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  • CDC Changes Reporting Methodology

    The CDC has changed the reporting of this chart to eliminate the "Influenza and Pneumonia Syndrome" category -

    from this - previous 6 weeks from P&I Syndrome:





    the chart now looks like this:







    the reason given:




    "What hospitalizations and death information will CDC report publicly?

    Added Nov 06


    From August 30-October 24, 2009 CDC publicly posted reports of both laboratory-confirmed influenza for all types of influenza AND syndromic cases, i.e., cases of presumed influenza and/or pneumonia based on ICD-9 coded hospitalizations or death reports each week. From the week beginning October 25-31, 2009; however, CDC will only publicly report laboratory-confirmed influenza-associated hospitalizations and deaths. The reason for this change in public reporting is that the interpretation of syndromic data (most of which is not laboratory-confirmed) relative to laboratory-confirmed data has been challenging. CDC will continue to collect and analyze both laboratory-confirmed and syndromic data reported to CDC by states.



    How accurate a representation are these numbers?

    Updated Nov 06



    Laboratory-confirmed data is thought to be an underestimation of the true number of cases because most people will not be tested for influenza. However, influenza and pneumonia syndrome hospitalizations and deaths may be an overestimate of actual number of flu-related hospitalizations and deaths because that diagnostic category includes other illnesses. Influenza and pneumonia syndromic reports are less specific to influenza, but are helpful in following disease trends."




    This is an ill advised move. A more acceptable way to address the problem of inaccurate number accumulation is to publish these numbers along with pertinent historical data and let the public decide what is relevant and what is not.

    I strongly urge the CDC to adopt the above suggestion.

    From John Barry - an historical perspective from his book The Great Influenza:





    "There was terror afoot in 1918, real terror. The randomness of death brought that terror home. So did its speed. And so did the fact that the healthiest and strongest seemed the most vulnerable.
    <o:p> </o:p>
    The media and public officials helped create that terror – not by exaggerating the disease but by minimizing it, by trying to reassure.

    Terror rises in the dark of the mind, in the unknown beast tracking us in the jungle. The fear of the dark is an almost physical manifestation of that Horror movies build upon the fear of the unknown, the uncertain threat that we cannot see and do not know and can find no safe haven from. But in every horror movie, once the monster appears, terror condenses into the concrete and diminishes. Fear remains. But the edge of panic created by the unknown dissipates. The power of the imagination dissipates.

    In 1918 the lies of officials and of the press never allowed the terror to condense into the concrete. The public could trust nothing and so they knew nothing. So a terror seeped into the society that prevented one woman from caring for her sister; that prevented volunteers from bringing food to families too ill to feed themselves and who starved to death because of it; that prevented trained nurses form responding to the most urgent calls for their services. The fear, not the disease, threatened to break society apart. As Victor Vaughn – a careful man, a measured man, a man who did not overstate to make a point – warned, 'Civilization could have disappeared within a few more weeks.'


    So the final lesson, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that.

    Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. <st1:city w:st="on"><st1:place w:st="on">Lincoln</st1:place></st1:city> said that first, and best.

    Leadership must make whatever horror exists concrete. Only then will people be able to break it apart."




    We must learn from history and the mistakes made to save lives in the present and future.






    * Thank you to Fla Medic for the use of the screen shots above. Also, hat tip to RoRo for the link to the CDC page.
    Last edited by sharon sanders; November 8th, 2009, 08:09 AM. Reason: hat tip fix
    "May the long time sun
    Shine upon you,
    All love surround you,
    And the pure light within you
    Guide your way on."

    "Where your talents and the needs of the world cross, lies your calling."
    Aristotle

    “In a gentle way, you can shake the world.”
    Mohandas Gandhi

    Be the light that is within.

  • #2
    Re: CDC Changes Reporting Methodology

    CBS News ran with the story. Thanks CBS.


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    hat tip to Fla Medic for link
    "May the long time sun
    Shine upon you,
    All love surround you,
    And the pure light within you
    Guide your way on."

    "Where your talents and the needs of the world cross, lies your calling."
    Aristotle

    “In a gentle way, you can shake the world.”
    Mohandas Gandhi

    Be the light that is within.

    Comment


    • #3
      Re: CDC Changes Reporting Methodology

      If one looks at how CDC has been reporting deaths on MMWR over the past ten years,
      Year..week.TOTAL DEATHS..P&Ideaths
      2000...43....12,232..............838
      2001...43....11,751..............761
      2002...43....11,306..............684
      2003...43....11,254..............684
      2004...43....11,247..............716
      2008...43....11,193..............731
      2009...43....11,136..............828

      Whether or not deaths are being counted as H1N1 or something else, the TOTAL DEATHS being recorded for week 43 are still under the totals of past years. This example is indicative for weeks 1-42, also. Even if the system is faulty, it's been faulty for the previous years, so comparing data is similar.

