# H1N1 burning out? Why? **URL:** \ **Category:** Great Debates\ **Created:** [December 8, 2009, 8:08pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492 "2009-12-08T20:08:26Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![WarmNPrickly](https://avatars.discourse-cdn.com/v4/letter/w/d78d45/32.png) [@WarmNPrickly](https://boards.straightdope.com/u/WarmNPrickly)\ **Post date:** [December 11, 2009, 7:44pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/41 "2009-12-11T19:44:26Z")
> [@gonzomax](#): > > The CDC quit testing because very few cases were h1n1. Can you cite this anywhere credible? I don’t mean a cite that they quit testing the strain of influenza. We all know they quit doing that as a standard in late July. Can you cite the reason behind not testing. What exactly, do you attribute the early rise of pediatric mortality to? Patients that died were in fact tested for H1N1, and 90% of them came up positive. ---
**Author:** ![PhiloVance](https://avatars.discourse-cdn.com/v4/letter/p/e19adc/32.png) [@PhiloVance](https://boards.straightdope.com/u/PhiloVance)\ **Post date:** [December 11, 2009, 7:53pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/42 "2009-12-11T19:53:04Z")
Come back, H1N1, it’s the ‘raison de etre’\* for the CDC. - [Raison d'être - Wikipedia](http://en.wikipedia.org/wiki/Raison_d%27%C3%AAtre) ---
**Author:** ![Labrador\_Deceiver](https://avatars.discourse-cdn.com/v4/letter/l/7c8e57/32.png) [@Labrador\_Deceiver](https://boards.straightdope.com/u/Labrador_Deceiver)\ **Post date:** [December 11, 2009, 8:00pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/43 "2009-12-11T20:00:13Z")
> [@WarmNPrickly](#): > > Can you cite this anywhere credible? No, becasue it’s dead wrong. They quit testing because it was the only strain of any significance in the US this fall. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [December 11, 2009, 8:00pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/44 "2009-12-11T20:00:49Z")
> [@gonzomax](#): > > They did not deny the problem. They went crazy trying to avoid it. Way overboard. It was a big thud. But that is a good thing. > The CDC quit testing because very few cases were h1n1. In fact, my understanding is that they quit testing because they were all turning up as H1N1, and seasonal flu isn’t due to start for a little while yet, so there’s no need to distinguish between the two. [The CDC says](http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm): > [@](#): > > As of September 19, 2009, more than 99% of circulating influenza viruses identified in the United States were 2009 H1N1 influenza (previously referred to as novel influenza A (H1N1)). Meanwhile, the [CDC says](http://www.cdc.gov/h1n1flu/diagnostic_testing_public_qa.htm) that most people aren’t tested lately because it won’t change your disease treatment, and the previous link has their guidelines on who it is important to test, which includes the hospitalized who are suspected to have influenza, pregnant women, and those with weakened immune systems. The medical center where I work is still on extended H1N1 precautions. Personnel who haven’t been vaccinated against seasonal and H1N1 influenza have to wear masks when involved in patient care. People entering the hospital have to be screened for flu-like symptoms, and children and teens are not allowed to visit inpatients unless there are dramatic extenuating circumstances (close family member dying, that kind of thing). Chicago has had at least one previously-healthy pregnant woman die due to complications from H1N1, and there is some evidence that [it seems to affect pregnant women substantially more than chance would suggest](http://www.chicagonow.com/blogs/doctors-next-door/2009/10/should-pregnant-women-really-get.html): “As a matter of fact, during about a month long study period last spring when H1N1 first appeared, pregnant women accounted for only 0.62% of confirmed and probable H1N1 cases. However, they accounted for 13% of the deaths.” As I cited above, the CDC considers pregnant women with possible influenza to be a group to definitively test. H1N1 is not a joke. It’s not a scourge killing all in its path, either, but that is no reason for you to spread blatantly incorrect information about it. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 11, 2009, 10:28pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/45 "2009-12-11T22:28:35Z")
[Actually](http://www.cdc.gov/flu/weekly/) there is still a fair amount of testing going on, just not most cases. Of the 478 positive specimens 98.5% are still Pandemic A/H1N1. Of note however is that we are starting to see the usual few positives for seasonal influenzas, even one influenza B pediatric death - which makes one less hopeful that H1N1 was _instead_ of the usual flu season. We also meanwhile continue to see total pneumonia and influenza dearths in the range that we normally see at the peak of seasonal influenza season (usually end of February to early March). OTOH percent outpatient visits are down. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 12, 2009, 2:35am UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/46 "2009-12-12T02:35:54Z")
