N D Burman Cape Town.
Their breakdowns don’t give a global figure of how many of the 226 patients had serious relevant comorbidities ie immunosuppression, cardiopulmonary, diabetic or morbid obesity. One cannot derive the number of serious comorbidity patients from the Mexican paper – in the Canadian paper only 30.4% had ‘major’ comorbidity. .
In the bigger 17week Canadian narrative series of 168 critical hospitalized cases there from April to August, 81% required ventilation; 90% received antivirals, so they cannot judge if these drugs had benefit or were adverse; mortality was only 17.3% by 90days – promising, but in a healthier northern population? from more sophisticated costly care? antivirals? or what?.
The smaller 10week Mexican series – 58 critical cases in 899 hospitalized (confirmed or suspected, not necessarily critical) cases from April-June is more helpful: 97% required ventilation; mortality was 41.4% in these critical cases by 60 days; survival was an impressive 7.4 fold higher in the 78% (45) who received Neuraminidase inhibitors who did not, p <0.006 – but the numbers were small (especially the 13 who were not given NAI), and they give no table to judge how they arrived at these odds, or the criteria by which NAI were given or were not given.
Neither of these studies are trials, so one cannot draw any objective conclusions about Neuraminidase Inhibitors NAI effect on serious morbidity or mortality. Considering that hyperacute patients die too fast, and the rest only receive NAI after 3-4 days if sick enough, only a prospective RCT randomized controlled trial with NAI in all suspected flu cases- with retrospective viral typing of samples -can show this, and truly assess cost/benefit. The cemetries are littered with acclaimed drugs that were widely used for years until enough deaths occurred for it to become clear that the drugs were actually killers. But legislation enacted by the last Bush Administration imdemnifies manufacturers from any liability in cases of calamity from their drugs!
Fortunately, with the swine flu rapidly on the decline at least in the USA, manufacturers cannot supply the millions let alone billions of doses of swine flu vaccine that they and the USA authorities targeted. As HealthNews says, how can they produce anything safe?
By contrast, increasing numbers of practitioners are reporting virtual abolition of swine flu outbreak in patients (both in private practice and in institutions) who take a modest vitamin D3 supplement of 4000-5000iu/day (with up to 1000iu/lb /day for 3 days in any acute infection) . Obviously the prudent will balance this with the usual protection from at least 800mg marine omega3 oil (eg 3gms 30% or 1g 80% fish oil; and a good multimicronutrient supplement including betacarotene; zinc; oral ACS colloidal silver; sutherlandia; sniffing vitamin C powder; and a few grams a day of oral vitamin C – just not enough to cause diarrhoea.
email from Roche: Sent: Wednesday, October 28, 2009 5:41 AM “You can imagine that with the sudden unexpected pandemic all they tried to do is to determine whether the traditional neuraminidase inhibitors like Tamiflu will be effective in treating and preventing the duration, severity and incidence of co-morbidities of the new strain of influenza. . Fortunately the odds are still in favour of receiving early treatment. We know that Tamiflu is effective in the treatment and prevention in most seasonal and pandemic strains of influenza A and B with very little resistance reported so far. The CDC site is a very useful resource for new information….”