Swine flu: not down for the count

Not just the states, of course. WHO also is dropping counts.

it also isn't just resources (though I completely agree about the infrastructure and surveillance investment.) State PH just doesn't see the value. They need targeted numbers.

Well, maybe time for free cell phone apps to let folks dial in with symptoms, in exchange for a local map. Not everyone has a computer, but everyone has a cell phone. overseas, too. Remote villages in Pakistan and Africa have cell phones even without reliable electricity to recharge the phones (observation relayed to me by health workers stationed there.) Go figure.

Counts are so passe.

We've got models.

Nice gross generalization about "everyone who objected to paying more taxes bears some of the blame for this". The way our bloated government allocates tax dollars on health issues has nothing to do with this ineffectiveness, right? Since the scientists and academics supposedly "have the ear" more of the current administration than the past one, what amazing improvements can we expect to accompany the almost certain higher taxes. Maybe just maybe you use a bit too broad a brush.

Well-I am so glad they are investing in cell phones in Africa. Those are also used by the Taliban and Somalian bad guys. But mostly its SatCom phones.

I guess underinvesting means that we should give cellphones to the poor because we left it out of the bailouts when we were busily paying peoples mortgages, bailing out banks with tax money? No wait, we already have a program for that too.

Spend, spend, spend but to what end?

Even if all they did was put it up as suspected cases that would have been plenty. We would know where to aim our efforts. Now we get to send kids to schools, parents to the offices with the unknown. Nice. Run that computer model, the numbers are just as ugly on the spread as they were for Bird Flu.

But no, its not good PR in the Obama Administration, or the WHO's obfuscation campaign to have real numbers. Come fall when it starts taking Americans who haven't got a clue whats coming except for the short little blurblets from CNN/NBC/CBS which constitutes the bulk of state run media, then we will start hearing numbers. They wont be able to hide them. Numbers that cant get into a hospital, numbers that have died... Now theres the real numbers. YOU...Get up off the ground you cant be dying, you dont fit the reality.

We are about to start school on the 11th. I expect by Labor Day they will figure it out as the cases begin to mount at the suggested exponentiation of 3 per person per day. Oh, dont report that yet either... Its bad for the Obama Administration.

Late September, just after it cools it will start to get its act together. Counting will be done by seeing missing students, workers at the office, the numbers IN the hospital, and the number of holes we are digging for those that are leaving feet first rather than on them.

But I am sure that someone will pipe up and tell ME that spending more money on something would have kept one person alive. Frist asked for 500 million from the Democrats. Nope, not going to happen. Obama asks for a billion..They give him a billion five.

But its 1.5 billion for what?

Vaccine? Shit 75% titer level MAYBE after two months. It will be mostly gone by then. For those of you who are injured by it because it was untested please understand we gave the manufacturers, doctors, nurses, and above all the government immunity from prosecution and liability that this is UHC. Everyone gets screwed.

Ventilators? Shit-Who is going to operate and maintain them?

Beds? Shit-Place to die or maybe get a very short shot at oxygen.

Doctors? Shit-Minimum of ten years to get one into the field.

Nurses? Shit-Six years

So this money is for WHAT? Yep, lets spend some MORE money as we have underinvested in ____________?

So we have 1 in 6 HCW's who have said they wouldn't show in a pandemic episode. They are the smart ones, they were also mostly doctors.

They are using bypass machines in the UK and Australia to keep people alive. They are also having to fly them to Sweden for treatment. So I guess that the UK with that vaunted UHC that is collapsing around their ears from Swine Flu has also underspent on healthcare? Underspent? How could that BE?

How could I say that? Could it be because their people are being asked on the phone if they are unconscious...And its not from a HCW. Some non medical person after a 30 minute wait asks you if you are unconscious. Kind of like private insurance here. Non medical types making decisions for you. Kind of like what Obamacare offers. And its going to be rationed from the start.

