Effect Measure

Five more schools in the New York City borough of Queens have closed because of suspected swine flu cases. Eleven schools have now been closed there and hundreds of students are down with a flu-like illness. Parents are understandably concerned, the more so because not many days ago Mayor Bloomberg and the city’s health commissioner (just named by Obama as the next director of CDC) were reassuring city residents this was pretty much lie seasonal flu.

We thought that was something that might come back to bite them, and now it has:

The city?s schools seem to have become both a sentinel and an incubator for the new H1N1 strain of flu, Mayor Michael Bloomberg and his departing health commissioner, Dr. Thomas R. Frieden, acknowledged Friday.

?It appears at this point in schools in New York City in these days to be spreading more rapidly than traditional influenza,? Dr. Frieden said. ?We don?t know why that is, but the fact we have neither a vaccine nor experience being infected with this strain of influenza are likely explanations.?

Some parents, school staff and teachers? union officials wondered whether the city was moving too slowly to close schools with high absenteeism. Nancy Crespo?s daughter, Alexis, a seventh grader, attends Intermediate School 238 in Queens, which was closed Thursday. She said that nearly 80 children were quarantined Tuesday in the auditorium, and that her daughter had a 102-degree fever that night. She called the school?s main office Wednesday but was brushed off, she said.

?I wish it would have been easier for me to get answers,? Ms. Crespo said. Mitchell Wiener, an assistant principal at the school, was still in critical condition Friday at Flushing Hospital Medical Center.

Mr. Bloomberg and Dr. Frieden defended their caution by saying that they were trying to balance the health of students with the child-care and educational needs of families.

?Day by day we?re learning more,? Dr. Frieden said. ?It?s a judgment call.?

Mr. Bloomberg added: ?We close schools as infrequently as we can. Our kids need more time in school, not less.?(Anemona Hartocollis and Javier C. Hernandez, New York Times)

They aren’t sure why the flu is spreading more quickly than seasonal influenza? Maybe because it’s a strain to which there is no natural immunity in the school population of students or staff? That was certainly the reasoning behind CDC’s initial recommendations to close schools when swine flu cases appeared. Closing schools is a tough call. It affects a lot of families and produces immediate push back, and CDC has modified its recommendations since the first week of the outbreak. But their first instincts were sound, and to their credit they have not engaged in the tendency to minimize the seriousness of the situation that Bloomberg and Frieden have yielded to.

Bloomberg may have been surprised by this development, but Frieden shouldn’t have been. I agree with him it was a judgment call. And no matter which judgment was made, there was a risk that someone would say he made the wrong one.

But I hope that seeing which way Frieden jumped on this one isn’t a harbinger of things to come when he is CDC Director.

Comments

  1. #1 Dark Horse
    May 18, 2009

    I think Dr. Niman got this right. The beloved teacher who died is the victim of a misquided propaganda campaign. Since Frieden has alllegedly been at the top of Obama’s list for CDC director, Frieden may be the one responsible for the abrupt change in the CDC policy on school closing. The fact that Frieden was in charge while this public health fiasco was unfolding in New York City does not augur well for any evolution of this pandemic virus with him in charge of information management and infectious disease policy.

  2. #2 revere
    May 18, 2009

    Dark: No, Frieden had nothing to do with the CDC policy, I feel quite sure. There was significant pushback from parents on school closures and school districts, governors, mayors, etc., felt they couldn’t go against CDC recommendations. In fairness to CDC, it wasn’t completely clear what the policy should be, and they always reserved the right to make changes as the situation seemed to indicate. The big difference is that Besser didn’t try to minimize the seriousness of flu and Frieden had a tendency to do so, either on his own or because Bloomberg wanted him to. To be fair to Frieden, he also made statements that flu can be a serious disease, but the overall impression was to minimize it, apparently for fear of “panickiing people.” This last fear is panic on the part of authorities and almost alays comes out badly, as here.

  3. #3 DemFromCT
    May 18, 2009

    The flaw in CDC plans is that in case of a severe pandemic the governor wold close all schools. In a cat 1, school closure is uncalled for (considered locally). but many plans at state level really didn’t account for “mild-middle” epidemics, so what we saw were spot closures, not area closures. All Queens schools are not closed, some are, as data is collected. These appear to be teacher union-city collaboration in data collection.

