Swine flu: how not to report a fatal outcome

I hate to take off on the press. I do it every once in a while, but not often. The slow and agonizing demise of the main stream press has major consequences for keeping the public informed about issues both big and small. It's also a personal tragedy for many dedicated professional journalists. Still, while newspapers-as-we-knew-them aren't dead yet, they are at least moribund, and like the famous definition of a statesman as a successful politician who is dead, there is more than a bit of a tendency to endow the working press with some virtues it doesn't have now and in general never did. There is quite a lot of truly dreadful reporting every day and it isn't new. Consider the tragic case of the GP in the UK who died after contracting swine flu:

Natural causes claimed swine flu GP

Swine flu sufferer Dr Michael Day died from natural causes with the major factor being a blood clot to the lungs, it has emerged.

No inquest will be held into the 64-year-old GP, who died on Saturday in the Luton and Dunstable Hospital, said a spokeswoman for Bedfordshire Police.

Tests carried out following his death showed he was suffering from the swine flu virus but a post mortem examination established he died from natural causes.

Sources said Dr Day died primarily from a blood clot to the lungs. He also suffered from heart disease and high blood pressure, and had viral pneumonia. (The Guardian, UK)

This is a news feed from a UK wire service, The Press Association. It was carried in many news outlets in the UK. Alas, it is not an outlier.

What's wrong with it? Two things. First, it's just taking dictation from a police spokesperson. It's reporting, all right, in the most literal sense. The Press Association "reported" what the police spokesperson said. And that's all they did. A tape recorder could do that (and maybe did). Second, there is a complete failure to examine the meaning of what was reported. Meaning in the most literal sense. What does it mean when someone who has swine flu dies of "natural causes"? This doctor had heart disease, high blood pressure and . . . viral pneumonia!. On the one hand we're told that a major risk factor for dying from swine flu is having an underlying medical condition. Like what? Heart disease and high blood pressure? And what does infection with the influenza virus cause in someone's lungs? How about viral pneumonia. How a police spokesperson could say, with a straight face, that the doctor didn't die of swine flu but "natural causes," and then that a reporter could copy it down and transmit it to readers as some kind of fact beggars belief. But it's quite common and barely raises surprise or comment.

The egregiously bad reporting aside, there are some interesting scientific questions in this personal tragedy (this is the first health care worker I am aware of to die in the acute phase of a swine flu infection). A CDC MMWR Dispatch widely reported last week reported in 10 cases from a Michigan tertiary care facility that treated Acute Respiratory Distress Syndrome (ARDS) in 10 swine flu cases. There were two unusual features in this case series (which is not obviously representative of all severely ill swine flu victims but still of interest). One was the high proportion of very obese patients. In CDC lingo, Body Mass Index (BMI) from 25 to 30 is considered "overweight." Obesity is a BMI over 30. If someone has a BMI over 40, they are considered "morbidly obese" (if you want to know what your BMI is you can go to one of many online calculators, for example, here; you'll need to enter your height and weight). Nine of 10 were obese by these standards (BMI over 30), and 6 of the 10 were morbidly obese (BMI over 40), 4 of the 6 with BMIs over 50. I'm a person of average height (5'10"). To have a BMI of 50 I would need to weigh 350 pounds. The relationship of marked obesity has not been previously noted.

I don't know the weight of the doctor who died (his photo is head shot but he doesn't appear morbidly obese), so there is no indication that obesity is an additional risk factor here. So why am I bringing up this report? Because there was another unusual feature in these 10 intensive care patients. Half of them had pulmonary emboli (blood clots in the lung):

Pulmonary emboli are not known to be a common complication of ARDS or of sepsis syndrome, but both ARDS and sepsis represent hypercoagulable states. Pulmonary emboli were not noted in patients hospitalized with novel influenza A (H1N1) virus infection in Mexico. One clinical study did not identify any increased risk for pulmonary embolism with seasonal influenza virus infection. However, a report of two patients with rapidly progressive hypoxemia associated with influenza A (H3N2) virus infection noted that they received a diagnosis of acute pulmonary embolism. Clinicians providing care to patients with novel influenza A (H1N1) virus infection should be aware of the potential for patients with ARDS to develop a hypercoagulable state and for pulmonary emboli to cause severe complications, including fatal outcomes. (Morbidity and Mortality Weekly Reports, CDC [cites omitted])

The unfortunate doctor in this case probably died of his pulmonary emboli, so he becomes yet another data point associated swine flu associated ARDS. Whether pulmonary emboli went along with obesity in his case is thus of interest. I understand that these scientific issues are probably beyond the ken of most non specialist reporters, but one would think that the death of the first GP at a time when the role of GPs in treating swine flu is a matter of discussion and controversy in the UK would have merited more than perfunctory treatment. And to call it perfunctory is perhaps being generous.

I regret beating up on a press already reeling from the catastrophic economics of their industry. If this case were unusual, now or in the past, I'd probably let it go. But it isn't unusual. When we acknowledge and mourn what we are losing with the demise of newspapers -- important things we got regularly -- we should remember other things we also got: regularly.


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I feel sorry for the poor man,viral pneumonia probably contracted helping others.They have removed the picture from the online paper now, but even to me an overweight, middle-aged, asthmatic he looked like heart attack material,a huge abdomen on a not so huge frame.I am on a diet.......
Sadly there are going to be a lot more of these oddly reported cases,what it has done is to raise awareness in the UK,until now the pandemic has been viewed by Joe Public with a great deal of scepticism,people are finally starting to see how this could all end up very badly indeed.

By Anonymous (not verified) on 15 Jul 2009 #permalink

Death by ânatural causesâ includes the normal course of a disease.


