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Discussion - N.Y.C. Funeral Director's Meeting

Re: Miscommunication? N.Y.C. Funeral Directors told to predict a 2.1% to 3.3% death rate among those who come down with swine flu this fall

Re: Miscommunication? N.Y.C. Funeral Directors told to predict a 2.1% to 3.3% death rate among those who come down with swine flu this fall

St Michael said:
If my memory is correct, Swine flu is expected to infect 40% of the general population. A 2.1 percent to 3.3 percent death rate among those who come down with swine flu this fall works out to a 0.8 to 1.2% overall mortality rate, about half that of 1918.

These are very realistic numbers.
Click to expand...

What is the difference between a CFR of those with H1N1 and those without? There is only one CFR.
 
Re: Miscommunication? N.Y.C. Funeral Directors told to predict a 2.1% to 3.3% death rate among those who come down with swine flu this fall

Re: Miscommunication? N.Y.C. Funeral Directors told to predict a 2.1% to 3.3% death rate among those who come down with swine flu this fall

Andy2000 said:
What is the difference between a CFR of those with H1N1 and those without? There is only one CFR.
Click to expand...

You can have a CFR for swine flu related deaths.

For example: If the hospitals gets overwhelmed with H1N1 patients that consume all the resources you will still have those non-H1N1 people that need care for a plethora of reasons (car accidents, old age, heart attack, shootings, chemo, etc)... Some of these people may die because they do not get the care they normally would have because of the pandemic.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

St Michael said:
If my memory is correct, Swine flu is expected to infect 40% of the general population. A 2.1 percent to 3.3 percent death rate among those who come down with swine flu this fall works out to a 0.8 to 1.2% overall mortality rate, about half that of 1918.

These are very realistic numbers.
Click to expand...

Can someone point to the CDC announcement or data that they are now using to revise the CFR to 2.1-3.3% for the USA?

St Michael said:
I spoke to a local funeral director several weeks ago. He was the only person I've spoken to locally who was well informed about H1N1, including local medical personnel. Regardless of any other profession, these folks seem to be kept in the loop, because they play a real role in disaster preparedness.

The funeral director I spoke to expressed opinions very similar to what is expressed in this article.
Click to expand...

I have no doubt funeral directors are concerned about the number of dead versus the number of infected individuals. But funeral directors are not epidemiologists or virologists and don't model the numbers or provide the forecasts. So where do these numbers come from?
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/09/AR2009080902447.html
"This epidemic will transmit faster than usual, because the population is more susceptible," said Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health who has been helping the CDC project the severity of the upcoming wave. "It's fair to say there will be tens of millions of illnesses and hundreds of thousands of hospitalizations, and tens of thousands of deaths. That's not atypical. It just depends on how many tens of thousands."
If Marc Lipsitch is wondering what bracket of tens of thousands the deaths will be in - where is the data to support assumptions of a CFR of 2-3 percent?
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

St Michael said:
If my memory is correct, Swine flu is expected to infect 40% of the general population. A 2.1 percent to 3.3 percent death rate among those who come down with swine flu this fall works out to a 0.8 to 1.2% overall mortality rate, about half that of 1918.

These are very realistic numbers.
Click to expand...


In 1918, with a US population of 100 million, 30 million Americans became ill with the pandemic H1N1. Of those, approximately 675,000 died, resulting in a case fatality rate of 2.3%.

If we replay the 1918 pandemic with 300 million population, all other things being equal, we would expect over 2 million deaths, which is at the lower end of the range based on the information presented in the article. Using the upper range figures in the article, US deaths would be around 3 million.

In summary, such a case would drastically change society as we know it today. An extreme scenario in anyone's book.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

Looks like there is a bit of over reaction here. Are we not talking "worse case Scenario"?
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

Flufreak said:
Looks like there is a bit of over reaction here. Are we not talking "worse case Scenario"?
Click to expand...

That is what we are trying to deduce.

Like I said before, the question is...where does Kasden get his information...what is the source? If the source is incorrect or he made a mistake and used the worst case scenario numbers than that we can disregard these numbers....

However, if his source is someone inside the CDC or government, then that we have to understand why that number exists...what justifies the higher CFR.

This is the debate at hand and members of FluTrackers have already contacted Mr. Kasden and MetFDA for clarification.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

In the article, the word possible was used 4 times, potential once.
I think we'll find "possible" should have been used one more time!
In the sentence below:

"The Centers for Disease Control has predicted a ______ 2.1 percent to 3.3 percent death rate"
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

St Michael said:
I can't locate any specific links at present, but the CDC has consistently talked about a 0.8% CFR.

If swine H1N1 infects 40% of the population, and has a 2 to 3% CFR for those infected, that works out to a total CFR of 0.8 to 1.2%.

