Scotland: Swine flu death brings total to 47 (CFR concerning)

[Hogweed]

http://www.google.com/hostednews/ukpress/article/ALeqM5gL2P8f4upUWubd8i1r7C_PZVS2bA

Swine flu death brings total to 47

(UKPA) ? 1 hour ago

There has been another swine flu death in Scotland - the seventh reported case this week.

An adult from the Ayrshire area is the latest victim and brings the total number of deaths in Scotland to 47, health bosses said.

The patient had an underlying health condition.

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

I am getting increasingly concerned at the CFR. Based on the latest stats from NHS Scotland roughly 20,000 new cases of swine flu are estimated a week in Scotland at the moment (in total - not number consulting a doctor which is only about 7,500 per week) and that's been fairly constant for the last few weeks. Death rate has been increasing in recent weeks and is now running at between 5 and 10 per week (lab confirmed). Now lab confirmed will be an undercount so if the estimated cases figure is correct then CFR is roughly a minimum of 0.02%-0.05% and continuing to climb towards 0.1%. If you take the CFR based on the number of people with actual recorded ILI (the traditional method) then the rate is already about 0.1%. If you assume that a number of deaths are being missed because they are not lab confirmed then the CFR will be even higher than that.

Whatever the exact figure these are far, far higher estimated CFR numbers than were noted previously in the UK. We already know there's increasing Tamiflu resistance in the UK but I continue to wonder if D225G is also present.

 

[ming]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Keep me updated HW and thanks for all your work - I don't understand the technical bits but I am very interested and aware. I get no feeling of confidence from our local health board or council, who don't seem to know what's going on at all.

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Keep me updated HW and thanks for all your work - I don't understand the technical bits but I am very interested and aware. I get no feeling of confidence from our local health board or council, who don't seem to know what's going on at all.

Put simply, In Scotland there is roughly 1 death for every 1000 people consulting a doctor with Influenza symptoms at the moment.

That was the figure the UK used for the "reasonable worse case" scenario published this summer. Just a few weeks ago that was drastically revised down. Since they revised it down the recorded rates have started rising considerably UK-wide. Based on the latest revised "worst case" figures Scotland would be expected to have about 50 deaths in total but we are now at 47 but with the vast majority of the population still uninfected.

 

[Snowy Owl]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Hogweed and Ming,

CFR is expected at 1% from infections, from a McIsaac point of view, all is OK.

Today in Press Conference Up Here in Qu?bec, Scot Highlands temp, the scarf covering the mouth and nose is becoming for about 3 months the rules of the game.

You are OK

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Hogweed and Ming,

CFR is expected at 1% from infections, from a McIsaac point of view, all is OK.

Today in Press Conference Up Here in Québec, Scot Highlands temp, the scarf covering the mouth and nose is becoming for about 3 months the rules of the game.
You are OK

1% - 1 in a hundred? Are you meaning lab confirmed? A death rate of 1% of those infected would be approaching 1918 territory. The ratio of deaths to lab confirmed cases is though in the region of 1% in Scotland at the moment.

47 confirmed deaths in Scotland would be equal to 310 lab confirmed deaths in Canada but Scotland has never reached anything like the ILI levels recorded in Canada so far.

Weather forecast is for a big drop in temperature in Scotland (and most of the UK) this weekend so scarves sound an excellent idea.

 

[Mathematician]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Death rate has been increasing in recent weeks and is now running at between 5 and 10 per week (lab confirmed).

Huh? A quick check of the HPS weekly reports at
http://www.hps.scot.nhs.uk/resp/swineinfluenza.aspx
gives cumulative death numbers going back the last few weeks as 42, 38, 33, 31, i.e., in the last month it's been as high as 5 ONCE and never higher.

FWIW, just comparing the number consulting a GP with the number estimated to have been infected, I don't believe their modelling as far as total infected goes. Their estimate for total infected tends to be less than 3 times the number who consulted a GP. Just looking around me at the behaviour of people I know, I find it hard to believe that anything *like* 1 in 3 people with ILI consults a GP (and that's without considering the people infected with H1N1v who don't have symptoms serious enough to count as ILI, which would seem to be a significant fraction, going on the latest seroprevalence results from England). So my armchair guess is that their estimates for number of people infected are serious underestimates.

 

[Missouriwatcher]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

"This suggests that currently there is no cause for concern in the current daily reporting pattern. Numbers of deaths are consistent with historical figures for this time of year.

The number of hospitalised cases has almost doubled during the past four weeks ? with an average of 144 cases per week since week 43 (19 to 26 October).

A high proportion of patients admitted to hospital were known to have underlying diseases, including chronic respiratory disease, diabetes or immunosuppression."

Death by age-group is also shown
http://www.documents.hps.scot.nhs.u...eports/weekly-influenza-sitrep-2009-11-26.pdf

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Huh? A quick check of the HPS weekly reports at
http://www.hps.scot.nhs.uk/resp/swineinfluenza.aspx
gives cumulative death numbers going back the last few weeks as 42, 38, 33, 31, i.e., in the last month it's been as high as 5 ONCE and never higher.

Yes but there have now been 5 deaths reported in the last two days since the report came out. So next week's total will be at least 5 deaths and I suspect more like 10 so that why I went with 5-10 per week as a current figure - will see over the next few weeks.

FWIW, just comparing the number consulting a GP with the number estimated to have been infected, I don't believe their modelling as far as total infected goes. Their estimate for total infected tends to be less than 3 times the number who consulted a GP. Just looking around me at the behaviour of people I know, I find it hard to believe that anything *like* 1 in 3 people with ILI consults a GP (and that's without considering the people infected with H1N1v who don't have symptoms serious enough to count as ILI, which would seem to be a significant fraction, going on the latest seroprevalence results from England). So my armchair guess is that their estimates for number of people infected are serious underestimates.