Death from flu is (as I understand it), death from natural causes. The piece is badly worded where it implies that if the cause of death were swine flu, then it would not be from natural causes, but death from pulmonary blood clots is from natural causes.

I think the purpose of the coronerâs report is to determine if the death was from âunnatural causesâ, i.e. human agency, in which case an inquest is necessary. If the death was from ânatural causesâ, then the death doesnât need to be investigated as a potential murder.

I agree this is bad reporting. I think the reporter didnât understand the meaning behind the terms being used. âNatural causesâ is a legal term, not a medical term.

"...the pandemic has been viewed by Joe Public with a great deal of scepticism...."

I have gone slightly mad attempting to interest, let alone convince, my now grown children to take my instructions and concerns about this threat seriously (along with those measures they need to take *now*, aside from being open to being educated about what (in all likelihood) is coming. At this point they just delete my emails (probably) without even opening them. They're all very "busy" right now, with their children, and all (as well as one on the way - delivery date - October).

I feel like Noah before the flood, they thought he was crazy for building that ark (please excuse my Biblical reference - no offense intended).

I hear you Paul. I feel that I have made some headway with my family and close friends, enough to get them picking up an extra can of tuna, avoiding large crowds, and washing their hands more often at least. My workplace is an entirely different matter though. Three years ago I was tasked with writing a pandemic plan for my workplace. I work in county government at a health agency. Not only did the majority of the management team poo-poo pandemic planning then, they continue to treat this as a non-event even now. Adding insult to injury, I was reprimanded recently for getting a tad too worked up when our boss dismissed my concerns about staff continuing to come to work ill (these are government employees with TONS of PAID sick leave!).
I have very strong concerns that the level of awareness, not to even mention preparedness, out there is quite dismal. Much of the reporting we have seen on this event has only compounded this problem.

By AZBurntBack (not verified) on 15 Jul 2009 #permalink

Paul and AZBurntBack: I am experiencing the same thing. Family and friends do the eye roll and smile when I even mention H1N1, H5N1, pandemic, etc., etc. The actual illnesses are one thing, but when Fall flu season hits and supply chains start breaking (milk, bread, gas, diapers, meds) it will be too late. Our federal government wants to remind us to wash our hands and cough in our sleeve. It better start warning of possible shortages of the most basic items.
I lived through gas shortages last Fall and witnessed people having fistfights at gas pumps over who was next in line. One guy hit another with a baseball bat. Americans are not used to having what they want, when they want it.

By Brenda Gundry (not verified) on 15 Jul 2009 #permalink

Interesting comments. While my friends are not taking the swine flu very seriously, my employer is definitely paying attention. Any employee exposed to the virus is expected to stay away from work for seven days, with pay. They are request to try to work from home, take questions over the phone, etc. The fellow in the cubicle next to mine got to take advantage of this in late June.

My child's summer camp is also taking this pretty seriously. Perhaps I'm in the fortunate minority.

By Anonymous (not verified) on 15 Jul 2009 #permalink

Well if all you do is sample then all you are going to get is samplings. Underlying causes are really primary causes as the flu sends your body into a tailspin. Sooner or later you crash. Does the same thing in people with healthy bodies now. It creates the loads of other symptoms that say that the grease has gone out of the gears and the gearbox shatters, resulting in death.

So, why dont the PTB start warning people via the media? Either the right questions arent being asked..Or they arent being asked at all.

Our information stream is being fed by the Administration and we are dependent on them for the "truth" as they see it. They are the keepers of the keys and in this case we only get to look in at their new toys.

Its like UHC.

Want to tell everyone up front that small employers are going to get socked with an 8% tax increase in one year? Want to tell people that you buy health insurance or the government will fine you? No, because thats the truth and this flu is the truth just not delivered yet. Same with the healthcare thats going to give government cash flow. Thats all it is.

The other guy is coughing in the background. Stable and recovering but actively shedding.Truth is that the demon is coming and going to knock the snot out of the USA, likely in the Northeast first as its so cool and even more likely by October. Truth is that HCW's, GP's, and everyone associated with health is going to take it in the shorts first.

I went to the hospital yesterday for my sick employee. Even now, there are no protocols being followed. No masks, no hand sanitizers. On 8, its just another day as usual with two to a room on the respiratory floor. Six swiney cases on that floor and I am in a full face plate and my own provided throw away gown. The N. assistant comes in to check the temp and bp. Not a mask on her. No zoot suit either. A few minutes later the respiratory specialist comes in and fiddles with the ventilator. Not wearing a thing. Why are they on 8? ICU is full with swineys. But not a soul wearing a mask, eye protection.

Why? Because both the government and media are withholding information that could save a bunch more people if simple practices were followed. And these are the guys that are supposed to save ME? I'll pass and live in a mask for six months.

We are only going to have a couple of hundred thousands of cases from H1N1. Why? Because thats all they are going to test for. If they acknowledged a huge outbreak then they would have to do more..That upsets the truth as they want us to view it. This way they get to come out with the fix, before they acknowledge the problem.

By M. Randolph Kruger (not verified) on 15 Jul 2009 #permalink

Consider how the BBC reported the same story, http://news.bbc.co.uk/2/hi/uk_news/8150527.stm, that his death wasn't "suspicious":

The death of a GP who was confirmed as having swine flu is not being treated as suspicious, the NHS has said.

Dr Michael Day, 64, who was a GP from Dunstable, died on Saturday.

There will not be an inquest into his death, confirmed Bedfordshire Police. The force has yet to release the cause of his death.

An NHS Bedfordshire spokesperson said: "The coroner has confirmed that Dr Day's death was not suspicious, but has yet to release information on the cause of death."

