Swine flu now a "full-scale pandemic"

Let us not forget Obesity.

Hemorrhoids.

Heart disease

Emphysema

AIDS

GERD

high blood pressure

high cholesterol

diabetes

arthritis

mental illness of a million stripes

eczema

halitosis

fart-a-tosis

bad dentistry & gum disease
 
"Sagging Arm Pits Pandemic Among the Elderly! Film at !!"

Oh, The Huge Mana TEE!

How will we ever survive the possibility of Pandemic Overload Pandemic?
 
What on Earth are you two going on about? A pandemic has a very specific definition. The current outbreak of a particular variant of H1N1 influenza is a pandemic. AIDS is also a pandemic. E-coli, arthritis and so on are not pandemic. Obesity is not technically pandemic since it's not communicable, but could be argued to be so under a more colloquial definition. What exactly do you hope to achieve by posting this crap other than making idiots of yourselves?
 
Here's one the first published analysis of the Swine Flu from the New England Journal of Medicine:
[FONT=Arial, Helvetica, sans-serif]Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans[/FONT]
Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team
[FONT=arial, helvetica]ABSTRACT[/FONT]
​
[FONT=arial, helvetica] Background On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U.S. outbreak. [/FONT]

[FONT=arial, helvetica]Methods Enhanced surveillance was implemented in the United States for human infection with influenza A viruses that could not be subtyped. Specimens were sent to the Centers for Disease Control and Prevention for real-time reverse-transcriptase–polymerase-chain-reaction confirmatory testing for S-OIV. [/FONT]

[FONT=arial, helvetica]Results From April 15 through May 5, a total of 642 confirmed cases of S-OIV infection were identified in 41 states. The ages of patients ranged from 3 months to 81 years; 60% of patients were 18 years of age or younger. Of patients with available data, 18% had recently traveled to Mexico, and 16% were identified from school outbreaks of S-OIV infection. The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%); 25% of patients had diarrhea, and 25% had vomiting. Of the 399 patients for whom hospitalization status was known, 36 (9%) required hospitalization. Of 22 hospitalized patients with available data, 12 had characteristics that conferred an increased risk of severe seasonal influenza, 11 had pneumonia, 8 required admission to an intensive care unit, 4 had respiratory failure, and 2 died. The S-OIV was determined to have a unique genome composition that had not been identified previously. [/FONT]

[FONT=arial, helvetica]Conclusions A novel swine-origin influenza A virus was identified as the cause of outbreaks of febrile respiratory infection ranging from self-limited to severe illness. It is likely that the number of confirmed cases underestimates the number of cases that have occurred.[/FONT]
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Full free article:
http://content.nejm.org/cgi/content/full/360/25/2605
 
Cuddles said:
What on Earth are you two going on about? A pandemic has a very specific definition. The current outbreak of a particular variant of H1N1 influenza is a pandemic. AIDS is also a pandemic. E-coli, arthritis and so on are not pandemic. Obesity is not technically pandemic since it's not communicable, but could be argued to be so under a more colloquial definition. What exactly do you hope to achieve by posting this crap other than making idiots of yourselves?
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Mortality seems to have nothing to do with pandemicness. Seems the disease does have to be transmittable, without any particularly high mortality. So I merely listed several diseases that meet that criteria. All in the hope of relieving some of the hype attached to the word "Pandemic".

The pertinent difintions, IIRC, is:

Pandemic= Epidemic in more than one geographical location.
Epidemic= "more cases than expected", no particular mortality rate required.

So, in toto, many of the above listed disease are pandemic. So many as to make the word "pandemic" useful only for shock value.
 
casebro said:
Mortality seems to have nothing to do with pandemicness. Seems the disease does have to be transmittable, without any particularly high mortality. So I merely listed several diseases that meet that criteria. All in the hope of relieving some of the hype attached to the word "Pandemic".

The pertinent difintions, IIRC, is:

Pandemic= Epidemic in more than one geographical location.
Epidemic= "more cases than expected", no particular mortality rate required.

So, in toto, many of the above listed disease are pandemic. So many as to make the word "pandemic" useful only for shock value.
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No. Those disease meet criteria for ENDEMIC.
http://en.wikipedia.org/wiki/Endemic_(epidemiology)
http://en.wikipedia.org/wiki/Mathematical_modelling_in_epidemiology#The_endemic_steady_state

Do you think epidemiologist make up terms for fun? This is the same pseudo-skeptical nonsense that affected the skeptical community when Global Warming first began to be considered seriously.
 
