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Hospitalized swine flu patients often deteriorate rapidly

October 12, 2009 | 10:53 am

PigEchoing results presented previously, two new papers published online today by the Journal of the American Medical Assn. show that patients hospitalized with pandemic H1N1 influenza last spring often deteriorated rapidly and had to spend long periods in the intensive care unit before they recovered. Many of them did not recover and died.

Australian and U.S. researchers reported last week that about a quarter of patients hospitalized with confirmed swine flu were admitted to intensive care units and that about 16% died. Now Canadian and Mexican researchers are reporting similar findings, although the death rate in Mexico--which was the first to bear the brunt of the outbreak--was more than double that seen elsewhere.

Dr. Anand Kumar of St. Boniface Hospital in Winnipeg, Manitoba, and his colleagues studied 168 critically ill flu patients in adult and pediatric ICUs at 38 Canadian hospitals. They reported that the severe illnesses occurred primarily in those between age 10 and 60. Seasonal flu affects a much higher proportion of the elderly. Most of the critically ill patients had suffered from flu symptoms for three to four days before entering the hospital. Once there, their conditions deteriorated rapidly and they entered ICUs within another day or two. The average stay in the ICU was 12 days and most required mechanical ventilation and a host of other treatments. Twenty-four of the patients died within the first 29 days and five more within 90 days. Overall, 67% of the patients were female and 30% were children.

Dr. Guillermo Dominguez-Cherit of Instituto Nacional de Ciencias Medicas y Nutricion "Salvado Zubiran" in Mexico City and his colleagues reported on 899 patients who were admitted to six Mexico City hospitals last spring with confirmed or probable swine flu. Of those, 58, with a median age of 44, became critically ill and 24 (41.4%) died within 60 days. As in Canada, many of the critically ill patients were obese, but their death rate was not higher than that of other patients. Of the 58, 45 patients were treated with antiviral agents such as Tamiflu and 54 required mechanical ventilation.

The fact that the disease progresses so rapidly means that hospitals need to be prepared to treat these patients 24/7, wrote Dr. Douglas B. White of the University of Pittsburgh, in an editorial accompanying the reports. He noted that even though the virulence of the virus in Canada and Mexico was relatively mild, the critical care cases consumed large amounts of medical resources. If the virulence should increase this winter, he added, hospitals across the United States may find their resources excessively strained and may have to perform triage, meaning some patients may not be adequately treated.

-- Thomas H. Maugh II

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Comments (8)

Swine flu has turned into a non-issue. I was in the emergency room at Kaiser two weeks ago for trouble breathing from flu symptoms and they didn't even test for Swine flu. The emergency room staff said they only test if you request it.

Almost the entire eighth grade class at the school my wife teaches at is out sick with confirmed cases of swine flu. The school isn't even bothering to notify the CDC or close down.

Nobody really cares about the swine flu in LA. Please report this instead of sensationalized fear mongering articles.

Wow, Jean Pierre. Arrogant much? If your brush with H1N1 was such a non-issue, why did you g0 to the ER? Trouble breathing is a non - issue for you? How do you even know you had H1N1?

Your wife's school didn't close, you didn't get a H1N1 rapid test - hey! Pandemic over! People have stopped dying ! Oh, no wait...

When H1N1 first emerged, health officials were pro-active with testing, reporting cases and administrating Tamiflu to everyone diagnosed with it and their contacts as well. There was uncertainty about the virulence of H1N1; people rightfully feared it could become as deadly as the Spanish Flu Pandemic of 1917-1918. Luckily, we have dodged that bullet so far but this is far from a benign disease. Health officials have stopped doing these things because logistically they just can't. Resouces are being stretched; Tamiflu for children is in short supply. It's about numbers, Jean Pierre.

According to the World Health Organization, worldwide, 40% of those who have developed severe cases of H1N1 were previously healthy. According to director of the National Institute of Allergy and Infectious Diseases, 30% of the people dying from H1N1 are normal healthy people. The seasonal flu kills the old, the very young and those with significant health problems. 90% of them are over 65. Seasonal flu doesn't kill healthy young people, often in a matter of days, even when receiving hospital care. H1N1 can. That's what this article is about. Did you even read it?