These numbers have been consistent all along. The only number I'm not certain about is the anticipated 40% infection rate.

If it is expected to vary between 40% and 50 to 60%, that would account for the 2 to 3% range in CFR for those infected.

What is surprising is not how shocking these numbers may seem, but how very consistent these numbers from the CDC have been for several months now, and how few people have paid them heed.
Click to expand...
Maybe I'm misunderstanding, but I thought the CFR is based on those infected and that overall mortality rates are based on population.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

JimO said:
As indicated above, I sent Mr. Kasden a request and link to the article. I asked him if he could both confirm the numbers (and give us a source) and confirm whether or not he was accurately quoted in the article.

The key issue IMHO is attributing the CFR numbers to the CDC. They don't appear to be rough guesses (2.1 and 3.3% are fairly precise numbers). If he had been quoted as saying that the CDC estimated 2 to 3%, then I would feel better about it. So, it appears that someone did a calculation and came up with the range, which was then used to calculate the total number of expected deaths.

The important question is, whose numbers are they? Many folks on this site look at this CFR range and consider it realistic, but this would be a huge departure from previous estimates released by the CDC and if they did provide those numbers, it would have to mean they have data that strongly indicates a major shift in the pandemic.

One more thing, if this was a "worst-case" planning scenario, then why the range? It would seem that a range would cover best expected case to worst case.

I'll report back immediately if I hear back from Mr. Kasden.
Click to expand...

You sum up many of my concerns quite well. Sometime doesn't feel right about the report, but in many directions. There are ways the original data could have been mis-interpreted (0.22-0.31% with the 50-80K deaths being nationwide, for instance). Or it could be something that slipped out, either on accident or on purpose, and there are certainly ramifications for it to have been leaked on purpose. It can be denied now or pointed to later as a means over covering backsides.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

JimO said:
Maybe I'm misunderstanding, but I thought the CFR is based on those infected and that overall mortality rates are based on population.
Click to expand...

That is my understanding as well.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

JimO said:
As indicated above, I sent Mr. Kasden a request and link to the article. I asked him if he could both confirm the numbers (and give us a source) and confirm whether or not he was accurately quoted in the article.

The key issue IMHO is attributing the CFR numbers to the CDC. They don't appear to be rough guesses (2.1 and 3.3% are fairly precise numbers). If he had been quoted as saying that the CDC estimated 2 to 3%, then I would feel better about it. So, it appears that someone did a calculation and came up with the range, which was then used to calculate the total number of expected deaths.

The important question is, whose numbers are they? Many folks on this site look at this CFR range and consider it realistic, but this would be a huge departure from previous estimates released by the CDC and if they did provide those numbers, it would have to mean they have data that strongly indicates a major shift in the pandemic.

One more thing, if this was a "worst-case" planning scenario, then why the range? It would seem that a range would cover best expected case to worst case.

I'll report back immediately if I hear back from Mr. Kasden.
Click to expand...

Good points!
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

St Michael said:
I can't locate any specific links at present, but the CDC has consistently talked about a 0.8% CFR.

If swine H1N1 infects 40% of the population, and has a 2 to 3% CFR for those infected, that works out to a total CFR of 0.8 to 1.2%.

These numbers have been consistent all along. The only number I'm not certain about is the anticipated 40% infection rate.

If it is expected to vary between 40% and 50 to 60%, that would account for the 2 to 3% range in CFR for those infected.

What is surprising is not how shocking these numbers may seem, but how very consistent these numbers from the CDC have been for several months now, and how few people have paid them heed.
Click to expand...

I can find none of the numbers that you quote above from anyone, including the CDC. Of all the pandemics experienced to date for which we have data, the highest clinical infection rate is 29%. And the CDC normally does not addresses mortality rates, only case fatality factors.

Please let me know if you are able to find your sources.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

On 28 of July 2009 the hospitalization rate for 5-24 year olds out of 1718 cases was 2.1%
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

Mamabird said:
Rest assured, the CDC did not give him any numbers that would look anything like what was quoted in the article. This is just really bad reporting.
Click to expand...

Please let us know where you got your information for the statement you made.
 
Re: N.Y.C. Funeral Directors meeting

Re: N.Y.C. Funeral Directors meeting

If those numbers came from the CDC, we really need to know the source, and then get an explanation, because once you get into worse case events like those described, most planners just throw up their hands. It is simply not one in which we can effectively deal.
Click to expand...

Well, I totally agree with you on this point - we need to know if this is coming from the CDC!!!

Your statement that I was referring to was so definative that it was NOT from the CDC, that I wanted to know how you knew that. Like maybe you had some inside info ;)
 
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