Re: Critical Care Fatality Rate for Hospitalized Cases USA, H1N1 Seasonal Influenza 2013-2014
This chart is on Fresno County's website and shows 20 ICU admissions with 6 deaths and the remaining 14 still in ICU. Even if the remaining patients survive, that is a CCFR of 30%, which is three times higher than the average seen in 2009-10. In fact, I don't recall any CCFR being reported at that level in 2009-10. Again, this is of even greater concern given the moderate levels of %ILI being reported. The result, as pointed out by NS1 is that the actual CFR would be higher with a higher numerator (more deaths) and a lower denominator (fewer cases).
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What Do These Numbers Mean?
The
Case Fatality Rate (
CFR) by definition is a
population-wide statistic for a definable disease / fatality cause.
Severity facets like Hospitalisation Fatality Rate and Critical Care Fatality Rate are
restrictive subsets of the sample population, but
generally share the same measure count (fatality count); most influenza fatalities have sought and had some form of medical interaction. A practical constraint on a numerator taken over an
exponentially-variant denominator results in non-comparatives.
Keeping those parameters in mind while noting that data collection and reporting standards vary widely, the reader must consider carefully any comparative interpretation of this data.
A
CFR cannot be evaluated next to a Fatality Rate associated with
InPatient Care or
Critical Care in a medical facility.
At most points of statistical significance, the medical fatality rates will be
scaled differently than a population-wide statistic.
If we had valid interpretations from 2009 and early 2010, our conjecture is that
40%-plus Fatality Rates would be found across many Critical Care Facilities, especially in the US and the UK during and just after the extended "divert" periods. Those periods experienced exceptionally high case loads
AND exceptional morbidity at presentation.
Today, the case loads vary considerably with many states demonstrating
sub-epidemic case numbers
while showing quantities of exceptional morbidity approaching and beyond 2009. That ratio should concern us.
The flashfire nature of high-intensity focused on a particular geography driven by a particular set of genetics is the matter of significant importance. The coalescence of
pH1N1 High-CFR Upsilon polymorphisms onto widely-circulating model backgrounds is a further point of logic.
If we take the
Upsilon sub-clade as a defined disease, the Fatality Rate
approaches 5% by report and potentially much higher if comprehensive reporting was made public. The
1918 population-wide
CFR has been estimated above 2% with fatality count estimates of 50 to 100 million people on a worldwide population close to 2 billion. While we cannot directly compare a population-wide rate with a sub-clade, we follow the increased mortality risk as a guide to take note of the
virulence factors associated with that dangerous
pH1N1 sub-clade.
Those
Upsilon genetics inform the cases being mechanically ventilated and 'ECMO'ed today, but, as yet, few sequences have been
made public to fully quantify the risk.
Overall medical facility Fatality Rates are obvious figures that should, in any estimation, be
continually available and approachable for the general public. That citizens like Jim Oliveros and Laidback Al must devote
professional expertise, give pursuit, carefully accumulate and then provide visualisations to these figures is further
unanswered evidence of the limited benefit derived from modern public health institutes in the face of
surging pathogenic disease, a predictable matter that comes each year.
