Sir Liam Donaldson, the Chief Medical Officer, said that the scenario of 65,000 deaths was based on 30 per cent of the population – around 18 million people – becoming ill. But the actual figure could be anywhere between 3,000 and 750,000 fatalities, he added.

The planning model given to the NHS shows that deaths could range from 19,000 to 65,000 if 30 per cent of the population were to become infected. It says that the NHS should prepare for as much as 12 per cent of the workforce to be off sick. However, the document emphasises that its figures are based on a “reasonable worst-case scenario for planning purposes” and are not a prediction. There is a chance the spread of the virus could slow during the summer holidays, peaking in October after children go back to school, it says.Sir Liam said the aim of the new flu service was to alleviate pressure on hospitals and GP services, enabling them to look after the “most seriously ill”. The Government was trusting the public not to abuse the service.

People will be given a diagnosis over the telephone or can get one by following an internet questionnaire. A “flu friend” can then obtain the antiviral drug from one of the depots around the country using the reference number given. Scotland, Northern Ireland and Wales have not yet set up such a service but could do so if the pressure on their health services continues to rise.

The Health Protection Agency said that its estimate of 55,000 new cases of swine flu in England in the past week includes people visiting GPs and those who are looking after themselves at home. Up to 85,000 people could be currently affected.

Sir Liam said the first vaccine deliveries next month would not be enough for everybody at high risk but sufficient would be available as winter approached.

What does this mean for the rest of the world?

-via Times Online

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As the 2009 pandemic evolves, the data needed for risk assessment, both within affected countries and at the global level, are also changing.

At this point, further spread of the pandemic, within affected countries and to new countries, is considered inevitable.

This assumption is fully backed by experience. The 2009 influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks.

The increasing number of cases in many countries with sustained community transmission is making it extremely difficult, if not impossible, for countries to try and confirm them through laboratory testing. Moreover, the counting of individual cases is now no longer essential in such countries for monitoring either the level or nature of the risk posed by the pandemic virus or to guide implementation of the most appropriate response measures.

Monitoring still needed

This pandemic has been characterized, to date, by the mildness of symptoms in the overwhelming majority of patients, who usually recover, even without medical treatment, within a week of the onset of symptoms. However, there is still an ongoing need in all countries to closely monitor unusual events, such as clusters of cases of severe or fatal pandemic (H1N1) 2009 virus infection, clusters of respiratory illness requiring hospitalization, or unexplained or unusual clinical patterns associated with serious or fatal cases.

Other potential signals of change in the currently prevailing pattern include unexpected, unusual or notable changes in patterns of transmission. Signals to be vigilant for include spikes in rates of absenteeism from schools or workplaces, or a more severe disease pattern, as suggested by, for example, a surge in emergency department visits.

In general, indications that health services are having difficulty coping with cases mean that such systems are under stress but they may also be a signal of increasing cases or a more severe clinical picture.

A strategy that concentrates on the detection, laboratory confirmation and investigation of all cases, including those with mild illness, is extremely resource-intensive. In some countries, this strategy is absorbing most national laboratory and response capacity, leaving little capacity for the monitoring and investigation of severe cases and other exceptional events.

Regular updates on newly affected countries

For all of these reasons, WHO will no longer issue the global tables showing the numbers of confirmed cases for all countries. However, as part of continued efforts to document the global spread of the H1N1 pandemic, regular updates will be provided describing the situation in the newly affected countries. WHO will continue to request that these countries report the first confirmed cases and, as far as feasible, provide weekly aggregated case numbers and descriptive epidemiology of the early cases.

For countries already experiencing community-wide transmission, the focus of surveillance activities will shift to reporting against the established indicators for the monitoring of seasonal influenza activity. Those countries are no longer required to submit regular reports of individual laboratory-confirmed cases and deaths to WHO.

Monitoring the virological characteristics of the pandemic virus will be important throughout the pandemic and some countries have well-established laboratory-based surveillance systems in place already for seasonal influenza virus monitoring. Even in countries with limited laboratory capacity, WHO recommends that the initial virological assessment is followed by the testing of at least 10 samples per week in order to confirm that disease activity is due to the pandemic virus and to monitor changes in the virus that may be important for case management and vaccine development.

Updated WHO guidelines for global surveillance reflect in greater detail these recommended changes, in line with reporting requirements set out in the International Health Regulations.

For those of you in hospitals, does this sound right to you?

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Health officials estimate that as many as 1 million Americans now have the new swine flu. Lyn Finelli, a flu surveillance official with the Centers for Disease Control and Prevention, voiced the estimate at a vaccine advisory meeting Thursday in Atlanta.  The estimate is based on mathematical modeling. Nearly 28,000 U.S. cases have been reported to the CDC, accounting for roughly half the world’s cases. The U.S. count includes 3,065 hospitalizations and 127 deaths.

