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Paradigm Shift Intervention Monitoring
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Spike In US Pneumonia
and Influenza Deaths
This dramatic jump in deaths raises concerns that the current H1N1 is more virulent and lethal than the H1N1 circulating in the fall. The early appearance of that virus dramatically increased the P&I, which then declined as the H1N1 levels declined. However, the current jump is well ahead of such a corresponding jump in H1N1, which would support a more lethal H1N1.
Recent reports from Tennessee have described a higher frequency of children with H1N1 entering the ICU as well as a higher percentage dying. These results are early, but mimic the increase in case fatality rate in eastern Ukraine in association with the release of sequences from Oct/Nov which had a strong association of D225G/N with fatal cases, who had significant lung damage.
The low number of positives in the US may reflect a sampling problem. Most tested samples have been from hospitalized patients, but the fatal and severe cases frequently are associated with a rapid movement of virus to the lungs and a high false negative rate. A high false negative rate would keep lab confirmed cases artificially low and preclude aggressive antiviral treatment. Similarly the increase in H274Y may also impact treatments involving Tamiflu.
Since most H1N1 fatalities have been young adults, an age distribution on fatal cases would be useful.