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December 31st, 2009
05:17 PM ET

Pandemic’s moderate numbers ‘best health news of the decade’

By Miriam Falco
CNN Medical Managing Editor

One of the biggest stories of 2009 – the outbreak of the pandemic H1N1 flu – coincided with the biggest story for my family – the birth of my son.

Many of my friends and colleagues asked me whether I missed being part of this huge medical story. At the time I easily said no. I'm a hard-core journalist, but having a baby and being there for him was much more important to me than any news story. That doesn't mean I didn't follow it.

Early on, the World Health Organization announced that the new virus was a new strain of the H1N1 virus, a type of flu virus that was not related to current or previous seasonal flu viruses. On April 23, the CDC said it had identified this new H1N1 strain to be a “swine influenza A, H1N1,” which usually infects only pigs, but in this case was also infecting humans. This is how H1N1 first began to be known as "swine" flu. However, not too long later, researchers determined it was brand new and included DNA from humans, birds and some European pigs, but that it did not originate in a pig.

Before the end of April, we first heard the word pandemic connected to this swine flu. On June 11, the WHO declared that H1N1 had reached the highest pandemic level – phase 6. Even though it had spread to several parts of the world, the virus was still deemed to be "moderate." But the fear was that the virus could change and things could get really bad.

By the time I returned from maternity leave at the end of July, nearly 8,000 people had been confirmed to have H1N1 and over 500 had died from this flu in the United States.

By the end of August, as more and more states reported "widespread" flu activity, a report from the President's Council of Advisors on Science and Technology described a worst-case scenario where the H1N1 flu virus could cause up to 90,000 U.S. deaths, mainly among children and young adults if it resurged in the fall. (Flu activity normally picks up in the fall, but it's estimated that 36,000 die each year from the seasonal flu – 90 percent of whom are 65 and older.)

Although the report was not meant to "predict" what would happen, it did suggest H1N1 could infect between 30 percent and 50 percent of the American population during the fall and winter and lead to as many as 1.8 million U.S. hospital admissions.

As of December 30, more than 120 million doses have been available for Americans. The CDC estimates that at least 60 million people have been vaccinated. Officials also estimate that as many as 67 million Americans had been infected with H1N1 by mid-November – not nearly 30 to 50 percent of the U.S. population as suggested by the president’s advisers. Hospitalizations are estimated at just over 200,000 – fortunately also nowhere near the worst case scenario of 1.8 million as the August report suggested.

Finally the death toll from the H1N1 flu was way below the 90,000 high estimated by the scientific advisers. The CDC estimates that as many as 13,930 people died from H1N1 between April and November 14, 2009. At least 243 of those were children who died since August 30. This number is very high compared with seasonal flu, which usually is a factor in only 80 deaths in children during a flu season.

H1N1 appears to have peaked in the U.S. for now. As of today, the last day of 2009, only four states are reporting widespread H1N1 flu activity. Around the world, many countries are seeing their case numbers decline while others are seeing a resurgence. And as the U.S. has had over 120 million doses of vaccine available already, many developing countries are still waiting for their first doses. Still as the WHO director-general Dr Margaret Chan told reporters this week, "the fact that the long -overdue influenza pandemic is so moderate in its impact, is probably the best health news of the decade."

So as 2009 comes to an end, the H1N1 story will extend into the new year. After listening and participating in countless CDC press briefings over the past several months, I asked CDC Director Dr. Thomas Frieden for his thoughts on this H1N1 pandemic. He says we need three things:

“First, perseverance. It's easy to say it's over, cases are going down, but influenza is unpredictable. We don't know what the future will hold. We have a unique window of opportunity to get vaccinated before the end of this flu season.

Second, we need preparation. Continuing to hone our preparations at every step of the supply chain, and every step of detection and response is important.

And third, we need to continue to invest in science - for better vaccines, and also better understanding of the pattern of influenza in communities and treatment. "


December 30th, 2009
01:53 PM ET

Two parents' view of health care reform

Editor’s note:
We profiled the King family in our 2008 documentary, “Broken Government: Health Care Critical Condition.” Matthew King was born in 2005 with a congenital heart defect requiring intensive medical care, which quickly ate up the family’s $2 million health insurance policy. The Kings avoided disaster only because Michael’s employer, the Las Vegas Police Department, raised the lifetime limit on its policies. We invited Terri and Michael to share their concerns about the health care bills that were passed by the House and Senate.

By Mike and Terri King

As the parents of a medically fragile child who will need open-heart surgeries for the rest of his life, we are terrified about these health care bills. We think this is just a gateway to socialized medicine, which we are against!

