UPDATE: Journal of American Medical Association studies of H1N1/Swine flu deaths in Canada and Mexico.
From the Wall Street Journal, Anand Kumar, lead author of one of the studies and ICU attending physician for the Winnipeg Regional Health Authority in Canada. “There’s almost two diseases. Patients are either mildly ill or critically ill and require aggressive ICU care. There isn’t that much of a middle ground.” About 3.9% of total reported cases of flu for the period in Canada had people who became extremely ill. More people are getting sick and not reporting it.
Total influenza hospitalization rates for laboratory-confirmed influenza are higher than expected for this time of year for adults and children. And for children 5-17 and adults 18-49 years of age, hospitalization rates from April – October 2009 exceed average flu season rates (for October through April).
The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and now exceeds what is normally expected at this time of year. In addition, 19 flu-related pediatric deaths were reported this week; 16 of these deaths were confirmed 2009 H1N1 and 3 were unsubtyped influenza A and likely to be 2009 H1N1. A total of 76 laboratory confirmed 2009 H1N1 pediatric deaths have been reported to CDC since April.
According to WHO, the majority of 2009 H1N1 influenza isolates tested worldwide remain sensitive to oseltamivir, an antiviral medicine used to treat influenza disease. Only 31 2009 H1N1 isolates tested worldwide have been found to be resistant to oseltamivir – 12 of these isolates were detected in the United States.
Flu Vaccine Situation
This week (Oct 6, 2009 press briefing), the flu vaccine became available in the internasal variety. Next week, it will become available in the injectable variety. The first was done yesterday with a priority on health care workers and children as well as people who care for infants. Flu mist, only able to be used for people age 2 to 49 and who do not have an underlying health problem. With the production of this strain, we have cut no corners. This flu vaccine is made as flu vaccine is made each year. By the same companies. In the same production facilities. With the same procedures. With the same safety, safeguards. We have had literally hundreds of millions of people vaccinated against flu with flu vaccine made in this way
What to Do if you Get Sick
You may have the flu if you have some or all of these symptoms:
runny or stuffy nose
sometimes diarrhea and vomiting
*It’s important to note that not everyone with flu will have a fever.
What should I do if I get sick?
If you get sick with flu-like symptoms this flu season, you should stay home and avoid contact with other people except to get medical care. Most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are:
Children younger than 5, but especially children younger than 2 years old
People 65 and older
People who have:
Blood disorders (including sickle cell disease)
Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)]
Neurological disorders (including nervous system, brain or spinal cord)
Neuromuscular disorders (including muscular dystrophy and multiple sclerosis)
Weakened immune systems (including people with AIDS)
Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider.
There are emergency warning signs. Anyone who has them should get medical care right away.
What are the emergency warning signs?
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
Fever with a rash
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Severe or persistent vomiting
Do I need to go the emergency room if I am only a little sick?
No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill. If you have the emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. If you go to the emergency room and you are not sick with the flu, you may catch it from people who do have it
Are there medicines to treat 2009 H1N1?
Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
How long should I stay home if I’m sick?
CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other things you have to do and no one else can do for you. (Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol®.) You should stay home from work, school, travel, shopping, social events, and public gatherings.
What should I do while I’m sick?
Stay away from others as much as possible to keep from making them sick. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. And wash your hands often to keep from spreading flu to others. CDC has information on “Taking Care of a Sick Person in Your Home” on its website at
Wash hands thoroughly with soap.
* check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
* check with their health care provider about whether they should take antiviral medications
* keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill
* stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
* get plenty of rest
* drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
* cover coughs and sneezes. Wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
* wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. For more information, see the Interim Recommendations for Facemask and Respirator Use
* be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention.
Get medical care right away if the sick person at home:
* has difficulty breathing or chest pain
* has purple or blue discoloration of the lips
* is vomiting and unable to keep liquids down
* has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
* has seizures (for example, uncontrolled convulsions)
* is less responsive than normal or becomes confused