As the potential pandemic fades into the obscurity of a couple weeks' worth of the 24-hour news cycle, cases continue to mount. New York City reported its first swine-flu death, an assistant principal in a NYC public school. As with most of the other deaths so far, this particular victim had medical complications that contributed to his especially severe illness. This is typical for influenza and other serious respiratory illnesses like SARS. One of the greatest risk factors for dying of SARS during the outbreak of 2003 was being a diabetic (Chan et al. 2003). Flu is dangerous. As noted by Thomas R. Frieden, New York City's health commissioner and Obama appointee to head CDC, “We should not forget that the flu that comes every year kills about 1,000 New Yorkers.” As I noted in a previous post, analysis of the outbreak data from Mexico suggests that the current influenza A(H1N1) has a case fatality ratio a little bit higher than the usual seasonal flu, so we should expect it to kill more people, though not dramatically more.
The number of cases continues to rise in Japan, another northern hemisphere country with high-functioning public health infrastructure, despite how late in the season it is. The Japanese government has closed over a thousand schools around the western cities of Kobe and Osaka in an attempt to curtail transmission. So far, there does not appear to be sustained community transmission, but again, it is remarkable that there is any transmission to speak of this late in the flu season. One other troubling part of this particular outbreak is that the school cluster around Kobe and Osaka is not associated with overseas travel as clusters in the United States and Europe have been.
WHO Director General Margaret Chan announced at the recent meeting of the World Health Assembly that the apparent quiescence of flu activity now -- even as WHO has kept its pandemic alert at level 5 -- could still be “just the calm before the storm.” She urged countries to work together to continue to control the current outbreak of A(H1N1), noting that those most vulnerable remain the poorest of the world's citizens. As quoted in the NY TImes, “I strongly urge the international community to use this grace period wisely. I strongly urge you to look closely at anything and everything we can do, collectively, to protect developing countries from, once again, bearing the brunt of a global contagion.”
Yes, cases continue to rise. Let's continue to take reasonable personal precautions, help with the battle against flu in countries of the southern hemisphere, and prepare for the next flu season here. It never hurt anyone to wash their hands a couple more times a day.