The irony of it all

In this morning's New York Times, Kevin Sack reports on the sad economic state of state and local health departments. In 2008, local health departments in the US lost 7,000 employess and it is anticipated that at least that many more will be lost in 2009. Given the current crisis with influenza, loss of public health infrastructure is cause for great worry.

Swine flu tweets

I’ve never understood Twitter, nor have I ever tweeted. But a colleague of mine, Phil Polgreen, recently told me about an interesting research project he is working on with Alessio Signorino, using real-time tweets to track public interest in swine flu. Some of the background and details of the project can be found here.

Open up this webpage, and you’ll see a map that will begin to light up all over with tweets—scroll across the tweets to read them! Right now it only works with Firefox or Safari, not Internet Explorer....

CDC also updates infection control guidance...

I like the new WHO interim guidance that Mike points to below--clear, concise, and resolves the confusion I have referred to in the prior interim guidance from CDC.  CDC has now updated their guidance as well, here.  There is no longer a reference to negative pressure rooms being preferred for S-OIV patients, except during aerosol generating procedures.  The guidance is still more complicated than that of the WHO (CDC recommends standard + contact + eye protection + N95 masks for room entry).  The major difference from WHO guidance is in the requirement for N95 masks for room entry--otherwise it amounts to droplet + contact precautions.

More on swine flu infection control measures

The World Health Organization today issued interim guidance on infection control measures for caring for patients with suspected or confirmed swine influenza. Their guideline recommends standard + droplet precautions, unless an aerosol generating procedure will be performed, in which case they recommend N95 mask, eye protection, gowns and gloves.

Expanded Screening

So, we have a couple probable cases in Iowa, and the CDC is now expanding their screening in areas with few or no cases to include anyone with fever (T > 37.8 C) and cough or sore throat who either requires hospital admission or who is seen at one of CDC’s “ILI-Net” sites. The new guidance is here. Expect many, many more cases to be confirmed in the next week.

Also, WHO has raised the pandemic alert level from 4 to 5.

The Testing Lag

Remember that right now, the only way a case can be “confirmed” is if testing at CDC (by RT-PCR or viral culture) is positive for the swine-origin influenza virus (S-OIV—yes, that’s the new abbreviation and I’m sticking to it this time!). The cases that are being tested today will not be reported as confirmed cases until Friday at the very earliest (collected, sent to state lab, found to be influenza A but not typeable by state lab, sent to CDC, and tested). The turnaround will be shorter once the testing kits from CDC go online at state and other labs across the country.

What this means is that in addition to the 91 cases in 10 states that are now being reported, we can assume that S-OIV is now widespread. As more cases are reported with no links to Mexico or to other confirmed cases, the epidemiologic criteria for testing outlined in prior posts becomes increasingly obsolete. Testing will become more and more widespread, and case counts will skyrocket. The epidemic will appear to be expanding rapidly, but most of the changes will reflect increased testing and recognition of prior spread. We won’t know what is really happening now (in real time), for at least a couple weeks. I believe we’ll see more deaths and severe clinical presentations, but that the current epidemic will fizzle out over the next month—to return in the Fall as one of the circulating seasonal strains. Hopefully there will be an effective vaccine by then.

In the meantime, we need to prepare for more pessimistic scenarios than the one I believe to be most likely.

The Virus Formerly Known as Swine Flu: An Update

Just a quick post to note the first U.S. death due to swH1N1, and to link to the latest CDC updates for clinicians and labs about identifying suspected patients and about testing them for swine influenza. As it relates to my post yesterday, CDC is sticking with the recommendation to test only those with suspected swH1N1, as defined by either close contact with a confirmed case, or travel to or residence in an area with confirmed cases. This seems right to me, the difficulty will be in limiting or prioritizing testing, especially in areas where cases have been identified and testing volume is so high that it could exceed lab capacity (at least until testing becomes more widely available).

I realize there is now some controversy brewing about what is the most accurate and yet most politically/diplomatically correct way to refer to this virus. For the time being, I will continue to refer to it as swine flu or swine influenza (H1N1), or in shorthand as swH1N1. I predict the media and public health officials will eventually settle on “North American flu”.

Addendum: For today at least, the name appears to be "swine-origin influenza".