While the H12N1 Swine Flu continues to spread in the UK the government continues floundering in it’s response. There appears to be complete confusion on the issue of Tamiflu, the antiviral drug used to “treat the flu.”  Chief Medical Officer Sir Liam Donaldson appears ready to distribute vouchers to anyone off the Internet or otherwise, just days after giving doctors permission to not prescribe Tamiflu if their phone rings too much.

Because patients must be treated with 48 hours after the onset of symptoms there is limited usefulness for the drug. It also does not cure the flu, it only shortens the duration by 1-2 days. While some projections are that widespread distribution of Tamiflu to the general population would save millions of lives, the reality is no one knows if Tamiflu would be effective at all  with this type of distribution. It is more likely to create widespread resistance and render Tamiflu a useless drug.  Tamiflu is a tremendous asset for a pandemic but it should be reserved for susceptible populations and specific situations and remain under the control of doctors, not the government. Isolation and preventative measures are our front line defense against the pandemic, not handing out Tamiflu to everyone.

A case in point is the Air Force Academy outbreak of Swine Flu. It is early and Tamiflu could be administered to the entire population since they live in close quarters and could be sequestered short term in the contained environment of the Academy. Or they could be more conservative and administer Tamiflu to anyone with a history of respiratory or immune problems making them a higher risk for serious complications, and restrict the campus short term. Letting everyone in Colorado Springs have a free voucher for Tamiflu would be irresponsible.

Tamiflu is not a panacea and using it as one will probably render it useless for the people who need it most. Lets hope the UK does not create a resitant strain of flu via massive distribution of vouchers.

UK new Health Secretary Andy Burnham predicted the H1N1 swine flu could be infecting 100,000 people daily by August with 40 deaths per day. With about 7000 cases currently and reportedly doubling daily, one has to wonder where these projections come from. With the current mortality rate and experience in the U.S. these projections seem inflated to say the least.

More troubling is Mr. Burnham’s statement that Doctors will be given the authority to not prescribe Tamiflu if they are overwhelmed with calls. Mr Burnham is engaging in the act of practicing medicine at this point. It should not be under his purvey to make such a declaration. That is a decision that should be left to the doctors and makes no sense, given that the UK reportedly has ample supplies of Tamiflu. Just because the phone is ringing has no bearing on evidence based medicine decision making.

Hopefully, health care reform in the U.S. when not lead to government meddling in patient care decision making of this nature. If your family doctor can’t decide whether your symptoms and history indicate the need for an  antiviral drug  they should take up another line of work. If they are not allowed freedom  in prescribing we may as well stay home and order whatever sounds good off the Internet. This is also someone who is very proud of the 18 week wait cycle. Eighteen weeks waiting for referrals for testing and treatment is not a model to emulate.  Health care reform can do better than this.

I

The Center for Disease Control has models reportedly showing the H1N1 wine Flu has infected over 1 million people in the U.S. this year. The number of deaths has been well below expected levels.

Reduction of Risk of Introduction of Novel H1N1 Virus into the Camp Setting

• Provide camp attendees, staff and volunteers with materials prior to arrival at the camp to notify them that they are not allowed to attend camp if they have had an ILI in the 7 days prior to the start of the camp.  In addition, they should be reminded that if they have been exposed to a person with novel H1N1 or ILI in the 7 days prior to the start of camp, they may attend camp but should closely self-monitor and report development of ILI symptoms immediately.
• Consider active screening of ALL newly arriving camp attendees, staff and volunteers by asking if they have had any symptoms of ILI in the previous 7 days. Provide education to individual campers about reporting ILI.  A careful health history of each arriving camper should be taken. Note any conditions that may place them at high risk for complications of influenza.
• Camp attendees, staff and volunteers should be instructed to immediately inform camp management if they currently have or have had an influenza-like illness (ILI) in the 7 days prior to arrival.
• Persons who currently have or have had ILI in the previous 7 days should not attend camp for 7 days after their symptoms began or until they have been symptom-free for 24 hours, whichever is longer.

See the CDC website for complete information

Swine Flu is really in the news at NBC!  Reportedly a few workers are out with the Flu.

