Moreover, the highest rates in the prior years were linked to peak levels of seasonal flu, and this season there is no seasonal flu. Over 99% of flu this season has been pandemic H1N1, and although reported levels have been declining, the P&I deaths are spiking to strikingly high levels.
The above CDC explanations do not address the size of the peak and the relationship to reported H1N1 levels, and raise concerns of serious undercounts,. Many hospitals continue to use the rapid tests, which in some instances only detect 10% of pandemic H1N1 infected individuals. The virus quickly moves to the lower respiratory tract in severe cases, and many media reports describe fatal cases that were first confirmed at autopsy.
Thus, the current testing methodologies may significantly under-represent pandemic H1N1 cases, and the true level may correspond to the current strikingly high spike in P&I deaths. The current MMWR tables break down total deaths by age, but the P&I deaths are listed as a composite number. An age breakdown of the P&I deaths in the 122 cities would be useful.