Sobering news indeed.
The Boston Globe reports that “of the 86 children who have died since the new swine flu arose last spring, 43 deaths have been reported in September and early October alone, the Centers for Disease Control and Prevention reported. That’s a startling number because in some past winters, the CDC has counted 40 or 50 child deaths for the entire flu season — and no one knows how long this swine flu outbreak will last.”
I had a mild heart-stopping moment just now when I was reviewing the WHO’s update on H1N1, published today on their web site, which hints at the real possibility of impending doom:
Severe respiratory failure
Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.
During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.
Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.
Vulnerable groups
An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people.
Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.
When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.
Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes.
Moreover, conditions such as asthma and diabetes are not usually considered killer diseases, especially in children and young adults. Young deaths from such conditions, precipitated by infection with the H1N1 virus, can be another dimension of the pandemic’s impact.
Higher risk of hospitalization and death
Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population.
Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.
A new round of the swine flu, which has been exploding in the Southern Hemisphere, could be making its way to the Northern Hemisphere in a matter of weeks. There will be deaths, but there are always deaths as a result of the flu. As Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health who has been helping the CDC project the severity of the upcoming wave noted, “It’s fair to say there will be tens of millions of illnesses and hundreds of thousands of hospitalizations, and tens of thousands of deaths. That’s not atypical. It just depends on how many tens of thousands.”
The Washington Post provides a good summary, noting that:
Perhaps more important, in every country where the virus has spread, it has continued to affect children and young adults much more commonly than typical flu viruses.
“In a pandemic where a greater fraction of illness and deaths occur in kids and young adults, that will be clearly noticeable to the public. There will be a sense that this is a greater severity of illness even if fewer people die overall,” the CDC’s Bresee said.
Most of those who have developed serious illness and died have had other health problems. But those include many common conditions, such as diabetes, asthma and obesity. Pregnant women appear to be especially at risk. And the virus can cause severe illness and death in otherwise healthy people in perhaps a third of cases.
In the Southern Hemisphere, the virus has been more intense in some places, including those with few resources. Countries with fragile health care like India and South Africa could be quickly overwhelmed if the swine flu starts infected a large number of people.
I guess we will have to wait and see. Preferably with suspenseful music in the background.
The number of confirmed cases of the disease rose above 1,200 in Australia on Monday and the virus is no longer restricted to schools and other institutions in that country, suggesting that a community-wide spread has begun. Such a spread in a region outside North America is the primary criterion for raising the alert level to Phase 6…
…they are concerned that infections continue in North America and Europe, even though the traditional flu season has ended in the Northern Hemisphere. “The disease patterns are not what we see from seasonal influenza,” he said. That suggests that the virus has greater capability for spread than does the seasonal flu virus.
The majority of the infections have been in people younger than 60, which is also different from seasonal flu. That suggests, some experts said, that older people may have been exposed to a different swine flu virus in the past that has conferred some immunity.
About half of the people who have died from the virus were previously healthy, with no underlying medical conditions. “That is one of the observations that has given us the most concern,” he said. “We don’t know why they died and why other people recovered. We are looking for clues.”
Swine flu cases continue to rise and while many people may not see what the difference is between this and the regular flu, the LA Times points out the flu pandemics have a history of foreshocks.
Scientists think the spring swine flu epidemic may be a “herald wave” of what’s to come. In 1918, a milder wave of flu cases occurred in late winter and early spring, before the deadly pandemic surge in the fall of that year. In 1957, Asian flu was causing unremarkable illness in China, before landing on American soil for the summer outbreaks and a severe winter season.
Another common feature of past flu pandemics is the age groups of the victims. The CDC says that seasonal flu contributes to some 36,000 deaths in the U.S. each year and 90% of those are senior citizens 65 or older. History has shown flu pandemics killing higher proportions of younger adults.
In the end, only time will tell, and hopefully it will tell us soon with winter moving into the Southern part of the world.
Plague Girl 