Pandemic Update – September 20, 2009

There have been over 4,370 deaths reported due to the new H1N1 virus. Brazil has the most reported deaths in the world with 1,024. The United States has altered its reporting system which makes it more difficult to discern how many deaths have occurred, but the number appears to be 687 lab-confirmed deaths. Argentina has reported 596 deaths. Thus, the greatest number of reported deaths remains in the Americas.

In Asia, the greatest number of reported deaths continues to be in India where at least 240 people have died. The absence of reported deaths in adjacent Pakistan strains credibility. Similarly, although 70 deaths have been reported in Malaysia, only 10 have been reported in adjacent Indonesia. Mainland China still has not reported a single death despite reporting over 11,000 cases. Adjacent Hong Kong has reported 22,000 cases and 12 deaths. Failure to acknowledge cases and deaths in Pakistan, Indonesia and Mainland China is dangerous to the health of their citizens. The rest of the world is also put at risk as all three countries have experienced lethal cases of H5N1 influenza. These three countries are at elevated risk for being ground zero for the production of a H1N1/H5N1 hybrid virus which may have the most damaging characteristics of its parent strains.

In Australia and New Zealand, the number of infected appears to be decreasing. How much respite these countries will have is not clear. The Spanish influenza caused the most death in these countries during their summers.

In Europe, the UK continues to be the worst affected country in terms of deaths: at least 80. There are some suggestions that the resumption of school is leading to a new increase in cases. The health care system continues to show signs of severe strain which appears to have resulted in deaths of individuals who did not have the new H1N1 virus but who did not receive adequate care due to misdiagnosis over the phone.Germany continues to report large numbers of cases, over 19,000, but no deaths.

There have been anecdotal reports of very rapid progression of disease, onset of symptoms to death within 72 hours, both in India and the United States. Whether this represents a different, more severe strain of H1N1 is unknown at this time. But, given the significance of such an event, this possibility should be given careful consideration.

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