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Nosi said:
Let us not forget Obesity.
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Obesity does meet criteria for pandemic and along with its associate diseases such as hypercholestrolemia and Diabetes.

Many of the other of your "list" are endemic except in areas where diet is changing where is may begin to meet criteria for epidemic.:rolleyes:
 
casebro said:
Yes, but aren't you talking 'confirmed' cases? There seems to be a huge ratio of unconfirmed:confirmed with flu. All I've got to go on is that in the 50's, 90% of the old folks showed an immunity to the Spanish Flu, when at the time of the pandemic, not nearly that many had the overt sickness.
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I'd have to investigate what specific kind of viral sampling went on that determined the swine flu of the 70s didn't spread much beyond the original outbreak at Fort Dix, but guessing based on how we monitor flu today, sentinel monitoring determines what is circulating.

We essentially take a poll of what is circulating by sampling methods. Sentinel monitoring collects the data on the number of cases doctors are seeing of patients with influenza-like illness (ILI). Of those a representative sample are cultured and the results are applied to the whole. Typically during flu seasons out of a couple thousand cultures a small percentage of those will be influenza and of those the types will be determined.

This is how the 2009H1N1 was detected in the first place indicating the monitoring system works.


Unconfirmed does not mean we can't count them. If a thousand people have similar symptoms and you culture 100 randomly selected from the 1,000, you can apply the outcome to the whole. It's very reliable.
 
casebro said:
I'll start:

We all have staph germs.

Our intestines have e-coli.

OOoo, what about the athlete's foot pandemic?

Chapped lips. Or does it count, being 'seasonal'?

Or the "Pandemic Hype" pandemic, causing panic enough to kill every last pig in Egypt. I guess the swine flu is pretty deadly- to Egyptian pigs. I wonder what strain of pigs they had been raising there?
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Flunked biology, did you?
 
Cuddles said:
What on Earth are you two going on about? A pandemic has a very specific definition. The current outbreak of a particular variant of H1N1 influenza is a pandemic. AIDS is also a pandemic. E-coli, arthritis and so on are not pandemic. Obesity is not technically pandemic since it's not communicable, but could be argued to be so under a more colloquial definition. What exactly do you hope to achieve by posting this crap other than making idiots of yourselves?
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They present an example of what the authors were talking about in the paper, Unskilled and Unaware of It.
 
casebro said:
Mortality seems to have nothing to do with pandemicness. Seems the disease does have to be transmittable, without any particularly high mortality. So I merely listed several diseases that meet that criteria. All in the hope of relieving some of the hype attached to the word "Pandemic".

The pertinent difintions, IIRC, is:

Pandemic= Epidemic in more than one geographical location.
Epidemic= "more cases than expected", no particular mortality rate required.

So, in toto, many of the above listed disease are pandemic. So many as to make the word "pandemic" useful only for shock value.
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The conditions you listed were not pandemic conditions. I realize you believe you understand the definition but I'm afraid you do not.
 
rjh01 said:
There is a bug in the software. As a result your link did not work. Use this one instead.

To be endemic you must be able to infect another person. So diseases caused by life style are not endemics.
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You also don't understand the definitions here.

en·dem·ic
adj.
1. Prevalent in or peculiar to a particular locality, region, or people: diseases endemic to the tropics. See Synonyms at native.
2. Ecology Native to or confined to a certain region.
n. Ecology
An endemic plant or animal.
[From Greek endmos, native, endemic : en-, in; see en-2 + dmos, people; see d- in Indo-European roots.]
en·demi·cal·ly adv.
en·demism n.

The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2003. Published by Houghton Mifflin Company. All rights reserved.
endemic
Adjective
present within a localized area or only found in a particular group of people: he found 100 species of plant endemic to that ridge [Greek en- in + dēmos the people]

Collins Essential English Dictionary 2nd Edition 2006 © HarperCollins Publishers 2004, 2006
endemic (n-dmk)
1. Relating to a disease or pathogen that is found in or confined to a particular location, region, or people. Malaria, for example, is endemic to tropical regions. See also epidemicpandemic
2. Native to a specific region or environment and not occurring naturally anywhere else. The giant sequoia is endemic to the western slopes of the Sierra Nevada. Compare alienindigenous
Usage A disease that occurs regularly in a particular area, as malaria does in many tropical countries, is said to be endemic. The word endemic, built from the prefix en-, "in or within," and the Greek word demos, "people," means "within the people (of a region)." A disease that affects many more people than usual in a particular area or that spreads into regions in which it does not usually occur is said to be epidemic. This word, built from the prefix epi-, meaning "upon," and demos, means "upon the people." In order for a disease to become epidemic it must be highly contagious, that is, easily spread through a population. Influenza has been the cause of many epidemics throughout history. Epidemics of waterborne diseases such as cholera often occur after natural disasters such as earthquakes and severe storms that disrupt or destroy sanitation systems and supplies of fresh water.
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Nothing in those definitions requires contagion.


