2009 Pandemic H1N1 Influenza A: Where Do We Stand Now?

Extreme Thinkover Guest Article

By Dr. John Bogen, MD

Updated November 8, 2009

What is the current status of the pandemic in the U.S?

The CDC reported that for Week 43 (ended October 31, 2009), both hospitalizations and deaths from influenza dipped slightly. A total of 18 pediatric deaths were reported for the week. Virologic surveillance of 14,151 specimens sent to U.S. labs for testing revealed that 37.2% tested positive for influenza, a slight decrease. Of those that tested positive, 0.3% were influenza B, and 99.7% were influenza A. Of the influenza A strains subtyped, 99.9% were the pandemic strain, and only 0.1% were strains associated with strains seen in prior seasons. http://www.cdc.gov/flu/weekly/

What do these data mean for the average patient? The seasonal influenza vaccine has so far had little use, since almost all the influenza currently circulating is the new pandemic strain. The pandemic vaccine has just now begun to be distributed and given to patients. We are still in the heart of the flu season. It is too early to tell from the data if the country itself has “peaked” in terms of the number of cases. There are also regional and local differences – some areas have already been hit hard, as evidenced by school closures. Other areas have not yet peaked. It is also too early to tell if the pandemic vaccine has made any difference in the overall numbers.

In usual “non-pandemic” influenza seasons, an estimated 36,000 deaths occur directly or indirectly from influenza in the U.S., with 90% of these in the elderly or in those with weakened immune systems. One piece of good news this season is that the elderly population seems to have some immunity to the pandemic H1N1 strain, probably due to different H1N1 strains that were in circulation until the 1957 H2N2 pandemic, at which time H2N2 replaced H1N1 as the seasonal strain. So, we are seeing far fewer total deaths, just over 1,000 (but perhaps as high as 3,000, according to other CDC data not currently publicized) since the pandemic started.

The bad news is that we are seeing more than the usual number of deaths in younger people (under age 65). People with weakened immune systems are still dying disproportionately, and we are seeing more than the usual number of deaths in previously healthy individuals including children and pregnant women.

Data on vaccine safety are difficult to obtain at this time, since distribution of the vaccine has just begun. Several highly publicized anecdotes of serious reactions have appeared in the lay press. Most of these were with the seasonal vaccine. Ongoing clinical testing of the pandemic vaccine has continued to show good short-term safety. One must keep in mind that a temporal association between vaccine and symptom does not imply causality, but patients with serious reactions (e.g. anything more than local muscle soreness from the shot and the common few days of general malaise following the shot) can and should be reported to VAERS. It is quite obvious that, worst case scenario, that deaths from pandemic influenza greatly exceed the number of serious reactions from the vaccine.

The next few weeks will be critical.

Between vaccine being distributed / administered and the pandemic running its course through communities, one would hope to see a downward trend in hospitalizations and deaths. The vast majority of unvaccinated patients who get pandemic influenza will be fine after a few days of misery. Similarly, patients who get the vaccine prior to getting sick from pandemic influenza will not have a serious reaction to the vaccine and also will not get ill or die from the virus. If we see fewer deaths this season from influenza, that would be a good thing, but hardly a consolation to the families and friends of people who died from the pandemic.

If I may offer my educated opinion, I predict we will see fewer than 10,000 deaths in the U.S. this flu season.

The overall mortality rate will “only” be approximately 0.01% (1 in 10,000). The pandemic strain will continue to be the dominant strain of influenza in the community. Next year’s seasonal influenza vaccine will include the current pandemic H1N1 strain (or a mutated version thereof that exists next spring), and influenza B. With luck, subsequent seasons will be mild because so many would have already gotten ill and developed immunity to the novel H1N1. The elderly will continue to have some natural immunity, and the vaccine and herd immunity will protect most of the rest of the population.

Swine Flu: The Most Effective Way to Protect Yourself

This post has been redacted and censored to comply with my employer’s Social Media Policy as of Nov. 1, 2010.  All references to my place of work and the system it is part of, as well as photos have been removed.  This action appears to be only recourse I have to preserve my Constitutional rights to free speech and the free expression of my views on Extreme Thinkover.


This Information about protecting yourself from Swine Flu was issued today by Employee Health at Censored by Corporate Social Media Policy .  These are the guidelines we are following as hospital staff–I urge all my readers to take to the same precautions:

Prevention is the best defense against infection. Protect yourself by following good health habits such as:

· Frequent hand washing with soap and water or use of alcohol-based hand gel.

· When you cough or sneeze, cover your nose and mouth with a tissue or use your sleeve (if you don’t have a tissue). Throw used tissue in trash and wash your hands.

· Avoid touching your eyes, nose and mouth – germs are often spread when a person touches something that is contaminated with germs and then touches their eyes, nose or mouth.

· Avoid close contact with people who are sick or keep your distance from other people when you are sick.

· DO NOT GO TO WORK IF YOU ARE SICK. Consider your co-workers. Contact your health care provider.

Symptoms of swine flu in people are similar to the symptoms of seasonal flu in humans and may include:

* Fever (greater than 100.4ºF)
* Sore throat
* Cough
* Stuffy nose
* Chills
* Headache and body aches
* Fatigue

Stay well!

P.S.: Don’t go out an buy a box of dust, respirator, or even medical facemasks.  They will NOT protect you.  The Centers for Disease Control is currently recommending the use of the above precautions rather than a facemask.  Click here for the link.  Currently the only approved facemask for respiratory illnesses is the “N-95,” which is available only to professional health care personnel and must also be correctly fitted to be effective.  If the CDC determines the Swine Flu is spread through the air, they will issue appropriate guidelines at that time.