This is a palliative for a problem. The UK is spending a lot of money on this to provide antivirals that it would appear aren't working either? Forget that its going to cost them almost 1/2 trillion to get through it and have the same outcomes... We spent the money !!!! WE did everything we could !!!

Are you unconscious. Yeah, they are but the ones answering the questions are certainly more conscious than their health care system is.

I guess if you are willing to bankrupt a country then you can have healthcare at all costs right up until the time you run out of someone elses money to spend. Then you don't have healthcare for anyone and the only way you would get it is if you were willing to pay the local witch doctor shaman for it.

Full circle.

We will just raise taxes because someone thinks that this is the answer to everything.

http://www.kentnews.co.uk/kent-news/Cost-of-swine-flu-could-be-catastro…

I'm not sure that a scare story in a small local UK newpaper is very convinving evidence of the entire country being bankrupt due to the National Health Service.

DemFromCT, case counts have little or no value for me at the local HD level too--I rely more on reports from sentinel physicians to get an estimate of current prevalence. The other factor is that case counts are now only generated from severely ill hospitalized patients, cases associated with clusters, and from specimens submitted by sentinel physicians. Even for cluster investigations, we sample no more than five patients, so that the number of reported cases from an outbreak would be the same whether there were five patients involved or fifty. I'd say that case counts lost their value as an estimate of prevalence once we were more than a couple of weeks into this thing. We're now focusing our surveillance activities on monitoring for changes in severity, as well as changes in affected populations.

And yes, it still comes down to resources. It would be great if I could get a daily poll from all the local primary care physicians on how many positive rapid flu tests they had, but it's enough of a chore getting the handful of sentinel physicians to report consistently on a weekly basis. Right now we can barely keep up with the current limited number of H1N1 case reports that we receive in addition to all our other notifiable disease case investigations. This one new pathogen has easily doubled our workload. Can't ask for help from our STD or TB people either, because they're short-staffed too.

I'm not sure how useful data generated from cell phones might be. There are currently websites that track diseases from the general public like www.whoissick.org and of course www.google.org/flutrends but they rely on too many variables to take very seriously. Cell phone-generated data could certainly be useful in places with really poor infrastructures, but I think in the US the data would be heavily biased from reports from the "worried well".

But, "counts" give the masses something to grasp that says, at least TPTB are doing something.

When they STOP publishing the counts it indicates to them, "there's NOTHING wa can do, so we chose to do nothing."

The changes in tactics are very misunderstood.

I see part of the resaon for the change as redirection of resources to more useful activity (that's just ONE reason..,)

As a layperson, I have what may amount to a silly question. Without case counts, how will we know when our area has been hit? I watched my county's case counts carefully, ready to make changes -- pulling my kids out of school, if necessary -- to our lifestyle.

Are there other ways for every day people like me to keep an eye on how things are developing locally? Our state had big numbers, but none of them ever reached the northern counties.

Are there other ways for every day people like me to keep an eye on how things are developing locally?

Curious,
this is a very good question (perhaps the key question when it comes to personally getting safely through a pandemic)

Due to the exponential growth pattern and the geographically very inhomogenous pandemic "wave front arrival times", the time interval during which there is a high risk of getting infected in a particular area (state,city) is a relatively short period of time ( only about two weeks ) during which the wave really crests in that area.

So it is very important to know exactly when the crest of the wave is going to hit the area (city,neighborhood) one is living in order to self-impose self-supplied quarantine for only that limited period of time.

Many countrie's flu surveillance systems do allow for a more differentiated geographical monitoring (i.e. at the state/province level)

Curious: CDC's Fluview site indicates whether flu is widespead, regional or sporadic in you area and your city/state health dept. should also have that info. But you never really had case counts. You just thought you had them. They are so inaccurate and underestimated that they were misleading, or at least, provided no more information than the more general system CDC is now returning to. So you've lost nothing but a misleading information source, which puts you ahead IMO. There is misleading info that makes you feel better or more in control, but I am never in favor of misleading info.