    This is a pic/graph of the St Francis outbreak… note the dates. It’s available on the NYC DOH page. The disappearance/reappearance in Queens is a little different than the picture we seem to be getting out of Japan, but there’s scant data to really know.

    Under those circumstances, it’s really hard to know – if the community has lots of flu already, but the cases (despite the death, acknowledged tragedy) are mostly outpatient – what the right thing to do is.

  4. #4 revere
    May 18, 2009

    Dem: Sharp observations. Thanks.

    I think the bottom line here is, as you say, it is difficult to know what is happening from the data we have. That means that how this is presented is critical to how whatever occurs is perceived. I see a difference between the Bloomberg/Frieden version and the CDC version, although both lead to the same actions. Maybe I am reading too much into this. I’d love to be wrong.

  5. #5 daedalus2u
    May 18, 2009

    Are people saying that the schools should have been closed before the teacher who died was exposed? That pushes the time frame for school closures back a lot.

    If people want the CDC and others to have sufficient information to make those kinds of calls at that stage of an outbreak, the CDC and others need a gigantic amount more surveillance data to work with. I am not sure if that level is feasible or even possible.

    That goes to the question of how many false-alarms are acceptable? You can always skew the false-positives vs. false-negatives by changing the threshold. The problem with that approach is that once there is a certain background of illness, you have to shut everything down because you can’t be sure that there isn’t a new more virulent and deadly strain starting to spread on top of what is already there.

    If this outbreak had occurred at a time when the incidence of seasonal flu was higher, it would have been much more difficult to track because there would have been a much higher background of non AH1N1.

  6. #6 bigTom
    May 18, 2009

    It seems that with fairly high probability the rapid spread of this is going to occur. At this point I would think the $64 billion question is can we keep the numbers down long enough (through a hopefully easier seasonal environment summer), to get a vaccine administered before a significant fraction of the population catches it? If the answer to that question is no, then control measures instituded at this time may make little difference in the end. If the answer is yes, then early control measures could make a huge difference.

  7. #7 EKoh
    May 18, 2009

    A big part of the problem is the so-called 24 hour news cycle. Many in the media have come to believe that if a situation does not develop, peak and resolve within a few days, any possile threat was “overblown” by the experts. Fareed Zakaria has does this recently and probably should be taken to task by public health professionals.

    One analogy I can think of is the hurricane season. Say the NWS forecasts a potentially bad season, but by mid-August only one weak tropical storm has developed. It would not be out of character for some talking heads to say the meteorologists and government prepardness types blew everything out of proportion, even though the peak of the hurricane season is yet to arrive. And if a bad storm does hit the coastline and many ignore the warnings, the same talking heads will never take responsibility for encouraging complacency.

  8. #8 SusanC
    May 18, 2009

    revere, As always you’re right on. Personally, I think whether they should have closed schools early is a judgment call based on many considerations. I know cos I’ve argued it both ways and taken flak for having changed my mind (see here and here).

    What I find most disturbing is the patronizing and dismissive way that Frieden and NYC have handled the public information part. They seem to have forgotten that these days there’s plenty of credible information out there, and if government cannot clearly articulate their reasons for certain actions, but rely on such bulldozing techniques, they will quickly lose credibility.

    I hope Frieden has learned a valuable lesson that he will take to the CDC. I am however more troubled that maybe he has not. Time will tell.

  9. #9 Erin Johnson
    May 18, 2009

    The local school in my neighborhood in Brooklyn is closed down til May 26, as well. Sort of unsettling.

  10. #10 Tom DVM
    May 18, 2009

    Maybe it is time to retire the spin-risk public relations masters and just tell truth…the whole scientific truth and nothing but the scientific truth.

    If you know…say so.

    If you don’t know…say so.

  11. #11 DemfromCT
    May 18, 2009

    daedalus2u, people are saying all sort sof things. ;-)

    I think for the most part, the CDC and NYC have been pretty open about what they think and what they are doing. Caution that “this is not over” is warranted. I like that the NYC DOH has data re St Francis right on the front page. But it’s not just about schools. I’d like to know what ERs are seeing, what doc offices and FQHC clinics are seeing, as well.

