Jennifer Lake's Blog

September 15, 2009

Anatomy of an Outbreak

 

Before it slips into popular memory as the first pandemic second-wave outbreak affecting “thousands”, events of Washington State University’s swine flu scare need a closer look. For the benefit of distressed parents, students, and staff, WSU created a blog to keep their community informed, so says the WSU administration, listed here http://hws.wsu.edu/blog/default.asp as a service of the campus Health and Wellness Services, executive director Bruce R. Wright. The blog was initiated on Sept. 1, with the first post appearing as Sept.2.

According to general news reports, such as Sept.7 (http://www.kansascity/440/story/1429055.html) the swine flu was suspected of infecting 2,200 students. Subsequent reports over the next 2-3 days raised the number to 2,600. (http://cnn.com/2009/HEALTH/09/09/washington.flu.university/index.html?… and http://cnn.com/2009/HEALTH/09/10/washington.flu.university/index.html). The end result, if it can be considered ended, is that one person was hospitalized for dehydration and in a statement from Dr. Dennis Garcia, “The symptoms are fairly mild; some people have said milder than a regular case of the flu.” The kansascity.com version (Sep07) is more forthcoming on details than CNN: “About 2,200 students at WSU have contacted the health service so far, and Garcia estimated 1,000 more may have gotten sick…The outbreak at WSU began soon after classes started [Aug24]..and officials at that time thought it might last six to eight weeks, ‘But if this weekend
is any indication, it could be over in another couple of weeks’ Dr. Garcia said.” WSU had been informed to expect as many as 5,000 cases.

The flu blog indicates, in part, the meaning of the 2,200 students who “contacted the health service” and ended up counted as H1N1 swine flu victims. The entry on Sep02, http://hws.wsu.edu/blog/default.asp?Username=healthycoug&EntryID=127 records “in addition to tracking the patients we checked in, we started to track all patient contacts for influenza-like illness. This number would include conversations with our telephone nurse as well as patients who came in, spoke with a nurse, and then decided they could self-care…
   “We had a total of  208 patient contacts yesterday for influenza-like illness (…86 phone nurse conversations, 72 drop-ins who decided to self-care and 50 patients who were seen by providers)…”

As the Sep02 entry notes, all testing had previously been discontinued –in other words, the only specimen tests of the outbreak were taken sometime on or between Aug 25 and Sep 01 when the numbers totalled 400 patient contacts. The other 1,800-2,200 counted by CNN, et.al., had to have come within the next 8 days, which piles on as much as 270 or more cases each day, at a time when the WSU staff was reporting that things were beginning to wane, perhaps 40 to 50 people calling or coming to the clinic.

The CDC’s Morbidity and Mortality Weekly Report has yet to record or report any positive swine flu results from WSU, but as the blog states, “It is also possible to have H1N1 and not test positive for type A influenza. We are treating all patients with influenza-like illness symptoms as if they have H1N1.”

Incidentally, on the CDC’s Advisory Committee on Immunization Practices (listed here, http://www.cdc.gov/mmwr/PDF/rr/rr5810.pdf) Seattle’s University of Washington is the only institution that has more than one person on the committee, and one of them, Kathleen Neuzil, happens to be the Chair of the ACIP Influenza Working Group –just a coincidence. ( WSU is way to the east, on the Idaho border just a few miles from the University of Idaho http://en.wikipedia.org/wiki/Pullman_Washington ) Washington University’s other participant, Janet Englund, was noted last year at the ACIPs Feb08 meeting to have a “conflict of interest” where she was advised to disclose “that she has research support from **Sanofi Pasteur and MedImmune. All other ACIP members present declared no conflicts” according to the CDC. http://www.cdc.gov/vaccines/recs/acip/downloads/min-feb08.pdf (page 7).

Is it reasonable to assume that 1,000 WSU students could go missing 3-5 days without the health authorities or campus staff knowing? The University’s flu guidance page (http://h1n1flu.wsu.edu) recommends under “more flu guidance” that students follow Regulation 73 for Absences which states, “Absences impede a student’s academic progress and should be avoided”, continuing with proceedures on squaring the missing time with instructors, www.registrar.wsu.edu/Registrar/Apps/AcadRegs.ASPX. Given ‘pandemic awareness’ and tracking protocols, does that make sense?