[http://www.cbsnews.com/stories/2009/10/21/cbsnews\_investigates/main5404829.shtml](http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml) I know you want to believe . Go ahead but this news story says otherwise. More, it says most tests show not only that it is not h1n1 but not even the flu . Do you people have a scintilla of skepticism or do you just believe what you hear. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [December 12, 2009, 3:50am UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/47 "2009-12-12T03:50:07Z")
> [@gonzomax](#): > > [http://www.cbsnews.com/stories/2009/10/21/cbsnews\_investigates/main5404829.shtml](http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml) I know you want to believe . Go ahead but this news story says otherwise. That cite was from October, which is well before normal flu season. How about a more recent link from the same source? Oh, [here’s one](http://www.cbsnews.com/video/watch/?id=5964424n&tag=contentMain;contentBody). ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 12, 2009, 5:10am UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/48 "2009-12-12T05:10:20Z")
Gonz, indeed the Feds advised that the states stop testing every case, [however](http://scienceblogs.com/effectmeasure/2009/10/cbs_news_on_swine_flu_testing.php?utm_source=combinedfeed&utm_medium=rss) “the pressure on CDC to stop the testing was coming from the states, not the other way around. It’s no secret that state health departments are hard pressed to keep their heads above water financially and are short staffed all around. Expensive swine flu testing was something they couldn’t afford.” (More at the link about the article and how they got it wrong.) That article does not bring any information to bear as to what the true total number of cases are. Still there is a meaningful point there: we clinicians turn out to be pretty piss poor at diagnosing who does and does not have influenza clinically and the testing available to us is even worse. We no doubt miss a lot of atypical cases and mislabel a host of other viruses as influenza when they are not. Fortunately most will get better either way but when there is a lot of true H1N1 around we are better off treating a high risk individual if they might be H1N1 then we are risking missing that opportunity. And in the early phases we tested a lot just to see what the spectrum of disease might look like. That was not sustainable. [Here](http://www.wdsu.com/health/21921287/detail.html) are the current best estimates. > [@](#): > > Swine flu has sickened about 50 million Americans, and killed about 10,000, according to new estimates released by federal health officials on Thursday. > > That means about 1 in 6 Americans have had the illness … The CDC also estimates that nearly 200,000 people were hospitalized through mid-November – about the same amount that occurs normally in an entire winter flu season. > > While the elderly account for most of the hospitalizations and deaths from seasonal flu, the largest proportion of reported swine flu hospitalizations and deaths are in non-elderly adults, CDC officials said. > > More than three-quarters of the deaths were people ages 18 to 64, according to the CDC. … it’s likely the new estimate is conservative, and undercounts elderly deaths, CDC officials acknowledged. > > Even so, the number of hospitalizations and deaths of younger people from swine flu far exceed what normally occurs in the same ages from the winter flu. > > “This flu is much harder on younger people,” Frieden said at a press conference in Atlanta. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 12, 2009, 5:12am UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/49 "2009-12-12T05:12:28Z")
[http://liveshots.blogs.foxnews.com/2009/12/08/study-h1n1-may-be-less-severe-than-feared/](http://liveshots.blogs.foxnews.com/2009/12/08/study-h1n1-may-be-less-severe-than-feared/) From this week. Is that current enough? ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 12, 2009, 5:16am UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/50 "2009-12-12T05:16:08Z")
[http://blogs.abcnews.com/george/2009/05/cdc-encouraging.html](http://blogs.abcnews.com/george/2009/05/cdc-encouraging.html) From the CDC. ---
**Author:** ![dropzone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dropzone/32/7515_2.png) [@dropzone](https://boards.straightdope.com/u/dropzone)\ **Post date:** [December 12, 2009, 5:24am UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/51 "2009-12-12T05:24:13Z")
Came here to post Doc **DSeid** ’s numbers. Now I would like to poinch’all back at them. One sixth of the population is significant, especially when so many were, prior to infection, healthy, young people. [Grandpa Simpson]I was at a local historical society and say a portrait on the wall of a Grunt who had served in France as an artilleryman until his death in October, 1918. I asked the docent if he had died of the flu. “Why, yes! How did you guess?” :rolleyes: ☹ [/Grandpa Simpson] ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 12, 2009, 5:25am UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/52 "2009-12-12T05:25:53Z")
