US up to 91 cases, including 1 death [Updated: New England confirmed cases]

The latest numbers of confirmed cases from the CDC were released about an hour ago. 91 cases have been confirmed, with the largest numbers in New York (51), California (14), and Texas (16). One new case has also been confirmed in Nevada, one in Indiana, one in Arizona, and 2 in Michigan; the other Ohio case I know of is still pending, apparently. Ongoing investigations are also taking place in multiple states, so expect the number to keep rising for the time being. [Update: 2 cases just confirmed in Massachussets, and three in Maine.]

The first fatality has also been reported: a 23-month-old child who had recently traveled to Mexico traveled to the United States from Mexico.

I've written previously about how difficult research in infectious disease can sometimes be, knowing that many of the isolates you're working with harmed or even killed someone, and changed someone's life forever. This child's influenza virus will now be marked with a lengthy name based on the date and location of isolation, and will be studied and dissected on a molecular level, and referred to in dry publications discussing the case--but that doesn't mean that those who carry out the research and write up the manuscripts in such clinical language are any less touched and upset when deaths like this occur.

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I've heard, "So we've had a death in the US. Compare that to the thousand seasonal influenza deaths per year."

This perspective doesn't make me feel any better. There seems to be something wrong with the logic, but i can't put my finger on it.

One death is a tragedy, a million a statistic... isn't that how it goes?

As much as I dislike Orson Scott Card, I do like his concept of the Speaker for the Dead - someone who's job it is to make each death more than a statistic.

For now, take comfort in knowing that science, by analyzing each death and helping to build statistics, makes one person's death have the potential to save lives. Small consolation to friends/ relatives, but perhaps as much as anyone can offer.

The WHO has just raised the Pandemic Alert level from 4 to 5

Stephen: I don't know of anything wrong with the logic, and it seems to me that it ought to make you feel better.

In fact, the CDC had been estimating 16,000 flu related deaths per year and recently raised the estimate to 36,000 flu related deaths per year (prior to this Mexican Swine flu epidemic) - even in a country like the U.S. with relatively good health care data, the numbers are squishy because more people probably die of complications from the flu (like pneumonia, etc) than from the flu itself.

Anyway, while this definitely seems to be a new variant of influenza, the key parameter for comparison for me is, "how many were there last year and in a typical year?". By that standard, this seems (thus far) to be a flu bug without much or any native resistance and so it hits hard - but at the end of the day, it's just the flu.

And I'm still in the camp that says that the Mexican Swine flu has been circulating around for months at a very low level of activity and has just recently "gone viral" as they say in internet speak an gotten heavy publicity.

I believe the child who died was from Mexico and travelled to the states. The death regardless is tragic. I also believe there were other health issues the child suffered...there are multiple reports in the media with more details...

By elizabeth (not verified) on 29 Apr 2009 #permalink

You're correct; I swear it said otherwise this morning, but perhaps I just read that too quickly. I edited it above.

I have to agree with MarketBlogic. From a pure statistical viewpoint using the CDC's and WHO's own numbers, this "swine flu" outbreak should not warrant the pandemic level, even for the residents of Mexico City.

To fully elaborate:
Without restating all of his/her numbers (see the original post), MarketBlogic's statistics and reasonable assumptions for their extrapolation only hint at the impact of the more advanced status of the USA's water treatment & sewage handling capabilities. Compound those two critically important barriers to disease transmission with USA's healthier nutritional habits plus the world's finest medical technology & healthcare delivery system and you have further stacked the odds against this reported flu epidemic.

Certainly there is no short-term harm in washing your hands or using hand sanitizer more frequently, or avoiding large crowds of international visitors (sporting events in particular), or even second-guessing decisions about dining out and food-handling safety. But at this time the statistics clearly do not appear to back this level of
pan(dem)ic attack.

The apparent paucity of factual support appears to strenthen claims that the H1N1 "story" is being grossly exaggerated. Some commentators suggest that this is due to a power-grab & publicity-hunger by the WHO, or increasingly incompetent reporters for the major news media, or even (the most Orwellian suggestion) to provide an outlet for releasing the pent-up anxiety of a populace already highly frustrated by any number of modern stressors.

I am not suggesting or supporting any of these claims, just the idea that the stats don't currently back up the "pandemic" claims.

Can someone from a purely epidemiological background comment in a manner understandable to those folks who are used to "USA Today" styled news McNuggets? Please leave out the pharmaceutical theorizing, homeopathic remedies and so forth; just address the pure statistical facts that support arriving at this "pandemic" level. (Anyone? Anyone? Bueller?)


(PS: you guys have a great, thought-provoking bullitin board here... thank you from another Iowan who is glad I found it.)

The pandemic definition doesn't necessarily reflect the number of cases in any particular area, but rather the characteristics of transmission and spread of the virus. WHO's phases are described here. Right now we're in Phase 5--widespread human infection. This is based simply on the number of countries where the virus has turned up, rather than any percentage of the number of flu cases it's causing there.

Thank you for clarifying the actual alert language, Tara.

After reviewing this information at the link you provided, it further justifies criticism that the larger news outlets have mischaracterized the nature of the WHO "level 5" warning. This warning level is primarily a means to qualify and communicate 1) that this outbreak has crossed regional borders and 2) it has the capability to be spread between human(s). It is not a good scale for giving an accurate indication of how serious or life-threatening the illness may be. By incorrectly citing a "WHO warning level 5" or similar reference, reporters are probably exaggerating the severity of this health threat to humans.