      Therefore, if there are similar numbers in TOTAL DEATHS, and we make the assumption that more are dying from H1N1, there are apparently LESS people dying from something else.

      Comment


      • #4
        Re: CDC Changes Reporting Methodology

        Thanks Missouriwatcher.

        So considering the P&I category above for 2009, if the predominate strain is novel H1N1, and those deaths are up then many less people are dying from pneumonia as to compared to previous years. And it is exactly that symptom which is present in most of the fatal H1N1 cases. Makes no sense really.
        "May the long time sun
        Shine upon you,
        All love surround you,
        And the pure light within you
        Guide your way on."

        "Where your talents and the needs of the world cross, lies your calling."
        Aristotle

        “In a gentle way, you can shake the world.”
        Mohandas Gandhi

        Be the light that is within.

        Comment


        • #5
          Re: CDC Changes Reporting Methodology

          Additionally, when comparing TOTAL DEATHS in age-group 45-64, for the past ten years, that age-range has the most TOTAL DEATHS nearly every week (since week 15). That means that there were fewer deaths in the other age-groups during the that same time.

          Comment


          • #6
            Re: CDC Changes Reporting Methodology

            And - California did not report last week which is approximately 10% of the total US population. There are no reliable figures that do not include statistics from California. California adjoins Mexico and this is an extremely pertinent region to collect data from for this pandemic.
            "May the long time sun
            Shine upon you,
            All love surround you,
            And the pure light within you
            Guide your way on."

            "Where your talents and the needs of the world cross, lies your calling."
            Aristotle

            “In a gentle way, you can shake the world.”
            Mohandas Gandhi

            Be the light that is within.

            Comment


            • #7
              Re: CDC Changes Reporting Methodology

              Compare week 42 to previous ten years:
              TOTAL DEATHS...P&I
              11,766..............820...year2004
              11,729..............799...year2000
              11,456..............733...year2001
              11,269..............726...year2005
              11,159..............654...year2006
              10,914..............665...year2007
              10,903..............775...year2009

              Still more TOTAL DEATHS in previous years. P&I for 2009 (weeks 40-43) have been in the top, comparing ten years data.

              Comment


              • #8
                Re: CDC Changes Reporting Methodology

                which does not make sense when you see that the percentage of visits for ILI are greatly increased in week 40 as compared to previous years.


                http://www.cdc.gov/h1n1flu/updates/us/#iligraph

                Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-2009 and Previous Two Seasons (Posted November 6, 2009, 4:30 PM ET, for Week Ending October 31, 2009)


                "May the long time sun
                Shine upon you,
                All love surround you,
                And the pure light within you
                Guide your way on."

                "Where your talents and the needs of the world cross, lies your calling."
                Aristotle

                “In a gentle way, you can shake the world.”
                Mohandas Gandhi

                Be the light that is within.

                Comment


                • #9
                  Re: CDC Changes Reporting Methodology

                  Originally posted by Missouriwatcher View Post
                  Compare week 42 to previous ten years:
                  TOTAL DEATHS...P&I
                  11,766..............820...year2004
                  11,729..............799...year2000
                  11,456..............733...year2001
                  11,269..............726...year2005
                  11,159..............654...year2006
                  10,914..............665...year2007
                  10,903..............775...year2009

                  Still more TOTAL DEATHS in previous years. P&I for 2009 (weeks 40-43) have been in the top, comparing ten years data.
                  I think this is why you should be using the percentage of deaths due to P&I figure as the CDC does. You don't know if there has been an under-report for example if you just go with totals. The CDC chart currently shows,

                  Comment


                  • #10
                    Re: CDC Changes Reporting Methodology

                    I agree with what you are saying. I just wonder if some are NOT dying of "something else" and are now listed as P&I, e.g. is H1N1 causing some people death instead of the ( ) condition they had that would have killed them that week? Or, is H1N1 creating a situation that makes another condition subside? Or, are the antiquated methods of counting, inadequate (of course, they would have been that way for the past ten years and all data would be under reported, but might be compared)?

