Ten Things I Think I Think about H1N1

I haven’t posted on H1N1 in a bit; honestly, I haven’t known what to think.  So, in homage to Peter King, here’s ten things I think I think about H1N1 today:

1.  Still, don’t panic.  Be Living Prepared for H1N1.  Read on.

2. Veratect on 5/15/09 announced the end of a valuable public service:

Due to the transition of surveillance and reporting on influenza A (H1N1) towards routine seasonal influenza tracking, Veratect will cease providing Twitter posts for this event as of 8:00p EST, May 15, 2009.

This is a shame.  I’m not certain that we have reached the end of this outbreak; nor whether routine seasonal influenza surveillance is sufficient, but I do understand that this was costing Veratect quite a bit to stand up two command centers and provide 24×7 coverage.

Also, note that a record blog posting by InSTEDD refers to this outbreak as the “Influenza A (H1N1) Media Hype”

3.  I’ve aggregated those official twitter feeds on H1N1 that I find most useful into my own H1N1 feed, @LP_H1N1.  This pulls from the @whonews, three CDC feeds, @birdflugov, and I think @healthmap.  I’ll add others if the situation warrants it, but for now, I think it’s good.  You can follow @LP_H1N1 directly or you’ll find the feed running in the column on the left or subscribe to the RSS for that feed directly.

4.  There are now 12 fatalities in the US out of 6500+ cases.  That’s a mortality rate of about .18%, really nothing to worry about.  The mortality rate of the cases in Mexico, where this virus originated, is about 1.9%, which would be something to worry about if the virus continued to spread exponentially throughout the world’s population.  However, according to the latest WHO figures, the global mortality rate (outside of Mexico) is about .17%.

Now, I am not an epidemiologist, but to me this suggests that as the H1N1 virus has spread, it has become less lethal as it has mutated.

5.  I’ve been trying to determine whether the spread of H1N1 infection is growing exponentially or linearly.  Obviously, if exponential, the infection rate is high enough to warrant concern.   And it appears that with the best public health infrastructure in the world, the growth of H1N1 in the US continues to be exponential while in the rest of the world, not so much – especially in Mexico, where this strain all started and has clearly now leveled off.  There’s a number of charts out there that show this.  Here is one.

6.  In doing this research, I came across a disturbing blog posting that, because I am unsure of the source’s credentials, I will not cite here.  However, the math is somewhat frightening. Based on confirmed data (cases and deaths) through early May, a mortality rate of close to 3% was being measured.  With an infection rate of 1.47% (again, measured average based on confirmed data), the spread of H1N1 and resulting deaths would look like this:

  • By 5/22/09 – almost 1 million infected globally; # of deaths assuming 3% mortality rate = 28,000; assuming .5% = 4,700
  • By 5/29/09 – 13 million infected, 250K+ dead at 3% mortality rate; 66K dead at .5% mortality rate
  • By 6/13/09 – over 3.8 billion infected, 116 million dead at 3% mortality rate; and almost 20 million dead at .5% mortality rate

However, according to the latest WHO figures, as of 5/25/09, there are only 12,515 cases globally with 91 deaths (and 80 of those in Mexico).

So, obviously, this scenario is not coming to pass, as clearly the calculated infection rate is not what we are observing.  And note that the .5% mortality rate I believe is the figure from the 1918 Spanish flu.  The .17% mortality rate measured globally (excluding the Mexican figures) is about the same as seasonal influenza; from that perspective, maybe Veratect was justified.

But essentially, what this means is, don’t panic.

7.  I am highly satisfied (make that thrilled) with the President’s choice of NYC Health Commissioner Thomas Friedan to head the CDC.  Dr. Friedan has done a great job at leading the City’s Department of Health and Mental Hygiene, overseeing the largest and best public health infrastructure of any City in the world.  I had the opportunity to consult with their Bureau of Emergency Management on a project to review the City’s bio-incident response plan and briefed the Commissioner personally on our findings just about a year ago.  I found him to be focused, strategic in his thinking, and a calm, motivating and highly effective leader.  He has the energy and the track record to head up the CDC and I’m confident will do a great job with the H1N1 and future challenges.

8.  I’m attending the Long-Island – New York City Emergency Management Conference this week and I am anxious to hear what the State, City, and surrounding counties have to say about how their pandemic response plans may need to change given the H1N1 experience.  I am also looking forward to sections about logistics (my specialty) and the weather, as I also worked on a project supporting the City’s Coastal Storm Plan.  Expect some blog posts live from the event!

