Wednesday, April 29, 2009

City of Fear

How the swine flu is terrorizing Mexico's capital. An on-scene report.

Alejandro Lelo de Larrea and Hugo R. Hernández | Newsweek en Español

Manuel Camacho Solís went home last week feeling intensely ill and struggling to breathe. Hours later, he went to the emergency room of a private hospital where he was diagnosed with pneumonia. Several tests later, the news got worse: the former mayor of Mexico City was suffering from swine flu. Camacho was not alone. The same day that his virus was confirmed, the Mexican government announced that 18 of its citizens had died of this particular flu, closed the nation's schools and asked scientists around the world for help in preventing a pandemic.

As cases of swine flu—and fear of the virus—move across global borders, Mexico now also faces political and economic fallout from the health crisis. Some residents are questioning whether the government should have started taking preventive measures sooner, when the World Health Organization (WHO) first informed authorities of confirmed swine flu cases in Mexico City, on March 18. Others fear the impact the outbreak will have on their recession-hit economy as foreign tourists cancel trips and businesses are forced to cut back on their operations.

The effects are clearly visible on the rapidly emptying streets of Mexico City. Sadness and depression—a stench of tragedy akin to the aftermath of the 1985 earthquake that killed more than 5,000 people in the capital—are palpable. Schools from elementary to college level have been shut, forcing more than 33 million students around the country to stay home until classes are scheduled to resume May 6. Church services have been canceled; movie theaters are closed and even stadiums are now off-limits in this soccer-crazy nation.

In Mexico City, priests at the main cathedral took an iconic crucifixion image known as the Healing Christ out onto the streets for the first time in more than 100 years as part of a procession to pray for health. Few people venture out in public without surgical masks, and police are distributing the face coverings at entrances to subway and bus stations. Fear of infection is keeping many people off mass transit anyway, and bus drivers refuse to allow barefaced passengers on board. Sneezing or coughing? Expect to be viewed with suspicion by those around you.

And in another blow to the economy, the mayor of Mexico City has ordered restaurants to shut their seating areas and serve only takeout meals. Private businesses have reduced their hours and are asking employees to work from home wherever they can. Firms that are still open are reporting that thousands of workers have called in sick and health centers ranging from basic clinics to top-tier hospitals are crammed with patients who fear they have the flu. Panic is starting to build, too. On Monday, thousands of Mexicans rushed to supermarkets to stock up on canned food, despite government assurances that there would be no food shortages.

Local authorities are trying to tamp down fear in other areas, as well. Clinics and hospitals are crammed with sniffling patients, but officials in Mexico City say that only about 2 percent are being kept for observation because they show swine-flu symptoms. According to Mexico's minister of health, José Ángel Córdova, around 2,000 cases of pneumonia have been detected nationwide. About half of the patients have been discharged, 700 remain hospitalized and 150 have died—although Córdova is still waiting to confirm whether swine flu caused all of the deaths.

These statistics, however, may not be reliable. Some Mexican doctors say that some swine-flu deaths have not been recorded as such because patients were not tested for the virus; others suggest that Mexican health authorities may be trying to conceal the extent of the crisis. In Mexico City's state-owned Darío Fernández Hospital, for example, four patients were admitted to the intensive-care unit in the last week suffering from pneumonia. All showed symptoms of swine flu, and two died last Friday. Yet their death certificates made no mention of the virus because the victims were not tested for it.

Another physician, who spoke with NEWSWEEK en Español but asked not to be identified, claimed that in the Gea González Hospital—the biggest facility run by the Ministry of Health in Mexico City—doctors have been explicitly told not to record pneumonia as a cause of death. "You must say that they died of cardiac arrest or anything else," said the physician about the instruction given to them. (The Ministry of Health did not comment on these allegations ahead of NEWSWEEK en Español's deadline this week.)

Meanwhile, scientists from around the world are working closely with Mexico to solve the mysteries of the mutated virus and to prevent it from establishing itself as a pandemic. Frank Plumber, director of Canada's National Microbiology Laboratory, found that the samples sent to his facility indicated the virus was related both to one found in North America several years ago and to a Euro-Asian variety of swine flu detected in Thailand. With so much unknown, doctors are extrapolating information based on their previous experiences with Asian bird flu. That may not always be appropriate. Initial indications, for example, suggest that the swine flu may be transmitted differently, because—unlike instances of bird flu—not all of those in close contact with the ill have been infected themselves. Another unanswered question is why the virus seems to affect some more virulently than others, with the bulk of the deaths so far coming mainly from Mexico.

Researchers are also struggling to find an effective vaccine, a development that is expected to take several months. Mexico's government has allocated additional funds to adapt the country's two biosecurity labs and to invest in the hunt for antigens. For now, Mexican doctors are focusing on treatment with antivirals like oseltamivir (Tamiflu) and zanamivir (Relenza). For Camacho, the former mayor, the treatment seems to have worked. Last Sunday, three days after he was hospitalized, doctors told him he was out of danger. Mexico, though, remains at risk on both the health and business fronts.

This report was adapted from an article originally published in the May 4 edition of NEWSWEEK's Spanish-language partner, NEWSWEEK en Español.

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