The deaths of the GP and the little girl, reported together in the Guardian, were newsworthy because they were both believed to be previously healthy and died suddenly after becoming ill with the flu. The concern was, did their deaths indicate the flu is becoming more virulent, causing sudden deaths in healthy people? In that light, the BBC story seems decidedly misleading (the possibility of foul play is not why the GP's death is headline in the BBC) and the Guardian's, as Revere points out, is misinformation at least.

So an obese GP with heart disease, high blood pressure and viral pneumonia (H1N1/2009)died "primarily" from pulmonary emboli!?! It's sad the reporter failed to inquire or research whether viral pneumonia itself created conditions conducive to the formation of a blood clot to the lungs.

I mean really, if the poor overweight dude did not have the H1N1/2009 virus clobbering his immune and respiratory systems, would blood clots still have formed!?!

Revere would one of your medico specialist friends possibly know...

The only nostalgia I feel for newspapers concerns late 20th century pop culture. As a gay teenager in the early to mid 1980s, I actually enjoyed watching that medium create model-singer-actor Samantha Fox's career via the UK Sun's Page 3 topless photo feature. There was something so utterly refreshing to see a brassy lass two years older than me strutting her stuff across fish and chip wrapping... Believe me, if this were 1985 and the Dr Michael Day "news article" had been syndicate placed on page two opposite Miss Fox, she'd have kicked up a storm:*) She'd have been on to the Sun's editors with, "Well, did that poor fat fuck die because of the swine flu virus, or not!?!"

By Jonathon Singleton (not verified) on 15 Jul 2009 #permalink

You guys are scaring me. So what do we need - 3 weeks of complete survival supplies, e.g. food, water, rxes? I was thinking I should get an IV setup in case my 87-year-old-mother-with-leukemia should contract the flu. And of course learn how to install an IV line, ha ha ha. But seriously, I'm thinking I should stockpile things like broth and crackers, cranberry juice, nutrition drinks, etc.

Here's one newspaper that says the UK doctor died of swine flu:

"Authorities in Britain announced the deaths of a six-year-old girl and a doctor who had contracted swine flu, bringing the number of fatalities there linked to the virus to 17."



You can read Revere's previous post on the costs/benefits of social distancing as you stock up on extra food supplies (always a good idea to have non-perishables/staples on hand if you can, surely); the point is not to be scared by the news but that we have to scrutinize the information we get from the media and our own reading and understanding of it. For example, the newspaper you quote doesn't say the GP died of the swine flu; it says his death, like 17 others, is linked to it.

Thanks for posting this. I thought I was just being an odd bod yesterday for thinking this.

By stillarebel (not verified) on 15 Jul 2009 #permalink

That was the sorriest attempt to NOT REPORT an H1N1 fatality that I have ever read..,

It sprang to mind immediately that this was a combination of really bad reporting, police ignorance, and possiblte cover-up all rolled into one.

Well, have been reading these postings and am grateful to see lots of other people thinking along the same lines! Now, Irealise that many of you are very educated and well informed about this type of thing, and I am just a run of the mill every day person, so, here it is - I need some advise from someone in the know; my 13 year old daughter is a spastic quadraplaegic with no independent movement and often very moist and noisy upper chest. The problem we have is that our other daughter came home from school on monday with a letter warning of a "..diagnosed suspected" case of swine flu at her school; not wishing any chance of the virus being brought back to her older sister, we have kept her off school. Now, my quandry is this - how long is the incubation period before symptoms become evident and in reality what are the implications for our disabled girl?? Lastly, when the elusive vaccine finally becomes available will it actually be safe to be administered to such a vulnerable young person? Would also like to know if any parents feel that it is ethical for the school to stoically remain open - is this the proverbial stiff upper lip or a blind refusal by the LEA and LHA to admit the gravity of the situation? Really would appreciate independent input as we live in a close rural community who although they left the dark ages long ago, are still more concerned about keeping up appearences and not stepping on the wrong toes.

Elaine--I'm not a Dr, so grain of salt, etc. But it's my opinion that the flu caseload has finally fallen in the US because school has been out of session now for a month in most places. I think it took that long for the school-contracted cases to wind down and the transmission from/to school kids' family members to slow down also.

Are you able to home school your other child for quite a while? Sadly, the flu is going to be in schools for the whole year, IMHO. Keeping her out for a couple of days won't do much, unless nobody else in the building was exposed enough to start shedding virus themselves?

By funky chicken (not verified) on 15 Jul 2009 #permalink

Elaine, it can happen anytime up to about 21 days. 3 days though has seemed to be enough. Vaccines? The question is whether you will even want to take it if you are healthy. This isnt going to be very well tested and it might not ever come available during the time that its out and running. The UK has it out in their papers that its only going to be tested for 5 days and there will be a requirement to report "adverse reactions" from GP's, pharmacies, HIV testing centers. Certainly at risk people such as your baby would be on the front list for a vaccine. If not, give her mine because I am not taking it under any circumstances. Just react to vax is all. Not for or against this non-existent stuff yet. We will see.

But now the powers that be are talking about using live attenuated vaccine and that I am told by my drinking buddy virologist is not such a great plan. Testing? He said this stuff could be so hot that it might kill you outright all by itself. The trick is to ensure that you get a high enough titer level in your body, without tipping over. This is also supposed to be a two shot whack to adults and three for children... 75% effective and loaded with adjuvants.

The short version is that something has gone a bit askew I think as Auntie Margaret Chen the WHO Chief touted this live virus stuff two days ago. Bad news in Black Rock. You might be able to get your kid vaxxed now if your doctor can get hold of some of the vaccinia which was used at the beginning back in March-San Diego. It would have to be sensitized for the current version which might not even be the version that comes clickety-clacking down the tracks but maybe. That too has to be screened for other things and I dont know the process of how its done too well. But it would likely get the kid over the hump. It is life limited though. Meaning its only limited protection for a really pissed off flu bug and you have to give it during the incubation period for flu I believe. The kid might get sick but likely would make it through with just a really bad case of flu with the vaccinia on board.