                    Comment


                    • #11
                      Re: CDC Changes Reporting Methodology

                      "Actual Causes of Death in the United States, 2000
                      Other actual causes of death were microbial agents (75 000), toxic agents (55 000)"
                      http://jama.ama-assn.org/cgi/content...ct/291/10/1238

                      The 15 leading causes of death in 2006 were:
                      1.Diseases of heart (heart disease)
                      2.Malignant neoplasms (cancer)
                      3.Cerebrovascular diseases (stroke)
                      4.Chronic lower respiratory diseases
                      5.Accidents (unintentional injuries)
                      6.Diabetes mellitus (diabetes)
                      7.Alzheimer’s disease
                      8.Influenza and pneumonia
                      9.Nephritis, nephrotic syndrome and nephrosis (kidney disease)
                      10.Septicemia
                      11.Intentional self-harm (suicide)
                      12.Chronic liver disease and cirrhosis
                      13.Essential hypertension and hypertensive renal disease (hypertension)
                      14.Parkinson’s disease
                      15.Assault (homicide)

                      In 2006, the infant mortality rate was 6.69 infant deaths per 1,000 live births.
                      The 10 leading causes of infant death were:
                      1.Congenital malformations, deformations and chromosomal abnormalities (congenital malformations)
                      2.Disorders relating to short gestation and low birth weight, not elsewhere classified (low birthweight)
                      3.Sudden infant death syndrome (SIDS)
                      4.Newborn affected by maternal complications of pregnancy (maternal complications)
                      5.Accidents (unintentional injuries)
                      6.Newborn affected by complications of placenta, cord and membranes (cord and placental complications)
                      7.Respiratory distress of newborn
                      8.Bacterial sepsis of newborn
                      9.Neonatal hemorrhage
                      10.Diseases of the circulatory system
                      http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf

                      Comment


                      • #12
                        Re: CDC Changes Reporting Methodology

                        I posted this on another thread and I believe it warrants further consideration. The table below is, I believe, from the study that resulted in the "36,000 deaths from influenza every year" mantra. However, the table below doesn't differentiate influenza from P&I. The total for all ages for P&I is shown as 8,097. It is only when one adds to that the total deaths listed as "Underlying respiratory and circulatory deaths" that one arrives at 36,155.

                        So, does this mean that we should be comparing total P&I deaths to ~8,100 estimated annual P&I deaths? If you look at the age distribution of those deaths, 90% are in people <65. So, then would it be more appropriate to compare the number of confirmed H1N1 deaths <65 to an average of 800 P&I deaths <65? Even this would be a conservative comparison given that we would be comparing laboratory confirmed deaths with estimated P&I deaths.

                        I'm beginning to believe that the 36,000 number is a gross exaggeration and that the H1N1 deaths confirmed to date exceed comparable deaths in a typical flu season. We have nearly 1,800 total deaths recorded and, at most, 10% are >65. That leaves over 1,600, which is twice the number of P&I deaths in a typical year for those <65.

                        Am I missing something here? If so, please tell me.

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                        "I know God will not give me anything I can't handle. I just wish that He didn't trust me so much." - Mother Teresa of Calcutta

                        Comment


                        • #13
                          Re: CDC Changes Reporting Methodology

                          What proportion of pneumonia and influenza deaths, respiratory and circulatory deaths and all-cause deaths are attributed to seasonal influenza?
                          For pneumonia and influenza (P&I) deaths, CDC estimates approximately 8,000 deaths are associated with seasonal flu. This represents 9.8% of (P&I) deaths. For respiratory and circulatory (R&C) deaths, CDC estimates approximately 36,000 deaths are associated with seasonal flu. This represents 3.1% percent of those deaths. For all-cause deaths, CDC estimates that approximately 51,000 deaths are associated with seasonal flu. This represents 2.2% of all deaths.
                          http://cdc.gov/flu/about/disease/us_...ted_deaths.htm

                          In light of the above, I've always wondered why people quoted 36,000 and not 51,000 fatalities. The reasons why they estimate high are also given:

                          Does CDC know the exact number of people who die from seasonal flu each year?
                          CDC does not know exactly how many people die from seasonal flu each year. There are several reasons for this: First, states are not required to report individual seasonal flu cases or deaths of people older than 18 years of age to CDC. Second, seasonal influenza is infrequently listed on death certificates of people who die from flu-related complications [12]. Third, many seasonal flu-related deaths occur one or two weeks after a person’s initial infection, either because the person may develop a secondary bacterial co-infection (such as a staph infection) [1,8,11] or because seasonal influenza can aggravate an existing chronic illness (such as congestive heart failure or chronic obstructive pulmonary disease) [3]. Also, most people who die from seasonal flu-related complications are not tested for flu, or they seek medical care later in their illness when seasonal influenza can no longer be detected from respiratory samples. Influenza tests are only likely to detect influenza if performed within a week after onset of illness. For these reasons, many flu-related deaths may not be recorded on death certificates. These are some of the reasons that CDC and other public health agencies in the United States and other countries use statistical models to estimate the annual number of seasonal flu-related deaths. (Flu deaths in children were made a nationally notifiable condition in 2004, and since then, states have been required to report flu-related child deaths in the United States through the Influenza Associated Pediatric Mortality Surveillance System).

