Ukraine in particular has “a shortage of ventilators and they have counted more than 100 deaths by now,” Dr. Nikki Shindo, a medical officer with the organization’s global influenza program, said at a news briefing.
Alarmed by deaths that health authorities believe could have been prevented with rapid treatment, the agency said it was revising its guidelines and urging more people to take antiviral medication even before they are sure they have the flu.
The new guidelines say that anyone with flu -like symptoms for three days, along with people in several high-risk groups — pregnant women, children under 2 and people with underlying respiratory problems — should not wait for laboratory tests to confirm the diagnosis but should be treated right away with drugs like Tamiflu.
“The pandemic virus can cause severe pneumonia even in healthy young people,” Dr. Shindo said, adding that “the virus can take life within a week.”
“The window of opportunity is very narrow to reverse the progression of the disease,” she said. “The medicine needs to be administered before the virus destroys the lungs.”
Although antiviral medications are most effective when used within 48 hours after symptoms start, Dr. Shindo said the drugs should be given even after that if a person is very sick.
Dr. Shindo said the guidelines, similar to those in use in the United States, had not been adopted sooner because the agency was not yet confident, as it is now, about the safety and efficacy of the antivirals, Tamiflu and Relenza. Doctors there were also worried about shortages.
The agency said the countries most affected were Afghanistan, Mongolia, Belarus, Ukraine, Azerbaijan and Kyrgyzstan. The first four have already been sent supplies; the other two are to receive them soon.
“Doctors involved in caring for very sick patients in intensive care units regretted that the patients arrived too late and even the most sophisticated medical procedures could not save their lives,” she said. “We asked what could have been done differently to avoid the tragic outcomes. All of them answered, without exception, that things may have been very different if they had been treated with an antiviral drug earlier.”
In Ukraine, it appeared to take about two weeks from the time the first deaths were reported in October for the authorities to link them to the H1N1 flu.
Although Tamiflu had been stockpiled, protocol required doctors to prove a patient had H1N1 with laboratory testing before prescribing the medicine, said Nadezhda Rudnitskaya, the chief of pulmonology at Lviv Medical University.
When authorities in Lviv, in Western Ukraine, finally officially connected the deaths to swine flu and called for quarantine measures, frightened residents began buying up inventories of masks and gauze, and prices of home remedies like garlic and lemon shot up. Politicians took to the airwaves with contradictory or incorrect information about the flu, and ambulance calls increased fivefold.
In the United States on Thursday, theCenters for Disease Control and prevention released new estimates of the number of American swine flu deaths: about 3,900, or more than three times the number authorities had previously used. The earlier number, about 1,200, represented laboratory-confirmed cases; the new numbers represent estimates that include people who ultimately died of other conditions, like pneumonia, but whose illnesses were trigged by the flu.
The new numbers, representing cases between April and Oct. 17, indicate that about 22 million people have contracted H1N1, and that the virus is “disproportionately affecting children and adolescents and relatively sparing the elderly, very different from seasonal flu,” Dr. Anne Schuchat, director of immunization and respiratory diseases for the disease control agency, said at a news conference.
Unlike seasonal flu, in which about 90 percent of the deaths occur in people 65 and over, in swine flu, they account for about 11 percent of deaths. About 540 children under 18 have died.
“I do believe that the pediatric death toll from this pandemic will be extensive and much worse than we see with seasonal flu,” Dr. Schuchat said.
pam belluck
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