Each county is limited to three testing samples - swine flu

[Control-Z]

“Physicians are actively looking as they should do at cases who have respiratory illness and fever, who have been in any of the areas where there swine flu such as New York City, Mexico, Texas or California,” she said. Each county is limited to three testing sample to prevent the CDC from becoming overwhelmed, Dr. Hudson said.'

http://www.midhudsonnews.com/News/2009/April09/29/swineflu_RC-29Apr09.html

There has been a lot of debate (fighting, name calling, insults...) over the discrepancy in the number of cases v confirmed cases of swine flu, from source to source. And I can see why people might be a little confused. It makes sense that the confirmed numbers will continue to be strikingly lower than the possible actual cases, given the restriction on testing. I hope this helps with some of the mud slinging that's been going on here.

[luvspeas]

1. Don't bother - there are always going to be ther GENIUSES here who think they know more than anyone.

[Control-Z]

4. You're so right.

But it's still good information for anyone who is confused by some of the silly arguments.

[Dorian Gray]

6. That's just the nature of online posting

everyone thinks they're smarter than everyone else.

[Control-Z]

12. DU has usually had less than most sites, though.

It's kind of disappointing to find so many posting here lately.

[Forkboy]

27. But in my case it's true.

:hide:

;)

[eyesroll]

2. I would also imagine that, as with every illness, the difference between actual vs. confirmed cases

at least in part, is due to people with mild symptoms not going to the doctor.

Do you go to the doctor every time you have flu-like symptoms? Probably not.

Even with all of this publicity, people with mild symptoms might just wait to see if they get worse before they go to the doctor. Then the symptoms don't get worse, so they don't go to the doctor, and there's no confirmation of the case, even though it did occur.

Happens with regular flu, happens with West Nile, happens with food poisoning...

[Control-Z]

5. I imagine there are

more people who don't go to the doctor than do. Unless I'm feeling unusually sick, I ride it out at home. I think most of us do.

So the 3 samples are taken from the unconfirmed group that does go.

[nadinbrzezinski]

3. It is also an expensive test

so it is also a matter of triage

[Control-Z]

9. This limited testing

certainly explains the low number of confirmed cases, and is every reason to recognize that there are probably a very large number of unconfirmed cases. I know there are a few posters who will insist that the only real cases are the ones confirmed. Such ignorance is just sad.

[Barack_America]

7. Thank the GOP for that. They nixed money for flu preparedness in the Stimulus.

I had a feeling that might come back to bite them in the ass.

Looks like it has.

[Control-Z]

10. I haven't been watching much TV.

Are the GOPs squirming?

[JDPriestly]

8. Limited to three tests for Los Angeles County, population 9,862,049?

Are you kidding? Talk about finding a needle in a haystack. I assume that local authorities also have the means to test for the virus. Am I right? The CDC is just a check, I hope.

[Control-Z]

11. That's what I thought.

Just three per county? How in hell can that possibly provide anything near an accurate accounting of real cases?

I did read or hear somewhere that the State of Emergency has enabled (funded) California to do its own testing. But I don't know how long it will be before it goes into effect, or if it has already.

[havocmom]

14. as opposed to county I live in < 1200 total population

but we don't have a doctor either, so I doubt anything gets sent.

[uppityperson]

13. Doing a search, I can not find any confirmation of this. Do you have another source?

as I do not find this anywhere else and do not want to take 1 report as absolute fact. Thank you.

What I am finding is that the rapid tests show probable or not, but the way to get an accurate test takes a while to grow it in a lab. Where I work (nursing home) we have a couple boxes of flu test kits for the rapid tests.

[Control-Z]

15. You know, I don't.

I was surprised when I found this one. It seemed to explain a lot. I'll go and try another search myself, with the key words (if I can remember) that I used before. Maybe something will come up. I'll let you know.

on edit: I haven't found another source yet, but I did find an interesting confirmation of sorts, for information I was sure I had heard about briefly sometime in the past few days:

'Starting Tuesday, the California Department of Public Health labs in Richmond will get chemical agents allowing them to test for the previously unknown flu strain, increasing the speed of the state's response to new cases.'

http://www.mercurynews.com/ci_12239723?source=most_viewed

[uppityperson]

16. Thanks, I did a varied key words and could find nothing, seems odd

thanks.

[Control-Z]

17. I'm still looking,

but I posted an edit to my response above before I saw this reply. See post #15 for edit.

[Control-Z]

18. Another interesting find

that seems to validate your understanding. From florida:

'Samples that contain pig proteins are considered probable cases of swine flu and are sent to the CDC in Atlanta. The labs at the CDC are the only ones in the nation capable of isolating the swine flu strain in these samples.'

http://www.orlandosentinel.com/news/local/breakingnews/orl-swine-flu-florida-042909,0,6105435.story

[bluedawg12]

19. This is a good perspective on - Interpreting Surveillance Data

Keeping An Eye on The Big Picture- Interpreting Surveillance Data

This comes from a progressive forum and written by experts in the field.

