Swine Flu Cases Overestimated?

[sabra]

Source: CBS News

CBS News Exclusive: Study Of State Results Finds H1N1 Not As Prevalent As Feared

(CBS) If you've been diagnosed "probable" or "presumed" 2009 H1N1 or "swine flu" in recent months, you may be surprised to know this: odds are you didn’t have H1N1 flu.

In fact, you probably didn’t have flu at all. That's according to state-by-state test results obtained in a three-month-long CBS News investigation.

The ramifications of this finding are important. According to the Center for Disease Control, CDC, and Britain's National Health Service, once you have H1N1 flu, you're immune from future outbreaks of the same virus. Those who think they've had H1N1 flu -- but haven't -- might mistakenly presume they're immune. As a result, they might skip taking a vaccine that could help them, and expose themselves to others with H1N1 flu under the mistaken belief they won't catch it. Parents might not keep sick children home from school, mistakenly believing they've already had H1N1 flu.

Why the uncertainty about who has and who hasn't had H1N1 flu?

In late July, the CDC abruptly advised states to stop testing for H1N1 flu, and stopped counting individual cases. The rationale given for the CDC guidance to forego testing and tracking individual cases was: why waste resources testing for H1N1 flu when the government has already confirmed there's an epidemic?

Some public health officials privately disagreed with the decision to stop testing and counting, telling CBS News that continued tracking of this new and possibly changing virus was important because H1N1 has a different epidemiology, affects younger people more than seasonal flu and has been shown to have a higher case fatality rate than other flu virus strains.

Read more: http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml?tag=stack

[Fire_Medic_Dave]

1. What dumbass "journalist" wrote this crap?

[Ms. Toad]

4. Why the negative reaction?

There are some questions I would explore more, but generally the article makes a valid point that many people don't seem to be aware of or don't understand.

Anyone "diagnosed" with the H1N1 influenza should still be vaccinated because, chances are, they were not tested to determine if that is what they actually had. I have talked to quite a few people who tell me they were definitively tested for the H1N1 virus. When I press a little harder, I find they were tested with an oral swab - one of a collection of tests for general influenza categories which are not specific to the H1N1 virus. My daughter is in this category - although she understands what her "diagnosis" really means - and will also be getting the H1N1 vaccination, since she is in a high risk group. For her, an "oops" as to whether her doctor made an accurate diagnosis would not be a good thing.

People who believe they are now immune based on their "diagnosis" with the H1N1 virus need to be aware that there is a reasonable chance that they might not have actually had the H1N1 virus - and if they want to be relatively certain that they are protected they should still be vaccinated.

I would question whether statistics based on H1N1 testing of individuals likely to have the H1N1 virus because of travel to Mexico are valid indicators of how accurate the "diagnoses" are currently - but I doubt the population that needs to get the main message of the article cares enough to read that far into the article.

[RaleighNCDUer]

6. You know, I agree with both you and Dave here -

The writing is crap because it doesn't lay out what the problem is in the opening paragraph, so people will look at the headline and opening paragraph and believe the H1N1 threat is over-rated.

And it IS a bit confusing - the H1N1 is not as prevelant as thought, therefore you should be more afraid of it. That is a bit of a mixed message.

[Igel]

9. Try this.

The article is surprisingly fact free.

It does have some facts. For instance, there's one from early last summer. The narrative goes thusly: In July there was a very low incidence of H1N1 viral infection; so therefore we claim that there's still a low incidence of H1N1 viral infection even though it's now October. It may be 3 months later, but what could possibly change? Nothing! Yes, that "therefore" implies logic such that the claim is a valid inference. But the logic doesn't hold water--we strongly suspect that the "fact" is quite possibly not true--and so the truth of the claim depends entirely upon whether the claim is true. The logic gets us nowhere but to a possible tautology devoid of relevant evidence.

In fact, the CDC says that nationwide over 60% of the samples tested--not just from hospitalization, but from the usual lab sample routine--are H1N1. A large portion of those remaining were typed as Influenza A--and might be H1N1 or not, there's no way of knowing. Now, that number may not be right. But it's not likely to be off by an order of magnitude.

In other words, the one clear fact from the 3-month-long CBS News investigation is moot: The incidence is not now low. Their claim is simply false, and yet the rest of their story is based almost entirely upon their claim.

