N.Y.C. Funeral Directors meeting

Treyfish · Aug 18, 2009

Boro prepares for fall?s swine flu cases

By Anna Gustafson
Thursday, August 13, 2009 9:14 AM EDT

http://yournabe.com/articles/2009/08/17/queens/queensxtfwnic08122009.eml


<TABLE class=photobox border=0 cellSpacing=2 cellPadding=0><TBODY><TR><TD class=photocell>

</TD></TR><TR><TD class=photocutline>Metropolitan Funeral Directors Association Director Martin Kasdan addresses individuals in Forest Hills last week about a possible swine flu surge this fall. Photo by Anna Gustafson</TD></TR></TBODY></TABLE>

City officials are bracing for a surge of swine flu cases this fall and funeral home directors need to be prepared to accommodate a possible related 50,000 to 85,000 deaths, the director of the Metropolitan Funeral Directors Association told a gathering of funeral home representatives in Forest Hills last week.

?As funeral directors, we really need to know what we?re about to face,? Martin Kasdan said. ?When swine flu comes back, it could possibly be devastating.?

About 15 officials from area funeral homes attended the meeting sponsored by the MetFDA at Schwartz Brothers in Forest Hills Aug. 6. The MetFDA is holding four meetings in the city and one in Westchester this month to better prepare funeral homes for a possible increase in deaths as well as a rise in the number of sick and absent employees.

MetFDA officials said they were also relaying information from the meetings to city agencies, including the city Health Department and the medical examiner?s office, with which they have been working in preparation for a potential second wave of swine flu.

Swine flu, otherwise known as H1N1, first hit the city in May in a group of St. Francis Preparatory students in Fresh Meadows. The outbreak occurred after the students had arrived home from a trip to Mexico, where the World Health Organization said the global pandemic originated.

As of July, more than 900 New Yorkers had been hospitalized with H1N1 and 47 had died, including two Queens residents, according to city statistics.

Flushing resident Mitchell Wiener, an assistant principal at IS 238 in Hollis, became the city?s first swine flu casualty May 17. A second unnamed woman from Queens died from swine flu May 24, according to the city.

City residents continue to come down with H1N1, but the numbers have continually decreased since the spike of cases in May, health officials said.

?The Health Department monitors influenza-like illnesses every day in New York City,? said city Health Commissioner Thomas Farley. ?While every hospitalization is concerning and every death is a tragedy, our surveillance data indicate that the number of people newly infected is declining.?

The Centers for Disease Control has predicted a 2.1 percent to 3.3 percent death rate among those who come down with swine flu this fall, which translates into an additional 52,000 to 86,000 deaths in the city over a three-month period, Kasdan said.

<SCRIPT type=text/javascript></SCRIPT>http://adsys.townnews.com/c97548837...1249916913.jpg?r=http://www.aviatorsports.com
?It?s mind-boggling,? Kasdan said of the possible death rate. ?Is the CDC right? Who knows ? hopefully not. But you need to be prepared.?

The potential upswing in fatalities poses a wide array of questions for city officials and funeral directors, such as where to store bodies, how to hold funerals in a climate where swine flu is passed easily from person to person and how many extra supplies will be needed.

?You may have to wait for funerals because the family is sick or until the cemetery says they?re able to do the burial,? Kasdan said. ?You might have to store bodies longer.?

Kasdan said the city medical examiner is already looking into possibly using vacant city buildings to store bodies, and the city has contracted for a unit to be built in Germany that will handle hundreds of bodies.

Reach reporter Anna Gustafson by e-mail at agustafson@cnglocal.com or by phone at 718-229-0300, Ext. 174.
:tiphat:http://yournabe.com/articles/2009/08/17/queens/queensxtfwnic08122009.txt

wotan · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

I have written to the reporter asking if she has tried to verify these numbers.

Nancy · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

Here's a rather nice graph of NYC mortality since 1800 (quaintly titled "The Conquest of Pestilence in New York City"), expressed as deaths per thousand of population. It shows the enormous progress made in the last 200 years in controlling infectious disease.

http://www.nyc.gov/html/doh/downloads/pdf/vs/2007sum.pdf

On this same page, farther down is another chart of general vital statistics.

In 2007, NYC had a population of just over 8.2 million. The number of deaths in 2007 was just over 54,000 (a rate of 6.5 per 1000).

