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Commentary
2009 Pandemic Anniversary In the United States
Recombinomics
Commentary 12:49
April 2, 2010
I also want to speak about the deaths. And I think it's very important to put in contrast what we've seen so far this year with the 2009 H1N1 pandemic virus and what we typically will see in a seasonal influenza. When we say that about 12,000 people have died from this virus, that estimate includes 90% of those people, about 11,000 are people under 65. And that's much more deaths in a particular year among younger people than what we typically see with seasonal flu. We estimate that the rate of death in young people is probably five times higher than what we would typically see with seasonal influenza.
The above comments from the March 29 CDC press briefing, which comes a year after the start of the 2009 pandemic in the United States, when two children in southern California had confirmed infections with swine H1N1.
On March 30 the first sample from a child (9F) in southern California was collected, and on April 1 the sample from a second child (10M) was collected. Sequences from these two samples (California/5/2009 and California/4/2009) were virtually identical and were swine H1N1 even though neither child was linked to swine or each other. Therefore, it was clear that a pandemic involving a jump of swine H1N1 to humans had begun.
The subsequent sequencing of samples from cases in Mexico left no doubt that the virus had already spread far and wide in North America, and within days additional cases throughout the US were lab confirmed.
In the year that followed the striking similarities between 2009 H1N1 and 1918 H1N1 accumulated, and these similarities invalidated the influenza surveillance program. The H1N1 primarily attacked those under 65 and quickly moved to the lung, creating a long series of false negatives from samples collected from the upper respiratory tract. In addition to false negatives by the rapid test as well as PCR tests, sequences from the upper respiratory tract differed from the lower respiratory tract.
As a result, a fantasy was created by extremely biased sampling and testing to create gross under-representations of infections and deaths.
The much cited 36,000 deaths for seasonal flu is not based on lab confirmation, but is linked to P&I data, which shows significant similarities between the number of pandemic deaths and seasonal flu deaths, even though 90% of the seasonal deaths are over 65, and 90% of pandemic deaths are under 65, as noted above.
The excessive deaths can be seen in Figure 1 of a recent PLOS report, or the P&I chart in each weekly CDC influenza report. These graphs show that the death rate above the baseline in 2009/2010 season is similar to prior graphs for seasonal flu, but the mean age of deaths in the current pandemic is 37.4 years in contrast to 75.7 years for seasonal flu. Moreover, the current pandemic mean age is closer to the 27.2 years for 1918, than 62.2 years for 1968 or 64.6 years for 1957 as noted in Table 2.
Thus, the CDC extrapolation of 2,000 lab confirmed H1N1 deaths to 12,000 true deaths is still a gross under-representation of the true number of deaths, which is why this week's P&I death rate is above the epidemic threshold, even though no state is reporting widespread H1N1 and only three southeastern states are reporting regional levels. The number of samples tested is at an all time low because the current surveillance is geared toward seasonal flu and an older population.
In short the weekly reports on lab confirmed cases have created a fantasy, which has little to do with the number of H1N1 infections and deaths in the US.
The absence of timely and represntative information on the current pandemic remains hazardous to the world's health.
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