Fever Free Swine Flu in CNN's Anderson Cooper
Recombinomics Commentary 14:29
September 24, 2009

COOPER: Well, because I -- I mean, I had similar symptoms to you. I was -- the cough was the worst cough I've ever had, and it, like, even hurt my heart while I was coughing. And I went to you, and you were really sick. And I asked you, "Is it possibly it's swine flu?"

And you said, "Probably not, because usually swine flu has a very high fever right away."

GUPTA: That's right. And, you know, it's interesting because I think the next day, I think, maybe you had gone to a different province. And I was feeling miserable the next day, and I hadn't checked my temperature. You know, you're in the desert, and it's hot outside. I hadn't really thought about it.

I went there, and my temperature was around 102 degrees. So, you know, pretty high, certainly, for me, 98 being normal, 98.6. So that was the first sign. And then, you know, I had that same cough that you did, the light-headedness, and I was freezing cold. I don't know if you had that, as well.

COOPER: Yes.

GUPTA: That was really the most memorable part of it. I was freezing cold despite being in the desert. Are you coughing right now?

COOPER: I'm still coughing, I will say. Just a little bit.

The above comments describe similar symptoms in CNN’s Anderson Cooper and Sanjay Gupta.  Gupta developed a fever and was subsequently lab confirmed, while Cooper had no known fever and therefore was not tested.  Consequently, he still has no confirmation of swine flu, even though he is still coughing two weeks later.

The lack of testing in H1N1 infected patients with no fever is widespread.  Although 50% of cases in Chile had no fever, and 30% of initial hospitalized patients in Mexico had no fever, the swine flu case definition in the US and most countries includes fever, so such patients are not tested.  In the US, the CDC link distributed to schools has a table of symptoms in lab confirmed hospitalized patients, and fever is at the top, since it was found in 93% of patients.  However, this high frequency is because of the case definition, which includes fever.  Consequently, those without fever are not confirmed because they are not tested.

Instructions to schools cite fever and one or more additional symptoms.  Thus, no fever means no swine flu and no testing.  These students are said to have colds, allergies, strep throat, or a stomach bug, and many remain in school, infecting other students.  Thus, they are not included in the number of students absent or in those who are absent and have flu-like symptoms, because the absence of fever excludes them from this category.  Similarly, the forms used by schools to report students with flu-like conditions also lists fever as a requirement, so students with headache, cough, and running nose are not reported as students with flu-like conditions.

Anderson Cooper, who was high profile and on assignment in Afghanistan was not tested, even though his symptoms matched Sanjay Gupta who subsequently developed a fever and was swine flu confirmed.  Dr Gupta’s first reaction to his co-worker’s symptoms was no fever means no swine flu.

Thus, the failure to recognize the frequency of H1N1 infections in the absence of fever leads to unnecessary spread in H1N1 in patients who assume they are H1N1 free.

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