An estimated 15 million to 60 million Americans catch seasonal flu each year.  The percentage of cases hospitalized has been growing, but that may be due to closer scrutiny of very sick patients. It takes about three days from the onset of symptoms to hospitalization, Finelli said, and the average hospital stay has been three days.

Other health problems have been a factor in most cases: About one in three of the hospitalized cases had asthma, 16 percent diabetes, 12 percent have immune system problems and 11 percent chronic heart disease.  The numbers again highlight how the young seem to be particularly at risk of catching the new virus. But data also show that the flu has been more dangerous to adults who catch it.  The average age of swine flu patients is 12, the average age for hospitalized patients is 20, and for people who died, it was 37.

Just a simple reminder to be sure to wash your hands often.  Those of you that work in hospitals, be sure to change out of your scrubs prior to leaving work.  It’ll help to contain the germs that you come into contact with throughout the day.

They’ve said that Swine Flu would get worse before it gets better, and it looks like they were right.

-via Associated Press

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Here we have the announcement in full, as I think it’s easier to read here than on the WHO’s website.  You can either click that link to read the announcement on their website, or click “read more” to read it here.

World now at the start of 2009 influenza pandemic

Dr Margaret Chan
Director-General of the World Health Organization

Ladies and gentlemen,

In late April, WHO announced the emergence of a novel influenza A virus.

This particular H1N1 strain has not circulated previously in humans. The virus is entirely new.

The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries.

This is only part of the picture. With few exceptions, countries with large numbers of cases are those with good surveillance and testing procedures in place.

Spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission. Further spread is considered inevitable.

I have conferred with leading influenza experts, virologists, and public health officials. In line with procedures set out in the International Health Regulations, I have sought guidance and advice from an Emergency Committee established for this purpose.

On the basis of available evidence, and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met.

I have therefore decided to raise the level of influenza pandemic alert from phase 5 to phase 6.

The world is now at the start of the 2009 influenza pandemic.

We are in the earliest days of the pandemic. The virus is spreading under a close and careful watch.

No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness.

We have a head start. This places us in a strong position. But it also creates a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty.

Thanks to close monitoring, thorough investigations, and frank reporting from countries, we have some early snapshots depicting spread of the virus and the range of illness it can cause.

We know, too, that this early, patchy picture can change very quickly. The virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time.

Globally, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity. As we know from experience, severity can vary, depending on many factors, from one country to another.

On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.

Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.

We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.

In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people.

Many, though not all, severe cases have occurred in people with underlying chronic conditions. Based on limited, preliminary data, conditions most frequently seen include respiratory diseases, notably asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity.

At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people.

Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.

Finally, and perhaps of greatest concern, we do not know how this virus will behave under conditions typically found in the developing world. To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.

Let me underscore two of many reasons for this concern. First, more than 99% of maternal deaths, which are a marker of poor quality care during pregnancy and childbirth, occurs in the developing world.

Second, around 85% of the burden of chronic diseases is concentrated in low- and middle-income countries.

Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems.

Ladies and gentlemen,

A characteristic feature of pandemics is their rapid spread to all parts of the world. In the previous century, this spread has typically taken around 6 to 9 months, even during times when most international travel was by ship or rail.

Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection.

Guidance on specific protective and precautionary measures has been sent to ministries of health in all countries. Countries with no or only a few cases should remain vigilant.

Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities.

WHO has been in close dialogue with influenza vaccine manufacturers. I understand that production of vaccines for seasonal influenza will be completed soon, and that full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come.

Pending the availability of vaccines, several non-pharmaceutical interventions can confer some protection.

WHO continues to recommend no restrictions on travel and no border closures.

Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection.

We are all in this together, and we will all get through this, together.

Thank you.

-via World Health Organization

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There have been seventeen deaths definitively linked to swine flu in the U.S. alone, and is responsible for at least 117 deaths world wide as of this writing.  Mostly responsible for mild disease, it spreads easily and has been diagnosed in 17,564 people in 64 countries, according to the World Health Organization.

It has recently appeared in patients in Bulgaria, Vietnam and Jamaica.  Although it appears mild, affecting mostly older children and young adults, experts fear that it could change into a more dangerous form.

-via Reuters, CDC

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“We wonder whether this strain will continue during the summer and give us more of a summer influenza pattern,” said Dr. Anne Schuchat, interim deputy director for science and public health program. “Unfortunately, we don’t know whether we’re going to get a break this summer with this virus.”

What about the rest of the planet?  Well, globally, there have been nearly 9000 convirmed cases in roughly 40 countries, killing 74.  Most of the deaths have happened in Mexico.  The World Health Organization hasn’t rased the world swine flu alert level, though they are poised to declare a full pandemic.