My plan is to monitor the daily WHO and CDC report on confirmed cases and confirmed deaths. Hope this article helps. :)

ProfileThe Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

http://scienceblogs.com/effectmeasure/2009/04/swine_flu_pictures_big_and_lit.php

Swine flu: pictures, big and little
Category: Epidemiology • Infectious disease • Influenza treatment • Pandemic preparedness • Public health preparedness • Surveillance • Swine flu • Zoonoses
Posted on: April 29, 2009 1:05 PM, by revere

As is usual (routine? no, nothing routine about this) in an evolving epidemic contradictory and confusing numbers are appearing. Some of them are the result of information lags (tallies not being updated), some are the result of using different criteria for counting (suspect versus probable versus lab confirmed, etc.), some are just rumors. WHO is saying that in Mexico there are only 7 confirmed deaths, 19 more lab confirmed cases, 159 probable cases and some 1300 being evaluated, based on official reporting to them by officials of a member state, the Mexico. Everyone knows there are many more cases, however, so the WHO related reporting is more confusing than informative. CDC says there are 91 confirmed cases in the US on their swine flu page but 64 cases on the CDC home page as of 12:30 pm ET, 4/29). That's an information lag, within the same agency. The fact that there are more confirmed cases in the US than Mexico is not a reflection of how many cases are really in each place but how they are being recognized, confirmed, counted and updated.

It's not just lay people who are confused. The scientists don't seem to be on the same page all the time, either. The sequences have been published on the web and a scientist who has taken a hard look at them sees only swine sequences, not swine, bird and human as CDC announced originally:

The preliminary analysis using all the sequences in public databases (NCBI) suggests that all segments are of swine origin. NA and MP seem related to Asian/European swine and the rest to North American swine (H1N2 and H3N2 swine viruses isolated since 1998). There is also interesting substratification between these groups, suggesting a multiple reassortment.
We are puzzled about sources of information that affirm that the virus is a reassortment of avian, human and swine viruses. It is true that the H3N2 swine virus from 1998 and 1999 is a triple reassortant, but all the related isolates are found since then in swine. (Raul Rabadan, Columbia University via ProMed)


With fast moving events it is quite understandable that early ideas would be revised, but when CDC's Dr. Anne Schuchat was asked point blank by a reporter at the Monday briefing if she could tell us which segments were human she gave a one word answer, "no." She then moved on to another question, so it wasn't clear whether she was refusing to answer or just didn't know. If CDC erred in this, as looks might be the case, the simplest thing would be to clear the record immediately and move on. This information isn't likely to make much difference in actions on the ground. An agency is much more credible when it acknowledges mistakes matter of factly (Obama is a master at this).

What's the take home message? We should stop fixating on hourly changes in numbers or differences about the sequences and keep our eye on the Big Picture. Right now that picture is still cloudy, but will be coming into sharper focus as new information accrues and is organized. Generally, though, we have a novel virus (in the sense that the human population is immunologically naive to it) that is spreading person to person and seems to have clinical characteristics not unlike usual seasonal influenza. Because of its novelty the number of people it could make sick is potentially far greater than a seasonal virus, however, since there is no naturally acquired immunity we know of at the moment (it may turn out there is some cross reactivity with some other strain from years past but so far we have no evidence of that).

As a Big Picture, it's not the most comforting, whatever the day to day numbers.

[nadinbrzezinski]

20. So we did not see antigenic shift

you realize that this will be a conspiracy for sure now?

I mean no bird and no human?

On the big picture though, this is looking more like 1918

SHIT

[bluedawg12]

23. The big picture appears to be a fairly rapidly spreading infection

the virulence seems moderate, but this is all pretty early. Plus, they have warned us that this may die down in the spring and summer only to re-emerge in the regular fall/winter flu season. However, by then, there may be a vaccine or by then the little buggers may become resistent to current meds. :shrug:

What we are seeing is an interesting picture of an epidemic, pre-pandemic as it emerges.

As far as the genetics of this, I'll wait for the experts to give us the final analysis. As President Obama said about something recently, "It's beyond my pay grade." :P


Either way, it's fascinating. :hi:

[Mojorabbit]

21. I posted earlier that bit about there being only

swine flu isolates as I am on the promed email list. I seem to remember that Canada was the first to bring up the avian, human, swine mix in their testing of Mexico's specimens. It is weird as that should be pretty basic to clear up.
As for the WHO the low count of confirmed cases is SOP for them and I have seen it in action watching H5N1 for the past five years. Effect measure is a great blog and the reveres also started the fluwiki blog which has wonderful up to date news.
http://www.newfluwiki2.com/frontPage.do

[nadinbrzezinski]

22. Ok some will accuse me of reaching for the tinfoil

I wonder if the 13 samples that were seen as negative at CDC, there was a problem in the Canadian lab...

Yes accidents happen... and don't require massive amounts of tin foil

[FedUpWithIt All]

24. Can you explain this for me?

[Mojorabbit]

26. Best as I can tell they are not finding avian gene fragments

in the samples. I will let you know if there is anymore discussion on this on that list as I am interested as hell in this facet of the picture.

[Mojorabbit]

28. Here is an interesting discussion

http://blogs.sciencemag.org/scienceinsider/2009/04/exclusive-cdc-h.html#more

[FedUpWithIt All]

29. Thanks for this Mojorabbit.

I am going to go read it.

I have been pretty ill today so i have been sleeping most of the day.

[Mojorabbit]

30. Feel better soon sweetie.

I'll be sending the good vibes your way.

[bluedawg12]

25. Yes, I appreciate WHO and CDC being cautious in reporting.

I want them to verify data and publish only the known facts.

I think the tricky part is that with the internet there is so much info out there and the surveillance data being posted ( as it should) that it seems like the viral spread is moving quickly and yet the analysis may appear slow.

That's why I think the article has it right, the daily updates are great for most of us, as they provide info about trends and precautions and alerts. In the meantime the virulence so far does not appear too severe, but, I say this with caution, as it is early.

I agree the reveres rock. Thanks for the additional link. :)