Pandemic H1N1 10 times more lethal to children than seasonal flu – The Argentinian study

One of the great falsehoods promulgated about the current influenza pandemic is that the new H1N1 virus is no worse than seasonal flu. This statement is based on comparing seasonal death rates among the elderly, which assume excess deaths in the winter are due to influenza, without testing, with lab-confirmed deaths due to pandemic flu. Such comparisons are not legitimate because we don’t know for sure that all the elderly deaths are due to influenza, not everyone who has died of pandemic flu is recorded due to inadequate testing and the current pandemic is not over yet. However, the most important reason why these comparisons are not valid is due to the ages of the people who die in a normal flu season versus this pandemic. The vast majority who die of seasonal flu are elderly. The vast majority of those who have died of the new H1N1 have been middle-aged and younger.

A recently published study in the New England Journal of Medicine attempts to quantify the mortality rate of the new H1N1 virus with seasonal flu on children in Buenos Aires. Here is what they found:

Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.

This is likely an underestimate of the true lethality of the new H1N1 virus relative to seasonal flu. Although Argentina was slow to close their schools, once the burden on emergency rooms became too great, they did engage in extensive social distancing measures including school and business closures. These actions likely reduced the number infected and, consequently, the number of children who would otherwise have died from pandemic flu. Such extraordinary steps were not taken during normal flu seasons.

The antivrial drug oseltamivir (Tamiflu) is rarely prescribed in Argentina for seasonal flu. However, as the deaths mounted in Argentina, this drug was prescribed with increasing frequency. There is reason to believe that people who received it promptly were more like to survive. From the study:

Of the 13 patients who died, 5 were hospitalized within 48 hours after the onset of symptoms; none received timely oseltamivir.

Without Tamiflu, the number of deaths among children in Argentina might have been much higher.

The American CDC was in close contact with Argentinian authorities during their outbreaks this summer. Further, they were likely well aware of the results of this study months ago. Yet, the Director of the CDC, Thomas Frieden, saw no reason to close American schools until a vaccine was ready. Further, the CDC was slow to encourage the use of Tamiflu to treat patients, despite clear evidence that children were dying due to lack of access.

The failure of the CDC to warn American parents that their children would be 10 times more likely to die of pandemic flu than seasonal flu is inexcusable. Many American children likely died because of CDC policies on school closure and Tamiflu prescription.

Reference

Libster et al. (2009) Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina. New England Journal of Medicine. December 23.

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4 thoughts on “Pandemic H1N1 10 times more lethal to children than seasonal flu – The Argentinian study

  1. as I understand, there were 10 times more deaths
    in children, not the CFR in children was 10 times higher.

    Do you doubt these seasonal death-estimates ?
    What are those deaths due to then ?
    Coincidence that they occur simultaneous to
    flu-peaks ?

  2. Given that the schools were closed in many areas for extended periods of time, the actual CFR is likely worse than 10 times seasonal flu.

    Flu may be a contributing factor to winter deaths among the elderly, but those deaths should not be considered equivalent to lab-confirmed deaths among children.

  3. from the article I conclude 11 times more children died in that sample, not 10 times.
    Double as many were hospitalized, assuming at least double CAR, so CFR~5.5fold
    not 10 fold nor 11 fold.
    With 13 deaths the sample is small and more seasonal flu deaths may have been
    missed than from mexflu due to more attention and testing.
    Anyway, CFR in children <0.01%

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