Re: H1N1 Update / US Pandemic SitRep Nov 12th

[Guest guest]

US Pandemic Situation Report- Nov 12th

The overall national trend is now one of declining impact. Reporting nationwide

continues to be highly variable from location to location. Some locations are

reporting decreases in case loads while others are reporting dramatic surge. The

below information pertains to those locations within the US reporting challenges

related to pH1N1.

School Absenteeism

Student absenteeism rate (elementary and high school): 10-40% (10-20% usual

range reported)

Teacher absenteeism rate (elementary and high school): not specified but still

documented

Local Medical Infrastructure

EDs and outpatient clinics continue to be overwhelmed by anxious well and truly

ill patients.

EMS and first responders report no appreciable impairment in operations.

Hospital ward level inundations have been reported. Excession of capacity was

not noted since last report. Healthcare worker absenteeism has contributed to

strain.

ICU capacity has been reported to approach near- to at-capacity. Demand for

ECMO or HFOV continues to be observed.

San Joaquin County, California declared a local state of emergency due to broad

medical infrastructure strain.

Mortuary services have not reported strain.

Fewer people are donating blood in the United States due to the pandemic. In

addition, some blood centers nationwide have had to throw out blood donations

after learning that the donor had influenza-like symptoms. Although the centers

claim that they have sufficient blood supplies now, a further decrease in blood

donations, particularly during the Christmas season, is a concern.

General Infrastructure Strain

Main sectors affected this week include primarily education, public health, and

medical care. Government and corporate sectors have not reported strain since

last report.

A pork producer from Clinton, North Carolina filed for bankruptcy after owing

about USD three million to various vendors. The company, Coharie Farms, blames

the loss on an increase in grain prices, a decrease in hog prices, and pandemic

(H1N1) 2009 " fears " . The owner of Coharie Farms plans to liquidate the company

and " some " of the 170 employees will be laid off. The company lost about 17

million dollars this year. Coharie Farms is the largest independent pork

supplier to field Foods Company. North Carolina has the second largest pork

industry in the United States.

Social Anxiety

Frustration and anxiety associated with failure of meeting expected public

access to pandemic vaccine and public perception of uneven distribution of

vaccine to priority groups has become the primary focus for public anxiety.

This relates to public outcry due to a perception of politicians and other non

medical-risk groups observed to be vaccinated ahead of those groups identified

and publicized by CDC for vaccine priority.

Worried well influx to emergency departments and parents keeping well children

home from school continues to be documented. Limited instances of parents

refusing vaccination after reports of adverse vaccine reactions (regardless of

credible proof the vaccine was the cause of the reaction) continue to be

documented.

The current focus for social tension revolves around vaccine availability and

uneven distribution.

In addition to strain and anxiety, doctors are dealing with threats, insults,

and bribes from patients. Doctors are compelled to reassure patients that they

are waiting their turns for the vaccine and not prescribing Tamiflu for

themselves or their families unless necessary. Two vaccine clinics in

ville, New York were canceled after parents began to threaten nurses.

According to staff members, one parent stated that he would " hunt down " the

nurse if anything happened to his child while another parent threatened to sue a

nurse if something happened to his child.

Primary triggers for social outcry and anxiety behavior continue to be 1) the

death of children or 2) pregnant mothers in a community. Publicly perceived

violation of expectation regarding availability (and now) distribution of

pandemic vaccine has become a prominent driver of social anxiety.

Environmental Conditions

Environmental conditions are currently moderately optimized for transmission

throughout the majority of the US and are projected to optimize fully within the

next 3 months.

Expected Progression

While national epidemiological statistics indicate a past peak and decline in

cases, high variability in local experience is still observed. Overall national

impact is declining.

Pandemic H1N1 is expected to continue to strain local medical capacity, however

now at lower levels. Variables in local transmission include herd immunity

levels achieved through prior community exposure to the virus, public and

healthcare worker uptake of pandemic vaccine, and virus genetic stability.

Veratect's West and East Coast Operations Centers remain vigilant for possible

resurgence following mass mixing events such as Thanksgiving and especially the

Christmas / New Year's holiday seasons. It is unclear to what degree the

pandemic will impact social functioning when environmental conditions are

maximally optimized in January-February. Veratect remains vigilant for

reporting of virus drift or recombination.

M. V, MD

CTO/Veratect

jim@...

>

> Reports on 2009 H1N1 influenza in the U.S. will now use estimates from the

CDC's Emerging Infection Program, rather than counting only laboratory-confirmed

cases, according to a CDC news briefing.

>

> The new estimates for the first 6 months of the pandemic -- from mid-April to

mid-October -- find that:

>

> -- Roughly 22 million people in the U.S. became ill from the virus.

> -- Nearly 100,000 were hospitalized.

> -- Some 3900 died, including an estimated 540 children under 18; some 2900

adults between 18 and 64; and 440 elderly.

>

> This week's MMWR carries a CDC analysis concluding that the seasonal trivalent

vaccine offers no protection from -- or increased risk for -- 2009 H1N1 disease.

An additional surveillance article on the pandemic notes that " severe outcomes

among children ... continue to be prominent " and provide support for the

recommendation that those aged 6 months to 24 years be targeted for vaccination.

>

>

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