  _____________________________

**Sanofi (makers of FluZone, Lyons France) and MedImmune (makers of FluMist, Gaithersburg, Maryland) exclusively  provide the U.S. military with mandatory vaccines http://www.cdc.gov/eid/content/13/4/617.htm

_____________________________


 

Wash. and Spin, cleaning up the numbers from WSU

Using the given data provided by the WSU Health & Wellness blog, the maximum number of possible suspect cases of flu does not exceed 1,700 right up to the present (Sep18). At the time the AP wire advertised the story around the country, claiming 2,200, (Sep07), the figures out of WSU showed a max. possible of under 1,000. The holiday weekend was still in progress (four days counted, Sep04-07) averaging 50 ‘total contacts’ each day. ‘Contacts’ include the phone-based outreach done by the H&W clinic.

The graph below uses WSU figures from the flu blog. Accepted as given is the possible cases for August beginning on the first day of classes, Aug. 24, as 392 possible cases. (Posted Sep01 http://hws.wsu.edu/blog/default.asp?Username=healthycoug&EntryID=125)

Date(posted)// Date(actual)// Total contacts//phone only//self-care,spoke to nurse//seen by provider

Sep 2…………….9-1……………………..208……………….86………………72…………………………….50
Sep 3…………….9-2……………………..185……………….72………………53…………………………….60
Sep 4…………….9-3……………………..114……………….42………………49…………………………….23
Sep 8…………….9/4-7………………….210……………….86………………65…………………………….59
Sep 9…………….9-8……………………..169……………….89………………36…………………………….44 *(saw physician)
Sep10……………9-9……………………..128……………….64………………37…………………………….27 *
Sep11……………9-10……………………..68……………….17………………28……………………………..13 *
Sep14……………9-11……………………..42……………….19……………….3………………………………20 *
Sep14……………9/12-13………………..26………………..9………………..–………………………………17 *
Sep15……………9-14……………………..60……………….26………………12……………………………..22 *
Sep16……………9-15……………………..33……………….12………………11………………………………10 *
Sep17……………9-16……………………..29……………….10……………….9………………………………10 *
Sep18……………9-17……………………..38……………….15………………12………………………………11

The actual number of students who saw a “provider”, sometimes listed as ‘physician’ (*), is 366 for Sep 1–17. At another WSU blog, http://osa.wsu.edu/pages/publications.asp?Action=Detail&PublicationID=949&PageID=77 , the numbers for August are mentioned on (Friday) 8/28/2009 under Announcements: “The WSU Health & Wellness Services (HWS) staff has seen 179 patients with influenza-like illness since Monday. Of these 179 patients, 32 were tested for type A influenza and 7 of those tests were positive [emphasis on “type A”]. These numbers were gathered from our database and are more accurate than previous estimates. Healthcare providers in the local community have also seen WSU students…but we do not have numbers available…”

The town of Pullman, Wash. is truly an American “college town” with the campus population rivalling that of the locals. Washington State University, founded in 1890, is the state’s original and largest land-grant university, according to the wiki —http://en.wikipedia.org/wiki/Washington_State_University . The Univiversity of Idaho is nearly it’s twin, chartered even a year earlier, with both schools opening their doors to students in 1892- they are also connected by a 7-mile paved bike trail and appear to have some uncompetitive parity of curricula. WSU is by far the dominant ‘tech’ school and research contractor, partnered with US gov’t agencies Dept of Energy, USDA, DARPA, and the CDC with whom it “works closely” on infectious animal diseases. In 2008, WSU received a $25million grant from the Gates Foundation for its Global Animal Health program and hosts the Washington Animal Disease Diagnostic Laboratory. See another blog article called “Global Emerging Infections System” –applied to people by the US Dept of Defense, but clearly having the stated goal of ONE MEDICINE: the merging of veterinary and human medical science and applications.

Some of WSU’s notable alumni include Edward R. Murrow, Bill Nye “the science guy”, Timothy Leary, a past long-time San Diego Zoo director, and a leading researcher on “slow virus diseases”. 

Health policy on college campuses follows CDC and the American College Health Association guidelines, which state “Meningococcal vaccination is recommended for all first-year students living in residence halls…” http://www.acha.org/projects_programs/meningitis/disease_info.cfm#recommendation How many of the 545 students (179 + 366) whom we can assess were seen by a ‘provider’ who actually looked back at them were incoming freshman, newly vaccinated, or perhaps in need of the mandatory meningitis vaccine?

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