                          'Tis a very loose definition when applied to seasonal flu. However for this year's "seasonal" flu, the definition seems much tighter. Only confirmed cases count.
                          Twitter: @RonanKelly13
                          The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                          Comment


                          • #14
                            Re: CDC Changes Reporting Methodology

                            Originally posted by RoRo View Post
                            What proportion of pneumonia and influenza deaths, respiratory and circulatory deaths and all-cause deaths are attributed to seasonal influenza?
                            For pneumonia and influenza (P&I) deaths, CDC estimates approximately 8,000 deaths are associated with seasonal flu. This represents 9.8% of (P&I) deaths. For respiratory and circulatory (R&C) deaths, CDC estimates approximately 36,000 deaths are associated with seasonal flu. This represents 3.1% percent of those deaths. For all-cause deaths, CDC estimates that approximately 51,000 deaths are associated with seasonal flu. This represents 2.2% of all deaths.
                            http://cdc.gov/flu/about/disease/us_...ted_deaths.htm

                            In light of the above, I've always wondered why people quoted 36,000 and not 51,000 fatalities. The reasons why they estimate high are also given:

                            Does CDC know the exact number of people who die from seasonal flu each year?
                            CDC does not know exactly how many people die from seasonal flu each year. There are several reasons for this: First, states are not required to report individual seasonal flu cases or deaths of people older than 18 years of age to CDC. Second, seasonal influenza is infrequently listed on death certificates of people who die from flu-related complications [12]. Third, many seasonal flu-related deaths occur one or two weeks after a person’s initial infection, either because the person may develop a secondary bacterial co-infection (such as a staph infection) [1,8,11] or because seasonal influenza can aggravate an existing chronic illness (such as congestive heart failure or chronic obstructive pulmonary disease) [3]. Also, most people who die from seasonal flu-related complications are not tested for flu, or they seek medical care later in their illness when seasonal influenza can no longer be detected from respiratory samples. Influenza tests are only likely to detect influenza if performed within a week after onset of illness. For these reasons, many flu-related deaths may not be recorded on death certificates. These are some of the reasons that CDC and other public health agencies in the United States and other countries use statistical models to estimate the annual number of seasonal flu-related deaths. (Flu deaths in children were made a nationally notifiable condition in 2004, and since then, states have been required to report flu-related child deaths in the United States through the Influenza Associated Pediatric Mortality Surveillance System).

                            'Tis a very loose definition when applied to seasonal flu. However for this year's "seasonal" flu, the definition seems much tighter. Only confirmed cases count.
                            I don't have a problem with the CDC estimating flu deaths in this manner; however, the press, public health officials, school officials, etc. are comparing actual confirmed H1N1 deaths with the 36,000 figure. That comparison is intrinsically flawed and the CDC has done nothing to correct it.

                            Confirmed flu deaths should, ideally, be compared with average confirmed flu deaths, but I realize they don't have laboratory confirmed data from prior seasons. So, at the very least, the current numbers should only be compared with average P&I deaths attributable to influenza. It would make the most sense to compare the CDC's P&I deaths plus laboratory-confirmed deaths to the 8,000 figure, but with the new reporting format, we can't even do that.

                            Also, the 36,000 number is so well established that it would be very difficult to change the public's perception. The CDC knows all this and should have clarified the number up front.

                            Should we try to make the case on FT?
                            "I know God will not give me anything I can't handle. I just wish that He didn't trust me so much." - Mother Teresa of Calcutta

                            Comment


                            • #15
                              Re: CDC Changes Reporting Methodology

                              Here's the confirmed influenza deaths from 1999-2005.


                              1999 -- 1,665 deaths
                              2000 -- 1,765 deaths
                              2001 -- 257 deaths
                              2002 -- 727 deaths
                              2003 -- 1,792 deaths
                              2004 -- 1,100 deaths
                              2005 -- 1,812 deaths

                              Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2005. CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2005 Series 20 No. 2K, 2008. Accessed at http://wonder.cdc.gov/cmf-icd10-archive2005.html on Nov 9, 2009 4:01:50 PM

                              Average from above = 1,303

                              Compared to: Confirmed H1N1 deaths April - October 2009

                              1,265.

                              Apples with apples.
                              Twitter: @RonanKelly13
                              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                              Comment

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