    Our biggest beef has been less than vigorous advice on what might come, which is avoided out of fear of scaring people. But now that something is occurring, I like the open nature of what we do know, and statements about what we do not know. I don’t see non-transparency. I do see lots of ‘we don’t know’. And we don’t, really.

  12. #12 DemFromCT
    May 18, 2009

    Tom DVM , I understand you don’t trust anyone or anything, but what in Canada and the US do you want them to say and do differently? Specifics, please.

  13. #13 Dark Horse
    May 18, 2009

    DemFromCT wrote:

    “but what in Canada and the US do you want them to say and do differently? Specifics, please.”

    I’ll tell you that hearing CDC’s Dr. Jernigan says there were upwards of a 100,000 cases really sent a chill down my spine. The only reason that estimate was given was in response to a reporter asking specifics. Given that the estimate was an order of magnitude higher than confirmed cases in the U.S., it seems to me that the public has the right to hear how widespread the CDC believes the infections to be. Perhaps that will erode some of the complacency.

  14. #14 DemFromCT
    May 18, 2009

    i think that’s fair, Dark Horse. i don;t know if they really know or are guessing, but the ‘tip of the iceberg’ of actual tests, and the ‘pattern, not the number’ is a frequent CDC message.

    For example, in the previous post, we were talking about ILI cases seen by sentinal docs in addition to CDC testing. That’s where some of that guesstimate comes from. So far, CDC says no major mutations. But I don’t know that they know. That’s different than not telling us.

  15. #15 DemFromCT
    May 18, 2009

    “But I don’t know that they know” refers to toal number of US cases.

  16. #16 Tom DVM
    May 18, 2009

    DemfromCT

    Whether or not I…”trust anyone or anything”…is a separate matter.

    The above statement is self-evident.

    /:0)

  17. #17 sophiequus
    May 18, 2009

    What I find interesting about the NYC death is this (from NYT):

    “Mr. Wiener, 55, had been “overwhelmed” by the illness, despite beginning a course of treatment with an experimental drug, Ribavirin, after he failed to respond to other antiviral drugs, according to Ole Pedersen, a spokesman for Flushing Hospital Medical Center, where Mr. Wiener had been a patient since Wednesday.”

    Are we assume he didn’t respond to tamiflu? Why? Hopefully no change in sensitivity…perhaps treatment was started to late to save his life? And if so, what is the time frame for initiating AV therapy?

    -sophiequus

  18. #18 melbren
    May 18, 2009

    This a non-scientific observation from “just a mom” who has been watching this outbreak with keen interest. I flew to California in mid-March to be with my daughter, a university student, who had been sick with “some sort of bug” for about a week and had finally ended up in the E.R. because of it.(She was not formally diagnosed with anything–and they weren’t routinely testing for any flu at that time.) But I do remember noticing at the time how many of her friends had her same cough–and even remarked to my daughter “you must have all had the same bug.” (Two weeks later and a few hundred miles south of there–swine flu was picked up at the border by an influenza surveillance site–who knows?) But my point is the cough. Back here in GA at the end of April/beginning of May my high schooler had a sore throat, and soon thereafter, had “that” cough. And many of his classmates had “that” same cough. A few days later they had clear, runny noses. (BTW, the doctors were telling us not to worry if our kids didn’t have a fevers–so we sent them school.)But I am writing to make the point that if we don’t have the “benefit” of watching for a fever as the “red flag of infectiousness,” perhaps we should be listening for a very distinctive, dry cough that accompanies a general feeling of overall “crumminess?”Once again–I’m not a professional–but my mommy instinct tells me to “follow the cough.” But I would certainly appreciate your thoughts on the matter.

  19. #19 phytosleuth
    May 18, 2009

    melbren, it’d be easy enough to see if your instincts are correct. Get them tested for H1N1.

    PS. I was in San Diego mid March and got a sudden chest thing (shortness of breath) with no other symptoms. Took doses of herbs and vitamin D3 and it went away a day later. It came back though 2 weeks later at home. Was I a carrier? Am 55.

  20. #20 revere
    May 18, 2009

    sopiequus: He clearly did not respond to Tamiflu but the drug isn’t that effective and works best ()when it works) early in the infection. If there is a viral pneumonia or ARDS Tamiflu won’t touch it at that point. So I don’t think this means it is resistant. Tamilfu or Relenza aren’t like antibiotics.

    melbren: There is undoubtedly a lot of this virus around, as CDC and everyone acknowledges. Counting the exact number is no longer possible (if it ever was). How long it’s been out there is a good question. There are a lot of viruses that cause ILI, not just flu, so that will await further investigation.