As I always say, ask your doctor. If there are a lot of other underlying problems then I doubt this would be a fix either.

Valerie... I just sent you a list of stuff you'll need if this gets ugly. Mom with leukemia? If this gets out of control you are going to be her doctor pure plain and simple. You do need to learn how to set a line. I can and its not hard unless the veins are crap. I would go down and give blood, bring it home and put it in the fridge and load up on the meds for it.

Here is the untested vaccine pharma and government ass covering law. It is indeed codified and later if it screws you up you will apply for a lump sum settlement. Now why would you want to have that in place before you know the problems? The fund is also an unfunded one that it describes. Congress would have to put money into it that you and I would have to pay into as taxes to cover it.


By M. Randolph Kruger (not verified) on 15 Jul 2009 #permalink

"Natural Causes"

It's like saying the unfortunate mountain-climber didn't die from the fall, but rather the abrupt stop at the end.

Maybe they're just trying to confirm that he was not the victim of the Avada Kedavra curse.

By Into the Woods (not verified) on 15 Jul 2009 #permalink

It's well known that those with heart disease can have strokes or heart attacks triggered by environmental stimuli or infectious disease; sudden noise (surprise), air pollution, flu, whatever. Do we say a guy who died in a bar of a heart attack died because it was triggered by 2nd hand smoke or alcohol, or someone who develops a fatal arrythmia because of being surprised from a car backfiring. It goes down as a heart attack. Certainly anyone with heart disease should be very concerned about contracting any form of influenza.

The police of course are not doctors and were simply ruling out foul play. The clot was concrete evidence they needed. A hypothesis that it came from his influenza was not needed from the police point of view and most people are intelligent enough to make the link between the two.

Reporters and editors report the news as given from government agencies, and then you have investigative reporting and opinion pieces where where needed that follow the news report. However, if you choose to believe in a conspiracy theory so be it. The UK papers are actually better at reporting news in the US and globally than US papers.

The biggest miss in this article is not looking at the patients the physician may have treated and see how many were given the flu by this physician, but this may follow in coming days after the news report, if not I would be disappointed. My father just finished a length stay in the hospital and I noticed on one occasion he was being examined by a Doctor who had something nasty, and wore a mask, presumably to avoid infecting patients from her coughs (It did not look very effective at doing so though). Influenza would have finished my father off at that point so I was a bit surprised medical staff are not required to stay home when they have a contagious disease (this was in a prestigous Boston area hospital BTW).

I found the original Guardian link which was not provided here


and this one said

"The first healthcare worker to die after contracting swine flu was not killed by the virus, Bedfordshire police said today."

This was not in your link, so it may have been edited out.

Obviously thats bad reporting and misleading and does not even provide the actual quote so I wonder if the police actually said that, and would explain the editing

You guys are scaring me. So what do we need - 3 weeks of complete survival supplies, e.g. food, water, rxes?

Three weeks? Huh, what!!!! Sorry, the new flu, if it tracks previous pandemics and it is, will be around all fall, winter, spring. After 3 weeks, you will be hungry for many months.

Seriously though. The more social distance the better. During the 1918 pandemic, cities that practiced mask wearing and rigorous social distancing did better than cities that didn't. According to histories I've read anyway. Some docs credit the draconian shutdown in Mexico City for ending their wave of swine flu. Remember, they really shut down.

I know the feeling about underlying risk factors. A friend has 4 risk factors including lung and heart problems, none severe and all well controlled medically. I warned her about the swine flu a few weeks ago. Went right over her head, she is dealing with other problems right now, like being laid off, and it wasn't obvious enough and soon enough to worry about it.

Maybe the vaccine will be ready in time and help. Flu vaccines aren't exactly novel, we make a new batch every year. I assume they aren't just going through the motions with them, like homeopathy.

I'm a reporter. I've been covering the virus since it emerged in April for my corner of the world. I have scoured daily for information across the globe that lends light to the situation, and attempt to translate it back to a public that wants to understand. I did read the initial reports from England about the GP who died from the list of afflictions, ending with viral pneumonia. Duh.

Unfortunately, there is the stronger impulse by institutions -- hospitals, schools, government -- to keep the public calm, and those institutions implore us not to sensationalize. I understand that; yet, most people are not dumb, and they, logical thinkers, want to know more. And yet (another yet), we are told by scientists and health care workers that this is an emerging phenomenon with too many unknowns to go on the record about anything. Again, don't scare the public. Wash your hands. Cough into your sleeve. So to defend the profession, there is little clear data to share (did you see how quickly we jumped on the study concerning the virus' severe effect on respiratory functions?) All this to say, I've looked for weeks for a site such yours to provide more context. Don't worry -- I won't quote Revere, but I will use points raised here when talking to officials on the record about the virus. Some reporters are here, some are listening, some are attempting to inform the public. Keep talking.

Most people I talk to assume the swine flu is "over" simply because the media doesn't report on it much. It drives me crazy, because those of us who are informed realize just how fast and quickly the virus is spreading. There are a few sites that help you stay informed, my favorite being flucount.org and according to them there have been 733 deaths in the world so far, with Argentina having roughly a 4% death rate. And it's July. Scary stuff.

Sorry im not very experienced at posting links, that site i was talking about is flucount.org .. And apparently in Puerto Rico 1 in 18 infections results in a death.