*That* is the meat of the story. Somehow, I've never been all that partial to 2-day old sunbaked swine corpse, even gussied up with apple slices or Hyderabadi mixed pickle with a sign attached saying it's "pareve". Yet that's what they've served up, and that's what many people are chowing down on. Yes, it's vile.

The recommendation they passed along, mindlessly, from the CDC stands. Of course, it didn't take 3 months of painstaking investigative work to say that since most people aren't tested, and the tests done in the doctor's office aren't all that reliable, what's dubbed H1N1 might not be H1N1. In other words, the bit about the CDC is an add-on, something that is a freestanding news bit and probably not foreseen when work on the article began. Fortunately, it's about the only thing that justifies the waste of dead tree and joules for the article (of course, it could have been presented in some 30 words, and we could have been spared the entirety of the rotten pig).

[Fire_Medic_Dave]

12. You did that much better than I did, thanks.

[Fire_Medic_Dave]

11. If someone had a fever of 103, severe cough, fatigue, sore throat, body aches, headaches and chills

all for 10-14 days, they likely had the flu. To say that they likely didn't have the flu because no test was done is complete BS. Of course they only show us the results from 4 states and we have no idea the symptoms associated with those samples and they fail to provide any numbers associated with test failures or lab failures and the article doesn't say whether the 4 states cited were among the states that specifically tested based on the symptoms and risk factors. Earlier this month 99% of the Influenza type A that was tested further was found to be H1N1. It is highly probable that your daughter, in fact, had swine flu, either way the vaccine isn't going to hurt her. The article was short on science and big on hysteria, that's my problem with it.

David

[Ms. Toad]

13. Well - playing devil's advocate -

Not all cases are that clear-cut.

My daughter's temperature reached 101.3, she was achy on awakening - but not generally the rest of the day - and had a sore throat and coughing. Her roommate was ill with something shortly before my daughter started showing symptoms, but did not go to see the doctor. My daughter tested negative on the rapid assay test, the particular version of which is only about 50% reliable for identifying influenza. She was given Tamiflu because she is at high risk for complicaitons, and the fever vanished (without NSAIDS) within 24 hours of starting Tamiflu and she was relatively symptom free by three days (at most) later.

The doctor who actually saw her believes she had the H1N1 virus (but is recommending vaccination anyway). According to him, her mild symptoms are consistent what he is seeing among other students on her campus (some of whom tested positive on the rapid - and others of whom did not).

Her regular doctor - who did not see her - says that her symptoms were too mild and disappeared too quickly to have been the H1N1 virus.

Whether she had it or not, though, her visit to the doctor contributed to bumping Ohio up to one of the states with widespread flu activity. Particularly given the differing interpretations of her illness by two doctors - and the report by her doctor that other cases at the college were similarly mild - I suspect there are quite a few borderline folks like her who are being reported as probable H1N1 cases - which are not in fact H1H1 cases (and should still get the vaccine).

None of that is to minimize how widespread the H1N1 virus actually is. From anything I can tell it is very widespread - but I also think that out of an overabundance of caution to encourage isolation of potentially contagious people, some doctors are telling a number of people who are borderline that they probably have the H1N1 flu - when they may in fact not have had it.

It wasn't the most scientific analysis I've ever read - but it wasn't targeted to a scientific audience, and wasn't totally out of the ballpark.

The main points it made were good: A lot of people mistakenly believe they were definitively diagnosed when they were not, and if you didn't at least have either a positive rapid assay for influenza - or unmistakable symptoms - it is probably a good idea to get the vaccination anyway to be on the safe side.

[Fire_Medic_Dave]

15. I agree with your last point.

The conclusion though that they probably didn't even have the flu is quite flawed.

[mzmolly]

19. Dr.s are in a difficult position because the test is unreliable.

I have a family member who is supposedly ill with it now, the symptoms are on the mild side so far. Hopefully they'll stay that way!

[mzmolly]

18. Family member who was diagnosed this week had the following presentation ~

sore throat, stuffy nose, mild fatigue, high fever of 102.7, vomited once after ibuprofen on a empty stomach, short lived chills, occasional cough. No headache or body aches to my knowledge?

Tested negative for influenza A/B but was diagnosed with H1N1 because the Dr. said the test was highly inaccurate. 10-70% accuracy from what I've read?

We're still considering the nasal vaccine when it's available, just in case the dx. was wrong.

We're on day three here. I've heard it lasts from 4-7 days? I hope that's true.

