Mexico

The cracks opened up by the flu

As the swine-flu outbreak appears to subside, Mexico is left to contemplate the cost and to ponder the authorities’ response

AFTER almost a fortnight of high alert and a five-day shutdown of ghostly calm, Mexico City this week began gingerly to return to its normal metropolitan bustle. Fears that swine flu might be a deadly epidemic have subsided: testing has shown that it was responsible for fewer than 50 of the 159 deaths that it was reported to have caused in Mexico. So far it seems to be barely more contagious than normal influenza, and is treatable with antiviral drugs. On May 6th Mexico City’s municipal government lifted a weeklong ban on restaurants seating customers. The national government allowed universities, high schools, churches and museums to reopen from the following day, while primary schools will do so on May 11th. Mexicans are dispensing with their face masks, and breathing a sigh of relief.

As they do so an inquest is starting into the authorities’ handling of what has turned out thus far to be a fairly mild bug. To some, the official reaction was both tardy and excessive. The first patient known to have had swine flu, Édgar Hernández, a small boy in a village in the eastern state of Veracruz, saw a doctor on April 2nd. The first confirmed death—Adela María Gutiérrez, a 39-year-old woman in the southern state of Oaxaca—occurred on April 13th. But the authorities did not send samples abroad for genomic analysis, the process that eventually identified the new virus, until April 22nd. They did not acquire the technology to test for themselves for another week. “They should have analysed the samples immediately,” says Laura Moreno Altamirano, a professor of public health at the National Autonomous University of Mexico. “Then they would have known that the virus wasn’t so aggressive, and they wouldn’t have had to implement all these measures.”

Those measures included closing schools, football stadiums, gyms, cinemas, bars and nightclubs; cancelling concerts, plays, festivals and church services; limiting restaurant services to takeaway and delivery; and augmenting a public holiday by a day to create the five-day shutdown.

This shutdown hit the economy hard. Because of its close links with America’s economy, and especially its crippled car industry, Mexico had already slid into a deep and worsening recession. In February output shrank by 10.8% compared with the same month last year, the worst number since these figures began to be collected in 1993. Agustín Carstens, the finance minister, said that the swine-flu outbreak will lop an extra 0.3% from GDP this year. Some private estimates are much higher.

The government has announced $1.3 billion in tax breaks and spending to help offset these losses, which will be financed with borrowing. But the damage to Mexico’s image abroad, and therefore to its tourism industry and food exports, may be long-lasting. Hotel occupancy has fallen to single digits. Several airlines have stopped flying to the country. Eight countries, including China and Russia, have banned some Mexican farm products. (China this week allowed a plane chartered by the Mexican government to pick up 71 Mexican citizens whom it had quarantined, although they had no flu symptoms.)

The episode has also exposed inequalities in Mexico’s health services. Many patients, particularly those in poor rural areas, receive dubious care or no care at all. Poorer people often prefer to buy drugs at a pharmacy instead of losing a day’s work dealing with the public-health bureaucracy, says Verónica Baz of CIDAC, a think-tank in Mexico City.

Local media reported several cases of ambulance drivers refusing to transport patients, and of hospitals lacking antiviral drugs. Rogelio Pérez Padilla, the director of the National Institute for Respiratory Diseases, admits there were “time lapses in distribution” from the government’s strategic reserve of 1.8m doses. But in a big developing country of 110m people, “some delays were to be expected,” he said.

The critics, of course, enjoy perfect hindsight. Miguel Ángel Lezana, the government’s chief epidemiologist, notes that between 1,500 and 1,800 Mexicans typically die of flu each year during March and April. There was no reason to suspect a new virus, he says, until a spike in cases among the young and healthy appeared towards the end of the flu season in early April. The subsequent fall in the number of cases is because of the government’s decisive action to impede the spread of the infection, according to José Ángel Córdova, the health minister.

Public opinion seems to agree. Polls show that around 70% of respondents approve of President Felipe Calderón’s handling of the swine-flu outbreak and of his overall performance. His government will soon be held to account, in a mid-term Congressional election on July 5th. The sickly economy, and doubts about whether Mr Calderón is winning a battle to tame violent drug-trafficking gangs, have given the opposition plenty of ammunition.

But the polls show his conservative National Action Party starting to cut what was a double-digit lead for the formerly ruling, centrist Institutional Revolutionary Party to around five points. It is a Mexican instinct to rally round the leader at a time of trial. As normality returns, Mr Calderón will have to persuade his people that his government’s actions saved lives.

