Scott McPherson's Web Presence

To say I am disappointed in the overall US response to the current swine H1, or A/H1N1v, or whatever the Hell we are supposed to call our pandemic of 2009, is to state things mildly.  And we have had failures on every front imaginable:  Risk communication, surveillance, sampling, and community response.

First, let me take the most recent CDC report I could find.  Dated 10 July 2009, the CDC report on pandemic H1N1 states that out of 37,246 cases, 211 persons have died.  The previous week, out of 33,902 reported or suspected cases, 170 have died.  This equals a case fatality rate of .005.  Statistically, it is in line with the .0045 I spoke of a little over two weeks ago.

But it is also consistent, which means that .0045, or .005, is not an abberation.

Meanwhile (and I TOLD YOU SO back on June 11th), the WHO has recommended to its major members that it stop swabbing each and every single case solely for the purpose of counting swine flu cases.  I said to take that approach over a month ago; the WHO moves a little more slowly, but it has been moving in exactly the same direction as what I have recommended since the first outbreaks began.

The WHO is recommending that other member nations continue to swab to determine spread in nations that previously have not experienced many cases.  They are also recommending swabbing in order to detect any mutations in the virus itself, specifically Tamiflu resistance and any changes in PB.

But our reporting methodology still relies upon human beings.  And those humans right now are exhausted, overworked, and tired.  Let me give you a glaring example of a hole in reporting:  the State of Florida.

Florida's Department of Health had the legislative equivalent of a shotgun wedding with previously-run county health departments a few years ago.  The marriage has gone pretty well, considering the scattershot states of being these health departments were in.  Post-9/11 funding and training has moved things along, and the October, 2001 anthrax attacks here in Florida also moved mountains.

But look at the swine flu surveillance report dated 4 July 2009.  Of Florida's 67 counties, nineteen did not report anything -- good, bad or ugly -- pertaining to swine flu.  These counties included Brevard, home of Cocoa Beach and Cape Canaveral; Lee, home of Ft. Myers; Charlotte, home of Punta Gorda (OK, maybe not so big); and rural Gadsden, which had already reported a swine flu case!

The total population in all the nonreporting counties alone exceeds 1,400,000 people. That makes the non-reporting counties of Florida larger than 11 states and on par with the states of Nebraska and Idaho.  Now, of course this does not mean these counties had cases, nor does it mean they did not have cases.  We do know for a fact that earlier, Lee and Brevard have had multiple confirmed cases. 

The point is that we are in the beginning of a flu pandemic, and we cannot get 19 counties to report their status?  What is wrong with these people?   How can we get an accurate count of anything if 19 counties are not reporting?

This is going on everywhere, I suspect.  But it does not affect the attack rate nor does it affect CFR.  If similar attack rates are happening elsewhere, they are probably happening in similar counties, reporting or not.  Swabbing or not.  And I have to suspect that with haphazard reporting comes - haphazard explanations of death.

"Oh yes, Mrs. MacGillicuddy.  She was 63 years old and had a bad heart.  It just gave out on her.  Yes, she said she felt bad.  Feverish, even.  But her heart killed her, poor thing."

It takes just one of those events in a third of the counties in America to reach alarming numbers of swine flu-related deaths.