# 3269
Reports of Swine-flu related fatalities from around the country continue to trickle in, although these, like the official case counts, are likely just `the tip of the iceberg.’
Two more deaths linked to H1N1 virus reported
(CNN) -- Arizona reported its fourth death from the H1N1 virus, commonly known as swine flu, health officials said Wednesday.
The H1N1 strain is relatively mild, but it's being closely watched for mutations that might become severe.
The victim was the second child in the Pima County area to die of flu complications, health officials said. The age of child who died Wednesday was not released, but the patient's health was "medically compromised."
Earlier, officials in Cook County, Illinois, recorded their second death from H1N1. The latest victim, from suburban Chicago, died within the past couple of days and had "significant underlying medical conditions," said spokeswoman Kelly Jakubek.
The first fatality occurred in a Chicago resident over the weekend. That victim also had underlying medical conditions, Jakubek said.
Officially, the number of deaths due to the H1N1 `swine’ flu virus here in the United States remains in the double digits. There are, however, real limits to our surveillance.
On average (and there is seasonal variability to this) 6,600 die each day in the United States.
Most of these deaths are `expected’, in that the victim was either injured, critically or chronically ill, or of an age where death due to `natural causes’ is not totally unexpected.
Autopsies, or post-mortem exams are usually carried out on victims who died from suspected foul play, misadventure (accident), under unusual circumstances, who were `too young’ to die from natural causes, or for those who were `unattended’ by a doctor at the time of their death.
The law, at least here in Florida, makes a distinction between an `attended death’ and an `unattended death’.
A death is considered "unattended" when it occurs more than 30 days after the decedent was last treated by a physician, except where death was medically expected as certified by an attending physician. -s. 382.002(4), Fla. Stat. (1993)
The law in other states is probably similar.
If the death was `attended’, the patient’s physician can sign the death certificate (usually without seeing the deceased) for someone who dies at home, or in a nursing home, and the body is released to the funeral home.
No post-mortem exam is done in these cases, and of course, there is no way to know how many were `flu-related’. Even those victims who end up on the medical examiner’s table are unlikely to be tested for the novel H1N1 virus.
The flu-related deaths we usually hear about are those who were already hospitalized and diagnosed with influenza, and who then died.
There are exceptions of course, such as when a child or young adult dies unexpectedly. A post-mortem exam is usually ordered these cases and sometimes influenza is identified as a contributing factor in their death.
But our ability to detect influenza-related deaths here in the United States is limited.
The CDC, which estimates 36,000 seasonal influenza deaths each year must use statistical modeling, not an actual count, to come up with that estimate.
The actual number of death certificates that list influenza as a cause of death each year is a fraction of that number. It is therefore likely that some number of novel H1N1-related deaths go unreported as well.
The good news is, that number does not appear to be any higher than we normally see with seasonal influenza. The 122 MRS (122 Cities Mortality Reporting System) has not shown any appreciable spike in deaths around the country.
Cold comfort to the families and loved ones of those who die from this virus, I know.
Influenza, whether seasonal or novel, is not a trivial illness. In a normal year influenza contributes to the deaths of hundreds of thousands of people each year.
Even though we continue to call it `mild’.
