Has H1N1 started to peak?

H1N1 cases fall in U.S. but could rise with Thanksgiving travel, gatherings – washingtonpost.com.

For the first time, this week showed a drop in case of H1N1 with only 43 states noting widespread H1N1 activity.  I was at a critical care conference this week and one of the speakers mentioned this very report.  He also raised concerns about a “second wave” problem related to holiday travel, that there will be a surge post-Thanksgiving due to family get-togethers and increased travel.  He also noted reports out of the Ukraine of mutated strains of the virus.  From the article:

The news came as scientists in Norway announced that they had detected a mutated form of the swine flu virus in two patients who died of the flu and in a third who was severely ill. It is the most recent report of mutations in the virus that is being watched closely for any change that could make it more dangerous.

In a statement, the Norwegian Institute of Public Health said the mutation “could possibly make the virus more prone to infect deeper in the airways and thus cause more severe disease,” such as pneumonia.

The institute said that there was no indication that the mutation would hinder the ability of the vaccine to protect people from becoming infected or impair the effectiveness of antiviral drugs in treating people who became infected…

The World Health Organization said viruses with a similar mutation had been detected in several other countries, including Brazil, China, Japan, Mexico, Ukraine and the United States. “No links between the small number of patients infected with the mutated virus have been found and the mutation does not appear to spread,” the WHO said in a statement.

With my apocalyptic thinking cap on I can see a “second wave” of the mutated resistant strain of H1N1 sweeping the world turning us all into zombies.  If only…

The only thing this really means is that there may be less ILI cases landing in our ED and thus onto our obs unit.  Which may or may not be a good thing.  Interesting stuff nonetheless.

 

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The kids are dying!…

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Shortage of shots as more kids die of swine flu – Swine flu- msnbc.com

What a way to sensationalize tragedy.

Yes, it is a tragedy when kids die.

Yes, it is unfortunate that we don’t have enough vaccine available.

Yes, some people believe that vaccines are bunk, especially the flu shot.

Yes, the hysteria is starting to rise.  It’s everywhere.  Makes one want to stay isolated inside the house and never leave, open the door with a N95 and turn the foyer into a positive-pressure space.  Makes me just turn off the news and news websites and pop a Xanax.

But why focus on kids?  Easy:  kids pull at our heart strings.  Kids are the easiest way to sway the public’s opinion.  Sad but true.

And I don’t need a special graphic to tell me that H1N1 is widespread in Oregon.  I just go to work.

Flu Hysteria!

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OMG! The flu is here!  Run for the hills while you still can!  Save yourselves! *cue mass hysterical screaming*

OK.  Everyone feel better?  I get it.  We’re trying to vaccinate, isolate and and not duplicate the scenario from 1976.  But truly, the flu is a nasty little bugger this year.  And that’s just H1N1, not even the seasonal flu.  It seems to be targeting the ones who are usually not affected by it.  The young, the 20’s, children especially those with health conditions (kind of a given though), pregnant moms and of course the elderly.  In my workplace, no one has been confirmed with it, but I have heard of several pregnant health care workers who developed full-blown ARDS and ended up ‘tubed in the ICU due to the flu.  Not pretty.  But for all our mass hysteria, not too bad yet.  And nothing really that far out of the range of normal flu mortality.  And compared to the 1918 flu, what we have here is but a fart in the wind.  Sure, we’re having to use droplet and contact precautions a lot more and I’ve had to trim the goatee a little more to make the masks fit better, but we’re not seeing a huge increase in the flu.  But enough.

I finished Flu: The Story of the Great Flu Pandemic, by Gina Kolata, a couple of days ago and it chilled me.  Millions dead. Those dying, died fast and ugly, literally drowning from massive pulmonary edema.  But I think one area where the book shines is the (cautionary?)tale of the 1976 flu debacle.  Remember?  The one where the government embarked on a massive program of flu vaccination because the highly respected elder statesmen of public health cried “Wolf!!!” over a couple of cases of swine flu.  Millions of vaccine doses later, a couple hundred extra cases of Guillian-Barré Syndrome and some deaths that may or may not be attributable to the vaccine and an epidemic that fizzled faster than Howard Dean’s Presidential ambitions, led to a higly charged atmosphere of dread and suspicion over the latest novel flu virus to hit our shores.  Will this one be the BIG one?  Or another fizzle?

So the talking heads, the CDC and infection control practitioners across the country gear up to warn of our impending doom at the hands of H1N1.  And yes, it may be nasty, but we don’t know for sure.  So go get your shot(s).  And to quote Dr. Mark Crislip,

2. I never get the flu, so I don’t need the vaccine. Irresponsible dumb ass. I have never had a head on collision, but I wear my seat belt. And you probably don’t use a condom either. So far you have been lucky, and you are a potential winner of a Darwin Award, although since you don’t use a condom, you are unfortunately still in the gene pool.

And some CDC stuff for the uninitiated (i.e. those not having to wear masks every day for work).

Respiratory Hygiene/Cough Etiquette in Healthcare Settings

Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting

*cue ominous music*

Just remember, you can’t out run the flu…

*cue spooky Vincent Price-laughter*

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