First and foremost, when the government pays your medical bills, it can restrict your behavior. Just imagine helmets required for children’s soccer, or a ban on fattening foods. We’re also afraid of the 40 percent excise tax on expensive health care plans. Won’t some companies just drop coverage altogether, and transfer the cost to the government? (The House bill would require most companies to offer coverage, but the Senate bill has fewer requirements). Won’t they pass on those exorbitant costs to their customers? Most alarming to a family like ours: Will they cut back needed treatments to make the policies less expensive?

The bill is full of new taxes – more than a dozen, and we might be missing some. One tax will be on our medical devices, which is insidious because it’s up to the government to define what is a “medical device.” For a while they talked about about taxing tampons and Q-tips. That’s out, but the Senate bill does have a big tax on tanning beds. What’s next? With all these new taxes, our premiums are going to skyrocket.

We believe this health care overhaul would leave us with less choice in Matthew's health care. We’re afraid that with all the new taxes sucking money out of the system, there will be less funding, and less incentive, to innovate and find new medications.

We also feel we’ll spend much more time in waiting rooms, waiting to see our doctors. Have you been to an emergency room or a department of motor vehicles lately? Citizens in countries with socialized medicine can wait months to see a specialist. Prior to an open-heart surgery, our son needs tests from many different specialists. From what we’ve heard, in Britain or Canada it could take months or even years to get that done. When the pressure in Matthew’s heart begins to rise again, we won’t have that long to wait.

Instead of increasing government involvement in our lives, we should lessen it. We need freedom to decide what we want for our families, whether it’s a health savings account and catastrophic coverage, or sticking with a traditional policy. We need more insurance choices, with companies allowed to sell policies in any state. We also need tort reform. Something needs to be done to stop expensive and frivolous lawsuits that force doctors to order needless tests and pay hundreds of thousands of dollars a year in malpractice insurance.

The health care system might be broken now, but this bill is a mess that’s not going to fix anything.


How we found Patient Zero
December 29th, 2009
02:39 AM ET

How we found Patient Zero

It was late April. I remember it being a somewhat quiet news day when I received the call. It was an editor on our international news desk alerting us that about 100 people had gotten very ill in Mexico City with severe flu-like symptoms.

They had no clue what was causing it at the time. The only thing health officials were telling us was that the patients had contracted a highly contagious virus that hadn’t been seen in humans before. The hunt was on: Dr. Sanjay Gupta and I hopped on the next flight out to Mexico City to track down the mystery virus that was getting so many people so sick.

Within 24 hours of arriving, the dense city of about 8 million people had figuratively turned into a ghost town. The mayor was urging people to stay inside; the hospitals were overcrowded; schools, public transportation, and restaurants closed their doors.

At one point, I remember walking down the unusually empty streets of Mexico City in awe. It was an eerie feeling, but also a defining moment for me as a journalist. I realized that people, not just in Mexico City, were scared of this unknown killer virus.

What was it? Would they be infected? What should they do? We didn't know it at the time, but H1N1 influenza was about to become a global epidemic and the world was already looking to us for answers.

A few days into our reporting on the ground, I received a phone call from CNN's senior executive producer for AC 360, David Doss. He had flagged a local health alert from the state of Veracruz, Mexico - there were unconfirmed reports that a little boy in the village of La Gloria was rumored to be “patient zero,” the earliest documented case of swine flu in the world.

Twenty minutes later, our crew was in the car, embarking on a three hour drive into the mountains of Veracruz to find the answer, the source of this outbreak. We had the wireless going on my laptop, phones to both ears, endlessly contacting our sources to confirm this story. We got it: Health officials confirmed to us that five-year-old Edgar Hernandez was in fact patient zero.

The catch? His village was in a very remote location with no phones, no electricity, no address to pop into our car’s navigation system. We knew finding patient zero would be a little like finding a needle in a haystack.

But as diehard journalists, this was the type of assignment we craved! I couldn’t wait to get there and to shuffle through that haystack. I knew in my gut we’d find him.

We walked around the village, visited their clinics, spoke to the locals. We met one man pulling his donkey up the dusty mountain road and asked him if he knew the Hernandez family. Turns out that man was patient zero’s uncle. He quickly walked us to the Hernandez’s home and we met Edgar, known as patient zero. He was no longer sick; he had survived the swine flu virus. He credits “ice cream” for curing him.

Being only 5 years old, Edgar couldn’t possibly realize the significance of being the first patient of what would be declared a global pandemic just two months later. But his mother certainly did. She feared Edgar could possibly be blamed for spreading it (which he did not) and she feared that their family would get sick again. She told us she didn’t understand what this virus was.