Fortunately, only a small minority of those who are infected with H1N1 die from it, but the frightening thing is, no one - not even the most educated infectious disease experts - can explain exactly why healthy young people are dying from this nor can they predict who it will happen to. It's like a flu lottery that you really, really want to lose.

A healthy 14 year old boy in my community died last week. Would you like to contact his parents Jean Pierre and tell them about H1N1 being a non-issue?

Recommended reading: http://blogs.usatoday.com/oped/2009/10/q-a-swine-flu-what-you-need-to-know-.html

Tilly -

We live in California. Do you really expect people to make educated and informed opinions?

Since when did you become the "Expert" on Pandemia and people's reactions to the "non-issue" H1N1? I would assume that you must be a doctor, or better yet gainfully employed as a Virologist.
I am neither, but i can tell you that the families and freinds of those affected by this sickness do feel it is an issue.
Please use common sense before spouting off about something you have no clue about Jean.

Many articles I've read on swine flu indicate that it is different: many cases throughout non-flu season; young, healthy people being most vulnerable; the way this flu causes severe and sometimes lethal respiratory disease. It became a pandemic within months.
Some people think it's cool to go against the tide and be nonchalant. Sometimes it's stupid. Sometimes it can kill you. It's a pose all the time...

I'd rather stay at home. Take herbs, homeopathy and recover than go into a hospital death trap.

A friend’s son was recently in the hospital in DC with appendicitis, and asked the nurse how many cases of swine flu they had, and was shocked to hear “none.” Over the next several days she asked the different nurses and each confirmed there had been none. We have heard repeatedly the past months about the raging epidemic and that it is more seriously affecting children. On her son’s last day at the hospital, the nurse seemed in a hurry to get them out of the room, and when asked why, the nurse said there were a lot of very sick children. When asked what they were sick with, the nurse replied “asthma.”
Two studies that were never written about in any major newspaper in the US, but which are very significant. One, “Childhood asthma is reduced by half when the first dose of diphtheria, pertussis, and tetanus (DPT) is delayed by more than 2 months vs given during the recommended period, according to the results of a retrospective longitudinal study reported in the March issue of the Journal of Allergy & Clinical Immunology.” Second, from “ScienceDaily: Children Who Get Flu Vaccine Have Three Times Risk Of Hospitalization For Flu, Study Suggests.” Reporters, let this be a call to you to end propaganda campaigns and report all the facts. Both studies paint a clear picture about the relationship between vaccination and chronic illness, and many other studies can be easily found with a few strokes of a keyboard.

According to the Asthma and Allergy Foundation of America:
* Asthma accounts for one-quarter of all emergency room visits in the U.S. each year, with 2 million emergency room visits. [7] (This epidemic dwarfs the swine flu epidemic)
* Each year, asthma accounts for more than 10 million outpatient visits and 500,000 hospitalizations. [8]
* The average length of stay (LOS) for asthma hospitalizations is 3 days. [9]
* Nearly half (44%) of all asthma hospitalizations are for children. [10]
* Asthma is the third-ranking cause of hospitalization children. [11]
* Each day 11 Americans die from asthma. There are more than 4,000 deaths due to asthma each year.In addition, asthma is indicated as “contributing factor” for nearly 7,000 other deaths each year. [14]
* Since 1980 asthma death rates overall have increased more than 50% among all genders, age groups and ethnic groups. The death rate for children under 19 years old has increased by nearly 80% percent since 1980. [15] (22 doses of childhood vaccines recommended from birth to age 6 in 1983 – 48 doses of childhood vaccines by the age of 6 recommended in 2009 – not including swine flu vaccine)
There is no action without an equal and opposite reaction. In the effort to prevent all experience with infectious disease, children are becoming immunologically and neurologically poisoned and have developed high rates of chronic illness and disability.

Swine flu is a great big hoax. Those who think you've had it had to believe what someone told you, but in reality you know nothing about what is happening to you. No virus popped out of your skin holding a sign that says "I am swine flu". You had to take someone's word for it.



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