New York City’s first swine flu related death came on Sunday evening, with the assistant principal of a school in Queens.  However, complications besides the virus were likely to play a part in his death.

-via MSNBC

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Respirator Masks

With the swine flu outbreak leading many to go for masks, including as far away as Sydney, Australia’s airport, you have to wonder how much a mask can actually help.  Apparently they are becoming hot items online.  While the thought is understandable, experts are skeptical about the usefulness of the masks.

Professor John Oxford, a virologist at The Barts and the London, explains: “Really, there is very little evidence that masks actually offer much protection against flu. I think handing them out to the public, as has happened in Mexico, just destroys confidence.”

Healthcare workers are another story, though.  Some countries have instructed their medical personnel to wear masks as well as special gloves.  This is especially recommended for those that will be in contact with potential victims.

Officials from groups such as the World Health Organization and England’s Health Protection Agency have steered clear of calling for masks for the general public. The Department of Health has focused on getting respirator masks, which have filters that stop a person from breathing in some particles in the air.  Respirator masks are much more effective than standard surgical masks and dust masks.

However, none of the masks can stop 100% of the particles from getting through, and they become less effective when they are moist.

The University of London’s deputy director of biomedical science had this to say about wearing masks:

If you sneeze with a mask the virus will be contained so from that point of view if everyone wore them it might stop the spread.  Or you could get the people with flu wearing them, but by the time they are diagnosed it could be too late.  And the problem is that when someone sneezes they tend to take a mask off. I think masks give people a false sense of security.  They are not bio-chemical suits. Masks are obviously just covering one part of the body so your hands and clothes could all have the virus on and when you take them off you will infect yourself.  However, because people are wearing a mask they will think they are protected and may go into crowded areas.  The best advice is to wash your hands and cover your mouth when sneezing.

Glamorgan University expert Gail Lusardi agreed with that statement, adding:

Masks alone will not prevent spread of the influenza virus and basic hygiene measures like hand washing, safe use and disposal of tissues and cleaning of environmental surfaces are key to preventing infection transmission.  A mask can be worn continuously for up to eight to ten hours, but must be replaced if it is taken off at any stage.

She also said it was important for the masks to be correctly fitted.  Some of the more expensive respirator masks are molded to fit the face, unlike standard masks that can be bought on the high street.

You can order respirator masks on Amazon.com

-additional reporting via bbc news

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A group of nuns walk wearing surgical masks in the Zocalo plaza in Mexico City, Saturday, April 25, 2009

Swine Flu has begun a quick spread and has been spreading at an insane rate. While the CDC website hasn’t yet been updated to reflect this, the news says that the number of reported cases in the United States has doubled today, from twenty to forty. It’s something that we all want to be able to track to make sure that we stay safe from the reaches of Swine Flu.

Thus, I’ve created a list of ways that you can keep track of Swine Flu online, as well as other flus, if you’d like to. It’s not a list that is exclusive to Swine Flu.

1) Check the World Health Organization’s Disease Outbreak News page and the CDC

This page provides the latest information on any and all disease outbreaks.  At the time of this writing, however, they are a little bit behind, as the latest update was yesterday, with the following:

26 April 2009 – As of 26 April 2009, the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas and 1 in Ohio). All 20 cases have had mild Influenza-Like Illness with only one requiring brief hospitalization. No deaths have been reported. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.

However, it had a link to a page devoted to Swine Flu, and the spread.

Be sure to also keep track on the Center for Disease Control website. This is especially important for those that travel often.  It is kept up to date fairly well (updated usually within hours, as they verify facts. Check the CDC page for Swine Flu here!

2) Use Google Flu Trends and News Alerts

Although Google Flu Trends hasn’t been updated to include specific flu trends, such as Swine Flu, it is still helpful in tracking influenza around the country.  I personally think that they should include map updates based on types of flu.  Google, get on that!

News Alerts can send you e-mail, update your RSS feed, and other sorts of things.  That way, you don’t even have to go out to Google News to get Google News.  It can come right to you!

3) Check the HealthMap to see the Spread

This is something that I have only recently discovered.  According to their about page: HealthMap brings together disparate data sources to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. This freely available Web site integrates outbreak data of varying reliability, ranging from news sources (such as Google News) to curated personal accounts (such as ProMED) to validated official alerts (such as World Health Organization). Through an automated text processing system, the data is aggregated by disease and displayed by location for user-friendly access to the original alert. HealthMap provides a jumping-off point for real-time information on emerging infectious diseases and has particular interest for public health officials and international travelers.

4) Remain Calm, and Keep yourself informed

Don’t make yourself a victim.  Keep calm and keep informed of things happening around the world.  It’s easier than ever to keep up on health news, and we’re just hoping to help you a little bit each day.

-photo credit: Examiner

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