Table. U.S. Human Cases of H1N1 Flu Infection
Web page updated June 12, 2009,
11:00 AM ET (Updated each Friday)
Data reported to CDC by June 11, 2009, 3:00 PM ET

States and Territories*	Confirmed and Probable Cases	Deaths
States
Alabama	123 cases	0 deaths
Alaska	11cases	0 deaths
Arkansas	13cases	0 deaths
Arizona	597 cases	5 deaths
California	1094 cases	6 deaths
Colorado	75 cases	0 deaths
Connecticut	637 cases	1 death
Delaware	187 cases	0 deaths
Florida	417 cases	0 deaths
Georgia	39 cases	0 deaths
Hawaii	198 cases	0 deaths
Idaho	29 cases	0 deaths
Illinois	1983 cases	5
Indiana	201 cases	0 deaths
Iowa	92 cases	0 deaths
Kansas	97	0 deaths
Kentucky	106	0 deaths
Louisiana	134 cases	0 deaths
Maine	33	0 deaths
Maryland	139	0 deaths
Massachusetts	1078	0 deaths
Michigan	419 cases	1 death
Minnesota	153	0 deaths
Mississippi	59 cases	0 deaths
Missouri	46 cases	1 death
Montana	27 cases	0 deaths
Nebraska	71 cases	0 deaths
Nevada	162 cases	0 deaths
New Hampshire	92 cases	0 deaths
New Jersey	348 cases	0 deaths
New Mexico	155 cases	0 deaths
New York	1160	13 deaths
North Carolina	61 cases	0 deaths
North Dakota	31 cases	0 deaths
Ohio	53 cases	0 deaths
Oklahoma	93 cases	0 deaths
Oregon	189 cases	1 death
Pennsylvania	626 cases	2 deaths
Rhode Island	62 cases	0 deaths
South Carolina	60	0 deaths
South Dakota	14 cases	1 death
Tennessee	110 cases	0 deaths
Texas	2049 cases	3 deaths
Utah	688 cases	2 deaths
Vermont	32 cases	0 deaths
Virginia	90 cases	1 death
Washington	584 cases	2 deaths
Washington, D.C.	33 cases	0 deaths
West Virginia	40 cases	0 deaths
Wisconsin	3008 cases	1 death
Wyoming	50 cases	0 deaths
Territories
Puerto Rico	7 case	0 deaths
TOTAL*(52)	17,855 cases	45 deaths

Data reported to CDC by June 4, 2009, 5:00 PM ET

States and Territories*	Confirmed and Probable Cases	Deaths
States
Alabama	94 cases	0 deaths
Alaska	3cases	0 deaths
Arkansas	9cases	0 deaths
Arizona	547 cases	4 deaths
California	973 cases	0 deaths
Colorado	75 cases	0 deaths
Connecticut	395 cases	1 death
Delaware	142 cases	0 deaths
Florida	247 cases	0 deaths
Georgia	33 cases	0 deaths
Hawaii	115 cases	0 deaths
Idaho	16 cases	0 deaths
Illinois	1357 cases	5
Indiana	173 cases	0 deaths
Iowa	92 cases	0 deaths
Kansas	92	0 deaths
Kentucky	96	0 deaths
Louisiana	134 cases	0 deaths
Maine	17	0 deaths
Maryland	89	0 deaths
Massachusetts	787	0 deaths
Michigan	298 cases	1 death
Minnesota	82	0 deaths
Mississippi	40 cases	0 deaths
Missouri	46 cases	1 death
Montana	15 cases	0 deaths
Nebraska	60 cases	0 deaths
Nevada	128 cases	0 deaths
New Hampshire	64 cases	0 deaths
New Jersey	148 cases	0 deaths
New Mexico	108 cases	0 deaths
New York	858 cases	8 deaths
North Carolina	30 cases	0 deaths
North Dakota	23 cases	0 deaths
Ohio	35 cases	0 deaths
Oklahoma	93 cases	0 deaths
Oregon	167 cases	0 deaths
Pennsylvania	299 cases	0 deaths
Rhode Island	18 cases	0 deaths
South Carolina	60	0 deaths
South Dakota	10 cases	0 deaths
Tennessee	104 cases	0 deaths
Texas	1670 cases	3 deaths
Utah	461 cases	2 deaths
Vermont	9 cases	0 deaths
Virginia	55 cases	1 death
Washington	577 cases	1 death
Washington, D.C.	24 cases	0 deaths
West Virginia	6 cases	0 deaths
Wisconsin	2217 cases	0 deaths
Wyoming	25 cases	0 deaths
Territories
Puerto Rico	1 case	0 deaths
TOTAL*(52)	13,217 cases	27 deaths

Summary of Situation

Updated June 11, 2009, 12:30 PM ET

A Pandemic Is Declared

On June 11, 2009, theWorld Health Organization raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway.

