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someone might be skeptical and say,
well, normally you tell us 36,000 people died in an average flu season
and we've only had 12,000 deaths. So this sounds like a pretty
The above comments, as a prelude to a reporter question at this week’s CDC press conference, highlight the problem with the CDC projections of 12,000 pH1N1 deaths. The 36,000 is an extrapolated number that is based on excessive deaths reflected in the P&I (Pneumonia and Influenza) deaths reported by 122 cities in the United States. These deaths are taken from death certificates and clinical presentations and are largely not lab confirmed because 90% of those killed by seasonal flu are over 65 (mean of 75.7) and have additional chronic conditions which can come into play when their health is challenged further by an influenza infection combined with a weakened immune system. The much cited 36,000 deaths in the United States is the same each year because the number represents a calculation made years ago.
However, as seen in the graph of P&I deaths, which is updated weekly there are significant variations in each of the 5 years represented in the figure, and the curve for the current season does not reflect deaths which are only 1/3 of a normal flu season.
Indeed, this year is clearly higher than three of the last four years, and a new wave would make this year more lethal than any of the past five years, CDC estimates notwithstanding.
The excessive deaths are those above the “seasonal baseline” and for the current season, the rate jumped above the baseline at the beginning of the season, when the fall wave began in the south at the beginning of August. The rate quickly passed the epidemic threshold and produced excessive deaths that are comparable to the height of the flu season in the 2007/2008 season, when H3N2 appeared at the in the season and produced a large number of deaths. However, as seen in the chart of the pediatric deaths, there was no corresponding jump in the 2007/2008 season, because seasonal flu targets an elderly population.
In the current season, the P&I declined after the fall wave, but after touching baseline it spiked higher and in early 2010 was higher than the peak associated with the fall wave, and was the highest it had been in three of the last four years. However, in early 2010 lab confirmed cases were low and the spike was noted in the New York Times. The CDC responded by saying it was either a blip due to the holidays or deaths due to other respiratory diseases. However, week 3 is always 3 weeks after the holidays, and no putative organism responsible for the sharp increases in deaths was noted.
Although the early 2010 spike came back to baseline, the level has been above baseline for almost every week this year, and in the latest week, the level has again moved above the epidemic threshold, even though no states are reporting widespread H1N1, and only three states (in the southeast) are reporting regional levels. Moreover, seasonal flu is non-existent.
Therefore, there CDC projection of 12,000 H1N1 deaths really has no support in the PI data, which is the source of the 36,000 deaths per year number repeatedly cited in media reports and data analysis challenged politicians and pundits.
Although the P&I number is reported each week in a table of all 122 cities, there is no age breakdown (although there is for the total deaths), which makes the source of these excessive deaths difficult to pinpoint. There are few flu deaths in the elderly population. Most have antibodies to the pandemic H1N1 from prior H1N1 exposures decades ago, so they are grossly under-represented in the pH1N1 deaths (mean age 37.7). Moreover, since there is no seasonal flu, the number of seasonal flu deaths in the P&I rate are negligible.
Therefore, the CDC has a projection of 12,000 pH1N1 deaths, which is 1/3 of an “average” flu season, but has no support in the P&I numbers of the last year, raising concerns that the number of pH1N1 deaths is more than three fold higher than the CDC estimate.
This anamoly has not been addressed by the CDC and the age breakdown of the P&I deaths for the past year have not been released.
The release of those numbers is long overdue.