Nov 13, 2009

US Panflu Update - 11/12/09 "Are we in the clear yet???"

US Pandemic Situation Report- Nov 12th

The overall national trend is now one of declining impact. Reporting nationwide continues to be highly variable from location to location. Some locations are reporting decreases in case loads while others are reporting dramatic surge. The below information pertains to those locations within the US reporting challenges related to pH1N1.

School Absenteeism

Student absenteeism rate (elementary and high school): 10-40% (10-20% usual range reported)
Teacher absenteeism rate (elementary and high school): not specified but still documented

Local Medical Infrastructure

EDs and outpatient clinics continue to be overwhelmed by anxious well and truly ill patients.

EMS and first responders report no appreciable impairment in operations reported.

Hospital ward level inundations have been reported. Excession of capacity was not noted since last report. Healthcare worker absenteeism has contributed to strain.

ICU capacity has been reported to approach near- to at-capacity. Demand for ECMO or HFOV continues to be observed.

San Joaquin County, California declared a local state of emergency due to broad medical infrastructure strain.

Mortuary services have not reported strain.

Fewer people are donating blood in the United States due to the pandemic. In addition, some blood centers nationwide have had to throw out blood donations after learning that the donor had influenza-like symptoms. Although the centers claim that they have sufficient blood supplies now, a further decrease in blood donations, particularly during the Christmas season, is a concern.

General Infrastructure Strain

Main sectors affected this week include primarily education, public health, and medical care. Government and corporate sectors have not reported strain since last report.

A pork producer from Clinton, North Carolina filed for bankruptcy after owing about USD three million to various vendors. The company, Coharie Farms, blames the loss on an increase in grain prices, a decrease in hog prices, and pandemic (H1N1) 2009 "fears". The owner of Coharie Farms plans to liquidate the company and "some" of the 170 employees will be laid off. The company lost about 17 million dollars this year. Coharie Farms is the largest independent pork supplier to Smithfield Foods Company. North Carolina has the second largest pork industry in the United States.

Social Anxiety

Frustration and anxiety associated with failure of meeting expected public access to pandemic vaccine and public perception of uneven distribution of vaccine to priority groups has become the primary focus for public anxiety. This relates to public outcry due to a perception of politicians and other non medical-risk groups observed to be vaccinated ahead of those groups identified and publicized by CDC for vaccine priority.

Worried well influx to emergency departments and parents keeping well children home from school continues to be documented. Limited instances of parents refusing vaccination after reports of adverse vaccine reactions (regardless of credible proof the vaccine was the cause of the reaction) continue to be documented.

The current focus for social tension revolves around vaccine availability and uneven distribution.

In addition to strain and anxiety, medical staff are dealing with threats, insults, and bribes from patients. Doctors are compelled to reassure patients that they are waiting their turns for the vaccine and not prescribing Tamiflu for themselves or their families unless necessary. Two vaccine clinics in New York were canceled after parents began to threaten nurses. According to staff members, one parent stated that he would "hunt down" the nurse if anything happened to his child while another parent threatened to sue a nurse if something happened to his child.

Primary triggers for social outcry and anxiety behavior continue to be 1) the death of children or 2) pregnant mothers in a community. Publicly perceived violation of expectation regarding availability (and now) distribution of pandemic vaccine has become a prominent driver of social anxiety.

Environmental Conditions

Environmental conditions are currently moderately optimized for transmission throughout the majority of the US and are projected to optimize fully within the next 3 months.

Expected Progression

While national epidemiological statistics indicate a past peak and decline in cases, high variability in local experience is still observed. Overall national impact is declining.

Pandemic H1N1 is expected to continue to strain local medical capacity, however now at lower levels. Variables in local transmission include herd immunity levels achieved through prior community exposure to the virus, public and healthcare worker uptake of pandemic vaccine, and virus genetic stability.

Veratect's West and East Coast Operations Centers remain vigilant for possible resurgence following mass mixing events such as Thanksgiving and especially the Christmas / New Year's holiday seasons. It is unclear to what degree the pandemic will impact social functioning when environmental conditions are maximally optimized in January-February. Veratect remains vigilant for reporting of virus drift or recombination.

 James M. Wilson V, MD
Chief Technical Officer and Chief Scientist
Veratect Corporation
Kirkland, Washington
jim@veratect. com