> [@gonzomax](#): > > [http://liveshots.blogs.foxnews.com/2009/12/08/study-h1n1-may-be-less-severe-than-feared/](http://liveshots.blogs.foxnews.com/2009/12/08/study-h1n1-may-be-less-severe-than-feared/) From this week. Is that current enough? You do know that’s the same study you already linked to in post #19, just in a different write up, don’t you? And already discussed at that time?:rolleyes: And the next link? An article from MAY that quotes the CDC as _downplaying_ the virulence of this pandemic but that things were still uncertain enough to warrant aggressive caution? Boy that supports your contention that the CDC stoked panic, told everyone it was supposed to be extremely virulent, and overreacted. Do you even read what you link to? ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 12, 2009, 2:37pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/53 "2009-12-12T14:37:26Z")
> [@dropzone](#): > > Came here to post Doc **DSeid** ’s numbers. Now I would like to poinch’all back at them. > > One sixth of the population is significant, especially when so many were, prior to infection, healthy, young people. > > [Grandpa Simpson]I was at a local historical society and say a portrait on the wall of a Grunt who had served in France as an artilleryman until his death in October, 1918. I asked the docent if he had died of the flu. > > “Why, yes! How did you guess?” :rolleyes: ☹ > [/Grandpa Simpson] 1/6th of the population is the point in contention. I do see people believing what they have been told. The fears you are expressing are last years news. We were told that it was going to come back more dangerously. But it did not.The numbers are far less than anticipated. That is pretty clear. You bought the fear. They sold it well. But it did not happen. The deaths are far below normal flu deaths. The cases are well over reported. It just did not happen. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 12, 2009, 2:45pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/54 "2009-12-12T14:45:30Z")
[Suite 101 - How-tos, Inspiration and Other Ideas to Try](http://generalmedicine.suite101.com/article.cfm/h1n1_virus_in_perspective_there_is_good_news) The Canadians can be more level headed . It is just a flu and not a very bad one. ---
**Author:** ![WarmNPrickly](https://avatars.discourse-cdn.com/v4/letter/w/d78d45/32.png) [@WarmNPrickly](https://boards.straightdope.com/u/WarmNPrickly)\ **Post date:** [December 12, 2009, 3:52pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/55 "2009-12-12T15:52:05Z")
As far as I can tell, that is what the CDC has said all of the time **gonzomax**. I think the problem is you are selectively hearing what the CDC is saying. You’re hearing about increased mortality and large numbers of hospitalizations, but confusing that with H1N1 being a more serious illness. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [December 12, 2009, 5:07pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/56 "2009-12-12T17:07:11Z")
> [@gonzomax](#): > > 1/6th of the population is the point in contention. I do see people believing what they have been told. The fears you are expressing are last years news. We were told that it was going to come back more dangerously. But it did not.The numbers are far less than anticipated. That is pretty clear. First, the fact that the numbers are less than anticipated isn’t true, because there have already been a lot more hospitalizations and deaths than for the typical flu for this time of the year. And **do** you understand that the peak of the flu season, which is when the bulk of deaths occur, is still over a month away? You know, those 40,000 deaths a year mainly occur during the middle of the actual winter, not during the fall which it still is - you can’t compare the number of deaths so far to what typically happens when there are still four more months of data to be collected. H1N1 isn’t a magical summer-fall flu and it’ll be sticking around for the normal duration, so it’s impossible to say yet if the predictions were accurate until April, when the flu season is over. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [December 12, 2009, 5:11pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/57 "2009-12-12T17:11:52Z")
