Dr. Schuchat has nothing to say

From the CDC Weekly 2009 H1N1 Flu Media Briefing, October 1, 2009 [hat-tip, Pixie]

Robert Bazell: You went into this in the beginning, but I think it’s something we’ve heard a lot about. And because of the stories we do and the e-mails we get. When should Tamiflu be administered to a sick child? Because there have been tragic deaths where the child’s parent takes the child to the doctor, the child is not in the adverse category and the doctor does not give Tamiflu because of following your guidelines. And then the child has died. This has happened a few times. I’m not asking you to comment on individual cases, but is there any thought to changing the recommendations and is there anyway of making it an easier decision? I know that’s a very, very tortured one for both the physician and the parent.

Anne Schuchat: you know, CDC has updated our antiviral guidance based on what we’ve learned from the H1N1influenza. And based on what we know about the antiviral medicines, and what we’re seeing with the patterns of virus that are out there. We’ve only so far seen a handful of Tamiflu resistance, but we know that is a possibility. And we also know that it can be very helpful in many instances. Our recommendations are that people who have severe disease and people who have chronic conditions or are pregnant who have a risk of having a bad complication from flu, should all be promptly treated with antiviral medicines. We also want people to know the clinical judgment is very important, that each provider is making decisions all the time. And each parent really needs to make those decisions of, my child is just getting worse now, and time to go back and check in. These are such sad stories. And really may heart goes out to the families that are suffering, this week in particular. But i think that our guidance is trying to make sure that we get antiviral medicines where they can be of the most good, and always flexibility for the clinician and the parent in that challenging encounter. Next question, please? From the room, I’m sorry.

As several commentators at PFI_Forum noted, Dr. Schuchat did not answer Mr. Bazell’s question: Given that children have died when physicians followed the CDC’s guidelines for Tamiflu prescriptions, would the CDC change those guidelines?

I guess no response means no change in CDC guidelines.

And that means more children will die unnecessarily.


2 thoughts on “Dr. Schuchat has nothing to say

  1. The question was:
    When should Tamiflu be administered to a sick child?

    And her answer is:
    And each parent really needs to make those decisions of, my child is just getting worse now, and time to go back and check in.

    That’s technically an answer, the problem is her answer makes no clinical sense. If you wait until it gets worse you’ll be outside the prime ‘two days from symptoms onset’ treatment window.

    As you and other PFI commenters have pointed out there just isn’t enough to go around, in part because of myopic decisions at the state level but also because people were discouraged/prevented from personally stockpiling.

    A question to ask is: If antiviral supply was not an issue would CDC guidelines be different? I think the answer to that is yes.

  2. Her answer is ambiguous, because “worse” is not defined. In Texas, the public health people are saying point blank they do not have enough Tamiflu for every child with the flu. They just plain don’t have it. So, doctors and parents have to guess what is “worse” enough to deserve Tamiflu. And if they guess wrong, the child dies.

    It is absolutely despicable that the state public health authorities and the CDC put the blame for this on doctors and parents. The latter have been put into a horrible predicament through no fault of their own. Meanwhile, the people who created this situation, which includes politicians, do not acknowledge their responsibility.

    What a bunch of mealy-mouthed cowards.

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