After the Storm

The Dirección General de Epidemiología of the Mexican Health Department (http://www.dgepi.salud.gob.mx/) published encouraging news last Friday. There has been a steady decline in the number of cases of influenza reported and the numbers of deaths recorded since the outbreak started in April. In fact, the mortality rate has dropped to about zero over the last week.

Friday's report listed a total of 4,000 cases of Novel Influenza A (H1N1) in Mexico. Of these cases, only 80 people died, a mortality rate of 2%. World health officials have applauded Mexico's handling of the crisis. It appears that the harsh measures adopted by the government might have kept the virus from spreading and causing more harm.

The public health emergency did reveal some shortcomings in the ability of government officials to evaluate the actual threat and respond accordingly. As World Health Official Ties Boerma, director of health statistics, declared, "What worries us is that the majority of the developing countries don't have an operating system that can determine if the influenza A (H1N1) virus is present."

A first step would be to increase spending for health care and scientific research. While the Mexican economy ranks 13th worldwide according to the World Bank, it is last among the 30 countries of the Organization for Cooperation and Economic Development with regard to governmental spending on health care and technological research. Closing down Mexico City cost millions of dollars in lost income. Timely investment in hospitals and hi tech laboratories might have reduced that loss.

A Return to Normalcy?

In a joint news conference yesterday, four government ministers, including Health Secretary José Angel Córdova, announced the relaxing of the influenza alert and a gradual resumption of social activity in Mexico City. Restaurants are permitted to reopen tomorrow. High schools and universities will reopen Thursday, May 7 and K-9 will return to classes the following Monday.

According to Mr. Córdoba, the number of people requesting medical attention for the flu had decreased since April 26. While chilangos will be allowed to emerge from their homes and return to public places, the health alert continues and control measures will stay in place. The next steps to be taken by students and teachers will be spelled out when classes resume.

Since the public health emergency was announced on April 23, there have been 822 laboratory-confirmed cases of the new influenza type A (H1N1) and 29 deaths attributed to this disease nationwide (WHO statistics). The virus has been detected throughout the republic, although the Federal District (Mexico City) had the most cases and the strictest public health measures.

The World Health Organization (WHO) reports that worldwide there have been 1,490 lab-confirmed cases of this disease in 21 different countries. In the US there have been 403 lab-confirmed cases, and only one death, which triggered the phase 5 pandemic alert announced by the WHO last week. The highest level alert, phase 6, would be declared if there were sustained community-level outbreaks in another region of the world. So far that has not happened.

The above map, taken from the WHO, shows the influenza situation in the Americas. Most cases have been detected in North America, although some possible cases have been reported in Colombia and Brazil. These are more worrisome as the southern hemisphere is entering its winter months that will bring a climate more favorable for the flu virus.

As health officials have warned us, the A/H1N1 virus will not disappear overnight. It will continue to infect isolated individuals in the population for some time to come. In fact the 1918-19 influenza outbreak that caused the so-called Spanish Flu, a strain similar to the current one, attacked in waves. For this reason it is important for us to take good care of ourselves and continue to heed public health measures.