# 3525
Considering the global spread of the H1N1 virus over the past 3 months, we are getting news reports regarding its impact from only a disappointingly small handful of countries.
And even in those countries that are reporting, my confidence in their numbers is pretty low.
Today Thailand announced a near doubling of fatalities over a week ago, with now 44 deaths reported.
Thailand's swine flu death toll doubles in a week
7/22/2009, 5:59 a.m. EDT
The Associated Press
(AP) — BANGKOK - Thailand's swine flu death toll nearly doubled over the past week with 44 people now dead from the disease, the government said Wednesday.
The Public Health Ministry last reported 24 swine flu-related fatalities a week ago.
"The rise in the number of deaths were due a fast spread of the disease, delayed medical treatment, and an increase in the cases of severe respiratory infection," said the ministry's Deputy Permanent Secretary Paijit Warachit.
"We have now told medical workers to give the anti-viral medicine as soon as the tests return positive to reduce the number of cases of delayed treatment," Paijit said.
The number of people infected with swine flu jumped to 6,776 from 4,517. Thirty-five people infected remained hospitalized with seven in critical condition.
The ministry urged those with flu symptoms to stay away from public places and seek medical attention if they persist after two days, or immediately if they have prior medical conditions.
Considering that this is summer, and not flu-season in Thailand, these numbers are worrisome. This fall and winter, there are concerns that they will see a big escalation in case numbers.
But what of Thailand’s neighbors?
Flu knows no borders, and yet we hear almost nothing out of Cambodia, or Myanmar, Laos or China.
In fact, the list of countries not reporting flu cases, or fatalities, far exceeds the list that are reporting cases.
Disease surveillance, particularly in the developing world, has never been a strong suit. It costs money, it often uncovers expensive-to-fix problems, and it puts not one nickel into the national treasury.
For many countries, it is simply a luxury they cannot afford.
In South Africa, where there are nearly 1,000 AIDS/HIV deaths each day, no one is looking to see if flu was a factor. No one has time, and it simply isn’t in the budget. Health Authorities there are dismissing the flu as a `non-event’.
Compared to their HIV pandemic, I guess it is.
Even here in the United States and in other industrialized nations, our ability to detect deaths due to causes like influenza is limited.
No one actually counts the number of deaths attributed to flu for the simple reason that influenza is rarely cited on a death certificate as a primary or contributing cause of death.
Instead we must use surveillance tools like the 122 MRS and mathematical models to track influenza.
Each day in the United States alone, more than 6,000 people die on average.
Most are under the care of a physician, are elderly or have health problems, and so when they die, unless foul play is suspected – no real investigation into the cause of death is undertaken.
The doctor generally signs the death certificate (usually without seeing the deceased), and puts down whatever major health problem the person may have had as the cause of death.
Usually the doctor puts down something `generic’ like coronary artery disease, chronic pulmonary disease, etc. Influenza, which may have triggered a crisis, and contributed to someone’s death, is rarely cited.
Unless someone is hospitalized for the flu, or is being treated by their doctor for influenza at the time of their death, it is unlikely that their deaths are attributed to this virus.
None of this is part of some grand conspiracy. We just aren’t set up to monitor and report accurately on the number of deaths due to influenza. We never have been.
As a blogger, I’m trying every day to get some sense of just how dangerous this novel H1N1 virus really is. It’s the question just about everyone wants answered.
And quite frankly, if you go by the reports we’ve received, it doesn’t appear overly severe.
And it is hard not to take that as good news.
Unfortunately, we have a decided lack of data available. And the numbers we are getting aren’t telling us the whole story.
We are probably still some weeks, or even months, away from getting a good handle on the impact of this virus.
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