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So far, the news about swine flu is better than expected. The pandemic may have reached its peak and is heading downward in all regions of the country; weekly deaths from swine flu have started to decline; the virus remains relatively mild; there seem to be few claims of serious side effects from the vaccine; and despite widespread complaints about shortages, vaccine supplies are steadily building up.

By mid-October, the latest estimates available, the swine flu had infected some 22 million Americans, sent roughly 98,000 to the hospital and killed roughly 3,900. Those numbers may sound high, but they are not apt to reach the levels of harm caused by a normal flu season. One big unknown is whether we will see a normal flu epidemic on top of the swine flu outbreaks or whether the swine flu will crowd out the seasonal flu, which has barely been detected here.

Supplies of seasonal flu vaccine have also been running short. The five companies licensed to make flu shots for this country had expected to make more than 118 million doses, but manufacturing glitches and the need to convert production to swine flu vaccine cut the supply of seasonal flu vaccine to 114 million doses. Even 118 million would not have been enough to meet demand that was revved up this year by all the publicity surrounding the new swine flu. (The vaccines are not interchangeable.)

Even as the swine flu seemed to be waning last week, health officials voiced concerns that Thanksgiving travels and get-togethers could lead to new outbreaks. And there were a few hints of troubling developments.

Some swine flu patients have developed serious bacterial infections in their lungs, including pneumococcal infections that invade the blood and other internal sites. The victims are mostly those with underlying chronic health problems like asthma, diabetes, heart disease and other longstanding ailments. There is a vaccine that can protect them from 23 strains of pneumococcal infection, and health officials are urging adults with chronic conditions to get it from their doctors now.

There have also been scattered reports of mutations in the swine flu virus that cause harm deep in the lungs of some patients or make the virus resistant to one of the standard drug treatments. However, neither mutation seems to be spreading widely.

This is no time for Americans to let down their guard. The number of children and teenagers killed by the flu continues to rise. Even if it is past its peak, the swine flu will go on to infect many millions more before it disappears. And if the swine flu follows the pattern of some previous pandemic strains, it could return in a new wave early next year.

As of last Wednesday, some 61 million doses of the swine flu vaccine had been used or were available to order, far less than needed to vaccinate the original target groups of 159 million Americans. As vaccine supplies build up, those who are at highest risk or could endanger others at high risk — pregnant women, people caring for infants less than 6 months old, health care workers with direct patient contact, children 6 months through 4 years old, and children 5 through 18 with chronic medical problems — would be wise to get immunized. So would others deemed at some risk, like young adults and older adults with medical problems.

The Swine Flu, as of Now,
NYT,
1.12.2009,
https://www.nytimes.com/2009/12/01/
opinion/01Tue1.html

Swine Flu Cases in the U.S.

Pass a Million, Officials Say

June 27, 2009

The New York Times

By DONALD G. McNEIL Jr.

Swine flu has infected more than a million Americans, federal health officials said Friday, and is infecting thousands more every week even though the annual flu season is well over.

That total of those who have already been infected is “just a ballpark figure,” said Dr. Anne Schuchat, director of respiratory diseases at the Centers for Disease Control and Prevention, adding, “We know we’re not tracking every single one of them.”

Only a tiny fraction of those million cases have been tested, Dr. Schuchat said. The estimate is based on testing plus telephone surveys in New York City and several other locales where the new flu has hit hard.

A survey in New York City, she said, showed that almost 7 percent of those called had had flu symptoms during just three weeks in May when the flu was spreading rapidly through schools. If that percentage of the city has had it, then there have been more than 500,000 cases in the city alone, though most have been mild enough that doctors recommended nothing more than rest and fluids.

The flu has now spread to many areas of the country, Dr. Schuchat noted, and the C.D.C. has heard of outbreaks in 34 summer camps in 16 states.

About 3,000 Americans have been hospitalized, she said, and their median age is quite young, just 19. Of those, 127 have died.

The median age for deaths is somewhat higher, at 37, but that number is pushed up because while only a few elderly people catch the new flu, about 2 percent of them die as a result.

Of those who die, Dr. Schuchat said, about three-quarters have some underlying condition like morbid obesity, pregnancy, asthma, diabetes or immune system problems. Even those victims, she said, “tend to be relatively young, and I don’t think that they were thinking of themselves as ready to die.”

The new flu has now reached more than 100 countries, according to the World Health Organization. The world’s eyes are on the Southern Hemisphere, which is at the beginning of its winter, when flu spreads more rapidly. Australia, Chile and Argentina are seeing a fast spread of the virus, mostly among young people, while one of the usual seasonal flus, an H3N2, is also active.

Five American vaccine companies are working on a swine flu vaccine, Dr. Schuchat said. The C.D.C. has estimated that once the new vaccine is tested for both safety and effectiveness, no more than 60 million doses will be available by September. That means difficult decisions will have to be made about whom to give it to first.

Swine Flu Cases in the U.S. Pass a Million, Officials Say,
NYT,
27.6.2009,
http://www.nytimes.com/2009/06/27/health/27flu.html

Swine Flu

Claims First American Victim,

C.D.C. Says

April 29, 2009

Filed at 9:37 a.m. ET

The New York Times

By THE ASSOCIATED PRESS

ATLANTA (AP) -- The CDC on Wednesday confirmed the nation's first swine flu death in the current outbreak, a 23-month-old child in Texas.

The first swine flu death outside of Mexico was confirmed by Centers for Disease Control and Prevention spokesman Dave Daigle.

The acting head of the CDC called the confirmation tragic, but said it's too soon to say just how fast the swine flu virus is spreading.

Dr. Richard Besser said in a nationally broadcast network interview that health authorities had anticipated that the virus would cause deaths, and said that ''as a pediatrician and a parent, my heart goes out to the family.''

But Besser said on NBC's ''Today'' show that it's too soon to say if the death in Texas suggests the virus is spreading to more states. Nor would he say whether officials think it will become a nationwide problem.

He also said he does not believe the flu strain has become more dangerous.

Besser went on to note that even with seasonal flu, there are always some people who can't resist it very well, and said authorities need to learn more about the threat.

Children, especially those younger than age 5, are particularly vulnerable to flu and its complications, and every year children die from seasonal flu.

According to the CDC, more than 20,000 children younger than age 5 are hospitalized every year because of seasonal flu. In the 2007-08 flu season, the CDC received reports that 86 children nationwide died from flu complications.

As of April 11, CDC had received reports of 53 seasonal flu-related deaths in children during the current seasonal flu season.