[uppityperson]

22. If you are healthy and actually had hini influenza, seems getting nasal vx can't hurt

except to waste it. Thinking here with "presumptive influenza" since rapid flu test give a high # of false negatives and they're not doing blood testing since it is more costly/takes a lot longer. (Rapid flu test, if it comes back +, you have it. If it comes back -, you might still have it. It is a test to tell for sure if you do, but not if you don't.)

If you had something, and want to get vx'd after you are healthy, seems it wouldn't hurt except to be a waste of vx IF you truly did have hini.

[mzmolly]

24. If they have enough of the vax to go around and recommend it

in our case, we'll consider doing it. At this point, we're gathering all info that we can.

A friend got a second opinion on her family dx of H1N1 and was told adenovirus was more likely? It's all very confusing.

[midnight]

2. Thanks for the post....

Consumers are not falling in line for the status quo bells and whistles. Consumers want stable information, and when it is blocked, and or not tracked per CDC advise, they become more alert to the stop, start, stop, in this stay informed process.....

[TreasonousBastard]

3. It was my understanding that the CDC did NOT stop...

the reporting and counting, but reset the counter in August for this year's flu season.

There are questions about diagnosis, what with the tests not being foolproof and some deaths actually caused by penumonia accompanying the flu, but they are still tracking the pandemic.

http://www.cdc.gov/h1n1flu/update.htm

[Ms. Toad]

7. It is not that the tests are not foolproof -

it is that they are not being done, except in rare cases.

What is being tracked and reported specifically as H1N1 infections are only cases severe enough to justify the relatively costly and time consuming specific test (or those who die from it). Otherwise, what they are tracking are visits to the doctor with flu-like symptoms.

Some doctors are testing for general types of influenza, but none of the rapid assays done in the doctor's offices are specific to H1N1. Some of those tests are only about 50% effective for influenza (in general), so even people who test negative for influenza but whose symptoms are consistent with influenza are being tentatively "diagnosed" with H1N1 on the basis that it looks like influenza, the test isn't reliable to rule it out, and the only influenza that is currently widespread is the H1N1 influenza.

Bottom line - if you go to your doctor's office, and are told during that visit that you have the H1N1 influenza, you should still be vaccinated if you want to ensure you are protected against it because there is no definitive same day test for the H1N1 virus. (Nonetheless, you will still be included in the visits to the doctor with flu-like symptoms.)

[Taverner]

8. No one out there is testing unless the patient is hospitalized

Dumb idea - we need to know how much of this is Swine Flu and how much is Flu with Paranoia...

[JoeyT]

10. I agree

And this would be a really simple matter under socialized medicine.
Under what we have now it's virtually impossible.

[Taverner]

5. Well no doctor is testing for it so yeah, there's a good chance

As far as I know, I could have H1N8, or R2D2....

But I will never know because all my doc will do is pocket the money and say "rest and fluids" :eyes:

[Why Syzygy]

14. It is the CDC's RESPONSIBILITY

to track cases. Their refusal to do so in this case piles on more suspicion.

[Fire_Medic_Dave]

16. Only to the paranoid.

[mzmolly]

17. I've heard that the test is highly inaccurate so when in doubt physicians are treating

anything that could be H1N1, as H1N1?

I have a family member who was recently diagnosed in spite of testing negative for flu. It's puzzling...

[mzmolly]

20. K and R. It's important to have accurate info

whenever possible. It would be good if they could come up with an accurate, cost effective test so that tracking is possible?

[likesmountains 52]

21. The CDC would like all of the state health depts to continue testing for H1N1, but

knows that the resources are just not available for widespread testing. The H1N1 specific test is very expensive and the state health departments can't afford to test every patient with FLI (flu-like illness). I live in Colorado and our hospital is only allowed to send 10 specimens A MONTH to the Colorado Dept. of Public Health. These 10 tests have naturally been reserved for the sickest (on ventilators usually) patients in the hospital. I believe that the CBC report kind of missed that whole point. The CDC did not stop recommending testing for any suspicious reason. It simply could not force the state health depts to spend $$$ doing it.

[mzmolly]

23. I wonder if CBS took into consideration the accuracy of the rapid test?

I wonder if the stats they quote are based upon a reliable method?

[Chemisse]

25. That certainly makes a lot more sense than some

Grand conspiracy on the part of the CDC.

The CDC has its own pressures, combating the impression that they over hyped the flu when it was first discovered, while still trying to be highly vigilant of the current spread.