This morning, even the Vice-President is warning people to avoid using mass transit, which is a strong precaution but also very alarmist and disruptive to a large segment of the public. (However, I would add that Joe Biden is never the wisest or calmest voice in any situation, so I consider the source on a statement like that.)

To put this into perspective: a person out and about on the streets of Mexico City has a much greater risk of being kidnapped than die of this flu pandemic. It's true: on average, about 250 people are kidnapped for ransom in Mexico each month yet in the last month fewer than 200 deaths are being attributed to the H1N1 flu outbreak... only 159 as of today.

People... be cautious, but calm down. This isn't wiping us out. It's the flu.


Why are so many cases clustered in NYC? Sure, NYC is a travel nexus. But even so, shouldn't states that border Mexico (esp. CA) show more cases?

As much as I dislike Orson Scott Card, I do like his concept of the Speaker for the Dead - someone who's job it is to make each death more than a statistic.

For now, take comfort in knowing that science, by analyzing each death and helping to build statistics, makes one person's death have the potential to save lives. Small consolation to friends/ relatives, but perhaps as much as anyone can offer.

I am a scientist born of scientist parents and the father of two intelligent and enquiring teenagers who have, over the last couple of years, brought home all manner of conspiracy theories acquired from their peers and, of course, the internet. Having dispatched with the majority of those theories (we are stalemated a little bit on an older topic or two), I am gratified that they have grown considerably more sceptical now and I am proud of their increasing knowledge of and respect for the scientific method and the detached mindset that is so integral to successfully applying it. My daughter, the younger of the two, is still several orders of magnitude more sceptical than her older brother, but he is definitely coming around. Imagine my consternation when they jointly confronted me with this article from the Toronto Sun:

It details how Baxter sent out contaminated vaccine material, and then âcalled the mistake the result of a combination of âjust the process itself, (and) technical and human error in this procedure.ââ. Both kids are now determined not to take any vaccines for any purpose until I can explain away several assertions they have developed, and worse yet, so are an increasing number of their friends. Even worse yet, most of their friends have the blessings of their parents who have signed their childrenâs vaccination release forms in the negative. Worst of all, my own subsequent researches into the matter have left me with an almost vertiginous sense of teetering on the edge of a very unpleasant abyss of woo woo which I do not even wish to contemplate, but nor do I feel entirely able to either sift through or debunk within a reasonable timeframe. They are now holding me ransom by quoting back at me my often imperious and always emphatic assertion that in our house the scientific method shall rule supreme and be considered firm and binding in all matters capable of being treated scientifically. The assertions that I find myself having troubles with are these:

1. Baxterâs official statement was ââWe have no evidence of any reassortment, that any reassortment may have occurred,â said Andraghetti, âAnd we have no evidence of any increased transmissibility of the viruses that were involved in the experiment with the ferrets in the Czech Republic.ââ. Therefore it is not speculation to assert the fact that said reassortment was possible. (I canât find a credible dissenting view in the medical literature.)

2. Since this could have created a pandemic of epic transmissibility (airborne) and lethality (>60%) both, it is not speculative to assert that millions of North Americans could have died, and it therefore follows that this is, if not the most important news story in history, certainly a notable occurrence worthy of some level of serious coverage by evening news programs over here.

3. Since no news articles were at that time or for some time to come presented by the mainstream media in the United States nor were any televised in Canada, one must conclude that one or both of two things is true: A. this was due to corporate/government manipulation of the media, or B. the media is too incompetent to report important scientific matters even when the issue pertains to the potential occurrence of millions of deaths AND even when the story is so sensational that it could have potentially attracted the highest ratings in many years. The clear inducements implicit in B, they argue, is highly suggestive that A is the case.

4. Irrespective of whether A or B above pertains (and of what might have motivated A for benign reasons, such as avoiding panic) they assert that only the alternative media provided adequate coverage and thus only the alternative media should now be trusted to report on events that pertain to âthe present pandemicâ and possibly even vaccines in general. [If they win this point in particular, I will feel considerably set back in general.]

5. Since Baxter asserts that its facility is fully BSL3 compliant, and BSL3 compliance is by definition exclusive of the possibility of casual errors being able to result in the observed outcome, one or more of the following must pertain: A. Baxter is lying or mistaken about being BSL3 compliant. B. BSL3 compliance is not adequate to prevent casual errors from potentially leading to lethal pandemics C. One or more parties within the facility intentionally circumvented the security measures which lower-downs wouldnât have been able to do because it would involve circumventing the auditing mechanisms which are compartmentalized and only accessible to the very higher-ups (a very crucial feature of BSL3).

6. Irrespective of which of A, B or C above pertain, they assert that all bets are now off regarding vaccine safety, and BSL3 facility reliability. They argue that the only latitude afforded by A B and C above is whether the act was the result of sinister intent, or systemic flaw, the latter of which would be only marginally more reassuring at best.

There were many, many others that I rejected because they are not entirely scientific (such as various other anecdotes about trials and blood and tissue products causing deaths, the gains Baxter stands to make if a pandemic occurs, their recent patents that pertain to fighting flu pandemics, their stake in antivirals, the strange media and politician flu hype, etc.). I pared it down to these six because I can handle the others just fine as they are circumstantial and speculative at best. As I am not a virologist or vaccine specialist, I could use a hand up with these last six. I donât even know what to believe myself now. I was completely unaware of this news story until a few days ago, which, I admit, I am vexed about. The only good thing to come of it so far is that it has led me to this fascinating website.