State data for Pennsylvania also indicate that the fall wave of H1N1 appears to have peaked in late October, says state health department spokeswoman Stacy Kriedeman. Though current activity far exceeds levels seen during normal influenza seasons, the department reports that since the beginning of November, there have been "clear declines in overall reporting from all areas of the state."
In Colorado, state officials also reported in a recent press release that surveillance data indicates that flu levels "peaked" in early October for the Denver metropolitan area. At Denver Health medical center, a hospital spokesperson reports that flu activity has seen a steady decline over the last few weeks and is now at the level one would expect for a normal flu season.
Additionally, health officials in Wyoming, Minnesota, and Nebraska, have all publically noted a decline in flu activity for their regions, according to the AP, and state data released by North Carolina and Rhode Island show a decline in overall flu activity.
The number of flu patients at Rhode Island Hospital and Hasbro Children's Hospital in Providence peaked at the beginning of November and is now dropping off, according to a spokesperson there.
In Kentucky's Barren River district, the district director, Dennis Chaney, said they are seeing a "gradual decline" in confirmed H1N1 cases, including numbers of ICU patients hospitalized with flu complications.
Chaney said, "I really feel that, in general, the community is taking personal responsibility for their behaviors as it relates to staying home if they're sick. Those campaigns for personal responsibility are being effective."
In Hillsborough County, Fla., however, a decline in emergency room visits doesn't necessarily indicate an overall decline in flu cases, according to health department spokesman Steve Huard. The increase in over-the-counter medicine sales tracked by the state suggests that many who come down with a less severe case of flu are "getting the message," Huard said, and treating themselves from home.
Widespread levels of flu in the state are still "chugging along," he said, but there may not be as many people going to the ER.
"We do believe our messages have been heeded by the public," said Kriedeman. " [The Pennsylvania Department of Health] has repeatedly emphasized…that most persons with the flu who…do not have danger signs of illness can generally remain at home and not seek health care."
Antiviral prescriptions, over the counter medicine use, and reports from "sentinel" health providers such as physicians, university medical centers and local health departments, are all additional measures that some states use to gauge the levels of flu activity among those who are not sick enough to merit a trip to the emergency room, or even a visit to their physician.
"Our most effective tracking tool [for San Juan County, Wash.] was real time school reporting of absent students…because most people do not seek medical evaluation with flu symptoms, this is an earlier indication of influenza than physician reporting, and much earlier that ER visits or ICU care," says James.