H1N1 Percolating In the South?

From Recombinomics -

Some of the nation's emergency departments are noting increases in flu-like illness cases that appear to be pandemic H1N1, and colleges are reporting the first increase in flu-like illness since the end of November, but it's not clear if these are early signs of a third pandemic flu wave.

The above comments provide additional data that a third wave in the United States has begun. Reports on flu at universities has increased 52% over last week, which is supported by anecdotal reports from emergency room physicians. The largest number of new student cases was again in North Carolina.

These developments parallel the start of the fall wave. The initial cases were in region 4 and this area has had the highest percent of samples being H1N1 positive. Similarly, state reports showed recent increases in North Carolina and Alabama, while earlier reports describe more severe cases in hospitals in Tennessee and North Carolina.

And -

In the past three pandemics, a fall wave has been followed by a winter/spring wave. A winter/spring wave would begin about now, but week 7 reports are incomplete and may have entry errors. Although there were only 19 patients listed, virus was not isolated in 8. Of the 11 isolates, sub-typing was not performed on 4. On the remaining seven all were H1N1, but 3 were said to be seasonal H1N1 at a time when seasonal H1N1 has all but disappeared. Thus, it is unclear if almost half the 7 H1N1 sub-typed were actually seasonal H1N1, or were pandemic H1N1 that were mis-reported or entered in the wrong field.

Week 7 is a critical time period. The fall wave has ended and a new wave should be forming, based on the pattern of the last 3 pandemics. However, surveillance has only identified 19 patients, all of whom are likely infected with pandemic H1N1, yet pandemic H1N1 was only confirmed in four.

The number of reported cases is low, but the low number is linked to poor surveillance. Most H1N1 infected patients are either not tested or tested with a rapid test which has a sensitivity which is notoriously low and even lower for H1N1 (the CDC has reported levels as low as 10%). This low sensitivity is due in part to the ability of pandemic H1N1 to quickly move to the lungs. More serious cases would be in ICU’s where collection of appropriate lung fluids would be easier and more likely to yield H1N1 virus. However, more than half of these severe cases have not yielded virus or were not sub-typed.

The Real Effect
This issue needs to be observed still as a new, more deadly outbreak could occur at any time. My opinion? Seeing as how the national health care is stalling, a minimum light flare up of deadly H1N1 would do wonders for pushing this legislation through.