Alice: I guess we should go over some ground again here for people who have started reading us more recently. You cannot go by the case fatality ratios in these compilations. they are almost certainly wild over estimates. We've written about this a couple of times (search on "case fatality") but we'll try to do it some more.

downeast: We try to pay tribute here to some of the really terrific reporters on the flu beat. When we do pull quotes we almost always try to include by-lines. But most reporting in the MSM is just repeating info from official sources. That worked once, when we didn't have direct access to thos sources. But now with the internet we can all be our own editors and go directly to CDC or WHO without a filter between. That's good, I think. Bad and irresponsible reporting has gotten us into the last three or four wars and helped elect some truly dreadful people. I won't miss that. I'm worried about the really terrific journalists wno are now struggling, since we really need them. This is an ugly transition for the news business. I hope it turns out all right when it stabilizes.

gindy: Separating fact from opinion isn't always easy and the GP issue in the UK is tied to an important policy issue involving health care and the NHS. So it's not just an overweight fatality. It's got a lot of dimensions.

raven: I'm not of the same mind. I do not think critical infrastructure is going to come crashing down. It doesn't have to for there to be plenty of mundane problems that all pile up at once to make one big problem. I don't have a personal stockpile of anything that would last more than a week (kif that) -- except for books. I do want to make sure my neighbors and community are able to help each other, though. That's my stockpile: the kindness of strangers.

raven: I'm not of the same mind. I do not think critical infrastructure is going to come crashing down.

I didn't say that and I don't think it will either. We've muddled through flu pandemics before 3 times in the 20th century. I barely remember the 1968 pandemic and don't remember anything unusual.

I was making a joke of Valerie's 3 week stockpile. It isn't a bad idea but if one is going to crawl into the survival shelter, 3 weeks isn't going to do it. More like 3 months.

I always have tons of emergency supplies on hand. Rural upbringing back in the days when you could be and were cut off for long periods of time by one natural disaster or another. Followed eventually by residing a few miles from the San Andreas fault.

Everybody is going to have to do their own planning for their own circumstances.

Well done, Revere. Covering it as it unfolds. You do it best.

Who could ask for anything more?

I don't have a personal stockpile of anything that would last more than a week (kif that) -- except for books. I do want to make sure my neighbors and community are able to help each other, though. That's my stockpile: the kindness of strangers.

That is beautifully said--and I agree, completely--our mutual stockpile is our collective kindness to, precisely, strangers. Kindness and generosity must have some ground to be effectual; making provision or laying in provisions is so that one can provide. How does that work? You must have provision to share; then, so can your neighborhood or community and so on.

I personally would suggest that everyone get that 3 month supply of food and things into the house. Get it wrong and we will lose more from starvation, gunfire and the Katrina Effect
than from the flu.

The governments out? We told you, "Prepare for the worst"

If you failed to do that and didn't heed the warnings you would and will understand what might happen.

My fear is it just turns absolutely numbers crazy for pneumonia and because there is no testing, thats what they will call it and not H1N1. Said it for years that they would have a few thousand cases confirmed and then pop.. Its pneumonia related death rather than H1N1.

The winter is supposed to be brutal in the NE this year which is a forecast that I believe. Pushes everyone inside and into contact and then it mutates into high path faster than one of the X-Men. The rest is history as they say.

Always assume and prepare for the worst...If it gets you after you have done everything possible in your mind then you didnt plan and execute properly.

But thats just me.

By M. Randolph Kruger (not verified) on 15 Jul 2009 #permalink

I'm afraid that that is the standard of reporting for most 'newspapers' on most topics these days in the UK. Copy down press releases verbatim, rearrange a few words and then publish. No research, follow up, absolutely minimal context. Despite the efforts of some journalists and editors, the papers as a whole are profit (And politics) driven such that this overides any attempt at educating and truly informing their readership. I wish I was exagerating, but I'm not.

The press SHOULD be beaten up on. Was it not the US press that assisted George Bush in getting us into the IRAQ war. Didn't they under report demonstrations against the war? Didn't they fail to investigate and challenge administration lies?
What gets reported and how is influenced from the top. This story may just be a case of a lazy reporter, but reporters soon learn what kind of stories get published and what don't and if they buck the system they are looking for lower paying jobs at independent new organizations or no job at all. I put less fault with the reporters therefore than with the news organizations.
News organizations are corporations and they put earning money for shareholders ahead of faithfully passing on the news. They are IMO fair game for any kind of criticism any of us wants to dish out.

The way the turnaround happened in this story was so strange, and so transparently dissembling, that I wonder if the theory that his life insurance had something to do with it is true? Are doctors generally covered for dying from infectious diseases contracted at work, or in a pandemic? Or would it come under an "act of god"? I don't think anybody is fooled by the later reports, but maybe it's a form of words that works?

I get the improtance of having some supplies for a long emergency--Katrina made that very clear to a lot of us. My question is, a month or two ago I read (can't recall where, but it was a reputable publication) that it was suspected that many of the cases of late seasonal flu this year (april and May) were probably H1N1. If that is true and if it is also true the number of cases now are vastly underreported b/c they are so mild and or not being tested, then doesn't that help with making the fall resurgence of this virus a little less bad--all the people who had it in the late spring and through the summer will not be able to catch it or spread it in the fall, right? (I am hoping that a bad cold I got in late march was really a mild case of H1N1 but probably not?)Or if they catch it they will have a much more mild course of illness, right, so won't be adding strain on the health care system, correct? That, plus the chance that some portion of healthcare providers will either have already caught the flu or be the first to get the vaccine, well, doesn't that mean that maybe things won;t get so dire in the fall/winter? Or do we expect that the virus will mutate and even those who caught it this spring/summer could get REALLY sick this fall/winter? Not that we shouldn't be doing more to prepare as individuals, communities, and governemts, but is there SOME hope this thing won't really devastate whole communities?