The numbers in the funeral directors' article above suggests they are assuming an attack rate of about 30%. Using rounded numbers, 30% of 8.2 million is 2.46 million. If 2.1% of those 2.46 million who get influenza die, the number of projected deaths is 51,660.

This would pretty much double the annual deathrate in NYC, only the doubling could be expected to occur over three months rather than an entire year.

Jeremy · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

So here are the numbers:

NYC has a population of 8.3 million people.
52,000-86,000 projected deaths
Roughly .6 to 1% mortality rate for New York City.

That would be worse than 1957.

Also, if we were to take that .6 to 1% number and use that as a baseline for the entire U.S. then you are looking at roughly 1.7 to 3 million deaths, since the U.S. has more 300 million people.

Then if we apply that number to the entire world, you are looking at roughly 40-70 million deaths, since the Earth has roughly 7 billion people.

Mind you, this is over a 3 month period.

Someone, please correct me if I am wrong on these numbers

Mamabird · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

Jeremy said:
So here are the numbers:

NYC has a population of 8.3 million people.
52,000-86,000 projected deaths
Roughly .6 to 1% mortality rate for New York City.

That would be worse than 1957.

Also, if we were to take that .6 to 1% number and use that as a baseline for the entire U.S. then you are looking at roughly 1.7 to 3 million deaths, since the U.S. has more 300 million people.

Then if we apply that number to the entire world, you are looking at roughly 40-70 million deaths, since the Earth has roughly 7 billion people.

Mind you, this is over a 3 month period.

Someone, please correct me if I am wrong on these numbers

I think your math is just fine. However, such mortality rates far exceed the 1918 pandemic, so you can bet the information did not come from the CDC.

Jeremy · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

Mamabird said:
I think your math is just fine. However, such mortality rates far exceed the 1918 pandemic, so you can bet the information did not come from the CDC.

The Centers for Disease Control has predicted a 2.1 percent to 3.3 percent death rate among those who come down with swine flu this fall, which translates into an additional 52,000 to 86,000 deaths in the city over a three-month period, Kasdan said.

So the question is really...does Kasdan get his information from the CDC or is he just projecting incorrect numbers that he thinks are from the CDC.

Andy2000 · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

Not even in Argentina has the CFR gone to 2.
A mutation not revealed publically wouldn't give accurate enough prediction models for a CFR of 2-3. There was an article in the Washington Post quoting Marc Lipsitch (Harvard) whose been helping the CDC model H1N1 in fall.
"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."
Three things: perhaps Mr. Kasdan simply got his facts wrong. Perhaps CDC modelled the highest scenario comparable to a bird flu pandemic (category 5) and he looked at that or perhaps he was looking at bird flu preparedness plans.

Mamabird · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

Jeremy said:
The Centers for Disease Control has predicted a 2.1 percent to 3.3 percent death rate among those who come down with swine flu this fall, which translates into an additional 52,000 to 86,000 deaths in the city over a three-month period, Kasdan said.

So the question is really...does Kasdan get his information from the CDC or is he just projecting incorrect numbers that he thinks are from the CDC.

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.

Jeremy · Aug 18, 2009

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.

That may be the case....

However this statement in the article jump out at me...

Kasdan said the city medical examiner is already looking into possibly using vacant city buildings to store bodies, and the city has contracted for a unit to be built in Germany that will handle hundreds of bodies.

Based on this statement, it would appear from what Kasden is saying, is that the NYC Medical Examiner is looking at places to store bodies. Now that may just be standard operating procedure for worst case planning procedures, but the fact that they already contracted for a unit to be built in Germany to handle hundreds of bodies is interesting.

Giuseppe · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

Jeremy said:
So here are the numbers:

NYC has a population of 8.3 million people.
52,000-86,000 projected deaths
Roughly .6 to 1% mortality rate for New York City.

That would be worse than 1957.

Also, if we were to take that .6 to 1% number and use that as a baseline for the entire U.S. then you are looking at roughly 1.7 to 3 million deaths, since the U.S. has more 300 million people.

Then if we apply that number to the entire world, you are looking at roughly 40-70 million deaths, since the Earth has roughly 7 billion people.

Mind you, this is over a 3 month period.

Someone, please correct me if I am wrong on these numbers

Difficult to digest...