  21. #21 Steinn Sigurdsson
    May 18, 2009

    Anecdotally, there are a lot of sick kids in SoCal…
    – saw a little girl throwing up in a restaurant, another being sent home as soon as he arrived at school.
    There seem to be 2-3 kids per class out with “a bug” in any random elementary or pre-school class, and the school nurse office at our elementary had a dozen listless or vomiting kids waiting to be picked up.
    One of ours had gastrointestinal upset and bodyaches, but no fever, and the other was listless but not sick.
    Unusual for this time of year, but could easily be observer bias.

  22. #22 long island gal
    May 18, 2009

    i was able to read the article regarding the assistant principal being affected with swine flu but i didn’t realize that he ended his life quickly. i heard some of my friends not afraid of this virus, but i myself is very very scared of it so i always make sure that me and my family get the utmost protection.

  23. #23 caia
    May 18, 2009

    Dem, Dark Horse:

    I heard recently that they’re no longer screening for novel H1N1 in places with already established clusters/outbreaks, but only in new places, to get an idea of the spread of the disease. While this is sort of instinctively disconcerting, it would fit with a high estimate of cases, and for that number being an order of magnitude bigger than the confirmed cases.

  24. #24 Lrod
    May 18, 2009

    Reveres: Heard on the radio (CNN) during lunch today that the asst. principal who died in New York developed hallucinations and delusions prior to hospital admission, that
    he had mild symptoms of H1N1 up until then and the hallucinations and delusions are what prompted his hospital
    admission. This seems rather strange for flu symptoms, right?

  25. #25 revere
    May 18, 2009

    Lrod: Difficult to say without more info. High fevers can do this, and CNS effects are a feature of H5N1. Some people also have CNS effects with Tamiflu. So there are a lot of possibilities, including that the report isn’t accurate.

  26. #26 Dark Horse
    May 18, 2009

    DemFromCT & Revere,

    As a journalist instead of a medical professional, could you please explain to me why the CDC/DHS tells us that the number of cases doesn’t matter anymore and that just severe cases are sampled. I’m sorry, the states and CDC are overwhelmed by sample backlogs doesn’t wash with me. Why not take some stimulous money away from tattoo removal or the drinking behavior of Chinese prostitues and put it into training some people to decode flu samples????
    I can understand why the government (state and local) would want to know what is going on with severe cases from a sequencing and mutation standpoint, but why are our federal and local governments off the hook now when it comes to letting people know when there is an outbreak in their particular area. If this is an overload problem now, what the hell is going to happen when the second wave hits?

    I live in Savannah, GA, and my grandchildren are in school nearby. I do not understand why I don’t know if there have been any cases in Savannah. Yes, I know how piss-poor the GA health department is. I have actually made presentations on pandemic flu to the GA legislature and was a member of the Chatham County (Savannah) Pandemic Planning Council. The people of Georgia have a small number of confirmed cases, this despite having the huge city of Atlanta and one of the largest US airports traffic-wise. Yet, looking at Week 18’s CDC Flu Weekly, Georgia, like Texas, California and other SW states shows the highest level of flu activity — that is, according to CDC, flu is widespread is Georgia. There is quite a disconnect here between what the state seems to know and what the CDC knows. The only people who don’t know are the taxpayers in the state of Georgia! But, we’re not alone, apparently the people of NYC didn’t know what was going on either, until the SHTF last Thursday.

    On a related issue, Obama allegedly has put some money into pandemic flu issues in his budget or some other funding proposal. What is this money going to be used for and when will it be used? It seems to me like this is a good time to spend some money on federal preparations.

  27. #27 revere
    May 18, 2009

    Dark: I think CDC;s position is on the national level. It is not feasible to count every case. They do want to indicate where flu is circulating and you should have that information for your area. The Georgia DPH is where you need to go to find out about local conditions (or your city health dept.). I think CDC’s position on this is the same as it is for seasonal flu, not a change. So if flu is widespread in your area, that is the answer you seek.