Also, Paxi's link works fine:

http://en.wikipedia.org/wiki/Endemic_(epidemiology)
 
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skeptigirl said:
With flu it is infectious about the same time symptoms start...
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What the hell are you talking about?? Flu is more contagious after symptom onset, but it certainly is contagious before that -- for at least 24 hours before that, in fact. Has your expertise finally reached a level where you're allowed to just make stuff up?
 
skeptigirl said:
I'd have to investigate what specific kind of viral sampling went on that determined the swine flu of the 70s didn't spread much beyond the original outbreak at Fort Dix, but guessing based on how we monitor flu today, sentinel monitoring determines what is circulating.

We essentially take a poll of what is circulating by sampling methods. Sentinel monitoring collects the data on the number of cases doctors are seeing of patients with influenza-like illness (ILI). Of those a representative sample are cultured and the results are applied to the whole. Typically during flu seasons out of a couple thousand cultures a small percentage of those will be influenza and of those the types will be determined.

This is how the 2009H1N1 was detected in the first place indicating the monitoring system works.


Unconfirmed does not mean we can't count them. If a thousand people have similar symptoms and you culture 100 randomly selected from the 1,000, you can apply the outcome to the whole. It's very reliable.
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Selection bias? Isn't your "sentinel monitoring" based only on those patients sick enough to seek medical help? Flu is rampant among patients seeking help for flu? Heart attacks are caused by ambulance rides? So "sentinel monitoring" will find a new strain of flu, but I don't see how it can be extrapolated to the number of cases in the general population.

Jillions of minor cases fly under the radar. Only random later tests for particular immunity will show former exposures, right? Like the study done in the 50's that showed 90% of old timers had immunity to Spanish Flu. Yet the reported cases during the epidemic were much lower.

Ever had a couple days when you were tired and achey for no apparent reason? Not the overt flu, but....

I've NEVER sought treatment for the flu. Are you going to call me a medical curiosity, or accept the fact that there are many "minor cases" for each confirmed, of any disease? Therefor diluting the 1/2% to an inconsequential number.
 
Can people who have thought that they had a bad case of 'the cold' actually had a minor case of the flu?
 
Dymanic said:
What the hell are you talking about?? Flu is more contagious after symptom onset, but it certainly is contagious before that -- for at least 24 hours before that, in fact. Has your expertise finally reached a level where you're allowed to just make stuff up?
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Feel free to find us a source citing the 24 hr pre-symptom onset of viral shedding for influenza. I looked at several sources before posting.

Stop with the uncalled for insults about my expertise.
 
casebro said:
Selection bias? Isn't your "sentinel monitoring" based only on those patients sick enough to seek medical help? Flu is rampant among patients seeking help for flu? Heart attacks are caused by ambulance rides? So "sentinel monitoring" will find a new strain of flu, but I don't see how it can be extrapolated to the number of cases in the general population.

Jillions of minor cases fly under the radar. Only random later tests for particular immunity will show former exposures, right? Like the study done in the 50's that showed 90% of old timers had immunity to Spanish Flu. Yet the reported cases during the epidemic were much lower.

Ever had a couple days when you were tired and achey for no apparent reason? Not the overt flu, but....

I've NEVER sought treatment for the flu. Are you going to call me a medical curiosity, or accept the fact that there are many "minor cases" for each confirmed, of any disease? Therefor diluting the 1/2% to an inconsequential number.
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First, I'm not involved in the discussion about case fatality rate. I don't agree we have enough data to determine that yet with 2009H1N1. And you are correct in a sliver of what you've said. It will take post pandemic serology sampling to determine the actual rate of undetected cases.

But as for influenza sentinel surveillance and the epidemiology of influenza, I can't have a reasonable discussion with you on this topic unless you expand your knowledge of the subject. Here, educate yourself and get back to me and we can discuss the finer points of sentinel influenza monitoring:

Methods for monitoring influenza surveillance data

Monitoring of influenza in the EISS European network member countries from October 2000 to April 2001

Optimizing Use of Multistream Influenza Sentinel Surveillance Data

Influenza Sentinel Physician Surveillance…In Only a Few Minutes a Week!

