California pH1N1 HFR and CCFR

[JimO]

The hospitalized fatality rate (HFR) and critical care fatality rate (CCFR) in California are continuing to be elevated. As of last Friday, out of 92 hospitalized cases in Kern County, over half (49) have been in ICU, 58 have been discharged and 13 have died, leaving 21 in the hospital. First, over 50% of hospitalized cases requiring critical care is very high, and of those with outcomes, the HFR is 18.3% (13 of 72). Since they don't report the number of ICU cases discharged, the CCFR would stand at 26.5% (13 of 49), assuming none of the remaining ICU cases die.

http://www.kernpublichealth.com/departments/cd/H1N1.aspx

The data from Fresno County is even more alarming. As of today, they report 29 ICU cases of which 9 have been discharged and 14 have died. Six remain in ICU. They don't report total hospitalizations. Of the cases with outcomes, the CCFR is an astounding 60.9% (14 of 23), with a minimum CCFR of 48.3% (14 of 29) if the remaining six patients survive.

http://www.co.fresno.ca.us/DivisionPage.aspx?id=31605

In Week 3, Orange County reports 8 deaths out of 35 severe cases, or 22.9%. It's not clear if severe cases are those requiring hospitalization or those in ICU.

http://ochealthinfo.com/civicax/filebank/blobdload.aspx?BlobID=32980

[JimO]

Re: California pH1N1 HFR and CCFR

Sacramento County reported its 18th death today. They also reported that 84 patients have been admitted to ICU. Without knowing the number of discharged patients, the CCFR is currently 21.4% (18 of 84).

http://www.flutrackers.com/forum/showthread.php?p=522931#post522931

[JimO]

Re: California pH1N1 HFR and CCFR

The above are contrasted with overall HFR, for states who report both fatalities and hospitalizations, of approximately 3%, which is similar to numbers seen in 2009-10.

http://www.flutrackers.com/forum/showthread.php?t=217093

[JimO]

Re: California pH1N1 HFR and CCFR

As a comparison, Dallas County, which has been hard hit this season, reported in Week 2 that there had been 35 deaths and 718 hospitalizations, which results in a HFR of 4.9%. This is higher than average, but much lower than what we are seeing in California.

It should also be noted that all the data for California is limited to deaths of children and adults to age 64, while data from other states includes older adults. I believe that it can be safely assumed that the HFR and CCFR for adults 65 and over suffering from severe cases of flu is generally higher, making the California data even more striking.

[JimO]

Re: California pH1N1 HFR and CCFR

Riverside County reported in January 44 severe flu cases (not sure if they are ICU or all hospitalized), with 7 deaths - 15.9%.

http://www.flutrackers.com/forum/showthread.php?p=522939#post522939

[NS1]

Re: California pH1N1 HFR and CCFR

The data from Fresno County is even more alarming. As of today, they report 29 ICU cases of which 9 have been discharged and 14 have died. Six remain in ICU. They don't report total hospitalizations. Of the cases with outcomes, the CCFR is an astounding 60.9% (14 of 23), with a minimum CCFR of 48.3% (14 of 29) if the remaining six patients survive.

http://www.co.fresno.ca.us/DivisionPage.aspx?id=31605

We have also begun watching Fresno, Jim.

At a 40% point-in-time ratio level for Critical Care Fatality, a High Intensity event is occurring. At 60%, our jaw drops.

We need ages and patient stats to exclude a nursing home outbreak or other confounding group effect for this cohort. State resources directed toward Fresno would allow independent monitoring of all known risk factors and proper collection of samples for genetic processing prior to the arrival of any "case definition" specialists from the federal public health organisations.

[JimO]

Re: California pH1N1 HFR and CCFR

Kern County just updated their numbers:

HFR - 16.5% (15 of 91 with outcomes)
CCFR - 31.3% (15 of 48)

[JimO]

Re: California pH1N1 HFR and CCFR

We have also begun watching Fresno, Jim.

At a 40% point-in-time ratio level for Critical Care Fatality, a High Intensity event is occurring. At 60%, our jaw drops.

We need ages and patient stats to exclude a nursing home outbreak or other confounding group effect for this cohort. State resources directed toward Fresno would allow independent monitoring of all known risk factors and proper collection of samples for genetic processing prior to the arrival of any "case definition" specialists from the federal public health organisations.

I looked through the articles posted related to Fresno County deaths and found some information on 8 of the 15 deaths:

January 9 - Woman
January 13 - Jail inmate 60-year-old Francisco Rosales Gamboa
January 22 - Two women 30s, man 60s, woman 50s
January 24 - Dr. Wayne Iwao Kodama 52
January 28 - Man 50s

[NS1]

Re: California pH1N1 HFR and CCFR

I looked through the articles posted related to Fresno County deaths and found some information on 8 of the 15 deaths:

January 9 - Woman
January 13 - Jail inmate 60-year-old Francisco Rosales Gamboa
January 22 - Two women 30s, man 60s, woman 50s
January 24 - Dr. Wayne Iwao Kodama 52
January 28 - Man 50s

Nice work, Jim!

Dr. Wayne Iwao Kodama
Male Age 52 Years
Dentist
Healthy Smiles Mobile Dental Foundation, Founder
Obituary

Young adults working with teenagers and children appear to have increased risk of fatality from pH1N1.

We do not yet see a group confounder.

[JimO]

Re: California pH1N1 HFR and CCFR

San Diego County reported 8 deaths last week for a total of 20. They do not provide hospitalization data, but this chart showing P&I deaths indicates a dramatic increase last week to over 14%, far higher than any level recorded in the past five years.

San Diego and Los Angeles typically report the highest numbers of flu deaths, but they seem to be a couple of weeks behind other areas of the state. We will likely see a sharp increase in deaths reported from southern California.

http://www.sdcounty.ca.gov/hhsa/programs/phs/documents/InfluenzaWatch.pdf

[JimO]

Re: California pH1N1 HFR and CCFR

Santa Clara County reported a total of 25 severe cases of flu and 9 deaths this season. In Week 4, 10 severe cases and 2 deaths were reported. At best, this is a CCFR of 36%; however, since 40% of the cases were just hospitalized this week, the number will likely be higher. Last week, it would have been 7 deaths from 15 severe cases, or a CCFR of 47%. This is nearly on par with Fresno County.

[NS1]

Re: California pH1N1 HFR and CCFR

Santa Clara County reported a total of 25 severe cases of flu and 9 deaths this season. In Week 4, 10 severe cases and 2 deaths were reported. At best, this is a CCFR of 36%; however, since 40% of the cases were just hospitalized this week, the number will likely be higher. Last week, it would have been 7 deaths from 15 severe cases, or a CCFR of 47%. This is nearly on par with Fresno County.

The 40%+ CCFR is on par with the concept of a non-ReAssortment / sub-segment set of genetic revisions that generate a flashfire of focal geographic severe clinical outcomes.

Next stage progression is high risk because the basic Clade2:188T background has now coalesced providing a simplified scaffolding for variant Upsilon sets. A Re-balancing downgrade is preferred.