    As I recall, the pandemic flu money was removed from the stimulus budget at the request of the Republican majority and specifically by Sen. Collins of Maine. What is needed is money to make state and local public health stronger and so far that hasn’t happened.

  28. #28 Patch
    May 18, 2009

    Interesting comments:

    http://www.nytimes.com/2009/05/17/opinion/l17swine.html?_r=1

    I fear that H1N1 (or perhaps the media) is lulling us into a sense of false security. And I’m one who is usually quite optimistic as regular readers will know.

    Perhaps the unsanitary conditions and close quarters of WWI were the perfect breeding ground in 1918 to create a terribly virulent flu. But the pattern here is eerily similar. I suppose it’s similar to 1968 too…who knows.

    But I shall not rest easy this Fall.

  29. #29 glock
    May 18, 2009

    5 more….. up to 16 schools closed now in NYC

    http://wcbstv.com/cbs2cre/queens.school.closings.2.1012152.html

  30. #30 james dolmutt
    May 18, 2009

    Lrod wrote “Reveres: Heard on the radio (CNN) during lunch today that the asst. principal who died in New York developed hallucinations and delusions prior to hospital admission, that
    he had mild symptoms of H1N1 up until then and the hallucinations and delusions are what prompted his hospital
    admission. This seems rather strange for flu symptoms, right?”

    Sounds like the fictional bug in Stephen King’s book “the Stand” called Captain Trips http://en.wikipedia.org/wiki/Captain_Trips

    Not trying to make light of what is a very sad and serious case, but just to flag up the fictional parallels.

  31. #31 o.jeff
    May 18, 2009

    “…the asst. principal who died in New York developed hallucinations and delusions prior to hospital admission… This seems rather strange for flu symptoms, right?”

    From http://www.cdc.gov/h1n1flu/sick.htm :

    In adults, emergency warning signs that need urgent medical attention include:

    * Difficulty breathing or shortness of breath
    * Pain or pressure in the chest or abdomen
    * Sudden dizziness
    * Confusion
    * Severe or persistent vomiting
    * Flu-like symptoms improve but then return with fever and worse cough

    children emergency warning signs that need urgent medical attention include:

    * Fast breathing or trouble breathing
    * Bluish or gray skin color
    * Not drinking enough fluids
    * Severe or persistent vomiting
    * Not waking up or not interacting
    * Being so irritable that the child does not want to be held
    * Flu-like symptoms improve but then return with fever and worse cough

  32. #32 sharon
    May 18, 2009

    I live in the Virgin Islands and so far our only confirmed case is in Tortola, but who really knows..I live in St. Croix and we have Hovensia oil refinery on our island. They had a ship come in from Mexico and would not let the crew off the ship..good thought.
    We also had something resembling a type of flu , cough and everything including diarrhea, going around about two weeks ago, but to my knowledge no one was tested.

    My concern is with a graph showing a subtype virus which was quite high..what is a subtype that they do not classify
    and why is it not being further studied? It is not even showing the B, C, or A strain, just an unknown subtype.
    How novel is that?

    Do we already have a mutation that is not falling into the usual category at all?

    I am just a grandma and this pandemic is totally frightening to those of us who have lived through a few flu bouts..i feel this is much worse.

  33. #33 CRH-Land
    May 18, 2009

    The truth of the matter is, Dark is right…We will never really know how many cases there are nor will the government. There are actually suspected cases that have already died in the US but they were never tested. I believe that the government has sent mixed messages, on the one hand minimizing the threat and on the other hand stating the there is a possibility that this can turn ugly very quick. My issues is that aside from telling people to go to Pandemicflu.gov, WHO is not getting the crux of the message out to the public. Most people are clearly not aware of the dangers that exist in this pandemic (I say pandemic because it matches the WHO definition, even though they themselves seem confused by it) and have no real idea of how to prepare. Why aren’t officials coming out and saying to the people to prepare and how to do so. I mean REALLY prepare, not just the washing hands bit? This in itself will IN THE LONG TERM reduce the panic.

  34. #34 tymbuktu
    May 18, 2009

    Sharon, I noticed this too on the CDC graph — an unknown A sub-type that was larger than the number of seasonal flu cases.

    Does anyone know if this is due to sample quality, something actually unknown or both???????