More than 70 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.

WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus. It’s uncertain at this time how serious or severe this novel H1N1 pandemic will be in terms of how many people infected will develop serious complications or die from novel H1N1 infection. Experience with this virus so far is limited and influenza is unpredictable. However, because novel H1N1 is a new virus, many people may have little or no immunity against it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against novel H1N1 virus.

In the United States, most people who have become ill with the newly declared pandemic virus have recovered without requiring medical treatment, however, CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the coming days and weeks. In addition, this virus could cause significant illness with associated hospitalizations and deaths in the fall and winter during the U.S. influenza season.

Background

Novel influenza A (H1N1) is a new flu virus of swine origin that first caused illness in Mexico and the United States in March and April, 2009. It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects and then touching your nose or mouth. Novel H1N1 infection has been reported to cause a wide range of flu-like symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, many people also have reported nausea, vomiting and/or diarrhea.

The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. The second patient was confirmed on April 17, 2009. It was quickly determined that the virus was spreading from person-to-person. On April 22, CDC activated its Emergency Operations Center to better coordinate the public health response. On April 26, 2009, the United States Government declared a public health emergency and has been actively and aggressively implementing the nation’s pandemic response plan.

Since the outbreak was first detected, an increasing number of U.S. states have reported cases of novel H1N1 influenza with associated hospitalizations and deaths. By June 3, 2009, all 50 states in the United States and the District of Columbia and Puerto Rico were reporting cases of novel H1N1 infection. While nationwide U.S. influenza surveillance systems indicate that overall influenza activity is decreasing in the country at this time, novel H1N1 outbreaks are ongoing in parts of the U.S., in some cases with intense activity.
CDC is continuing to watch the situation carefully, to support the public health response and to gather information about this virus and its characteristics. The Southern Hemisphere is just beginning its influenza season and the experience there may provide valuable clues about what may occur in the Northern Hemisphere this fall and winter.

 

CDC Response

CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.

CDC is issuing updated interim guidance in response to the rapidly evolving situation.

Clinician Guidance

CDC has issued interim guidance for clinicians on  identifying and caring for pateints with novel H1N1, in addition to providing interim guidance on the use of antiviral drugs. Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) with activity against influenza viruses, including novel influenza H1N1 viruses. The priority use for influenza antiviral drugs during this outbreak is to treat people hospitalized with influenza illness, and to treat people at increased risk of severe illness, including pregnant women, young children, and people with chronic health conditions like asthma, diabetes and other metabolic diseases, heart or lung disease, kidney disease, weakened immune systems, and persons with neurologic or neuromuscular disease.

With the H1N1 Swine Flu in 74 countries I expect to see an official pandemic declared by the WHO by the end of next week. With the moderate nature of the H1N1 flu to date it will not change much other than headlines.

The H1N1 Swine Flu has passed the threshold to be considered a worldwide pandemic. Politics are in play. A pandemic (level 6) declaration can be economically devastating to an already fragile world economy.Mexico all but stated the flu was gone after massive losses to the tourism industry. At this point the H1N1 Flu is a relatively mild form of influenza but pandemic declarations are based on geographic spread, not on severity. No one wants to be a flu country. Practically speaking, travel to Mexico isn’t much different than anywhere else as the numbers mount throughout the world. No politicians want what we have, a flu pandemic. So now the World Health Organization will undoubtedly find a way to redefine pandemic. Think about how pointless the colored terror threat levels have become.

Education instead of obfuscation is the better way. Yes we have a pandemic but it is mild. Give the public a little credit for not being as gullible as we are made out to be. And the mild character could change in the future. An interesting poll would be what percentage of Americans know the current threat assessment level. What percentage would know the pandemic level assessment? Call a pandemic a pandemic and educate people on prevention. Perception management has no place in the public health arena. Education does.

FYI:

Current Threat Level

June 2, 2009

• The United States government’s national threat level is Elevated, or Yellow.
• For all domestic and international flights, the U.S. threat level is High, or Orange.
• The Current HiN1 Flu is Level 5
• Hand Washing and staying 5-6 feet away from coughing people makes you very safe
• Odds of being killed in a terrorist attack-about 1 in ten million