Mexico Hits Out At Neighbors

China Quarantines Mexicans

Beijing, Fearing Flu, Locks Down Dozens of Travelers -- Offers Little Information or Medical Help

ANDREW BROWNE

BEIJING -- The A/H1N1 flu outbreak is leading to a potential diplomatic row between China and Mexico, as Chinese health authorities round up and quarantine scores of Mexicans -- only one of whom is thus far reported to be sick -- as they fly in on business and holiday trips.

Mexico's foreign minister said Mexican citizens with no signs of infection had been isolated in "unacceptable conditions" in China. Patricia Espinosa told a news conference Saturday that such measures were "discriminatory and ungrounded" and that the government is advising Mexicans to stay away from China.

She also criticized four Latin American countries -- Argentina, Peru, Ecuador and Cuba -- for suspending flights coming from Mexico against the recommendations of the World Health Organization.

More than 70 Mexicans are in isolation around China, according to Mexican officials, and that number is rising as Mexican travelers call in to their embassy to report their plight.

China has been rounding up all travelers aboard an AeroMexico flight from Mexico that arrived on Thursday in Shanghai with a 25-year-old Mexican man now ill with human swine flu in Hong Kong.

That man is the only known Mexican sufferer in China to date. However, Mexicans on other flights say they have been singled out for harsh treatment.

Gustavo Carrillo, a 36-year-old general manager of a Mexican technology company in China who lives in Beijing with his wife and three sons, was taken off his Continental Airlines plane on Saturday and rushed into quarantine at a Beijing hotel. He had traveled to the U.S. from China on a business trip and hadn't visited Mexico.

Mr. Carrillo said health officials took the temperatures of other passengers after the plane landed, but didn't check his after they saw his Mexican passport. Instead, they led him down the aisle past gawking passengers. "It was embarrassing and humiliating," he said. "It's just pure discrimination."

Mexicans who were on the flight to Shanghai with the 25-year-old flu victim complain about how China has enforced its quarantine, offering little information and only the most basic medical testing. Among them is a family of five, including three young children, who transited to Beijing. They were then roused from their hotel room in the Chinese capital in the early hours of Saturday and whisked to an infectious diseases hospital. There, according to the father, Carlos Doormann, AeroMéxico's finance director, they were isolated in a room with bloodstained sheets and what appeared to be mucus smeared on the walls.

"I'm frustrated and sad," said Mr. Doormann, whose family has since been moved to the nearby Guo Men Hotel on the outskirts of the Chinese capital, where they are in quarantine along with five other Mexican nationals, including Mr. Carrillo.

According to accounts from Mexicans in the hotel, Mexican travelers arriving on various flights from Mexico and the U.S. were singled out by health officials who boarded their aircraft wearing white protective suits, masks and rubber gloves. They led away Mexican passport holders, while non-Mexicans watched from their seats.

Several said that Chinese television camera crews and photographers surprised them at the doors of their aircraft as they emerged. They said the filming continued through the windows of an isolation ward at the Beijing Ditan infectious diseases hospital.

"We felt like we were in a zoo," said Angel Yamil Silum, a 27-year-old business student, who arrived in Beijing with his girlfriend on Saturday as transit passengers en route to Bangkok for a holiday and ended up at Ditan and then the Guo Men Hotel.

Chinese authorities allowed Mexico's ambassador to China, Jorge Guajardo, to enter the hotel on Sunday but refused him permission to see the quarantined Mexicans or to call up to their rooms, Mexican officials said. The embassy is shuttling soft drinks, pizzas, chips and other Western food into the hotel along with CDs, toys for the children and other entertainment.

Chinese officials deny that Mexicans are being unfairly targeted. "There is no discrimination at all," said Zhang Jianshu, head of the news office at the Beijing Health Bureau. "We treat all people the same," he said, adding that there are many Chinese passengers in isolation. He said the measures are in line with the requirements of the World Health Organization.

The spokesman for China's ministry of health, Mao Qun'an, said he sympathized with the Mexicans. "We totally understand their feelings," he said. He added: "The isolation is not only good for their health, but is also good for the public. It's not discrimination at all."

China's government was widely blamed for a slow and ineffective initial response to Severe Acute Respiratory Syndrome in 2003 and appears eager to demonstrate to the Chinese public that it is taking the threat more seriously this time.

The Doormann family's ordeal began at 2:00 a.m. on Saturday when a Spanish-speaking woman, who identified herself as a Chinese health official, called their hotel room and instructed the family to "pack immediately and go to the hospital," Mr. Doormann said.

"I said, 'can't we wait? I have three little kids'," Mr. Doormann recalled. The children are ages 8, 6 and 5. But at 4:30 a.m. they were whisked through the dark streets of Beijing to Ditan, a recently opened showcase medical facility. