Mainlining at Chambers St.

originally posted by Dan McQ:
originally posted by SFJoe:
But it doesn't help explain why people 18-45, say, don't get it as much.

I'm not sure that is entirely true. See this table from the May 8 MMWR. The 15-29 age group accounted for the highest percentage of confirmed cases in the US and Mexico. While the 30-44 age group had a lower percentage of cases, it had the highest percentage of cases requiring hospitalization. Some of the incidence difference between those two groups may be because the 15-29 age group is more likely to be in a school (i.e., close contact) setting. Since this virus has been shown to spread more effectively than usual seasonal flu viruses that might conspire to increase the incidence. The reason will probably turn out to be a combination of reasons.

Another interesting piece of info: the CDC indicated last Friday that 50% of those hospitalized did not get treatment with antiviral agents and only 16% got them within 48 hours.
I saw a presentation by the flu folks from CDC and NYC public health last week, but I can't access the slides.
 
originally posted by Christian Miller (CMM):
But as a chart and stats guy, I pronounce this posting Grand Cru quality.

You are the charts and graphs guy? Where have you been? Why haven't you been posting any charts and graphs?
 
originally posted by Don Rice:
Here's how the new AOC flu varietal went down at our place

Alan (age 10) had it worst last week; 5 days of fever, TV, jello, boredom. His pediatrician said "congratulations Alan you whipped the swine flu!" - He puffed up with pride and has been cheerfully boasting about it.

James (age 7) had an easier case; 2 days of low grade fever, then a couple days of grouchiness.

Melissa (reported to be 39 these past few years) was totally knocked out for a couple days then bounced right back.

I'm chalking up my flu-avoidance to a regimen of liberal pours of gamay and cabernet franc. That and twenty handwashings a day.

I really hope that's the end of the story!
Is it warm in here?

Don; are your Gamay and Cabernet Franc coming from the same bottle?
 
originally posted by Dan McQ:

Another interesting piece of info: the CDC indicated last Friday that 50% of those hospitalized did not get treatment with antiviral agents and only 16% got them within 48 hours.
Which means that 34% got drugs that couldn't help them in all likelihood. The data from the Phase III trials (which didn't look at very many people who were sick enough to be admitted to hospital, granted) is pretty clear that there is a steady loss of effect as neuraminidase inhibitors are started farther from symptom onset, and that by the time you get to 48 hours you can no longer discern a benefit.
 
Absolutely correct Joe. That's why we have been advising providers to start treatment as early as possible when people present with ILI and especially if they have a rapid test indicating influenza A. OTOH, the majority of cases have mirrored the anecdotal Rice household series where people get better without antiviral medication.
 
originally posted by Dan McQ:
Absolutely correct Joe. That's why we have been advising providers to start treatment as early as possible when people present with ILI and especially if they have a rapid test indicating influenza A. OTOH, the majority of cases have mirrored the anecdotal Rice household series where people get better without antiviral medication.
Absolutely, though the Rices would have suffered less on drug. I'm a little pissed on the topic today--my assistant called in sick last week with a cough and a 102.5* fever 12 hours after symptom onset and couldn't get her doctor to prescribe tamiflu even after I told her to insist. She was out for 10 days and had secondary bacterial bronchitis in the meantime.
 
originally posted by SFJoe:

Absolutely, though the Rices would have suffered less on drug. I'm a little pissed on the topic today--my assistant called in sick last week with a cough and a 102.5* fever 12 hours after symptom onset and couldn't get her doctor to prescribe tamiflu even after I told her to insist. She was out for 10 days and had secondary bacterial bronchitis in the meantime.

I'll remember this advice should my luck abate.

For now I'm happy believing in the protective qualities of Pothiers gamay and Guion CF.
 
originally posted by Don Rice:
originally posted by SFJoe:

Absolutely, though the Rices would have suffered less on drug. I'm a little pissed on the topic today--my assistant called in sick last week with a cough and a 102.5* fever 12 hours after symptom onset and couldn't get her doctor to prescribe tamiflu even after I told her to insist. She was out for 10 days and had secondary bacterial bronchitis in the meantime.

I'll remember this advice should my luck abate.

For now I'm happy believing in the protective qualities of Pothiers gamay and Guion CF.
Of course, 10% or so of people on tamiflu throw up, which can't be true of Pothiers gamay.
 
originally posted by SFJoe:

Of course, 10% or so of people on tamiflu throw up, which can't be true of Pothiers gamay.

One of that 10% cohort was a colleague of mine who developed a whopping case of aspiration pneumonia as a result. OTOH, you can always try Relenza and wheeze your way to health.
 
originally posted by SFJoe:
This flu seems particularly prevalent among people under 18, for reasons no one can particularly explain.
From Margaret Chan (head of WHO) today:

"We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.

In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people."
 
originally posted by SFJoe:
originally posted by SFJoe:
This flu seems particularly prevalent among people under 18, for reasons no one can particularly explain.
From Margaret Chan (head of WHO) today:

"We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.

In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people."

That's faintly reminiscent of the 1918 flu. Then, the majority of fatalities were confusingly in young adults aged 18-30, the opposite of the normal inverted bell curve of flu fatalities. That was attributed to prior antigenic exposure in the elderly and a "cytokine storm" in people with mature immune systems, thereby excluding the young from the worst aspects of the infection.

Mark Lipton
 
The details of the 1918 morbidity and mortality remain quite controversial, it must be said. Cytokine storms are currently fashionable, but CNS tropism was all the rage at one time.
 
originally posted by SFJoe:
The details of the 1918 morbidity and mortality remain quite controversial, it must be said. Cytokine storms are currently fashionable, but CNS tropism was all the rage at one time.

Is the cytokine storm theory part of the "it was really secondary infections" story?
 
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