But if one projects there figures in all-year period of time:

86,000:3=x:12 --> 344,000 | 344,000 / 8,500,000=around 4%

If it is assumed that an half of population may fall ill then we have around 8% case-fatality rate.

If the figures above mentioned (86,000 excess deaths in three-months time) do refer to only the hospitalized cases, the data from Australia - for example may help: to date, we have had 3,650 hospitalized confirmed cases of H1N1 2009 with 118 deaths, so the rate for these patients is around 3.2%... (http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/F998919755CCCD32CA25761500153B8A/$File/bulletin180809.pdf)

Jeremy · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

If someone would like, they can email or call MetFDA and ask Kasden where he got his numbers.

http://www.metfda.org/contact.html

Snowy Owl · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

Hi Jeremie,

As for the buildings if you look at preparedness plans most big cities in much of the world have already identify the buildings and modus operandi in a worst case scenario.

Snowy

Giuseppe · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

It remains a big question: are the virological reports from southern hemisphere saying these experts that some major antigenic and/or genetic changes happened to H1N1 2009 virus subtype?

Official reports from Chile and Argentina are pointing to widespread outbreaks but no data about a death-rate above 1%, to date.

Influenza activity is declining in both these countries and so far nothing - on the press - points toward thousands or hundreds of thousands excess deaths.

So, why do US health authorities mention an higher case fatality rate, if the evidences we have from the press and from authoritative sources are against their hypothesis?

To note, finally, that H1N1 2009 continues to be re-introducted in all the world nations and countries, and doesn't remain restricted to one or two southern hemisphere locations.

Treyfish · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

You would prolly learn of it here, before CNN..and then CNN.

JimO · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

ironorehopper said:
If the figures above mentioned (86,000 excess deaths in three-months time) do refer to only the hospitalized cases, the data from Australia - for example may help: to date, we have had 3,650 hospitalized confirmed cases of H1N1 2009 with 118 deaths, so the rate for these patients is around 3.2%... (http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/F998919755CCCD32CA25761500153B8A/$File/bulletin180809.pdf)

But that would mean that one third of the population would have to be hospitalized.

JimO · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

I called and got Martin Kasden's e-mail address and sent him the article along with a request for his source.

Laidback Al · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

ironorehopper said:
It remains a big question: are the virological reports from southern hemisphere saying these experts that some major antigenic and/or genetic changes happened to H1N1 2009 virus subtype?

Official reports from Chile and Argentina are pointing to widespread outbreaks but no data about a death-rate above 1%, to date.

Influenza activity is declining in both these countries and so far nothing - on the press - points toward thousands or hundreds of thousands excess deaths.

So, why do US health authorities mention an higher case fatality rate, if the evidences we have from the press and from authoritative sources are against their hypothesis?

To note, finally, that H1N1 2009 continues to be re-introducted in all the world nations and countries, and doesn't remain restricted to one or two southern hemisphere locations.

I want to reinforce what IOH is pointing out. Right now, the Southern Hemisphere is in the middle of the influenza season and apparently novel H1N1 is the dominant strain. A look at the number of fatalities from some of these countries (e.g. Argentina 400+, Brazil 340+, Chile, 100+) simply doesn't support a high CFR in these countries. So, to re-pose the question, is there some virological data or sequences that suggest a tremendous increase in the CFR when the H1N1 virus returns in the next 60-90 days to the Northern Hemisphere?

wotan · Aug 18, 2009

N.Y.C. Funeral Directors meeting

The reporter is apparently standing by the numbers. The article apparently is an accurate description of what was stated. If it is bad it came from the presenter, not the reporter.

Commonground · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

In the absence of vaccines, one lessen that can be learnt from the South's battle with A/H1N1 is that people who belong to the high risk group should seek treatment early, best within 48 hours after they fall ill. Patients who developed serious complications or died often sought treatment too late, Larking said.

The WHO considers people with cancer, HIV/AIDS, chronic respiratory conditions, cardiac disease, diabetes, might be higher risk to the A/H1N1 influenza, along with pregnant women, the morbidly obese, and smokers.

http://www.flutrackers.com/forum/showpost.php?p=282570&postcount=1

JimO · Aug 18, 2009

Re: N.Y.C. Funeral Directors meeting

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.

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