By SPIEGEL Staff
Death from swine flu comes unexpectedly, as was the case with six-year-old Kharra Skye Davis from Hot Springs, Arkansas, who spent 20 hours fighting for her life, and with Kyree James Gamble, 5, from Littlestown, Pennsylvania. Both were healthy children, and both lost their lives before they had truly begun.
In the case of Kharra, who died in September, the cause of death was respiratory failure. The little girl had attended a birthday party, and by that evening she had a fever of 40.5 degrees Celsius (105 degrees Fahrenheit). Kharra quickly developed pneumonia, and by the next day she was dead.
In Kyree's case, doctors fought the virus for 22 days. The boy's small body was resilient, but in the end he suddenly developed a staphylococcus infection that his lungs were unable to fend off. His mother Marci stayed by his side until the end.
Jamming the Emergency Rooms
The swine flu has struck the United States with a severity not yet seen in Germany and other European countries. The illness is now widespread in 48 of the 50 US states, say the infectious disease experts at the Centers for Disease Control and Prevention (CDC). To facilitate patient care, US President Barack Obama has declared the swine flu epidemic a national emergency.
Worried parents and their coughing children are jamming the emergency rooms at many hospitals. In some cities, hundreds of people spend hours waiting in line for the vaccine, which has been scarce until now. Schools are closing, because there are either not enough teachers or students to continue classes.
According to CDC estimates, up to 34 million Americans may have already contracted the virus between April and July. More than 3,900 Americans, including at least 450 children, have already died of the disease or its consequences.
The H1N1 mortality rate in the general population is at least 30 times as high in the United States as it is in Germany. But will it stay that way? Or is the United States simply a few weeks ahead of Europe in the progression of the epidemic?
Rising Infection Rate
The number of people infected with the virus is rising in Germany, where it has already claimed its first fatalities. By Wednesday of this week, 16 people had died of swine flu across Germany. Fear of the virus is rampant. While only a minority of Germans wanted to be vaccinated at first, doctors' offices are now inundated -- and chaotic.
There is considerable uncertainty within both the general population and the medical community. How high is the risk of becoming infected? And how serious is the illness? Even epidemiologists can say little more than that the virus is currently spreading rapidly throughout the entire northern hemisphere. But no one knows how many people are actually infected.
According to the Robert Koch Institute (RKI), the German federal institution responsible for disease control and prevention, there are now 30,000 registered cases of swine flu infection. But that number is relatively meaningless, because the RKI database generally includes only those cases in which a very complex, costly and rarely performed series of laboratory tests has confirmed the diagnosis.
"A precise estimate is not possible at this time," says Gérard Krause, the head of the RKI's Department for Infectious Disease Epidemiology. The virus has become so widespread that it can now be contracted virtually anywhere. Many of those with symptoms don't even go to the doctor, while a significant percentage of those infected have no symptoms at all. Scientists are surprised by how many people already have antibodies against H1N1 in their blood without even knowing that they had the swine flu.
Conversely, not everyone who is sick in bed with a fever and a cough has the swine flu. More than 200 different viruses can cause flu-like symptoms. Of the throat swabs taken from patients suspected of having swine flu that were sent to the RKI's National Reference Center, only 40 percent actually tested positive for H1N1 in the end. In other words, three out of five patients believed to be infected with the virus did not have swine flu.
How Dangerous Is the Virus Really?
Because the numbers are so imprecise, no one knows how dangerous the virus really is. The RKI stresses that swine flu symptoms are "mild in most cases." But will the virus end up killing one out of every 250 infected individuals, as the initial data from Mexico had suggested? Or will the mortality rate be closer to one in 10,000, as later calculations indicated? Or is possible that the H1N1 mortality rate is even much lower, because the total number of infected individuals is much higher than health officials believe?
The US's experience with the virus shows that the infection strikes young people at a noticeably higher rate than normal. "This is a younger people's flu," says CDC Director Thomas Frieden. To be on the safe side, the agency has released the last national stockpiles of Tamiflu powder for children and ordered new packages of the flu medication.
The mortality rate for swine flu is also higher among young people, as opposed to the seasonal flu, which is more often deadly in the elderly. Those particularly at risk are pregnant women, the obese and people with other underlying disorders. Many of the people who died of the disease in Germany already had chronic conditions such as reduced pulmonary function, were severely disabled or were heavily overweight. A man in Heidelberg who died of the swine flu had been waiting for an organ transplant.
However, a number of patients in the United States without underlying risk factors have also died. This is what many find truly frightening about the virus. It can apparently lead to sudden lung failure in young, completely healthy people, who have to be taken to an intensive care unit within hours. But even putting them on an artificial respirator cannot save all of these patients.
About two weeks ago, a completely healthy, 48-year-old mother of four died of the swine flu at the University Hospital Bonn. It was a death that shocked many people.
© SPIEGEL ONLINE 2009
All Rights Reserved
Reproduction only allowed with the permission of SPIEGELnet GmbH
