine with Codeine. Says he will alright to fly on Friday morning.
Friday morning he isn't alright to fly, which I thought was suspicious since we were heading to my parent's house. Thought he was just trying to get out of going...:)
Good thing the daughter and I were gone for 4 days because he did indeed have H1N1, and wound up cracking two ribs from his coughing. This is the sickest I have ever seen him in the 10 years I have known him. He was out of work for about 7 days, is back now, but still not up to 100%.
Neither of the kids or I are symptomatic, so I guess we got lucky.
I have no concerns over the national emergency declaration. It would seem that this declaration actually eases up federal regulations on hospitals who are looking to handle a large influx of patients. As opposed to the thought that this is another political move to put more power in the government's hands, it seems that this move does quite the opposite in loosening up federal restrictions and letting hospitals decide how best to care for their patient population. Does it have a potential for abuse? I'm sure, but I really don't know enough about the law to comment on that.
I posted this somewhere else, but it is certainly relevant in this thread. I was debating posting it in the other thread "Swine Flu Propaganda" because it really fits there, but due to some of the discussion here, I decided this was the best place:
The FDA does a good job of compiling information, the only issue is finding it. Here can be found the package inserts and approval letters of all the current H1N1 vaccines on the market (3 injectable/inactivated and one nasal/live) from CSL, Novartis, Sanofi Pasteur, and MedImmune. If you look at the package inserts, look under the heading "Description" and there is information on how the vaccine is prepared, and all the ingredients of the preparation, both active and excipients.
For example:
"Influenza A (H1N1) 2009 Monovalent Vaccine, for intramuscular injection, is a sterile, clear, colorless to slightly opalescent suspension with some sediment that resuspends upon shaking to form a homogeneous suspension. Influenza A (H1N1) 2009 Monovalent Vaccine is prepared from influenza virus propagated in the allantoic fluid of embryonated chicken eggs. Following harvest, the virus is purified in a sucrose density gradient using a continuous flow zonal centrifuge. The purified virus is inactivated with beta-propiolactone, and the virus particles are disrupted using sodium taurodeoxycholate to produce a “split virion”. The disrupted virus is further purified and suspended in a phosphate buffered isotonic solution.
Influenza A (H1N1) 2009 Monovalent Vaccine is formulated to contain 15 mcg HA per 0.5 mL dose of influenza A/California/7/2009 (H1N1)v-like virus.
The single-dose formulation is preservative-free; thimerosal, a mercury derivative, is not used in the manufacturing process for this formulation. The multi-dose formulation contains thimerosal, added as a preservative; each 0.5 mL dose contains 24.5 mcg of mercury.
A single 0.5 mL dose of Influenza A (H1N1) 2009 Monovalent Vaccine contains sodium chloride (4.1 mg), monobasic sodium phosphate (80 mcg), dibasic sodium phosphate (300 mcg), monobasic potassium phosphate (20 mcg), potassium chloride (20 mcg), and calcium chloride (1.5 mcg). From the manufacturing process, each dose may also contain residual amounts of sodium taurodeoxycholate (≤ 10 ppm), ovalbumin (≤ 1 mcg), neomycin sulfate (≤ 0.2 picograms [pg]), polymyxin B (≤ 0.03 pg), and beta-propiolactone (< 25 nanograms).
The rubber tip cap and plunger used for the preservative-free, single-dose syringes and the rubber stoppers used for the multi-dose vial contain no latex."
For obvious reasons, I will not post all four vaccine descriptions in addition to the seasonal flu ones in this post, but you can look for yourself.
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm181950.htm
By following the link on the left of the page under "Resources for You" you can click on the "Complete List of Vaccines Licensed for Immunization and Distribution in the US" button (or follow this link: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm )
Scroll down to the influenza vaccines and you can directly compare the ingredients in, say, Sanofi Pasteur's seasonal flu vaccine versus their 2009 H1N1 vaccine. They will be the same. This should be no surprise, though, because making this vaccine was no different than making a new seasonal flu vaccine year after year. It is the same vaccine, produced by the same methods, just different "identifying" parts of the inactivated virus are put in the product.
In fact, if we had predicted earlier that this strain of H1N1 would have circulated this year, we could have included it in the seasonal flu shot, negating the need for another shot at all, and very few people would have had any problem with it. Anyone can look at this information for themselves. Both the seasonal flu shot and the 2009 H1N1 vaccine are produced in exactly the same way with exactly the same ingredients (save for viral antigen).