I continue to wonder whether stopping the "counts" means that the procedure for identifying new variants will suffer.

that would be frightening.

newore: No, the virologic surveillance is a separate issue. Even the lab confirmed cases weren't being sequenced. So these are independent issues. Sequencing is very time and resource intensive and is only done on a tiny fraction of isolates. It has nothing to do with the count.

Hi Revere,

I live in Australia, where school holidays (two weeks) end on Tuesday, and infection rates are expected to increase as we enter the real peak of our flu season. I'm curious about reporting and how it relates to probable actual numbers. The Commonwealth Department of Health and Aging here is reporting 16,000-odd confirmed cases of novel H1N1, and 1900-odd hospitalizations. Obviously that looks really frightening: nearly 12% of confirmed cases require hospitalization by the official numbers. What do you think the "unofficial numbers" would be? Ten times as many cases -- 160,000? More? Fewer? Impossible to know?

happy beach travels to you and all the revere gang...

I've heard that states and CDC will continue to count hospitalized cases and deaths from H1N1. This is actually more helpful information than the case counts posted previously, as it will allow comparisons between states with rates that can be calculated if divided by the population.

Thanks Revere and H1N1 Watcher -- I agree, misleading information isn't going to help, whether it makes me feel better or not. I do have a friend who's an ER nurse, so she's got an idea what's happening. But she's also of the mindset that it's "just like seasonal flu."

One more question for the experts: I'm hearing again and again how this thing is just going to EXPLODE this fall. I'd love to see schools postpone the school year until the vaccine is rolled out, even if that means kids staying home until January. I know it's not a perfect solution, but the "send 'em and let's see what happens" plan doesn't really work for me either.

I'm strongly considering home schooling until the vaccine is available. In your opinion -- and I know it's just an opinion -- is that overkill? Am I being too overprotective? Should I wait and see how things go in my area? As H1N1Watcher points out, things change really rapidly.

I have a first grader and a preschooler and both would be crushed by having to stay home, but they are so little -- and I'm in a risk group as well (asthma).

Anyone?

Curious - As an 8-year homeschooling veteran with the grey hairs to prove it, my motto is "when in doubt, take them out." Homeschooling is not for everyone, but a year of it won't hurt you or your kids. On the other hand, our homeschool group passed around something in the spring - it may have been H1N1 - it was certainly awful - so just taking them out doesn't necessarily protect you. We spend a lot of time being sneezed at in museums and libraries (and believe it or not, people take their kids to the library when they're off school sick). We are all trying to make these choices right now. Good luck!

laurie: CDC's rule of thumb was 20 cases for every reported case but they admitted it was just a guess. It could be 100 o 15. One thing for sure. The reported/confirmed cases are a wild underestimate.

bc: Hospitalized and fatal cases are better for several reasons (easier to confirm) and are some indication of virulence, although without knowing the number of infected we are still in the dark about much. But I agree with your point.

Curious: I hate to give advice like this because I don't know. I do have small grandchildren and I am not advising their parents (my children) to keep them out of school in the fall, but I could revise that once I see what things look like. It's not a matter of principle but a matter of making a judgment under uncertainty. Right now it's a lot like seasonal flu clinically (although not epidemiologically), so I think my advice would be consistent with that. Whether things will explode or not we'll have to see. I think it could well happen, but I don't think it's a certainty. There's been a lot of infection already and the resulting herd immunity could make a difference. Or not.

How big a town do you want to make the statement. 50 billion pounds.. X 1.63 dollars = 82,155,767,334 USD...And change. If that holds and its about equal by population then it will cost the US four times that. About 1/2 trillion...

And change

http://edinburghnews.scotsman.com/business/Swine-flu-39will-cost-UK.547…

At the risk of feeding the trolls...

MRK: You do know we spend 2.4 trillion annually on healthcare, right? About 5 times the number you cited.

And not only does the UK cover everyone, while we leave 40 million people wholly uninsured and countless numbers under-insured, but they actually have better health outcomes than we do on most measures.