But that is why we were there - to find the source of this illness in order to understand it better. At this point, the CDC and the World Health Organization still didn’t know how the virus was spreading. But by discovering the earliest patients of an outbreak like this, health officials could begin to gather clues as to exactly what happened and, more importantly, how to treat and stop it from spreading.

As a journalist, there have been a few defining moments which I’ve felt I had a front row seat to something really big, to a small piece of history. Finding patient zero was one of the moments.

Follow Danielle on Twitter @DanielleCNN for more behind-the-scenes information and exclusive photos from the field.


December 28th, 2009
12:53 PM ET

A restaurant-style view of reform

By David Martin
CNN Medical Senior Producer

Imagine you’re hungry and someone gives you a coupon for a free meal at what’s been touted as the best restaurant in the world. The only problem is the restaurant is never open.

This could be the case for some of the estimated 15 million new Medicaid patients created by the congressional health care overhaul.

These patients are hungry for health care, but they may not be able to find a doctor who will serve them.

Almost half of the newly-insured under the congressional health care legislation come by expanding Medicaid. In the Senate bill, for example, a family of four earning up to $29,326 would be eligible. The House bill provides subsidies for families of four earning under $88,200.

Two problems: A shortage of primary care doctors and a shrinking number of doctors accepting Medicaid. According to the Association of American Medical Colleges, there are about 256,500 family doctors - about 16,000 fewer than we need. As for accepting new Medicaid patients, one recent survey found only half of all doctors accept all or even most new Medicaid patients. Among family and general practice doctors, who should be the front door for health care for the millions of newly-insured patients, 35 percent said they accept no new Medicaid patients.

Medicaid reimbursements to doctors are simply so low there is little financial incentive to take these patients. Some doctors say they actually lose money on Medicaid patients. To continue with the restaurant analogy, doctors are asked to serve up steak but are paid for a Big Mac.

As one primary care doctor told me in an e-mail, “I have concerns about where these 15 million will find a medical home … will it be existing practices, community health centers, ER’s, Wal-Mart or urgent care centers? How will rural settings or inner cities be able to meet the demand? We in primary care are already pushed to see increased numbers and this will ask us to spend less time with established patients and see more numbers. Is that good medicine?”

I visited a free clinic this year. The volunteer doctors were busier than ever, treating everything from colds and the flu, to asthma, diabetes, tooth decay, and on and on. Many of the patients belonged to a group we generally call “the working poor,” and most had put off seeking treatment as long as possible. They were uninsured and couldn’t pay, or insured and couldn’t afford the co-pay. One woman couldn’t afford a $40 inhaler. A diabetic who had recently lost his job as a pizza cook couldn’t afford the test strips needed to manage his condition. Another woman, who worked at a fast food joint, had lived for months with the pain of two teeth broken off at the gum line. The visit was a grim testimonial to the painful gaps in our health care system.

Some of these folks will likely be among the new Medicaid recipients. Unfortunately, they may not be able to find a family doctor. And that could mean they won’t get screened for diseases, will wait to get treated and may well be back at the emergency room. The only difference now is they will not get an enormous bill they can’t pay.

Will the health care reform change the way you get health care?


December 24th, 2009
09:31 AM ET

How can I get rid of a lingering cough after having H1N1 flu?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Scott, Oregon

“After suffering through the H1N1 flu for almost a week, I feel completely healthy, save for a lingering cough. There is not much if any mucous involved, it's just a sensation that makes me constantly want to clear my throat. I am a healthy 33 year old male with no chronic illness; no allergies and I have never smoked.”

Answer:

You are not alone, Scott. Persistent, nagging cough is a common complaint among people who contract the H1N1 virus, even healthy non-smokers like you. Some say that the cough lasts for days – sometimes weeks – after other overt symptoms like fever, nausea, fatigue and congestion go away.

It's sort of like having a house guest who has worn out their welcome.

So why does the cough stick around for so long? The H1N1 virus causes inflammation in the respiratory tract, which includes the back of the throat and bronchial tubes that branch out in the lungs. The virus attacks that lung tissue, causing irritation. So although you are not suffering from the flu any longer, irritation in the mucus membranes lining your respiratory tract is still healing, and that is manifesting as a cough you cannot shake.

Unfortunately, the best thing for you to do is wait it out. Your cough could be a bothersome symptom for another two or three weeks, but it should dissipate as your respiratory tract heals. There are some effective cough medicines out there available over the counter, and even stronger ones in prescription form, but the good news: this is likely to get better on its own.

Incidentally, residual cough is common with most flu, including seasonal strains. As long as you are fever-free and otherwise feel well, there is little chance that your cough is spreading the H1N1 virus. The incubation period for H1N1 – the time during which you are most infectious to others – is between one and seven days.