If you get a seasonal flu shot, there is absolutely no reason why you should not get the 2009 H1N1 vaccine if you are in the risk categories recommended by the CDC. If you do not get a seasonal flu shot but should, then there is no reason why you should not get both the flu shot and the H1N1 vaccine.
Also, in reference to an earlier post, I would highly recommend the flu vaccine to a pregnant patient, especially the 2009 H1N1 due to the pathogenicity (not necessarily virulence) of the virus. Fever producing illnesses like the flu can be very dangerous for mother (increase risk of complications) and fetus (increase risk of miscarriage). The benefit far outweighs the risk in this case.
In addition, to comment on some earlier posts. It was my impression that this virus is not only concerning due to a lack of immunity, but also due to the age groups most affected by the virus. In the seasonal flu, most hospitalizations are in patients > 65 yo. With 2009 H1N1, incidents of hospitalizations were highest in children < 4 yo. 90% of seasonal influenza deaths occur in patients > 65 yo, while in 2009 H1N1, the number of reported deaths is highest in people 25-49 years old (median 37). In fact, the incidence of infection with 2009 H1N1 is lowest in persons > 65 yo than all other age groups.
I'm certainly no expert on the subject, but I see this as something "more" than the typical seasonal flu. Will it be worse? I don't know. But I keep hearing that "36,000 people die each year of seasonal influenza, the 2009 H1N1 is no worse than the seasonal flu." The problem is that the people dying of H1N1 are NOT the same people dying of seasonal flu. I expect we will see more flu-related deaths this year than usual, even if the virus remains fairly mild. As in, still the 36,000 deaths per year of seasonal influenza (or at least the 32,400 in patients > 65 yo) plus additional deaths from the 2009 H1N1 on top of that.
It seems that on one side you have people saying that this virus will wipe out half the population of the US, while on the other, people are saying that this virus is no big deal, seasonal influenza is worse, it is pointless to get vaccinated. While I certainly agree that this event will probably just be a footnote in history, if that, there is a lot of potential here for things to get worse very quickly.
Of course, just my .02
SR
Saturation
10-31-2009, 06:03
Got the H1N1 vaccine yesterday- will let you know if I start drooling or stuttering :p
Took the Hubby to Las Vegas a couple of weeks ago for our 7 year anniversary. Get back on Monday, Tuesday he isn't feeling too well. Wednesday he goes to the flight doc after I drive him bonkers about going. Doc tells him he has the flu, didn't say what kind, just the flu, as well as an Upper Respitory Infection. Put him on a Z-pac , musinex, and cough medicine with Codeine. Says he will alright to fly on Friday morning.
Friday morning he isn't alright to fly, which I thought was suspicious since we were heading to my parent's house. Thought he was just trying to get out of going...:)
Good thing the daughter and I were gone for 4 days because he did indeed have H1N1, and wound up cracking two ribs from his coughing. This is the sickest I have ever seen him in the 10 years I have known him. He was out of work for about 7 days, is back now, but still not up to 100%.
Neither of the kids or I are symptomatic, so I guess we got lucky.
A 3-4 day "bug" has been traveling across our office here, which I suspect has been H1N1 as it has knocked some healthy people out for days. Was in Vegas this past weekend, came back and on Tuesday started to get sniffles, by the evening I had a 102 fever and a dry cough had started. Suspecting the flu, I popped 4 Advil and got Mucinex DM to deal with the cough. Good thing, because next day the Doc told me I had H1N1 and asked me to continue with the OTC treatment, since I was not in any high risk group. I was pretty aggressive with hot herbal teas, Zicam, and stayed hydrated. Have been off work since then and my flu symptoms lasted 3-4 days. All in all, my personal experience wasn't too bad (Malaria felt magnitudes worse). The sore throat and the dry hacking cough were the worst parts of it.
I still have a cough and my ribs are a bit sore, fortunately didn't break any.
Draw your own conclusions. <<LINK (http://www.latimes.com/media/graphic/2009-11/50272107.gif)>>
The Reaper
11-04-2009, 08:21
Draw your own conclusions. <<LINK (http://www.latimes.com/media/graphic/2009-11/50272107.gif)>>
Taking care of the homies.
TR
I hear NAMRU is in transit to Lviv Ukraine. Google it up.