    Thanks

  35. #35 DemFromCT
    May 18, 2009

    multiple issues here, Dark Horse. Assuming the total number is in hundreds of thousands (nationally, as CDC guesstimates) that’s way too many to test. Local communities would quickly run out of test kits. Once there are too many cases to test, the actual numbers matter less than knowing whether it is in your community. Those communities who do not have a case are likely doing more testing than those that do, simply to document when it arrives. This is a strategy used during regular flu season. Once you know flu is in town, if you look like you have flu, treat like flu. If you are sick enough to be hospitalized., or if there’s enough illness in a school, the hospital patient or cluster will be tested. Unless there’s greater need to know about a specific case 9such as a health risk factor), it won’t be chased down.

    There is panflu money in the latest supplemental on the iraq-Afghan war. Some 350 million are for state and local health departments, 1.5 billion overall for HHS and CDC, partly to replenish tamiflu stockpiles.

    http://appropriations.house.gov/pdf/PressSummary05-07-09.pdf

    TomDVM, your statement is not at all self-evident. When people say “I don’t know” (which they do a lot) you are not taking them at face value, you are calling them spin-meisters. In fact, you seem to be labeling “them” that, whoever “they” are, regardless of what “they” say. I asked for specifics because, aside from the general info about preparation (we all want them to do more), I am unsure what you think people are lying about or withholding information on. Info (what’s known) seems to be flowing fairly well.

    tymbuktu, there is a group of ‘none of the above’ viruses that are untypable. They are not seasonal A, swine A or B. They may not be a single virus but rather a collection of them. They may be from labs that don’t do the sub-testing. If they don’t cause significant disease, they may not be pursued or better characterized at this time. The resources at CDC are not infinite.

  36. #36 raven
    May 18, 2009

    Looks like it is time to start making a vaccine. We don’t have much beside social distancing and the 2 related drugs to deal with this pandemic. How long is it going to take before a neuraminidase inhibitor resistant strain emerges? This virus is already resistant to amantadine/rimantidine.

    It seems worse than seasonal flu, perhaps because large segments of the population have no immunity but nowhere like the 1918 flu. But still, if we have to shut down the schools and workplaces next winter, that alone is going to have an impact.

    The capacity is there to make both seasonal and a new flu vaccine. Maybe not huge amounts of both, but even a few million doses is worth a lot. That would cover at risk individuals and health care workers. You really don’t want half your hospital and related staff out sick during a localized outbreak.

    The weather is getting warmer and the virus should be dying down. It isn’t. If it gets into the southern hemisphere during their winter and/or SE Asia, and the third world, an outbreak next winter here is very likely.

    We spent 1-2 trillion bailing out Wall Street, the banks, and insurance companies. A billion for a just in case vaccine sounds reasonable by comparison.

  37. #37 justamom
    May 18, 2009

    CRH-Land – How exactly should we be preparing? Stocking up on food, water, medicine? I just don’t know what else they’re supposed to tell us to do besides washing hands, cough etiquette, and staying home when we’re sick. I’ve read several places that they’re not telling the people enough, but what should we be doing that we’re not doing at this time?

  38. #38 shelly
    May 18, 2009

    It feels as if the numbers are being fixed.
    The pressure is on not the test for swine flu thus it feels as if we are being manipulated.
    At my son’s school 50% of the students in his class were home with flu like symptoms. At what point does the school need to close for a few days?
    The doctors are advising the kids to stay home and rest. One mother took her son to the doctor. He was tested for strep told he had a virus. And send home. So there are many, many people not tested.
    I hate manipulations of numbers. We have gotten into much trouble as a country for this.

  39. #39 caia
    May 18, 2009

    justamom: IMHO, having (at least) a couple weeks of supplies in is good idea, if only so that you can stay home when you’re sick. The more people can simply stay home once someone is ill, rather than having to run out for milk, bread, canned soup, tissues, toilet paper, medicine… the less likely they are to pass it on to others while running those errands.

    This seems only logical to me, and far less stocking up than some people suggest… and yet it seems like even this modest advice is being removed from government recommendations. That may be what CRH-Land was referring to.