MRK -- It sounds like you have found/assembled the penultimTE preps list. I know there are a number on Flu-Wiki. Just wondering if there is a link to one or if I may request one from you as well as we will be caring for my 85-year-old mother who has medication-controlled COPD and emphysema.

I have seen your name on numerous sites ever since I started following the alarming appearance of H5N1 and do have some preps but it seems we now have a small window in which to finish the job. Husband was a police officer @ 25 years ago and Marine combat Vietnam Veteran so has had his share of medical emergencies hands-on.

I also wonder if scientists feel that those who get H1N1 now will have immunity or if mutations will render them just as vulnerable or somewhat less vulnerable.

I don't see too much discussion about the mixing of H1N1 with H5N1 to produce an uber 1918-like virus. Is this "the subject we dare not broach" or is it for some reason seen as such a long shot it's not worth discussing??


tym B. I have a list that you can use. But I always tell people to get as many lists as possible. Someone always has something that the other doesnt. Do I see a complete melt down of society? Not at this CFR. But I do see a complete financial meltdown. Overspent, drop in tax revenues and that boys and girls means higher taxes in a time of higher taxes. If it goes high path, then well its the full monty. We are screwed and big at that.

You can hit me a memphisservices@bellsouth.net if you want me to e it to you.

There are other sites you should hit just in case. Make a contribution of course to the Hesperians when you do even if its only 10 bucks or ten cents.


Start with: Where there is no doctor. Start printing if you hear stuff like the power is going to go out.. Computers wont work.

Fact is that if you use the UK as an example I would say they are teetering on collapse there. 50,000 dead just got upped to 65,000. Media? Dont know. But if even 10,000 soon to be croakers show up then the moderately bad cases of that and everything else are not going to get that vaunted UHC care. Even if it were private care those rooms are going to go too. How much would you spend to live? Good question. So it becomes a shambles.

The US? There are 56,000 beds with professionals to run them. If we even had 100,000 have to be hospitalized types, we will over run that capability in a day. So, you go now to get whatever meds you need, extra oxygen tanks or what have you. Else that oxygen tech might not show up one day, nor will a lot of things.

If this goes after 1/2 of the population in fast operation then I could foresee the PTB stopping all ground traffic to let it burn in place rather than complete and total infection from happening. The list is based on availability and money to do it. I have six months now and the last two are because its going to be a lot more expensive if it cant be harvested in the supplier nations of the world to the US. What happens to our food stream if China/Mexico go offline?

There arent enough printing presses to print paper money to buy it is what.

I am a NIMS-800 NGO and if this goes kaplooey I can only hazard a guess as to what will happen. 5%? We can handle 5% with difficulty... Great difficulty. 8% in most areas would be a complete rout especially in the bigger cities. Military intervention? More like a complete takeover and the best way to prevent that is to make sure that the system is intact. Sitting at home, watching TV on your generator driven house is a good thing. Most have waited too long for the bigger stuff, now we are just talking basics to make it.

Make your plan based upon zero assumptions of things being available and working. You have a little time..About a month. Basics sitting on the shelves or in a corner are just that. Buy only what you normally use and keep storability, freshness and calories in mind. Splurge on the calories. Might need them.

By M. Randolph Kruger (not verified) on 16 Jul 2009 #permalink

Lulu: With flu, anything is possible. From a public health perspective, however, any flu pandemic is a big deal. It may or may not be from the perspective of an individual, but in the aggregate they always take a toll. I doubt very much if this one will lead to any significant collapse of critical infrastructure, but there could be major stresses on some institutions like schools and the health care system. I am expecting a rough ride. But no one knows. The adage is: hope for the best and plan for the worst.

revere and anon:

While adopting a Blanche DuBois approach to emergency preparedness may be appealing and I certainly am in favor of a community-centered approach to pandemic (and other emergency) response, I would urge you both and any other reader with 1wk or less of any critical resource to take a little more prudent, long-range self-reliant approach when considering how well you should stock your pantry.

Relying on the kindness of strangers can have it's downside - especially if you run out of strangers - or they run out of kindness (or food).

Just ask Blanche.

By Into the Woods (not verified) on 16 Jul 2009 #permalink

Respectfully, Revere has it right, not me in my post above: in the end, at the end of every plan however well prepared, we will find that our provision is kindness and generosity; not only where we expect it, but from strangers, people we don't know. Revere is just making the point, if I may say so, that we can't get very far just looking after ourselves or our own, and to think we can is the real folly. Generosity, kindness transcend every shortage or suffering and are a stockpile we all have and cannot run out of.

Revere, obviously, is doing plenty of provisioning and preparing with the work of this blog and I am sure elsewhere; here, we indeed experience the kindness of strangers.

anon: Thank you for the kind words. In truth, none of us knows how we will react. I hope to acquit myself honorably but life is complicated. I think all of us will do the best we can but that will mean different things to different people because circumstances and everyone's own hostages to fortune vary. At the moment the best I can do is advocate for things I think will be best for everyone, including me and my family. I guess we'll all find out together. Good luck to us. All of us. Everywhere.

Furthermore, isn't Revere here saying and doing exactly what we would wish of our officials or politicians; that they aren't making special provisions for themselves, or taking advantage of their knowledge or position to safeguard themselves or their families beyond what they have helped provide for all of us, but are taking what comes the same as everyone, like an honourable person would. And furthermore, in the humbleness of their office, they see that we must all rely equally on that common stockpile that we all have and cannot exhaust.

"I have six months now and the last two are because its going to be a lot more expensive if it cant be harvested in the supplier nations of the world to the US."

Somehow this, combined the Tennessee global Internet listening post, makes me just a little bit cheerful. I want to imagine that it also involves an always-on oscilloscope in some capacity.