[From the N.Y. Times today](http://www.nytimes.com/2009/12/11/health/11flu.html): \*" Federal health officials said Thursday that almost 10,000 people had died of swine flu since April, a significant jump from mortality numbers released last month…Several flu experts said they were not shocked by the sudden jump because the new figures were as of Nov. 14, when this fall’s wave of swine flu cases was reaching its peak…How many will ultimately die of the H1N1 flu depends heavily on whether there is a third wave in January, as happened in the 1918 and 1957 pandemics, and on whether the virus changes to be more lethal or drug-resistant…Mr. Osterholm was troubled by recent predictions that the pandemic would be the mildest on record. “So the C.D.C. says 50 million have been infected so far,” he said. “Another 50 million have been vaccinated. And maybe 20 million have got innate immunity because of their age. You do the math — that’s 120 million who are immune out of 320 million, so two-thirds of the population is still not immune. It’s amazing how many people are acting as if this is all wrapped up. The numbers could still go up dramatically.” Dr. Arnold S. Monto, a flu expert at the University of Michigan School of Public Health, said the flu might reach the lower end of a widely publicized forecast made in August by the President’s Council of Advisers on Science and Technology, which predicted 30,000 to 90,000 deaths. Deaths appear to be lower than expected, Dr. Monto said, partly because young victims are better able to tolerate the aggressive drug and oxygen therapy used in hospitals to save those with overwhelming pneumonia… Dr. Frieden said Thursday that all the experts he consulted were divided over whether the country would have a January wave. “Half think we will,” he said, “and half think we won’t.”\* > [@gonzomax](#): > > I do see people believing what they have been told. The fears you are expressing are last years news. We were told that it was going to come back more dangerously. But it did not.The numbers are far less than anticipated. That is pretty clear. You bought the fear. They sold it well. What was “their” nefarious purpose here, **gonzomax**? To get people concerned enough to protect themselves as much as possible, to prevent serious illness and save lives, and to forestall a worst-case scenario? The fiends! Here I am, vaccinated against usual seasonal flu and H1N1 influenza, and it might turn out to have been an unnecessary precaution. It’s as if I evacuated my home due to the threat of a powerful hurricane, only to find that the storm didn’t strengthen to category 5 levels as fast as predicted or show definite signs of steering a course directly for my house. To hell with those forecasters, I’ll ignore them from now on! ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [December 12, 2009, 5:12pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/58 "2009-12-12T17:12:20Z")
> [@gonzomax](#): > > [http://blogs.abcnews.com/george/2009/05/cdc-encouraging.html](http://blogs.abcnews.com/george/2009/05/cdc-encouraging.html) From the CDC. That was from **May**. (Sorry, missed **DSeid** ’s noting of that.) And the Canadian link says that the **media** (not agencies that monitor diseases) were freaking out a tad too much, which is not hard to believe. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 12, 2009, 5:48pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/59 "2009-12-12T17:48:34Z")
[http://www.freep.com/article/20091208/FEATURES08/91207072/1033/Swine-flu-far-less-severe-in-latest-calculations](http://www.freep.com/article/20091208/FEATURES08/91207072/1033/Swine-flu-far-less-severe-in-latest-calculations) Yep it is being downgraded yet again. It was a thud. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 12, 2009, 7:56pm UTC](https://boards.straightdope.com/t/h1n1-burning-out-why/520492/60 "2009-12-12T19:56:17Z")
Do you really not realize that that’s the third article you’ve posted talking about the [same study](http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000207), each time presenting it as something new? Since you seem to be so impressed with the study that you post three separate articles about it on three separate occasions, you may actually want to read the actual thing. It actually was a prediction of what this Fall was going to look like made before the Fall happened, based on its behavior in the Spring. > [@](#): > > These estimates suggest that an autumn–winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0–4 and adults 18–64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed… > > … these findings, along with surveillance data on the age-specific rates of hospitalization and death in this pandemic ([http://www.cdc.gov/vaccines/recs/ACIP/do​wnloads/mtg-slides-oct09/12-2-flu-vac.pd​f](http://www.cdc.gov/vaccines/recs/ACIP/do%E2%80%8Bwnloads/mtg-slides-oct09/12-2-flu-vac.pd%E2%80%8Bf) ), indicate that the burden of hospitalization and mortality in this pandemic falls on younger individuals than in seasonal influenza [21]. A shift in mortality toward nonelderly persons has been observed in previous pandemics and the years that immediately followed them [22]. > > These estimates are valuable for attempting to project, in approximate terms, the possible severity of a fall–winter wave of pH1N1, under the assumption that the virus does not change its characteristics. In the 1957 and 1968 pandemics, it appears that perhaps 40%–60% of the population was serologically infected, and that of those, 40%–60% were symptomatic [2],[23]–[25]. Current estimates of the transmission of pH1N1 range between about 1.4 and about 2.2, consistent with estimates of the reproduction numbers