Death Toll of 2009 Swine Flu Outbreak Is 10 Times Higher Than Once Thought

A new study funded by the World Health Organization finds that the H1N1 virus claimed thousands more lives globally.

Thousands of people wait in line to receive an H1N1 flu vaccination during a clinic at the Bill Graham Civic Auditorium Dec. 22, 2009 in San Francisco, Calif. The city had 16,000 doses of the vaccine on hand for residents of the city.
National Journal
Marina Koren
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Marina Koren
Nov. 26, 2013, 12:12 p.m.

In April 2009, a case of an un­ex­pec­ted type of sea­son­al flu was re­por­ted in Cali­for­nia. Labor­at­ory tests re­vealed that the H1N1 vir­us, dubbed the swine flu be­cause of its sim­il­ar­ity to a vir­us found in pigs, was un­like any­thing any­one had ever seen in hu­mans or an­im­als.

Re­ports of people in­fec­ted with the vir­us spread like wild­fire, reach­ing tens of mil­lions in the United States. In a mat­ter of days, the gov­ern­ment de­clared a pub­lic-health emer­gency, and the Cen­ters for Dis­ease Con­trol and Pre­ven­tion began dip­ping in­to its na­tion­al stock­pile of in­flu­enza-bat­tling sup­plies, like vir­al drugs, res­pir­at­ory devices, and gloves. By June, the World Health Or­gan­iz­a­tion de­clared a glob­al pan­dem­ic, with H1N1 pop­ping up in more than 100 coun­tries, in­clud­ing all 50 U.S. states.

A year after the out­break, WHO re­por­ted 18,449 labor­at­ory-con­firmed deaths from the H1N1 pan­dem­ic world­wide, a num­ber widely con­sidered too low. A WHO-fun­ded study pub­lished on­line Tues­day in the journ­al PLOS Medi­cine has found that the death toll from the 2009 out­break is 10 times high­er than the ori­gin­al count, total­ing nearly 203,000 deaths around the world.

The re­search­ers, more than 60 in 26 coun­tries, ex­plain that the ori­gin­al stat­ist­ics were based only on people with con­firmed cases of H1N1, ex­clud­ing those in­fec­ted who were nev­er tested and dia­gnosed but nev­er­the­less per­ished as a res­ult of the vir­us.

Re­search­ers com­bined vir­o­logy data from WHO and mor­tal­ity in­form­a­tion from 21 coun­tries, which ac­count for about 35 per­cent of the world’s pop­u­la­tion, to es­tim­ate the num­ber of H1N1-in­duced res­pir­at­ory deaths. They then pro­jec­ted those res­ults onto the rest of the globe. If deaths stem­ming from oth­er health prob­lems, such as heart dis­eases, ex­acer­bated by the vir­us are taken in­to ac­count, the pan­dem­ic’s cas­u­al­ties can reach up to 400,000.

Most of the deaths oc­curred in people young­er than 65, the study found. By con­trast, sea­son­al in­flu­enza usu­ally af­fects older in­di­vidu­als. A ma­jor­ity of deaths also oc­curred among those liv­ing in cer­tain parts of the Amer­icas, with Mex­ico, Ar­gen­tina, and Brazil show­ing the highest death rates in the world. The toll was far lower in New Zea­l­and, Aus­tralia, and most parts of Europe.

The H1N1 vir­us con­tin­ues to cir­cu­late in the U.S. and abroad, and it has joined the ranks of oth­er sea­son­al flu vir­uses that cur­rent flu shots pro­tect against. The threat of an­oth­er out­break like the one in 2009 is low — at least for this spe­cif­ic kind of vir­us.

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