OTOO-With all due respect to everyones opinion on where we are, where we are going to be in six months for everyone I think that the US government and the governments of the world are doing you and all of us a disservice. Starvation took millions during the Black Death. The crops were harvested in 1918 but late and commodity prices were off the scale by the standards of the day.

I can tell you also and this is cast in stone and fact. Every table top exercise held here in the US for just this type of scenario failed at about a week. Done, gone, technically finished before they were out the gate after the cascading effects of what was presented kept on coming. I participated in two, realized that they were futile as did Pezzuli who is an elected official in a town of 100,000 and a contributor reader here. We both agreed that first thing to do was to protect family, friends if able and then if there was anything left to take care of other peoples kids.

That (exercises) were conducted during the warning phase some two years ago. Then we went to the preparation phase. H5N1 and the sudden surge of it made a lot more people move, but not enough.

I dont recall if you were a reader four years ago. You may have been in the background. The US is in a particular fix as the utility companies have nearly all coal fired plants in the NE. If this happens in the winter and its a given that it will, there is only a three week supply of coal. Even if the nukes are left on line, they will be short by 1/2 and thats a mighty damned cold 1/2 if you are talking about Pennsylvania, Ohio, upper New York.

Cant send miners into a hole where they will get flu. Thats homicide in just about every state. Even if they had it, they cannot store it because of the sheer volume. No place to put it. Cant leave it on railcars because you have to have a full time switcher to move it as the cars that are used are reused and re-reused each day on their shuttles. There arent enough of those cars to use as storage, nor are there enough locomotives to move them.

Then there are the logistics of just getting it there. Coal trains leave Utah, Tennessee, Kentucky etc every day... Who is going to drive the trains in a 30% infection and 5% CFR event? The drivers are limited by the law and their unions as to how many hours they can work.

Add in that the US is importing food at high numbers as evidenced by all of the diseases that are imported.

We are too separated from the food supply to the user. A guy in a mud hut in Africa with a bean crop out back has a better chance in a high number/high CFR event than we do. New York, Boston, Chicago and every major city above the Mason-Dixon Line where it is below 38 degrees on average at night starting on about October 15th could find themselves freezing and/or starving. Not immediately, but if ground traffic is stopped then all bets are off.

As I have said before, DHS will tell you that you were warned. There wont be a Katrina bailout with the military taking charge..They might do it initially, but the USGOVT cannot feed a third of its people for more than a few days in the best of cases and we aren't in one of those.

All you have to do to win this game if it starts to be played is have food, water, heat in the winter. Preparations? Up to you. I would say that the WHO statement that there are too many cases now to even count is a warning bell ringing.

I have said it before...When it happens, there will be nothing but astonishment as the nanny state will fall apart in more and more rapid fashion each day. Thats if it remains mild and only sickens people. There certainly isnt going to be any money for any of the programs after this that the givers give to the gimme's of the US. Thats going to cause problems too.

O-scopes are used to monitor frequency levels BTW. Me, I have three military band radios and a 100 watt shortwave and a multiplexer to boost it into the HF and UHF ranges.

Do I need any of this stuff? Not if a pandemic with high numbers and CFR's doesnt show up. They ought to have a town crier screaming that everyone should prepare because thats what they have told people to do for 5 years now. Now its on us, they backed off telling the case numbers, what its doing, what that vaccine could do to you, food could become very scarce in even a 5% event.

But if you look out the window today all is good in the Obamahood. Slam on Obama? Yes it is.

Anyone want to take or make bets in light of current events on whats going to happen?

By M. Randolph Kruger (not verified) on 17 Jul 2009 #permalink

Re "hope for the best, plan for the worst". That truly is the bottom line, but I didn't really see any one comment here that nailed what that means.

First and best case scenario is that the flu doesn't get any more virulent on its return. Its return is a given. (BTW I have a "mild case" of the bugger myself, going on 13 days now.It's not so bad that I couldn't go to work and piddle through the day if I had to)

So in this scenario, alot of mildly ill people will continue on to work, spreading it about. Production may drop some, some will remain home, and of course some will get really sick and even die. Certainly emergency rooms and hospitals will take the brunt of it and getting health care if you're ill with other things will be compromised, but I doubt that there will be huge repercussions to the overall infrastructure. In a case like this, having a week or two of emergency supplies, just in case supply chains shut down a day or two at a time during the worst of it, is a good idea. My biggest concern would be if I or a family member had a chronic condition requiring medication or other kinds of care and devices....I would want to be sure to have alot of extra meds on hand as well as general first aid supplies.

Second Scenario: The flu returns and is more virulent, but not 1918 style or above. In this case you will have the health care system swamped, and more chance of infrastructure shutting down perhaps several days at a time. Again your preps are going to be the same, but adequate for at least a month of intermittent shut downs. If you or family members are in the high risk categories you may decide to SIP, not send children to school, work from home or be very careful at work to use all sanitary precautions. As more people make that same decision more infrastructures will be affected. It's a matter of degree.

Scenario 3: Severe pandemic...the strain comes back much more virulent, at least 1918 cfr or above. This would be the time when you would want to avoid all public contact during the outbreak in your area. This scenario means health care is virtually non-existent, infrastructures may shut down for weeks at a time, schools will probably close, and you better be prepared for the worst. You need at least 2 to3 months of supplies and you need to have not only enough medicine and medical supplies for underlying medical conditions, you also better get trained in how to administer certain kinds of care (like putting in an IV, etc.)

Problem is, we don't know how bad it's going to be in wave 2 or wave 3. Planning for the worst is a lot of expense and trouble, so most people are at best going to plan for the best.