9.  Current WHO Map of H1N1 influenza cases:

GlobalSubnationalMaster_20090525_1000

WHO has a timeline of influenza A (H1N1) that provides a really cool flash application that lets you scroll through these maps on a daily basis to monitor the spread of H1N1, starting with the latest map.  It’s my click of the day!

10.  These are my non-H1N1 thoughts of the day, and again, in homage of Peter King, they will be all-sports related:

  • I can’t believe the Red Sox lose 2/3 to the Mets, and 5/10, with Big Papi not hitting anything, and still ending up in first place.
  • I got cheated out of watching the Coca-Cola 600 on Sunday by rain; then by sun on Monday afternoon (we took the kids to the park), and again by rain in Charlotte on Monday evening.  Good for you David Reutimann for being the first to figure out to stay out during the last caution when rain was threatening!  But I think NASCAR has to change the rule that if rain ends an event that was running under caution, the final standings should go back to the last green flag lap – and not the order after pit stops run under yellow.
  • Go Magic!  Any team that barely beats the Celtics (without KG) has to go all the way…. though I have a feeling this is Denver’s year.  (Did I really say that?)
  • So if BB can’t sign Jason Taylor, trade for Julius Peppers, draft an OLB, while losing ILB rookie Tyrone McKenzie for the season I think it is time to mess up everyone else’s preparation for the Pats D and switch to the 4-3 as the primary set and have Mayo and Thomas play outside with Bruschi in the middle.

That’s it for now.  Keep Living Prepared for H1N1!

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5 Responses

  1. Hello Mark!

    You are doing an excellent job with your blog and postings. I wanted to provide you wih some additional insights:

    Item 4: You write “Now, I am not an epidemiologist, but to me this suggests that as the H1N1 virus has spread, it has become less lethal as it has mutated.” Problem is, although many speciments of this H1N1 have been sequenced, the molecular virologists are not finding any significant mutations, and the reason it seems to be more virulent in Mexico is unknown. I say “seems” because we rally don’t know how many cases there were in Mexico. This is important, because the case fatality rate (CFR) is number of deaths divided by number of cases. If 100 people died of H1N1 in Mexico, is that severe? It depends. If there were 200 cases and 100 deaths, that would be a CFR of 50%, very high and comparable to H5N1. If it were 100 deaths out of 100 million cases, that would be 1 out of a million . . and not much to worry about. Sinvce Mexico was not looking for cases before April, we know hown many people died in hospitals of H1N1, but we don’t know how many didn’t die. The Mexican CFR could easily be similar to that of the rest of the world, we just don’t know.

    But one thing we do know, researchers have found no mutations which could account for a decrease (or increase) in lethality, and believe me, they are looking!

  2. #5- The harder you look, the more you’ll find. The US has been looking very hard for cases, so its not surprising that they are finding more and more.

    The definition of a “confirmed or probable case” involves testing a specimen from the sick person in a lab. In the first weeks of this outbreak, only one lab in the US could confirm a case, and that was CDC in Atlanta. After CDC distributed test kits and procuedures, there are almost 50 labs in the US which can confirm novel H1N1, so it’s not surprising the number of lab-confirmed cases continues to grow.

  3. #6

    In the U.S., the Case Fatality Rate from the 1918 influenza pandemic is estimated to be 1.9%, not 0.5%

  4. Keep in mind that even in the 1918 flu, where an estimated 675,000 Americans died, most people did not get sick, and of those who did 98% had a miserable week and then recovered completely.

    Also, the number of “Confirmed and Probable” cases is a small percentage of actual cases. Many people with the flu never see a doctor, and of those who do, very few get the lab test needed to make a confirmed diagnosis of H1N1.

    CDC flu expert Dan Jernigan last week estimated that about 100,000 people were sick with the flu, about half of those with H1N1, and it is continuing to spread. The good news is that as the number of people sick with H1N1 goes up, the CFR is even lower than reported.

  5. Thanks Frank for the additional info and fact corrections. I wondered where I got the 0.5% figure from, and it is cited in several places – most often cited as the percentage of the total population that died from the 1918 pandemic (50 million people – though that would still be too low) not the MPR of those infected. Anyway, thanks for the correction. The additional info you provide just feeds the “Don’t Panic” response here.

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