H1N1 diagnosis not made until days before Clark County man's death

A 33-year-old Clark County man who died Sunday of the H1N1 virus was not diagnosed until well into his 13-day hospitalization, the state's chief health officer revealed Monday.

Whether the slowness of the diagnosis played a role in the first death of a state resident from the H1N1 virus, also known as swine flu, is unknown, Dr. Mary Guinan stressed.

"We have to be careful not to jump to conclusions," Guinan said. "We're trying to find out what happened."

The man, who had no underlying health issues, was not diagnosed until a couple of days before his death, Guinan said.

If a patient is diagnosed early, the anti-viral drugs Tamiflu or Relenza can be effective in interrupting the reproductive cycle of the virus, an action that lessens symptoms and helps the body fight off the virus.

Guinan said it is best for doctors to run a sophisticated test called the Polymerase Chain Reaction on patients with flu-like symptoms to confirm an H1N1 diagnosis. It is possible, she said, that other less sophisticated "rapid" tests would come back negative.

"We may have to educate doctors on testing," Guinan said. "This is a time for education for everybody."

Guinan's observations late Monday came on the heels of the afternoon disclosure by Dr. Lawrence Sands, chief health officer of the Southern Nevada Health District, that three other Clark County residents are currently hospitalized with the virus.

At a morning briefing where he talked about the death of the 33-year-old man, Sands did not mention the hospitalizations. When pressed later, he did.

He said he could not go into any detail on those now hospitalized for "confidentiality reasons."

At the briefing, Sands said he did not know what hospital the H1N1 patient died in, where he was employed or whether the man's fellow employees had contracted or been tested for the disease.

Citing privacy regulations, Sands said he could not release the deceased's name.

At the briefing, Sands said he did not believe the man's family had tested positive for the disease. He later said he wasn't sure.

Sands said he did not know what symptoms caused the man to be hospitalized nor did he know how long the man was in the hospital before he was diagnosed with the virus. The man had been hospitalized on June 15, Sands said.

He said it would not be helpful for people to know where the man died, where he worked or whether his family now has the disease.

"Exposure is not unique to anywhere in the community," he said, adding that knowing that your workplace or hospital had a case of the H1N1 virus isn't going to help people take any better precautions.

"H1N1 is now widespread in the community," he said.

Sands said that his office always releases pertinent information related to public health.

He noted that the district asked more than 50,000 people to get tested for hepatitis in 2008 after the district found a number of patients of clinics run by Dr. Dipak Desai had contracted the disease.

The death of the Clark County man from H1N1 came a little more than two weeks after a 70-year-old woman from New York died of the virus in Nevada. The tourist was diagnosed with the illness after she arrived in Las Vegas.

"It is not unexpected that we would see patients with severe illness and additional deaths related to this influenza strain," Sands said. He stressed that most cases of the virus have been mild, allowing people to recuperate on their own.

Sands pointed out that any flu can be deadly, with 30,000 deaths out of the 200,000 cases of flu registered in the United States each year. A normal seasonal flu outbreak kills 250,000 to 500,000 people worldwide.

The World Health Organization declared a pandemic in early June, when the number of confirmed cases in the world reached 30,000.

Officials with the Centers for Disease Control and Prevention now estimate that more than 1 million Americans have been infected with the H1N1 strain.

On Monday, international officials reported that, for the first time, a case of H1N1 had proven resistant to Tamiflu, the leading pharmaceutical weapon against the new virus. The resistance had been seen in a patient in Denmark, who recovered.

In Southern Nevada, public health officials say the vast majority of H1N1 cases they've seen are mild.

Four of those cases were reported from Marion Earl Elementary school earlier this month.

Health officials did not recommend that the school be closed, but urged parents to keep sick children at home.

The day after the H1N1 cases were reported in the media, the school had an absentee rate of nearly 60 percent as 365 students stayed home.

Officials were uncertain how many students were actually sick because many children were kept home as a health precaution.

The U.S. Centers for Disease Control and Prevention has reported that 70 countries had confirmed cases of the virus. Out of the 28,000 who have contracted the disease in the United States, 127 have died.

As of Friday, state officials said there were 240 confirmed cases of the H1N1 virus in Nevada.

There have been 80 confirmed cases in Clark County.

"But that's just the tip of the iceberg," Sands said. "Most of the people who've gotten it have had a mild case and never been tested."

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.