Of course if several weeks go by and the cough has not subsided, you may decide to visit your doctor.


December 23rd, 2009
12:11 PM ET

Health care reform – summarizing your comments

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Late last night, I finally finished reading the senate bill and the manager’s amendment. I will admit: it was tough to get through and took me back to my medical school days. At some point, I would love to know how many people have read it or understand it well enough to formulate a decision. That is not, however, where I want to go today.

Instead, I want to try and summarize the hundreds of blog comments I have received. It appears most people are in favor of addressing the access issues of the uninsured and the underinsured. Most seem to think that is a noble, worthwhile and perhaps even moral goal. The largest concerns seem to revolve around cost and concerns about the possibility of worse care.

More specifically, there were many comments about the increase in taxes necessary to pay for this. That will likely happen for a segment of the population making over a certain amount of money. That amount is still being debated. There is a plan to decrease Medicare spending by close to 500 billion over 10 years. Supporters say this will finally remove inefficiencies. Critics charge it will lead to worse care for seniors. There could be a tax on Cadillac health plans. If your plan costs more than $23,000 to cover your family – not what YOU pay, but the total cost of the policy, there will be a 40% excise tax on any amount over that $23,000 amount. No doubt, most agree it is going to cost a lot of money to insure 31 million more Americans.

One thing that hasn’t received as much attention is a term that could cause eye glaze, but is worth talking about.

Comparative effectiveness.

It is this idea that we pay too much for too little, and we should spend some time figuring out what really works with regard to health care. It is this idea that perhaps we over-test, over-prescribe and yes, perhaps perform too many procedures, and yet our health overall doesn’t reflect that higher overall spending.

It is this idea that if we spend some time really figuring out if knee surgery is in fact better than taking anti-inflammatories for arthritis, and to stop performing as many of these operations if it isn’t better. I am not picking on my orthopedic colleagues. The same can be said of operations in my specialty of neurosurgery, or really just about any aspect of our health care system. You may be surprised to know that we can’t always guarantee better health outcomes because more money was spent, a medication was prescribed or an operation was performed. The answer is not always that easy.

The rub is this: If comparative effectiveness data shows a particular procedure is not as effective as believed, it is possible insurance companies may be hesitant to cover it. Instead, you may get a letter stating the procedure is not warranted. Supporters of this will say this is a good strategy to reduce costs. Critics will use the R word: Rationing.

What do you think of comparative effectiveness? Does it have a place in this discussion? And, how do you think it will impact the physician – patient relationship?


December 22nd, 2009
12:21 PM ET

Health care reform and personal responsibility

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

As we continue this discussion, there are a few emerging themes. (read the Senate health care legislation) So, to keep the direction focused, I will try and take on one at a time.

The topic I would like to explore today is “personal responsibility.”

In many different ways, it seems you have questions about this topic. So, let me attempt to summarize it this way.

Will increasing access to health insurance make people more responsible about their health? Should it? And, will it improve their health overall? It is an important question to me as a doctor, because the measure I care most about is a healthier society, and the corresponding health of individuals.

There is no question that people who have unlimited resources, in terms of money and insurance, are often the unhealthiest of all. So, it would seem that access to health insurance alone does not equate to good health. On the other hand of course, over 40 million people don’t currently get a chance to test that theory.

Personal Responsibility.

How would you define the current obligation of any individual for their own health? And, if you would believe in the power of personal responsibility, how do we get better at it as a nation?

Programming Note: Tune into Larry King Live tonight at 9pm ET for a discussion about life after death. Can we come back from the dead? People who say they've done it say "yes"! Dr. Sanjay Gupta and Deepak Chopra take on the mystery of life after death – only on CNN at 9pm ET.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


December 21st, 2009
01:34 PM ET

Real-life effects of reform getting lost in the noise

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Last night I was up late covering the senate vote on health care for CNN. The number of e-mails I was receiving while discussing this on air was staggering. I realized that as much as we talked about cloture and reconciliation, most people who didn’t read the 2,000+ page bill (which is most everyone) really wanted to know what this bill means for them. They didn’t care as much about the compromise that was struck by Sen. Ben Nelson, which would obligate the federal government to pick up the Medicaid tab for his state of Nebraska into perpetuity. They are still not sure if a public option is a good thing or not, and they aren’t sure how the exchange would work for them. In short, there is a collision of politics and health care, and sometime the impact on individuals gets a little lost in the shuffle. (Read the Senate health care legislation)

I want to use this blog as a platform to try and address some of your specific questions and to also throw out some key information that may have flown under the radar. I will start with a number. 2014. This is the year most of the provisions of the bill would kick in under this version of reform. That’s right – four years away. Many people think health care reform in binary terms. One moment there is a vote, and the next moment you have it. Many wish it were that easy. It is true that children may benefit earlier in some areas, but for the vast majority of the more than 40 million uninsured, things aren’t going to change significantly for a few years. And, speaking of the more than 40 million uninsured, this bill won’t impact all of them, but instead roughly 31 million.