My question is, do you feel luckY

By maryinhawaii (not verified) on 18 Jul 2009 #permalink

maryinhawaii:There is a qualitative difference between advising the public to have enough supplies to be self sufficient for a few days or even a week and telling them to prepare for a month or two month. The latter presupposest a total breakdown of civil society and critical infrastructure that if it happened there would be no way to prepare for and in my view is not even remotely likely to happen. I am not even discussing it because I think it is a paranoid fantasy; and because if we promote it it will have seriously bad consequences. Most people in this world and in my community cannot possibly prepare for that and the ones who try to will be put in a mindset about what they owe their neighbors and what their neighbors owe them that is harmful and destructive, with no benefit, only downside, because I am of the firm view it will not happen. It didn't come close to that in 1918 and in many places life was essentially normal. If you think that is remotely possible then you should act accordingly. But I don't. There are plenty of survivalist sites on the internet that love to get into this, but I want to keep this a reality based venue.

To a large degree I feel that Revere might be right about the severity... CFR's at least and at least so far. But it wont matter if its a long and protracted flu taking people down. The economics of this are now starting to come into play. The UK said it would whack their economy by 5%, starting a huge deflation. Ours? Probably worse because we are so terribly leveraged now already. Thats something that was covered before but more than one analyst group has taken that to a 24% effect for even a pandemic lasting 3 months with few fatalities. High CFR's? Meltdown... financial meltdown and the money thats now down to about 66 cents of real buying power per buck would go to the value of the gold we hold... about 23 cents.

But understand that having even two weeks of normal consumption things on the shelves is just that. A month would be much better, two better still. Dr. Webster at St. Jude has three and its rotated... His wife has charge.

Four months of food would be pushing it on out there but if it starts turning high path then it would be cheap and frankly folks, nothing has gone our way in the US of A. lately. Take a pandemic, add a dash of terrorism, throw in an economic collapse, and a natural disaster such as a major quake during this mess and STIR !

So how much do I think you ought to have on the shelves? Not less than the three. Six may be redundant and overkill but if its rotating whats it hurting? Not a thing except for your pocketbook. It indeed will be a short crop this year so if for no other reason...Do it cause its cheap.

Its an old story that we preach here. Katrina-Warned, get out, leave do it now and the nanny state people complained that they had no money, no way to do it. The water rose and the government failed us kind of thing. No not really, the 300 million that was sent for levees was outright stolen. It was sent to other state projects with no oversight.

Then, after the city was flooded the state government played politics trying to get Bush to violate Posse Comitatus so the Congress could impeach. He didnt bite and Brownie be damned for 3 days the state government "assessed." Then tried covering their asses by saying "send us everything you've got." Not a federalization request, just send us everything you have. Could you be more specific please?

Federalizations? This is going to be the Dem and Rep governors responses. We request full federal assistance if they have to declare. Then they have their political outs and a goat to sacrifice named Obama.

Oh and the pandemic? The bills from Katrina still have to be paid and the difference is this time out is that this is the water sucking out sea in Banda Aceh. We know what it is, we know what can happen, we are seeing it happen and we are doing jack about it. In fact we facilitated its movement into the population of the world.

Many have chosen to minimize it, some maximize it. Get it wrong and you either have an overly full pantry for Xmas, or you get to eat rats for it. You can always donate food, but you cant give away hunger.

Revere is aware of the medical side of it. Others are aware that if the downside comes as he states then it will fail and fall, fail and fall and if it stops somewhere between crap and a full blown oh shit then its the Revere suggestion that it wont/didnt happen. But do you want to take chances is the question?

Its up to you what you do. Time for some personal responsibility in the US to come into play. What happens if we go to the full monty? I havent a clue other than to tell you that if you are sitting on food you are not going to be hungry. Everything else is post of the pandemic. Assume the worst is a very good idea IMO because anything less than that becomes more acceptable.

By M. Randolph Kruger (not verified) on 18 Jul 2009 #permalink

Revere. I am not delusional so I don't really appreciate my remarks being construed as "paranoid fantasy"

There is, many top scientists agree, a very real chance that H1N1 could mix and reassort with H5N1, picking up virulence from that enormously deadly virus while maintaining its current transmissibility.

No one is saying it's an odds on favorite, but it is definitely within the realm of possiblity. And if a pandemic with a cfr of say 30...halfway between the current CFR of A/H1N1 and H5N1....(or even 20 or 10) were to occur I think certain infrastructure disruptions entirely possible.

Therefore for you to say "....a total breakdown of civil society and critical infrastructure .... in my view is not even remotely likely to happen. I am not even discussing it because I think it is a paranoid fantasy," completely disregarding that above possibility, is disconcerting to say the least.

In our just in time society, the breakdown of supply chains even of just food or fuel delivery for a few days here and a few days there could cause such a back up in supply vs demand that having a month or two extra provisions would be wise just to eke ones way through these periods without shortages along the way. How you turn that into "paranoid fantasy" is beyond me, and frankly rude.

By maryinhawaii (not verified) on 19 Jul 2009 #permalink

mary: I apologize. I was actually reacting to something else, but it came out aimed at you. It was rude and I shouldn't have said it that way. However I stick by my assessment of today (not related to your comment).

I think there's around 130000 cases now globally with a mortality rate of around 0.7% (70 deaths for every 1000 cases). There's good maps and graphs on http://www.flutrack.info for tracking the outbreak, seems to be updated a couple of times a day...

Buried in the middle of an article on another swine flu death are some details from Dr Day's post-mortem:

"A post-mortem examination carried out on Bedfordshire GP Dr Michael Day found that swine flu was a significant factor in his death on 11 July. In a statement, NHS Bedfordshire said: "The final coroner's report following the post-mortem into Dr Day's death has confirmed that swine flu was a significant contributory factor into his death." In addition, Dr Day, 64, suffered a blood clot to the lungs and was known to have high blood pressure and heart disease."