Swine Flu


Swine flu may hospitalize 1.8 million patients in the U.S. this year, filling intensive care units to capacity and causing “severe disruptions” during a fall resurgence, scientific advisers to the White House warned.

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Swine flu, also known as H1N1, may infect as much as half of the population and kill 30,000 to 90,000 people, double the deaths caused by the typical seasonal flu, according to the planning scenario issued yesterday by the President’s Council of Advisers on Science and Technology. Intensive care units in hospitals, some of which use 80 percent of their space in normal operation, may need every bed for flu cases, the report said.

The virus has sickened more than 1 million people in the U.S., and infections may increase this month as pupils return to school, according to the Centers for Disease Control and Prevention in Atlanta. If swine flu patients fill too many beds, hospitals may be forced to put off elective surgeries such as heart bypass or hernia operations, said James Bentley with the American Hospital Association.
“If you have 1.8 million hospital admissions across six months, that’s a whole lot different than if you have it across six weeks,” said Bentley, a senior vice-president of the Washington-based association, which represents 5,000 hospitals.
The scenario projections were “developed from models put together for planning purposes only,” said Tom Skinner, a spokesman for the CDC, at a briefing in Atlanta today. “At the end of the day, we simply don’t know what this upcoming flu season is going to look like. It could be severe, it could be mild, we just don’t know.”

Past Pandemics
The models were based on past pandemics, and the CDC is working on new projections based on the latest data gathered from swine flu patients, Skinner said. Those estimates should be available “soon,” he said, without further specifying.
President Barack Obama was urged by his scientific advisory council to speed vaccine production as the best way to ease the burden on the health care system. Initial doses should be accelerated to mid-September to provide shots for as many as 40 million people, the panel said in a report released yesterday. Members also recommended Obama name a senior member of the White House staff, preferably the homeland security adviser, to take responsibility for decision-making on the pandemic.
“This isn’t the flu that we’re used to,” said Kathleen Sebelius, U.S. health and human services secretary. “The 2009 H1N1 virus will cause a more serious threat this fall. We won’t know until we’re in the middle of the flu season how serious the threat is, but because it’s a new strain, it’s likely to infect more people than usual.”

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Clinical Trials
Data from clinical trials to assess the safety and effectiveness of swine flu vaccines will start to become available in mid-September, health officials reported Aug. 21. Full results from the two-dose trials won’t be available until mid-October.
“We are making every preparation effort assuming a safe and effective vaccine will be available in mid-October,” Sebelius said today at the CDC’s Atlanta offices.

H1N1 has already reached more than 170 countries and territories in the four months since being identified, the Geneva-based World Health Organizationsaid. Swine flu causes similar symptoms as seasonal strains. It has so far resulted in worse than normal flu seasons, with increased hospitalizations and cases of severe illness, the WHO said in an Aug. 12 release.
New Zealand and Australia, in the midst of their normal flu seasons, have reported intensive care units taxed to capacity by swine flu patients. The experience provides clues to what the U.S., Europe and Japan may see when the H1N1 virus returns.


President’s Advisers
The president’s advisory council describes as a “plausible scenario,” that 30 percent to 50 percent of the U.S. population will be infected in the fall and winter. As many as 300,000 patients may be treated in hospital intensive care units, filling 50 percent to 100 percent of the available beds, and 30,000 to 90,000 people may die, the group’s report said.

“This is a planning scenario, not a prediction,” according to the report. “But the scenario illustrates that an H1N1 resurgence could cause serious disruption of social and medical capacities in our country in the coming months.”
Peter Gross, chief medical officer at Hackensack University Medical Center in New Jersey, said if the group’s scenario comes true, “I think every hospital in America is going to be in a crunch. We’ll be hard pressed to deal with those predictions,” he said.

‘Overblown’ Estimates
The estimates seem “overblown,” Gross said, given that swine-flu outbreaks in 1968 and 1957 failed to cause as many deaths, even with medical technology and disease surveillance less advanced than today.
“Influenza, you can make all the predictions you want, but it’s more difficult than predicting the weather,” Gross said yesterday in a telephone interview, after the advisory report was made public. “If influenza was a stock, I wouldn’t touch it.”
The 775-bed hospital is planning for an outbreak, upping its order of flu medications and discussing where to put patients if the worst occurs, Gross said.

The President’s Council of Advisers on Science and Technology is chaired byJohn Holdren, the director of the White House Office of Science and Technology, Eric Lander, the head of the Broad Institute of Massachusetts Institute of Technology and Harvard University in Cambridge, Massachusetts, and Harold Varmus, the chief executive officer of Memorial Sloan-Kettering Cancer Center in New York.
The 21-member group of scientists and engineers, created by Congress in 1976, advises the president on policy involving scientific matters.

