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

Table. U.S. Human Cases of H1N1 Flu Infection
(As of May 22, 2009, 11:00 AM ET)

States*	Confirmed and Probable Cases	Deaths
Alabama	66 cases	0 deaths
Arkansas	3 cases	0 deaths
Arizona	520 cases	2 deaths
California	553 cases	0 deaths
Colorado	59 cases	0 deaths
Connecticut	81 cases	0 deaths
Delaware	94 cases	0 deaths
Florida	129 cases	0 deaths
Georgia	27 cases	0 deaths
Hawaii	33 cases	0 deaths
Idaho	18 cases	0 deaths
Illinois	877 cases	0 deaths
Indiana	106 cases	0 deaths
Iowa	71 cases	0 deaths
Kansas	34 cases	0 deaths
Kentucky**	22 cases	0 deaths
Louisiana	86 cases	0 deaths
Maine	9 cases	0 deaths
Maryland	41 cases	0 deaths
Massachusetts	197 cases	0 deaths
Michigan	176 cases	0 deaths
Minnesota	39 cases	0 deaths
Mississippi	7 cases	0 deaths
Missouri	24 cases	1 deaths
Montana	10 cases	0 deaths
Nebraska	29 cases	0 deaths
Nevada	32 cases	0 deaths
New Hampshire	23 cases	0 deaths
New Jersey	47 cases	0 deaths
New Mexico	97 cases	0 deaths
New York	327 cases	1 deaths
North Carolina	12 cases	0 deaths
North Dakota	5 cases	0 deaths
Ohio	14 cases	0 deaths
Oklahoma	50 cases	0 deaths
Oregon	101 cases	0 deaths
Pennsylvania	73 cases	0 deaths
Rhode Island	9 cases	0 deaths
South Carolina	36 cases	0 deaths
South Dakota	4 cases	0 deaths
Tennessee	89 cases	0 deaths
Texas	900 cases	3 deaths
Utah	122 cases	1 deaths
Vermont	2 cases	0 deaths
Virginia	25 cases	0 deaths
Washington	494 cases	1 death
Washington, D.C.	13 cases	0 deaths
Wisconsin	766 cases	0 deaths
TOTAL*(48)	6,552 cases	9 deaths

Table. U.S. Human Cases of H1N1 Flu Infection
(As of May 18, 2009, 11:00 AM ET)

States*	Confirmed and Probable Cases	Deaths
Alabama	61 cases	0 deaths
Arkansas	3 cases	0 deaths
Arizona	476 cases	1 death
California	553 cases	0 deaths
Colorado	56 cases	0 deaths
Connecticut	53 cases	0 deaths
Delaware	65 cases	0 deaths
Florida	101 cases	0 deaths
Georgia	24 cases	0 deaths
Hawaii	21 cases	0 deaths
Idaho	8 cases	0 deaths
Illinois	696 cases	0 deaths
Indiana	81 cases	0 deaths
Iowa	66 cases	0 deaths
Kansas	34 cases	0 deaths
Kentucky**	14 cases	0 deaths
Louisiana	57 cases	0 deaths
Maine	12 cases	0 deaths
Maryland	34 cases	0 deaths
Massachusetts	143 cases	0 deaths
Michigan	158 cases	0 deaths
Minnesota	38 cases	0 deaths
Mississippi	3 cases	0 deaths
Missouri	19 cases	0 deaths
Montana	4 cases	0 deaths
Nebraska	28 cases	0 deaths
Nevada	30 cases	0 deaths
New Hampshire	19 cases	0 deaths
New Jersey	15 cases	0 deaths
New Mexico	68 cases	0 deaths
New York	254 cases	0 deaths
North Carolina	12 cases	0 deaths
North Dakota	3 cases	0 deaths
Ohio	13 cases	0 deaths
Oklahoma	32 cases	0 deaths
Oregon	94 cases	0 deaths
Pennsylvania	56 cases	0 deaths
Rhode Island	8 cases	0 deaths
South Carolina	36 cases	0 deaths
South Dakota	4 cases	0 deaths
Tennessee	82 cases	0 deaths
Texas	556 cases	3 deaths
Utah	91 cases	0 deaths
Vermont	1 cases	0 deaths
Virginia	21 cases	0 deaths
Washington	294 cases	1 death
Washington, D.C.	13 cases	0 deaths
Wisconsin	613 cases	0 deaths
TOTAL*(48)	5,123 cases	5 deaths

H1N1 Flu (Swine Flu) has possibly spread in a community based transmission from person to person in Japan with over 100 cases now. Since this is different from infections resulting from travel to the U.S or Mexico it may result in elevating the status to a  world pandemic. The H1N1 Flu is still considered mild in severity, even if it becomes labeled a pandemic.

The H1N1 virus continues to expand with over 170 patients hosptialized nationwide. The Swine Flu is the causitive agent for about 50% of the cases of flu in the U.S. at this time. There are no known reported cases in Larimer County at this time.