So, while there might be some valid arguments for why the NHS model shouldn't be adopted wholesale in the USA, you're going to have to find something better than the kneejerk assumption that their system is more expensive and less efficient thank ours -because it isn't.

Just look at the math.

People need to stop sensationalizing the swine flu. It's a glorified flu.

@21: this is not a killer flu.
But it is certainly not a 'normal flu' either.

'normal flu' does not infect millions of people in the mid of summer.

And 'normal flu' does not kill young & healthy pregnant women as it is now almost daily the case with novel H1N1 :-(

M.Randolph Kruger, I had to post a reply as I really feel your comments regarding the UK are rather misleading!
I work in healthcare, and have so far seen no evidence of our system falling down around our ears. The pregnant woman who was tranferred to Sweden,was not transferred for mechanical vetilation, but for ECMO, which is completely different. We have 5 units which provide ECMO in the UK, since it a resource which is rarely required in these circumstances. Yes unfortunate for the woman involved, but she is still alive!
I agree that callers to the NHS Pandemic Flu Line, are asked if the individuals they are calling about are conscious. This does however provide a crude way of triaging people, and ascertaining if an ambulance is required immediately.
Your point on Tamiflu-we are lucky that the UK has ordered in enough for the entire population, and it appears to work on those who need it. Friends and colleagues have recovered quickly after they have commenced anti-viral medication.
I understand your point regarding finances,but in the UK we have healthcare free at the point of delivery. Our NHS is not perfect, but those of us who work in it believe it to be one of the best systems in the world.

Victoria-I have no idea where you are in England of course but what you are saying is directly counter to what I am being told by 2 GP's, 1 researcher and three people who live in the London area.

The fact is that the telephone lines were put in because the GP's couldnt handle it. I think thats a fair statement. The sick are told to stay at home as they are told here. There has been more than one incident and fairly widely spread that people didnt even get Tamiflu even after being told they had it because a person on a wire said that they thought they didnt need it. There have also been about 20 incidences of people getting Tamiflu, taking it and they had some other condition that wasnt recognized.

This is 100,000 cases in a week. Thats reported. If the number of cases triple to within even three days, the system IS as ours here in the US would fail. There simply isnt enough equipment or people to operate it for the really bad off.

Math-you are starting from the assumption that healthcare is a right. Its a costly service that we made it across 50,000 years of evolution paying for it. We could go and on about it, but this isnt paper money. Someone will have to pay for it. One way or the other. If the UK system which you are forced into, forced into questionable vaccinations if they deem it necessary and more importantly forced to pay for collapses then its just the way it is. There are problems with both systems, but I can tell you that entitlements isnt in the Constitution of the US. Even though there are a lot of people who think so.

By the way... the 82 number is a conversion to dollars from pounds. Its also the Brown Govts. number and not mine. Go kill your messengers... SkyNews.

Sorry BMI- I missed your one line.

One of my people (Jimmy) got it from his kid. He has been in the hospital now for three weeks and fortunately he has all of his insurance paid for by me.

Normally one doesnt get pneumonia from flu, run up to 103 and have to be taken to the hospital by ambulance. That was one day after having been told by his MD that it was mild and that it would be over in a week. 34 years old, recurrent fever, pneumonia just now clearing. He can stand if assisted.

I guess its glorious if you are Roche or GSK. Mr. Lopez doesnt think its very good.

But neither do I. I need him back on the ramp.

We are concerned about money....what price a life?
yes we will have to pay for this virus, in one way or another. If you polled the UK population and asked them if they would prefer an increase in taxes to NO Flu defence, I wonder how they would respond. They would pay!

There are 60 million Uk-seyians. Whats that come out to per person?

MRK:

I suppose it's probably easier to feel you've won an argument if you totally ignore the other person's points, but I wasn't talking about the philosophical issue of healthcare as a right; I was talking about efficiency.

According to your own numbers, we here in the US spend 5 times as much on healthcare and what do we get for that?

We get coverage for only a fraction of our population, and we get worse health outcomes.

Does logic enter into your diatribes at ANY point?