So, let’s start here: Based on what you know about this bill, do you think you will be impacted? Has this affected your current plan, if, for example, you are working for a large corporation? What information is still lacking for you?

Click here to see Dr. Gupta answering some of your health care reform questions.


December 18th, 2009
12:09 PM ET

100 million H1N1 vaccine doses available, flu waning in U.S., officials report

By Miriam Falco
CNN Medical Managing Editor

The Department of Health and Human Resources says as of Friday, December 18, more than 100 million doses of H1N1 flu vaccine will have been made available for states to distribute. This news comes at a time when the so-called swine flu seems to be waning in the United States. It was just a few short weeks ago when the H1N1 flu virus was widespread, in 48 states, and people lined up for hours just to get one of these vaccinations. Now at least four states – Wyoming, Colorado, South Dakota and Nebraska – are reporting "no activity" at all. This may lead many to think that the pandemic is over, that there's nothing to worry about any more. However health officials keep reminding us that flu is unpredictable and we're just now entering the earliest part of what is considered the beginning of a normal flu season.

Yesterday, health officials also announced the latest statistics on how many Americans were affected by H1N1. So far 47 million cases have been reported; nearly 213,000 hospitalizations; nearly 10,000 deaths; and five times more pediatric deaths than in a typical flu season.

Eight months after this global pandemic began, World Health Organization officials say that they are frequently asked whether the pandemic is over or another wave should be expected in late winter or early spring. "The answer is right now is that we simply are not able to answer this question," Dr. Keiji Fukuda, special adviser to the WHO's director-general on pandemic influenza, told reporters Thursday. He also said that even if the H1N1 flu seems to have peaked in North America, other countries such as Switzerland, France, Kazakhstan, Kyrgyzstan and Russia are seeing high activity.

Perhaps more eye-opening was that Fukuda's announcement that six manufacturers and 12 countries had pledged 180 million doses of H1N1 vaccine, which would go to about 95 countries. The WHO had hoped to distribute these vaccines in late November or December, but that has now slid to sometime in the next few weeks. So the U.S. will have been able to distribute more than half of the number of vaccine doses as the WHO hopes to distribute to 95 different countries, most which couldn't afford to buy them themselves.

The question in the U.S. is, with more vaccine becoming more easily available, but flu activity dramatically down compared with just a month or two ago, will people who haven’t been vaccinated yet or gotten sick still get a flu shot or nasal spray?


December 17th, 2009
06:15 PM ET

How do I choose a heart rate monitor?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From the Paging Dr. Gupta blog, Terry asks:

"I would love some advice on choosing a heart rate monitor."

Answer:

Well, it turns out, Terry; our folks at CNN.com gave some great advice on this. Advice that I paid attention to since I’ve been working hard this year to get in better shape and am now training for a triathlon as a part of CNN’s Fit Nation Challenge.

As I train, something I've been focusing on is heart rate target training. It's actually pretty simple to do. First of all, calculate your maximum heart rate. The way that you do that, you subtract your age from the number 220. So, mine would be 180. Now, you calculate a range between 60 percent and 70 percent of that number. Mine would be from 108 to 126. Try and keep your pulse rate in that range while you work out. A heart rate monitor is a simple device to help you calculate your target heart rate and keep track of your workouts so you can measure your progress.

So Terry here is a rundown of heart rate monitors depending on what you’re looking for and how much you want to spend. There are a lot of monitors out there. New monitors are equipped with GPS, speed calculating shoe sensors and data analysis tracking every detail of your performance over time.

So, the experts CNN.com quoted said the new Garmin Forerunner 310XT is the optimal choice, but it is very expensive. It's almost $350. It does work anywhere in the world and you can get your heart rate, measure movement, elevation, distance and speed. Now, if you're looking for something more affordable, like a lot of people, Nike offers a slim watch size unit called the Nike Plus Sport Band. It runs about $59 and displays your distance, pace and calories burned. It holds about 30 hours worth of workout data. Check out more options at CNN.com/technology.

Keep in mind the longer your keep your body at that target heart rate I talked about, the more efficient your cardiovascular system will become, and overall, the fitter you will be. Good luck Terry hopefully tracking your heart rate will help you make your workouts even better.


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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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