Shiloh
Editor, Senior Moderator
Source: http://www.thespec.com/News/CanadaWorld/article/586508
'Pretty healthy' people dying from H1N1
June 20, 2009
Stories by Helen Branswell
The Canadian Press
TORONTO (Jun 20, 2009)
Whether speaking of a 58-year-old man or a 38-year-old woman or a little boy of nine, officials announcing swine flu deaths are almost always quick to note "underlying health conditions" may have contributed to the fatal outcome.
Asthma, heart disease, diabetes, maybe even obesity are among the conditions used to help explain why swine flu infection is hospitalizing and killing younger people, people who would be expected to make a full recovery from seasonal flu.
It could create the impression that only the sickly are dying from the new H1N1 flu virus -- a claim no one is making. To the contrary, many, including the World Health Organization, say between one-third and one-half of swine flu deaths have occurred in people who were previously healthy.
But how healthy is previously healthy? The answer depends on whom you ask.
Dr. Anand Kumar is a critical-care specialist who has been treating swine flu cases in embattled intensive care units in three Winnipeg hospitals.
He says a small portion of the ICU patients look like flu's typical victims, people with health conditions known to be badly exacerbated by a bout of influenza. But more are younger and -- until they got sick -- healthier than flu patients hospitals typically see during a regular influenza season.
"For the most part, these young, relatively healthy people aren't marathon runners or anything like that," he admits.
"They're normal people. ... If you asked them, 'Are you healthy?' they'd say, 'Yeah, pretty healthy."'
Dr. Michael Gardam, head of infectious disease prevention and control for Ontario's public health agency, believes the constant refrain of "underlying conditions" bespeaks a sort of wishful thinking, an attempt to explain away the unusual age range of the people the new virus is sending to hospital or to the morgue.
"That's the story that I think people haven't really registered," says Gardam. "We're clinging to these 'Oh, they had underlying illness, therefore it's OK."'
"But ... I would argue that the 30-year-old with mild asthma -- how big of an underlying illness is that compared to again the 80-year-old person with bad lung disease from smoking who's got heart disease? That's the usual group that unfortunately gets really sick with flu, not this healthy adult group."
You'll find little argument that this virus, at this time, is causing more severe disease in people far younger than those normally hospitalized and killed by flu or its complications in a typical flu season.
"This is not a disease of older adults. There's no question," says Dr. Allison McGeer, an influenza expert with Toronto's Mount Sinai Hospital.
"For people under 50, this is a significantly more severe disease than seasonal flu. For people over 50, it's much better," she notes.
But are the people under 50 who are being badly hit by the virus specimens of perfect health or are many of them already shaded by the broad umbrella known as "pre-existing health conditions?" How you view a condition like asthma -- seen in 41 per cent of the hospitalized cases in New York City -- may influence how you answer that question.
"A lot of that is about labelling people," McGeer admits.
"Half of me doesn't want you to think you're diseased if you have asthma, and the other half of me wants you to get your flu vaccine because you're at increased risk."
"How do you walk that line?"
Year in and year out, public health authorities get plenty of evidence many people who have some health issues plunk themselves firmly on the "healthy" side of the divide.
Scads of people with asthma, diabetes and other conditions and women who are pregnant forego the flu shots public health officials urge them to get, suggests Dr. Scott Harper, an influenza expert with New York City's Department of Health.
"The majority of deaths that are being seen have well recognized underlying health risks," he insists.
One such potential new risk factor is obesity. An early study from the U.S. Centers for Disease Control suggested it may be contributing to poor outcomes in people who contract the new H1N1. The WHO is concerned about that possibility.
"Obesity is now a huge global problem," says Dr. Nikki Shindo, an expert with the WHO's global influenza program.
"And if obesity is a risk factor, then I would be very much worried about some of the populations that are living with obese conditions."
'Pretty healthy' people dying from H1N1
June 20, 2009
Stories by Helen Branswell
The Canadian Press
TORONTO (Jun 20, 2009)
Whether speaking of a 58-year-old man or a 38-year-old woman or a little boy of nine, officials announcing swine flu deaths are almost always quick to note "underlying health conditions" may have contributed to the fatal outcome.
Asthma, heart disease, diabetes, maybe even obesity are among the conditions used to help explain why swine flu infection is hospitalizing and killing younger people, people who would be expected to make a full recovery from seasonal flu.
It could create the impression that only the sickly are dying from the new H1N1 flu virus -- a claim no one is making. To the contrary, many, including the World Health Organization, say between one-third and one-half of swine flu deaths have occurred in people who were previously healthy.
But how healthy is previously healthy? The answer depends on whom you ask.
Dr. Anand Kumar is a critical-care specialist who has been treating swine flu cases in embattled intensive care units in three Winnipeg hospitals.
He says a small portion of the ICU patients look like flu's typical victims, people with health conditions known to be badly exacerbated by a bout of influenza. But more are younger and -- until they got sick -- healthier than flu patients hospitals typically see during a regular influenza season.
"For the most part, these young, relatively healthy people aren't marathon runners or anything like that," he admits.
"They're normal people. ... If you asked them, 'Are you healthy?' they'd say, 'Yeah, pretty healthy."'
Dr. Michael Gardam, head of infectious disease prevention and control for Ontario's public health agency, believes the constant refrain of "underlying conditions" bespeaks a sort of wishful thinking, an attempt to explain away the unusual age range of the people the new virus is sending to hospital or to the morgue.
"That's the story that I think people haven't really registered," says Gardam. "We're clinging to these 'Oh, they had underlying illness, therefore it's OK."'
"But ... I would argue that the 30-year-old with mild asthma -- how big of an underlying illness is that compared to again the 80-year-old person with bad lung disease from smoking who's got heart disease? That's the usual group that unfortunately gets really sick with flu, not this healthy adult group."
You'll find little argument that this virus, at this time, is causing more severe disease in people far younger than those normally hospitalized and killed by flu or its complications in a typical flu season.
"This is not a disease of older adults. There's no question," says Dr. Allison McGeer, an influenza expert with Toronto's Mount Sinai Hospital.
"For people under 50, this is a significantly more severe disease than seasonal flu. For people over 50, it's much better," she notes.
But are the people under 50 who are being badly hit by the virus specimens of perfect health or are many of them already shaded by the broad umbrella known as "pre-existing health conditions?" How you view a condition like asthma -- seen in 41 per cent of the hospitalized cases in New York City -- may influence how you answer that question.
"A lot of that is about labelling people," McGeer admits.
"Half of me doesn't want you to think you're diseased if you have asthma, and the other half of me wants you to get your flu vaccine because you're at increased risk."
"How do you walk that line?"
Year in and year out, public health authorities get plenty of evidence many people who have some health issues plunk themselves firmly on the "healthy" side of the divide.
Scads of people with asthma, diabetes and other conditions and women who are pregnant forego the flu shots public health officials urge them to get, suggests Dr. Scott Harper, an influenza expert with New York City's Department of Health.
"The majority of deaths that are being seen have well recognized underlying health risks," he insists.
One such potential new risk factor is obesity. An early study from the U.S. Centers for Disease Control suggested it may be contributing to poor outcomes in people who contract the new H1N1. The WHO is concerned about that possibility.
"Obesity is now a huge global problem," says Dr. Nikki Shindo, an expert with the WHO's global influenza program.
"And if obesity is a risk factor, then I would be very much worried about some of the populations that are living with obese conditions."
