H1N1 Primer

There has been a lot of information — much of it directly contradictory — about H1N1 (“swine flu”). I think we can safely say that it hasn’t lived up to its hype — I believe the President suggested that as many as 30,000 Americans would be dead from swine flu by October, its peak. This makes it easy to dismiss it entirely… except for the fact that some people will be very badly affected, and even die.

Frankly, the whole discussion sets off my “OCD” when it comes to the numbers — any non-seasonal flu became labeled “swine flu” without testing; only the hospitalized cases were tested. I’ve read that when studies were done actually testing “diagnosed” cases of H1N1, the actual rate of H1N1 was something like 1/3 or fewer of the “diagnosed” cases. If this is the case, and only 30% of diagnosed H1N1 is really H1N1, then the actual rate of complications may be actually much higher than suspected. After all, if one million people are “diagnosed” with H1N1, but only 300,000 people actually have it, then the rate of complications is actually X/300,000, rather than X/1,000,000, which might make a very big difference. On the other hand, most of the people who come down with H1N1 have no complications, are not diagnosed, and don’t even go to the doctor — it’s just dismissed as a case of the sniffles or whatever. This very easily could mean that the 1,000,000 “diagnosed” cases of H1N1 should actually number in the several millions, and then the rate of complications would go from being X/1,000,000 to X/3,000,000. See how frustrating that is for a numbers person to handle??

So, I haven’t posted on H1N1, because — especially with all the contradictory information, and so much of it, I’ve suffered from SFO — “swine flu overload” — and didn’t want to wade through all the contradictory claims, searching through all the articles and studies that may be horrendously biased (one way or the other), trying to figure out what to do or say or think. But the folks at Midwifery Today did do all the grunt-work, and put together The H1N1 Primer for Pregnant Women, which looks pretty balanced, thorough, and accurate (or at least, honest, and as accurate as can be with all the various hyperbolic claims put forth on both sides of the issue). Plus, they have a lot of links at the bottom of the page which are bound to yield even more information.

One thing is for sure, though — the best defense is a good offense — wash your hands, avoid sick people, keep your immune system up by eating properly and taking vitamin supplements as necessary to stay healthy.

3 Responses

  1. We have had one maternal death so far, that has been associated with complications from H1N1.

  2. I’m in Iowa City, IA and we had a huge outbreak of H1N1. At the beginning they were telling everyone to come in, be tested, and they were testing, telling anyone who tested positive for H1N1 to STAY HOME from work and only come back to the hospital if they became seriously sick. Then a few weeks past…first they changed ‘everyone come in to be tested’ to ‘only come in if you are really sick’ because people were picking it up at the hospitals. Then they stopped testing intirely because it was too expensive to test everyone, they just said if you got the flu it was ‘probable H1N1’, and don’t go anywhere, especially to the doctor’s, unless absolutely necessary. Why was this so annoying (in addition to the obvious)? My family all came down with it, but since all I could say was we ‘probably’ had H1N1 already, my OB really wanted me to have the vaccine. (I decided with all the things I KNOW are harmful/medically unnessecary I’m going to argue with her about I might as well humor her on this one)

  3. Part of the confusion is over what is “testing” for the flu. There are basically three levels of diagnosis — (1) looking at symptoms for “influenza-like illness,” which may or may not really be the flu; (2) the influenza A quick test, which can be done in the doctor’s office, but is not very accurate. This test doesn’t distinguish between seasonal and H1N1. (3) Genetic sequencing, which does tell you the flu variety, but is slow, expensive, and labor-intensive. Because genetic testing takes up so many resources, it is generally only done on patients sick enough to be hospitalized. The various patient counts and case estimates are based on these different ways of diagnosing the flu. For instance, the oft-quoted 36,000 deaths from regular seasonal flu is not based on a direct count, but an estimate of “excess” deaths in the winter from influenza-like illness. On the other hand, pediatric deaths are directly counted, and this year, typed for variety.

    I think it is pretty clear now that this flu hasn’t been too awful in terms of mortality. History tells us that humanity isn’t always so lucky. I’m not sure it’s fair to blame Obama (or the CDC, or the WHO) for over-hyping the pandemic. They don’t have crystal balls to tell what will happen when a new virus hits the real world. Public health officials have a tricky job, to prepare for the worst without freaking out the population.

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