U.S. Human Cases of H1N1 Flu Infection
(As of May 15, 2009, 11:00 AM ET) States* Confirmed and Probable Cases Deaths
Alabama 55 cases 0 deaths
Arkansas 2 cases 0 deaths
Arizona 435 cases 1 death
California 504 cases 0 deaths
Colorado 55 cases 0 deaths
Connecticut 47 cases 0 deaths
Delaware 60 cases 0 deaths
Florida 68 cases 0 deaths
Georgia 18 cases 0 deaths
Hawaii 10 cases 0 deaths
Idaho 5 cases 0 deaths
Illinois 638 cases 0 deaths
Indiana 71 cases 0 deaths
Iowa 66 cases 0 deaths
Kansas 30 cases 0 deaths
Kentucky** 13 cases 0 deaths
Louisiana 57 cases 0 deaths
Maine 14 cases 0 deaths
Maryland 28 cases 0 deaths
Massachusetts 135 cases 0 deaths
Michigan 142 cases 0 deaths
Minnesota 36 cases 0 deaths
Missouri 19 cases 0 deaths
Montana 4 cases 0 deaths
Nebraska 27 cases 0 deaths
Nevada 26 cases 0 deaths
New Hampshire 18 cases 0 deaths
New Jersey 14 cases 0 deaths
New Mexico 68 cases 0 deaths
New York 242 cases 0 deaths
North Carolina 12 cases 0 deaths
North Dakota 2 cases 0 deaths
Ohio 14 cases 0 deaths
Oklahoma 26 cases 0 deaths
Oregon 94 cases 0 deaths
Pennsylvania 47 cases 0 deaths
Rhode Island 8 cases 0 deaths
South Carolina 36 cases 0 deaths
South Dakota 4 cases 0 deaths
Tennessee 74 cases 0 deaths
Texas 506 cases 2 deaths
Utah 91 cases 0 deaths
Vermont 1 cases 0 deaths
Virginia 21 cases 0 deaths
Washington 246 cases 1 death
Washington, D.C. 12 cases 0 deaths
Wisconsin 613 cases 0 deaths
TOTAL*(47) 4,714 cases 4 deaths

Time to move to Wyoming or Mississippi-Only states with no reported H1N1 Swine Flu Cases. Then again, its probably just not been found yet, it won’t be long.

U.S. Human Cases of H1N1 Flu Infection
(As of May 14, 2009, 11:00 AM ET) States* Confirmed and Probable Cases Deaths
Alabama

41

Arkansas

1

Arizona

431

California

473

Colorado

47

Connecticut

38

Delaware

58

Florida

65

Georgia

36

Hawaii

10

Idaho

5

Illinois

620

Indiana

70

Iowa

58

Kansas

28

Kentucky**

13

Louisiana

45

Maine

13

Maryland

28

Massachusetts

109

Michigan

141

Minnesota

34

Missouri

20

Montana

5

Nebraska

23

Nevada

25

New Hampshire

18

New Jersey

12

New Mexico

51

New York

224

North Carolina

12

North Dakota

1

Ohio

12

Oklahoma

22

Oregon 94

Pennsylvania 50

Rhode Island 8

South Carolina 34

South Dakota 5

Tennessee 63

Texas 439
2 Deaths
Utah 80

Vermont 1

Virginia 20

Washington 195
1 Death
Washington, D.C. 10

Wisconsin 510

TOTAL*(47 States)

4,298 cases

3 deaths

*includes the District of Columbia

**one case is resident of KY but currently hospitalized in GA.

U.S. Human Cases of H1N1 Flu Infection
(As of May 11, 2009, 12:41 PM ET)

States*	Laboratory confirmed cases	Deaths
Alabama	4
Arizona	182
California	191
Colorado	39
Connecticut	24
Delaware	44
Florida	54
Georgia	3
Hawaii	6
Idaho	1
Illinois	487
Indiana	39
Iowa	43
Kansas	18
Kentucky**	10
Louisiana	9
Maine	4
Maryland	23
Massachusetts	88
Michigan	130
Minnesota	7
Missouri	14
Nebraska	13
Nevada	9
New Hampshire	4
New Jersey	7
New Mexico	30
New York	190
North Carolina	11
Ohio	6
Oklahoma	14
Oregon	17
Pennsylvania	10
Rhode Island	7
South Carolina	32
South Dakota	1
Tennessee	54
Texas	179	2
Utah	63
Vermont	1
Virginia	16
Washington	128	1
Washington, D.C.	4
Wisconsin	384
TOTAL*(44)	2600 cases	3 deaths
International Human Cases of Swine Flu Infection See: World Health Organization *includes the District of Columbia **one case is resident of KY but currently hospitalized in GA. NOTE: Because of daily reporting deadlines, the state totals reported by CDC may not always be consistent with those reported by state health departments. If there is a discrepancy between these two counts, data from the state health departments should be used as the most accurate number.

U.S. Human Cases of H1N1 Flu Infection
(As of May 9, 2009, 11:00 AM ET)

States*	Laboratory confirmed cases	Deaths
Alabama	4
Arizona	182
California	171
Colorado	41
Connecticut	14
Delaware	44
Florida	43
Georgia	3
Hawaii	6
Idaho	1
Illinois	421
Indiana	39
Iowa	43
Kansas	12
Kentucky**	3
Louisiana	9
Maine	4
Maryland	23
Massachusetts	89
Michigan	103
Minnesota	1
Missouri	10
Nebraska	13
Nevada	9
New Hampshire	4
New Jersey	7
New Mexico	30
New York	190
North Carolina	7
Ohio	12
Oklahoma	4
Oregon	15
Pennsylvania	10
Rhode Island	7
South Carolina	42
South Dakota	1
Tennessee	46
Texas	110	2
Utah	60
Vermont	1
Virginia	16
Washington	83
Washington, D.C.	4
Wisconsin	317
TOTAL*(44)	2254 cases	2 deaths