from prior pandemics [26]–[30]. To convert our estimates into population impacts, one needs to make an assumption about the attack rate and its age distribution. For each 10% of the US population symptomatically infected (with the same age distribution observed in the spring wave), our Approach 1 estimates suggest that approximately 7,800–29,000 deaths (3–10 per 100,000 population), 40,000–140,000 intensive care admissions (13–46 per 100,000 population), and 250,000–790,000 hospitalizations (170–630 per 100,000 population) will occur. These estimates scale up or down in proportion to the attack rate; for example, they should be doubled if 20% of the population were symptomatic, producing for example 15,000–58,000 deaths (6–20 per 100,000 population). Approach 2 suggests much smaller figures (for each 10% of the population symptomatic) of 1,500–2,700 deaths (0.5–0.9 per 100,000), 6,600–11,000 ICU admissions/uses of mechanical ventilation (22–35 per 100,000), and 36,000–78,000 hospitalizations (12–26 per 100,000). Again, these numbers should be scaled in proportion to the attack rate. … > > … The estimates provided here may be compared to those for seasonal influenza. Compared to seasonal influenza, these estimates (assuming a 25% symptomatic attack rate) suggest a number of deaths in the US that could range from about half the number estimated for an average year to nearly twice the number estimated for an average year [33] (Approach 1), or a range about 10-fold lower than that (Approach 2); however, the deaths would be expected to occur in younger age groups, compared to the preponderance of deaths in persons over 65 in seasonal influenza. Such a shift in age distribution is typical for pandemics and the years that follow them [22]. Under Approach 1, and assuming a typical pandemic symptomatic attack rate of 25%, the estimated number of hospitalizations for an autumn–winter pandemic wave is considerably more than the approximately 300,000 estimated for typical seasonal influenza [34], whereas Approach 2 suggests a number between 1/3 and 2/3 of that observed in typical seasonal influenza. It should be noted that most hospitalizations, and about 90% of deaths attributed to seasonal influenza, are categorized as respiratory and circulatory, not including the more specific diagnoses of pneumonia and influenza; that is, they are due to myocardial infarction, stroke, and other proximate causes, but are nonetheless likely initially caused by influenza infection [35]. The deaths included in our study may have reflected more directly influenza-related causes and may not reflect these indirect causes of influenza-related death. Indeed, it is unclear whether the proportion of indirect respiratory and circulatory causes of death and hospitalization will be as high in this pandemic year, given the younger ages involved in most severe cases. Given these differences between the estimates here based on virologically confirmed deaths and the ecological statistical approach to estimating influenza-attributable deaths and hospitalizations for seasonal influenza, it will be difficult to interpret comparisons between the two types of estimates until (after the pandemic has finished) comparisons can be made between the ecological and the confirmed-case approach to estimating burden of hospitalization and deaths. In case you found that hard to follow, they took the behavior of Pandemic A/H1N1 during the first wave and, before the Fall, extrapolated to a Fall wave with some major assumptions. Their model _predicted_ that the Fall H1N1 wave would spare the elderly, who have the highest mortality rates from influenza most years, and instead hit the young, who normally do not die from influenza. The total death rates that would result could be less than or more than the usual seasonal influenza death rate depending on how it actually behaves in the Fall (by now behaved) but would be shifted to the younger populations. In other words this study is just another model that predicted what we have observed - the elderly are spared from H1N1 and those under 65 are at much greater risk than during typical years. Or as the CDC just stated on the basis of data from the Fall wave “the number of hospitalizations and deaths of younger people from swine flu far exceed what normally occurs in the same ages from the winter flu.” Again, the still open question is what happens from here. Does it behave like other pandemics have and come back sometime between January and March? Does it mutate? Does it recombine? Does it just fizzle away from here? Do we get spared the usual seasonal influenza this year or do we get it either with or without another H1N1 wave? As one of your links quoted Besser of the CDC saying back in May so it is still today: > [@](#): > > I don’t think it’s time to let our guard down. I think we have to continue to be aggressive in an uncertain situation [Previous page](https://boards.straightdope.com/t/h1n1-burning-out-why/520492.md?page=2) [Next page](https://boards.straightdope.com/t/h1n1-burning-out-why/520492.md?page=4)