They are using the same methodology used in the rest of the UK. The number attending a doctor with ILI is reduced by the sentinel positivity rate so it would be assumed that maybe only about 3000 cases are actual H1N1 which is more like 1 in 7 cases consulting rather than the 1 in 3 you state above. Also keep in mind that most of these cases are young children and parents are more likely to seek attention for their kids.

I can only presume they know what they are doing...

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

"This suggests that currently there is no cause for concern in the current daily reporting pattern. Numbers of deaths are consistent with historical figures for this time of year.

You would not expect the number of deaths from all causes to be out of line with previous years as expected deaths from all causes figure for this week ("historical figures for this time of year") is around 120-180 deaths per day and a death rate of 5-10 per week from swine flu would not be noticed. You'd need about 40 deaths per day to make a dent in that wide a range.

 

[Missouriwatcher]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

The CDC was figuring CFR as deaths divided by number of hospitalizations.

According to the Scottish website (http://www.documents.hps.scot.nhs.u...eports/weekly-influenza-sitrep-2009-11-26.pdf), there have been 1100 hospitalizations since week 27 and 42 deaths. Using these numbers, gives a CFR of .038 or 3.8%. The highest CFR's look to be in the over 60; 50-59; and 40-49 (based on the graph). Ages 0-4 would be the smallest CFR.

US shows as CFR @.059 or 5.9%. For ages 65 and over @ 10%; 50-64 @ 13%; 25-49 @ 8%; 0-4 @ 1%.
http://www.cdc.gov/h1n1flu/in_the_news.htm#c

Even if numbers of deaths and hospitalizations are understated, one can roughly figure the CFR on these figures and assume they apply to the higher numbers. Remember, these are only for hospitalizations compared to deaths.

After reading post below, this is called the hospitalization death rate, although a one time CDC had documents stating this as CFR.

 

[ming]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Missouri, we have a head count of 47, and a population of only 5 million. This is way higher than Norway with the same population, is it not ? Nobody else seems to think so or even have noticed this !

 

[Snowy Owl]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Ming again emphasis on scarf, when the temperature of the nose is below 37 degrees celsius it allows the virus to replicate easely.

Covering your nose (2,3 binding site) and mouth (2,6 binding site) is the best.

Snowy

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

The CDC was figuring CFR as deaths divided by number of hospitalizations.

According to the Scottish website (http://www.documents.hps.scot.nhs.u...eports/weekly-influenza-sitrep-2009-11-26.pdf), there have been 1100 hospitalizations since week 27 and 42 deaths. Using these numbers, gives a CFR of .038 or 3.8%. The highest CFR's look to be in the over 60; 50-59; and 40-49 (based on the graph). Ages 0-4 would be the smallest CFR.

US shows as CFR @.059 or 5.9%. For ages 65 and over @ 10%; 50-64 @ 13%; 25-49 @ 8%; 0-4 @ 1%.
http://www.cdc.gov/h1n1flu/in_the_news.htm#c

Even if numbers of deaths and hospitalizations are understated, one can roughly figure the CFR on these figures and assume they apply to the higher numbers. Remember, these are only for hospitalizations compared to deaths.

That's the hospitalization fatality rate which is distinct from CFR which has a specific meaning. It seems that more people are being hospitalized per case now. though with rates having doubled in recent weeks.

Just to expand up Scotland's lab-confirmed swine Flu deaths would equal a US total of 3000 lab confirmed deaths (about twice the US actual lab confirmed figure) but the US has already peaked at quite a high level and Scotland is supposedly barely above background for the time of year.

Here's the Scottish historical comparison ILI chart. Note according to this Scotland hasn't even got above seasonal peak from last year and the US peaked (for now anyway) at over double last year's seasonal peak.

Now note the colour of Scotland on the latest WHO ILI map. It's just yellow for "medium" (and was low until two weeks ago) but has had more confirmed deaths per population than any of the countries marked "High" or "Very High"

 

[Missouriwatcher]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

WHO numbers seem to be at least 3 weeks behind what is currently happening. Maybe Scotland is not reporting to WHO as rapidly as others.

 

[ming]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

We have 47 deaths, 7 in the last week .

 

[Snowy Owl]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

This is normal Ming, obviously not in this time but it is less then seasonnal flu.

Check it out (Edimburg University.

Snowy

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

WHO numbers seem to be at least 3 weeks behind what is currently happening. Maybe Scotland is not reporting to WHO as rapidly as others.

No these are the latest figures for the latest week (and the Scottish rate has been slightly declining in the last few weeks). I have to say I have some "issues" with them (more later when I have time) in any case but even so, supposedly Norway has many times the number of cases as Scotland but with fewer deaths yet everyone is looking at Norway and Ukraine etc.

 

[Hogweed]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

This is normal Ming, obviously not in this time but it is less then seasonnal flu.

Check it out (Edimburg University.

Snowy

It is possible that Scotland is just better at lab-confirming suspected deaths which is why the death rate looks higher than other countries. The Scottish confirmed death rate per head of population is triple that of England for comparison and yet we are all on the same island.

 

[Missouriwatcher]

Re: Scotland: Swine flu death brings total to 47 (CFR concerning)

Ming, the majority of cases have been "mild" (not hospitalized). In US, 70% of hospitalized cases had underlying conditions. Unfortunately, some of these cases succumb more readily to H1N1.

Scotland lists cause of death, in 2004:
Influenza: 3
Pneumonia: 2,399
Chronic lower respiratory diseases: 2,907
Asthma: 94

http://www.gro-scotland.gov.uk/files/04t6-1.pdf