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

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.

H1N1 Swine Flu Without Fever?

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 8, 2009)

States*	Laboratory confirmed cases	Deaths
Alabama	4
Arizona	131
California	107
Colorado	25
Connecticut	4
Delaware	39
Florida	6
Georgia	3
Hawaii	5
Idaho	1
Illinois	392
Indiana	29
Iowa	5
Kansas	12
Kentucky**	3
Louisiana	7
Maine	4
Maryland	4
Massachusetts	83
Michigan	49
Minnesota	1
Missouri	9
Nebraska	4
Nevada	8
New Hampshire	3
New Jersey	7
New Mexico	8
New York	174
North Carolina	7
Ohio	6
Oklahoma	4
Oregon	15
Pennsylvania	2
Rhode Island	7
South Carolina	29
South Dakota	1
Tennessee	36
Texas	93	2
Utah	24
Virginia	14
Washington	33
Washington, D.C.	1
Wisconsin	240
TOTAL*(43)	1639 cases	2 deaths
International Human Cases of Swine Flu Infection See: World Health Organization *includes the District of Columbia **case is resident of KY but currently hospitalized in GA.

Park Lane Elementary School in Aurora Colorado was closed indefinitely today due to one confirmed case of  H1N1 (swine flu) in a student. The CDC just changed it’s guidelines and does not suggest school closures based on one confirmed case. In conjunction with the state health department Park Lane Elementary School felt closure was in the best interest of the students. For further information see Aurora Public Schools
There are now 10 cases of H1N1 flu in Colorado.

U.S. Human Cases of H1N1 Flu Infection
(As of May 3, 2009 11:00 AM ET) States # of
laboratory
confirmed

Alabama 1
Arizona 18
California 26
Colorado 4
Connecticut 2
Delaware 10
Florida 3
Illinois 3
Indiana 3
Iowa 1
Kansas 2
Kentucky* 1
Massachusetts 7
Michigan 2
Minnesota 1
Missouri 1
Nebraska 1
Nevada 1
New Hampshire 1
New Jersey 7
New Mexico 1
New York 63
Ohio 3
Rhode Island 1
South Carolina 15

Tennessee 1

Texas 40
(1 Death)
Utah 1
Virginia 3

Wisconsin 3

TOTAL STATES (30) 226 cases 1 death

International Human Cases of Swine Flu Infection
See: World Health OrganizationExternal Web Site Policy.

*Case is resident of KY but currently hospitalized in GA.

The outbreak of disease in people caused by a new influenza virus of swine origin continues to grow in the United States and internationally. Today, CDC reports additional confirmed human infections, hospitalizations and the nation’s first fatality from this outbreak. The more recent illnesses and the reported death suggest that a pattern of more severe illness associated with this virus may be emerging in the U.S. Most people will not have immunity to this new virus and, as it continues to spread, more cases, more hospitalizations and more deaths are expected in the coming days and weeks.

CDC has implemented its emergency response. The agency’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by the new virus.