H1N1

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CNN reports that H1N1 is still a problem, particularly in the Southeastern U.S.  Traditionally, epidmiologists model the spread of a contagious disease based on two factors: the transmission rate between people and the frequency of contact between individuals.  A study by  Yoo, Kasajima and Bhattacharya (2010) incorporates a third factor that will affect the spread of a disease:

We modify this standard model to incorporate avoidance response—that is, the idea that the frequency of contact among individuals will itself depend on the prevalence of the disease in the population. Unlike the standard [susceptible-infected-recovered] SIR-model, in our model the attack rate changes over time as disease prevalence changes. We assume attack rate to be the product of three factors: a constant baseline attack rate that represents a “biological” transmission rate; a baseline contact frequency which differs among subgroups; and avoidance response parameters which are influenced by the prevalence rate of the disease.

The avoidance response parameters measure the degree to which individuals decide to forego contact with other people. I am curious how the advent of the internet has affected avoidance response.

The internet helps to disseminate information faster.  Thus more people will be aware of a contagious disease and can change their behavior to avoid others.  On the other hand, one potential downside is that people may become desensitized to pandemic information if one is able to access more information on pandemics worldwide.

On the positive side, the internet allows decreases the marginal cost of staying at home.  Office workers can work online from home with little problem; students may be able to “attend” classes through online meetings through Skype or other software.  You can shop, watch video, and of course read blogs to pass the time.

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It is sometimes called the Great Swine Flu epidemic and sometimes the Great Spanish Flu epidemic, but in either case it was ferocious.  World War I killed twenty-one million people in four years; swine flu did the same in its first four months.  Almost 80 percent of American causalities in the First World War came not from enemy fire, but from flu.  In some units the mortality rate was as high as 80 percent.

This passage is from an interesting book I am currently reading called A Short History of Nearly Everything by Bill Bryson.  An (unfortunately) prescient passage in the book describes a certain flu virus we all became familiar with last summer:

From time to time certain strains of virus return.  A disagreeable Russian virus known as H1N1 caused severe outbreaks over wide areas in 1933, then again in the 1950s, and yet again in the 1970s.  Where it went in the meantime each time is uncertain.  One suggestion is that viruses hide out unnoticed in populations of wild animals before trying their hand at a new generation of humans.  No one can rule out the possibility that the Great Swine Flu epidemic might once again rear its head.

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As I predicted, the H1N1 influenza virus has returned to the U.S. this fall.  FluTracker gives a visual representation of the spread of the disease.  

In response to the spread of H1N1, President Obama declared the H1N1 outbreak a national emergency.  The declaration will  ”allow a hospital to set up a make-shift satellite facility for swine flu patients in a local armory or other suitably spacious location, or at another hospital, to segregate such cases for treatment.”  Without the waiver, “[u]nder federal law, if the patients are sent off site …the hospital could be refused reimbursement for care as a sanction.”

However, the national emergency declaration won’t help increase the speed of production for the H1N1 vaccine. The state of New York had previously declared that all health care workers must be vaccinated for against H1N1.  However, the state recently waved this mandate, not because of a change of opinion but because of vaccine shortages.  The FDA has approved an experimental intravenous use of peramivir against H1N1 in emergency cases.  The FDA approval states that “peramivir can be used when other drugs have failed or when delivery by a route other than intravenous is not expected to be feasible.” 

Should people with flu-like symptoms go to the doctor?  The answer is yes.  However, you may have H1N1 even if your test gives a negative result.  The rapid-test version will only give a positive test result for  11 out of every 100 people who actually have the H1N1 virus (at best).

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Two weeks ago, the U.S. government released its H1N1 vaccine to the public.  Many people have had a number of questions about whether or not they should get the vaccine.  The CDC website has a list of Key Facts and a Q&A section that is helpful.  

There are five major groups who should have priority of getting the vaccine:

  • pregnant women,
  • people who live with or provide care for infants younger than 6 months (e.g., parents, siblings, and day care providers),
  • health care and emergency medical services personnel,
  • people 6 months through 24 years of age, and,
  • people 25 years through 64 years of age who have certain medical conditions that put them at higher risk for influenza-related complications.

There are a number of people who should NOT get the vaccine.

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination.
  • People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
  • Children younger than 6 months of age (influenza vaccine is not approved for this age group), and
  • People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

The H1N1 vaccine is prepared using the same method as used for the seasonal flu.  However, because the H1N1 vaccine was developed too late, it could not be added to the seasonal flu vaccine.  Thus there are two flu shots available now, one for the seasonal flu and one for H1N1. 

If you think you have the H1N1 illness, you can use this self assessment tool to verify whether or not you should see a doctor.

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The Washington Post reports that most Americans are not very concerned about swine flu.  Should they be worried?  Maps from the New England Journal of Medicine and RhizaLabs detail that swine flu is still a problem.

The CDC reports that “from April 15, 2009 to July 24, 2009, states reported a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection. Of these cases reported, 5,011 people were hospitalized and 302 people died.”  However, the CDC does not seem too concerned either.  The CDC has decided to discontinue confirmed and probable case counts on July 24, 2009 (aggregate national reports of hospitalizations and deaths will continue ).

So it is logical for Americans to not be concerned about H1N1?  I believe that public health officials still need to take H1N1 very seriously.  It is very likely that a second H1N1 outbreak will occur this fall and winter during flu season.  During the traditional flu season, H1N1 monitoring must increase.

For the average American, however, I believe there is little reason to worry.  This is not because they will not get H1N1, but instead because there are only a few steps they can take to prevent it.  The CDC recommends: avoiding sick people, washing your hands frequently and covering your face with a tissue when you sneeze.  The first two steps will help prevent you from getting H1N1, but both are logical and most people should already be doing these.  The third step will not help prevent you from getting H1N1, but will prevent the spread of the disease to others if you have it.

The Healthcare Economist’s advice to you is wash your hands, avoid sick people and–until flu season begins–worry about something else other than H1N1.

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