Influenza monitoring in the Swiss Sentinel Surveillance Network

Internet-based monitoring of influenza-like illness (ILI) in the general population of the Netherlands during the 2003–2004 influenza season
 
Nosi said:
Can people who have thought that they had a bad case of 'the cold' actually had a minor case of the flu?
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With any upper respiratory infection, you cannot determine which organism is causing the infection with a high degree of accuracy without a lab test of some kind (there are several different kinds of lab tests available).

However, depending on the organism, the symptoms, the medical history and sentinel evidence of what is circulating in the community at the time, you can reliably diagnose some infections sometimes on symptoms alone. The degree of accuracy depends on the situation.

With influenza in adults, fever >101 and a cough are highly predictable for influenza when flu is known to be circulating in the community. I read an article today, however, which suggested using those criteria might result in missing cases. Of course, but based on other data from other studies, I believe you would miss less than 10%.

A variety of respiratory viruses found in symptomatic travellers returning from countries with ongoing spread of the new influenza A(H1N1)v virus strain
The most common finding was rhinovirus, observed in 28 of 82 cases (34%) and three of these patients also had a second viral infection (enterovirus, metapneumovirus and adenovirus). The frequent identification of rhinovirus and other viruses demonstrates that the criteria for suspected cases of influenza A(H1N1)v are relevant as indicators of a viral infection, but not specific for influenza A. On the other hand, applying more restrictive criteria would probably have excluded most infections with the new A(H1N1)v strain, considering that their clinical presentation has been reported to be relatively mild. This illustrates a dilemma with surveillance actions aiming at revealing the spread of new respiratory infections. If the applied criteria are too strict (for example fever above 39°C, cough and muscle pain), the epidemic is likely to be underestimated, because only the severe cases are identified. If on the other hand the criteria are liberal, as illustrated by the current epidemic, most of the cases will probably have other aetiologies. The positive predictive value of clinical criteria for identification of influenza A is particularly low in the early phase of an epidemic, when the incidence of influenza A is low, but will become relatively high during the peak when a large proportion of respiratory infections will be due to influenza A virus. The value of broad virology testing decreases in the course of an influenza epidemic, when the detection rate of other aetiologies may decrease from above 50% as observed in this report to below 10% during the influenza peak (unpublished observations from our laboratory).
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I find the assumption here that many cases of 2009H1N1 were 'mild' to be inconsistent with other studies that found 90% had high fever and cough. I think when the epidemic began, there was an over estimation of cases without fever because a couple of cases had turned up among the severe cases in Mexico. No one wanted to miss cases thus missing the need to prophylax exposed persons or failing to isolate patients. This initial reaction to control the outbreaks IMO, led to an over-concern for the afebrile cases. That resulted in over stating the afebrile cases.

Again, this is my opinion from closely following the research and the pandemic response as it has been unfolding.
 
paximperium said:
Obesity does meet criteria for pandemic and along with its associate diseases such as hypercholestrolemia and Diabetes.

Many of the other of your "list" are endemic except in areas where diet is changing where is may begin to meet criteria for epidemic.:rolleyes:
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And on a related note, the 'underlying medical conditions' the persons who've died from this flu have are about as common as toast.

Risk factors for severe swine flu a wide umbrella under which many stand: experts
Whether speaking of a 58-year-old man or a 38-year-old woman or a little boy of nine, officials announcing swine flu deaths are almost always quick to note "underlying health conditions" may have contributed to the fatal outcome.

Asthma, heart disease, diabetes, maybe even obesity are among the conditions used to help explain why swine flu infection is hospitalizing and killing younger people, people who would be expected to make a full recovery from seasonal flu.

It could create the impression that only the sickly are dying from the new H1N1 flu virus - a claim no one is making. To the contrary, many, including the World Health Organization, say between one-third and one-half of swine flu deaths have occurred in people who were previously healthy.

But how healthy is previously healthy? The answer depends on who you ask.

Dr. Anand Kumar is a critical care specialist who has been treating swine flu cases in embattled intensive care units in several Winnipeg hospitals.

He says a small portion of the ICU patients look like flu's typical victims, people with health conditions know to be badly exacerbated by a bout of influenza. But more are younger and - until they got sick - healthier than flu patients hospitals typically see during a regular influenza season.

"For the most part, these young, relatively healthy people aren't marathon runners or anything like that," he admits.

"They're normal people.... If you asked them 'Are you healthy?' they'd say 'Yeah, pretty healthy."'
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