| last update: Oct 23, 2008
Potential number of fatalities: One of the most serious and seemingly widespread misconceptions is that in the "worst case scenario" for an H5N1 pandemic, the number of U.S. human fatalities would be about 1.9 million (e.g., CNN: http://www.cnn.com/2006/HEALTH... ) In truth, it is not possible to rule out that in a worst case pandemic the number of U.S. fatalities could be much greater.
Tara O'Toole, M.D., MPH, and Director of the University of Pittsburgh Medical Center's Center for Biosecurity, has reportedly speculated that 40 million Americans could die (Washington Post: http://www.washingtonpost.com/... ).
And not everyone agrees with him, but one of the world's foremost flu scientists, Robert Webster, has been quoted as saying, "50 percent of the population could die." He also reportedly said that he had stored a three months supply of food and water at his home in case of an outbreak (ABC News: http://abcnews.go.com/WNT/Avia... ).
According to World Health Organization (WHO) statistics, the overall CFR (case fatality rate - the percentage who die after coming down with a case of flu) has been over 60% for the laboratory-confirmed H5N1 cases that have occurred so far. In the three previous flu pandemics (1918, 1957, 1968) the AR (attack rate - the percentage of the population that become ill) in the previous three flu pandemics has been roughly 30% (federal government document (Fig 3a): http://www.pandemicflu.gov/pla... ). Assuming an AR of 30%, a CFR of 60%, and a US population of 300,000,000, this would work out to over 50 million deaths.
The Center for Infectious Disease Research and Policy (CIDRAP) has pointed out that the CFR is "a single criterion that will likely be known even early in a pandemic when small clusters and outbreaks are occurring" (CIDRAP: http://www.cidrap.umn.edu/cidr... ).
Indonesia is the nation that has so far experienced the most laboratory-confirmed human cases of H5N1 bird flu (130), with a CFR of over 80% (WHO: http://www.who.int/csr/disease... ). One of the best-known clusters of cases was a familial cluster of seven laboratory-confirmed cases in north Sumatra in April-May '06. Six died (U.S. government: http://www.pandemicflu.gov/pla... ; scroll down to Update II and download the pdf; see page 2 of the pdf). --ssal
Human-to-human transmission: The misconception is that so far, the only human H5N1 cases that have occurred have been the result of bird-to-human (often abbreviated "B2H") transmission (Crofsblogs: http://crofsblogs.typepad.com/... ). In fact, there is general agreement that beginning in Thailand in 2004 there have been several instances of H2H (human-to-human) transmission, although none yet that has resulted in sustained H2H transmission.
In the seven-case cluster in north Sumatra (see above), HHS Secretary Michael Leavitt pointed out that there was apparent H2H2H transmission. There are other instances in which the occurrence of H2H2H transmission has been suggested.
A summary of clusters of human cases can be found at Pandemic Flu Information ( http://web.mac.com/monotreme1/... ). --ssal
Age and risk of death: The misconception / possible misconception is that from the standpoint of age, those who would have the greatest risk of death in an H5N1 pandemic would be infants and the elderly (as is the case with seasonal flu). Actually, people who are in the prime of their lives may also face a high death risk.
In the 1918 flu pandemic, the deadliest flu pandemic of the last century "....most deaths occurred among young, previously healthy adults." (HHS: http://www.hhs.gov/pandemicflu... )
And, as can be seen in a World Health Association graph showing the outcomes of 373 laboratory-confirmed human H5N1 cases, the case fatality rate for people from 20 to 39 years old was 71%. For 10 to 19 years old, 76%. [For readers who have never seen it, the WHO graph is recommended viewing.] http://www.wpro.who.int/NR/rdo... --ssal
Government rescue: HHS Secretary Michael Leavitt: "If there is one message on pandemic preparedness that I could leave today that you would remember, it would be this: Any community that fails to prepare with the expectation that the federal government or for that matter the state government will be able to step forward and come to their rescue at the final hour will be tragically wrong, not because government will lack a will, not because we lack a collective wallet, but because there is no way that you can respond to every hometown in America at the same time." (U.S. News & World Report: http://health.usnews.com/usnew... ) --Kobie and ssal
Reliance on family/friends: The misconception / possible misconception is that if a pandemic happens, we can rely on family/friends. But if our family and friends have not prepared, they will not be able to take care of you.
If they have prepared, they may not be able to support you with their preps. -- cottontop
Number of Indonesian cases: Indonesia has arguably been the "hottest" human H5N1 case zone in the world. The misconception / possible misconception is that "officially reported" number of human cases in Indonesia in 2008 is accurate. Actually, the number is almost surely higher.
From the Flu Wiki diary, "Indonesia - September 9, 2008 to ...," a statement just under the "Indonesia Summary" table reads, "Unfortunately, the drastic decrease in suspected cases counted in recent months is attributable mainly to news restrictions in Indonesia. This table should NOT be used to support the conclusion that suspected viral infections are decreasing in Indonesia." ( http://newfluwiki2.com/showDia... ) --ssal
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