Is the US facing Flu-maggedon?
Flu season has come early to the US this winter, and hospitals in many cities are overwhelmed by the surge in cases. Boston has declared a public health emergency, and Google Flu Trends, which monitors the prevalence of certain search terms to track the disease, shows the US topping the world. Ominous news coverage shows emergency rooms overflowing. Just how worried should we be?
What is going on?
The flu season in the northern hemisphere falls anytime between October and May, but usually peaks in February. According to the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, flu activity in the US started picking up in November and hit its stride in December, but that is hardly unprecedented – in 2010 the UK’s flu season started in December.
The flu season in the northern hemisphere falls anytime between October and May, but usually peaks in February. According to the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, flu activity in the US started picking up in November and hit its stride in December, but that is hardly unprecedented – in 2010 the UK’s flu season started in December.
Last year’s US flu season, which started in March, was very mild. This year, the viruses are largely the same, although according to the CDC their prevalence is different – a strain that was common last season is rare this time around, for example. However, the disease they cause seems no worse – both this year and last, around 8 per 100,000 cases are severe enough to need hospitalisation, although this year’s figures might be affected by a time lag in reporting hospitalised cases, says Lone Simonsen of George Washington University – who is down with flu.
Is this really the worst flu season in years, then?
Hardly, according to CDC records. So far, the rise in cases looks a lot like the 2007-2008 season, which was classed as “moderately severe” – and nothing like the first wave of the H1N1 “swine flu” pandemic of 2009 (see graph). Case numbers could keep climbing, but so far seasoned flu watchers are not betting on anything unusual. “Severe flu causes a lot more deaths than what we have seen so far this year,” says flu epidemiologist Mike Osterholm of the University of Minnesota, Minneapolis.
Hardly, according to CDC records. So far, the rise in cases looks a lot like the 2007-2008 season, which was classed as “moderately severe” – and nothing like the first wave of the H1N1 “swine flu” pandemic of 2009 (see graph). Case numbers could keep climbing, but so far seasoned flu watchers are not betting on anything unusual. “Severe flu causes a lot more deaths than what we have seen so far this year,” says flu epidemiologist Mike Osterholm of the University of Minnesota, Minneapolis.
So why do things seem so bad?
One reason is that case numbers have risen fast. The US calculates those numbers by monitoring cases that turn up at designated “sentinel” clinics across the country. Last year the number of cases the clinics saw peaked at a little more than half the number of cases they are already seeing now, over roughly the same time. That doesn’t mean the total number of cases by the epidemic’s end will necessarily be greater this year than in previous years, however; cases may also fall off quickly. Or they may not – an apparent drop in cases reported last week by the CDC could be because some sentinel clinics did not report over the New Year’s holiday.
One reason is that case numbers have risen fast. The US calculates those numbers by monitoring cases that turn up at designated “sentinel” clinics across the country. Last year the number of cases the clinics saw peaked at a little more than half the number of cases they are already seeing now, over roughly the same time. That doesn’t mean the total number of cases by the epidemic’s end will necessarily be greater this year than in previous years, however; cases may also fall off quickly. Or they may not – an apparent drop in cases reported last week by the CDC could be because some sentinel clinics did not report over the New Year’s holiday.
“Rule Number 1 of Flu Club: Never predict how a season will play out until it is over!” warns Jake Dunning at Imperial College London. Regardless of how the rest of the flu season turns out, the initial sharp increase in cases causes its own problems, overwhelming healthcare systems for a time and causing knock-on problems as other patients are put on hold.
Is that why we are seeing beds in hallways and tents outside US hospitals?
Yes. “In previous decades hospitals kept excess capacity, so if there was any overflow, it showed things were really bad,” says Osterholm. Now, he says, financial cutbacks mean there is no such surge capacity: “every hospital bed is filled 24/7.” So overflow happens more readily.
Yes. “In previous decades hospitals kept excess capacity, so if there was any overflow, it showed things were really bad,” says Osterholm. Now, he says, financial cutbacks mean there is no such surge capacity: “every hospital bed is filled 24/7.” So overflow happens more readily.
Hospitals in the US are already operating at full surge capacity most of the time, agrees Jack Herrmann, a public health preparedness expert at the US National Association of County City Health Officials. “There are beds in hallways at most large metropolitan hospitals on any given day.”
There’s little cause for concern, then?
Not so fast. What the flu season is really showing, fears Herrmann, is that efforts to bolster the US’s capacity to respond to public health disasters, prompted by the terrorist attacks in 2001 and hurricane Katrina in 2005, have been hit over the past four years by financial cutbacks. The US Institute of Medicine’s forum on public health preparedness for catastrophes is meeting this week to discuss how to improve hospitals’ preparedness for disasters – “or,” says Herrmann, “just the flu season”.
Not so fast. What the flu season is really showing, fears Herrmann, is that efforts to bolster the US’s capacity to respond to public health disasters, prompted by the terrorist attacks in 2001 and hurricane Katrina in 2005, have been hit over the past four years by financial cutbacks. The US Institute of Medicine’s forum on public health preparedness for catastrophes is meeting this week to discuss how to improve hospitals’ preparedness for disasters – “or,” says Herrmann, “just the flu season”.
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