  40. #40 DemFromCT
    May 18, 2009

    shelly, there’s a good article in the NY times about school closing struggles (and it is a struggle to figure out what the right thing to do is):

    “There’s no right answer,” Mayor Michael R. Bloomberg said at a news conference. “I’ve asked the question, ‘What would you do, Dr. Frieden, if you wanted to prevent the spread of flu around the entire student population?’ And the answer is, ‘Closing the schools for a month, prohibit all interaction among kids outside of school, and even then there’s no guarantee that you can do that.’ The bottom line is, case-by-case basis is probably the right thing.”

    In NYC, ~10% seems enough absenteeism to consider school closure.

    http://www.nytimes.com/2009/05/19/health/policy/19guidance.html?hp

  41. #41 DMCD
    May 18, 2009

    In regards to the reports of Mr. Weiner hallucinating or having delusions, consider that he may have become disoriented due to hypoxia and/or dehydration by this point.

  42. #42 pft
    May 19, 2009

    The fact of the matter are that you can not stop the spread. Now if the ER’s start filling up and bed in the ICU are in short supply, then you do stuff like close schools and suspend sporting events and public gatherings to slow it’s spread. But it’s not going to be stopped by man’s intervention.

    You hope this won’t be a bad one. The lack of numbers being reported other than the numbers of schools closed is disturbing. Right now I have 6 deaths in the US, and the assistant principal is said to have had a existing condition that is not being disclosed. About 10-12 % of students coming down with flu in some schools, most reporting mild symptoms.

    While it may not be seasonal flu, it seems to be causing not much more problems than a bad seasonal flu, and will likely become a new seasonal flu as all new flus seem to do. The flu is no fun, but what can you do, it will run it’s course.

    Preparations for a worst case pandemic should already have been underway. We can give trillions to bail out the banksters and spend trillions fighting in Iraq and Afghanistan but spending on public health is called socialism and would require higher taxes. It’s all BS.

    melbren, I had similar symptoms in April 10,000 miles away before the swine flu news broke. It did not feel like flu though, no fever, just soar throat (not too bad) and a not very productive cough, stuffed up nose. It lasted a week and then came back a bit nastier 2 weeks later, this time with also a GI disturbance that was short lasting (12 hrs), running nose, mild soar throat that cleared up quick, and a productive cough that lasted maybe 10 days. Still felt like crap for another week. My wife did not get it so it seems not very contagious. Might have been 2 separate viruses, I have not had a cold or flu for many years, and never had a flu shot, so I was overdue for something. I would not worry about it if everyone is healthy in the end.
    If it was novel H1NI maybe you will have some partial immunity during the next wave.

  43. #43 pft
    May 19, 2009

    The fact of the matter IS that you

    Sorry, must be the flu went to my head, destroying neurons.

  44. #44 Pork Flu
    May 19, 2009

    The death of a 28-year-old man in a Little Rock hospital over the weekend could be linked to the H1N1 virus better known as Swine Flu.

    That’s according to Pulaski County Coroner Garland Camper , who tells KARK 4 that the man’s autopsy revealed he had suffered from more than one strain of flu. Camper calls that “somewhat unusual.”

    http://arkansasmatters.com/content/news/fulltext?cid=222431

  45. #45 Scientist!
    May 19, 2009

    Doubtless that there are many ways these kids are getting exposed in school, because they are so socially close. We’re being told to cover our mouths and wash our hands, but are the school kids being told not to pass around their cell phones? If you’ve ever watched an idle classroom of kids on their phones, you’ll see how free they are with them.

    Look at this YouTube video. See what Bobby just texted me? Let me borrow your phone. Hey, Sally wants to talk to you. Look at this website. Check out this tweet. Can you take a picture of me with my friends? Try this new app I got.

    Have you ever taken a swab to your cell phone and cultured it? Dirtiest. Fob. Evar.

  46. #46 caia
    May 19, 2009

    Forget the cell phones — what about the desks? We used to have 7-8 classes per day, and one coughing kid could easily expose a half dozen she never even saw just by sitting at the same desks… let alone all the people she actually interacted with.

    Actually, assuming 6 classroom classes in a day, make that 6!, because from homeroom she’d expose the next six kids, then first period the next five, then second period the next four, etc. And that’s not even counting however many lunch periods they have (and how many study halls take place in the cafeteria after lunch.)

    Face it: You could take Luddite children, and if you packed them in and circulated them the way schools do, you’d a prime mechanism for maximum number of contacts, quite aside from cell phones etc.