New Estimates
Seasonal flu usually kills about 36,000 Americans, Skinner said. Swine flu causes more severe illness needing hospitalization among younger people than seasonal flu, while leaving people 65 and older relatively unscathed, saidMike Shaw of the CDC.
The median age of those with the pandemic virus has been 12 to 17 years, the WHO said on July 24, citing data from Canada, Chile, Japan, U.K. and the U.S.
“We don’t know whether the number of severe illnesses will be much greater, but we do know that it’s a new virus and therefore people are very vulnerable,” said Anne Schuchat, director of the CDC’s Center for Immunization and Respiratory Diseases, in an interview yesterday.


Disease Burden
About 100 million people in the U.S. get the annual flu shot, Schuchat said. Pregnant women, who have “a disturbingly high burden of disease” from swine flu, only get vaccinated for seasonal flu about 15 percent of the time. Pregnant women are a top priority for vaccinations, she said.
Seasonal flu usually kills about 36,000 Americans. Swine flu causes more severe illness needing hospitalization among younger people than seasonal flu, while leaving people 65 and older relatively unscathed, said Mike Shaw, associate director of laboratory science at the CDC’s flu division.
The median age of those with the pandemic virus has been 12 to 17 years, the WHO said on July 24, citing data from Canada, Chile, Japan, U.K. and the U.S.
“People who get infected with this strain happen to be the healthiest members of our society,” said Shaw in a presentation yesterday at the agency.
The H1N1 strain is genetically related to the 1918 Spanish Flu that killed an estimated 50 million people. Variations of the Spanish Flu circulated widely until about 1957, when they were pushed aside by other flu strains. People whose first exposure to a flu virus was one of those Spanish Flu relatives may have greater immunity to the current pandemic, Shaw said.


* Text by Tom Randall and Alex Nussbaum, August 25, 2009

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With the number of confirmed U.S. swine flu cases double the 20 it was yesterday, the government says that it is closely monitoring the swine flu outbreak and is preparing for further spread.

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“This is obviously the cause for concern and requires a heightened state of alert, but it’s not a cause for alarm,” President Obama said today at the National Academy of Sciences (NAS).

In the U.S., 40 cases have been confirmed by the U.S. Centers for Disease Control and Prevention (CDC) in five different states: New York, California, Texas, Ohio and Kansas. All individuals have recovered, including the one that was hospitalized, Richard Besser, acting director of the Center for Disease Control (CDC), said in a press conference today. Twenty of the cases have stemmed from a New York City preparatory school. Although that’s more than twice the number originally reported, the additional cases were a result of further testing rather than continued spread of the flu, Besser noted. The CDC is distributing kits to test for swine flu in affected states, and as testing ramps up, Besser said, “I expect we will see other cases across the country.”

New cases are being reported in Canada and across the Atlantic, according to a report by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. As of April 26, six confirmed cases of swine flu in Canada and one in Israel had been reported. An informal map of cases worldwide is being collected by a biomedical researcher in Pittsburgh.

Meanwhile, the European Union has issued a travel warning to citizens, urging them to avoid nonessential travel to the U.S. or Mexico, reports The New York Times. The CDC will be distributing information cards at U.S. ports of entry to inform travelers about the flu’s symptoms and precautions that should be taken to avoid it. Later today, the CDC will also issue a travel advisory recommending that all nonessential travel to Mexico be avoided.

“This is a serious event, and we’re taking it seriously,” Besser said. “This situation is evolving very quickly,” he said, and a clear picture of how the disease is spreading may not be available for another week or two.

Although a vaccine for the flu strain, which is similar to those responsible for the 1918 and 1957 outbreaks, is likely months away, biotechnology companies are anxious to get to work, notes FierceBiotech, a biotech industry newsletter. The CDC is discussing whether to include strains of this flu in next year’s flu vaccines.

By dubbing the outbreak a public health emergency yesterday, the government authorized states to release 25 percent of their antiviral drugs from the Strategic National Stockpile, which means that 11 million courses of the drugs are en route to the affected states, said Besser.

Although the drugs could help treat those infected with the virus, Besser noted that, “there’s no single action that will control an outbreak… It starts with personal responsibility, but it doesn’t end there.” He recommended that people take standard precautions such as frequent hand washing, covering coughs and sneezes and staying home from work and school if feeling ill.

At the speech to the NSA, Obama concluded, “If there was ever a day that reminded us of our shared stake in science and research, it is today.”

By Katherine Harmon