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Monday, August 3, 2009

CDC Changes Tracking - Again

This is almost too incredible for words. The CDC has yet again announced that it is changing the way it tracks the H1N1 Swine Flu virus in the U.S.

Excerpt from CDC Website:
CDC discontinued reporting of individual confirmed and probable cases of novel H1N1 infection on July 24, 2009. CDC will report the total number of hospitalizations and deaths weekly, and continue to use its traditional surveillance systems to track the progress of the novel H1N1 flu outbreak.
In the past, they had reported confirmed cases and deaths by state in a spreadsheet format.

Excerpt from CDC Website regarding reporting changes:
In addition, because of the extensive spread of novel H1N1 flu within the United States, it has become extremely resource-intensive for states to count individual cases.
I'm not sure why this should be too difficult to continue for the Center that is tasked with keeping up with these types of issues. This is incredible.

They currently are reporting a nation-wide 5,514 hospitalizations and 353 deaths. So now to keep up with the increase in illness and deaths, you'll have to check the website every Friday and do the math yourself to see how many new illnesses and deaths there were from the previous week.

So, in the middle of a brand new pandemic, lets not have our governmental agency tasked with keeping our health safety at the forefront even bother to let us know on a state level what is going on.

They have a link to all the states (found here) where you can go and get an estimate of the activity in your state. The link will take you to the Department of Health website for each individual state. But not all states are created equally. Some states are doing a fabulous job of breaking down information for their residents, others leave a lot to be desired.

A click on the CDC link for TN now takes you to the State of TN flu website. It is not readily apparent anywhere on the first page of the TN Link what the numbers are for H1N1 in our state.

There used to be a box at the very top of this page with the total number of confirmed cases to date. This box is no longer there. I had to click and click on links that I thought might give me numbers; then I found a link that led me through 5 additional links to finally find a map that had an estimate of the number of confirmed cases in my state. Ridiculous. Here's the link for TN - not found anywhere on the TN state website, but linked through to the federal pandemic website, to their state information, to a map. Well, finally - it says there are 283 confirmed cases in TN. Is the average person going to take this much effort to get this information? No. They are going to assume that it must not be worth much concern if the numbers aren't readily listed.

I for one would like to know a little more specifically, on a state and local level, how this new pandemic is progressing. Especially with school about to start, sporting events getting underway, the seasonal flu season approaching - and instead of providing us with more detailed information to make good decisions for our family, we are getting generalities.

If you go to the Mississippi state link, for example, they have a nice little map on their first page showing the number of cases by county. Now that is much more useful information to have in my opinion. They even have a statistics link that provides the numbers by county. This is good reporting of the information that their residents need to have available.

Most state sites also have a disclaimer:
Individual case reporting is resource-intensive, and because people with respiratory illnesses now are not always tested for flu, case counts represent a significant underestimate of the true number of novel H1N1 flu cases.
So even for those sites with excellent reporting, we are told that the numbers are significantly underestimated. Hmm. How much is significantly???

Another excerpt from the CDC website:
What monitoring system will CDC use to replace counting confirmed and probable novel H1N1 flu cases?
Instead of reporting confirmed and probable novel H1N1 flu cases, CDC has transitioned to using its traditional flu surveillance systems to track the progress of both the novel H1N1 flu pandemic and seasonal influenza. These systems work to determine when and where flu activity is occurring, track flu-related illness, determine what flu viruses are circulating, detect changes in flu viruses and measure the impact of flu on hospitalizations and deaths in the U.S
Does this mean that they are going to track H1N1 in with regular seasonal flu instead of separating it out? Who knows?

The Texas state website says something very similar:
Texas is returning to using its standard seasonal flu surveillance network to track and report flu activity.
It is apparent that the work will now be shifted to our shoulders to keep up with what is going on across the nation and the world so we can be prepared should a more severe version of this pandemic show up at our door this fall.

Other interesting quotes from the CDC's 24 July 2009 transcript:
We are continuing to see transmission here in The United States in places like summer camps, some military academies and similar settings where people from different parts of the country come together. You know, I think this is very unusual to have this much transmission of influenza during the season, and I think it's a testament to how susceptible people are to this virus. We as a country or as a population have protection. So in these special circumstances, like camps or close quarters in the military academies, we're seeing the virus spread. This week we have posted the latest numbers for case counts, but I want to mention this will be the last where you will see that kind of reporting. Our website shows, as of today, 43,771 laboratory identified cases of the new H1N1 virus. And 302 deaths that have been reported to us here from The United States. But as we've been saying, that's really just the tip of the iceberg, so we're no longer going to expect the states will continue this individual reporting and we're going to transition to other ways of describing the illness and the pattern.

But I want to turn to the southern hemisphere where a lot is going on. You probably heard about this in the media. Based on the information that's been shared with us and the laboratory findings and our people on the ground, we think that the circumstances are quite similar in different places and that this virus is capable of causing a range of illness. Severe life-threatening disease that requires intensive care unit and mechanical ventilation and also milder illness that gets better on its own. And this is really important for people to know this virus is out there, it's circulating, it causes a range of illness and we in The United States have to get ready for the fall.

Regarding illness in some children:
Yesterday we provided a little update about the clinical patterns that we were seeing with the H1N1 virus. There was a report about four children who had severe neurologic complications. Fortunately, most of these children have done well. But it's just a reminder that seizure, encephalitis and other neurologic complications can occur in influenza. This is reported in the literature -- quite a bit for seasonal influenza -- and now it's also occurring with this new H1N1 virus. We don't know whether neurologic problems will be more common with this virus, but we want clinicians to be on the lookout for that and to think about testing and treating for influenza in such circumstances.
All this to say - stay informed, do your homework, know what is going on in your state, know what the pandemic plans are for your state, know what you'll do if a family member becomes ill, know what you'll do to care for children who need to stay home from school, know how you'll handle the possibility of weeks off from work due to family illness, know that you have food, water, and medications on hand to care for your family for an extended period of time - in short, think it through and be prepared.

Best case this will pass us by like nothing more than seasonal flu. But I for one don't want to be caught unprepared.

Another good article:

Are We Prepared for Flu Outbreak?

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