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Reported Cases in
Ukraine Double Again To 871,037
The above numbers from the latest update from Ukraine (see map) continue to alarm. More than half of the Oblasts and cities listed exceed the epidemic threshold, including Kiev and Kiev Oblast, raising concerns that the increase in case numbers will accelerate. Moreover, hospitalization of 39,603 raises concerns that the number of deaths will also accelerate, since 11% of hospitalized cases in California died.
Although WHO has suggested that these alarming number may reflect sub-standard medical and housing conditions, the numbers remain alarming. Mill Hill indicated that at least 15 samples were H1N1 positive, indicating they now have a small database of Ukraine sequences. Although initial reports indicated there were no "major" changes, which presumably referred to reassortment, and no Tamiflu/Peramivir resistance, further analysis was required to rule out significant changes which were presumably linked to SNPs.
However, because the virus already has demonstrated an ability to cause fatal infections in a disproportionate number of children and previously healthy adults, small changes in the virus could lead to increases in viral load leading to an increase in cytokine storm frequency and hemorrhagic pneumonia, as reported for earlier cases.
Therefore release of full sequences at this time is warranted.
Similarly, more detail on the number of fatal and hospitalized cases with hemorrhagic pneumonia would be useful.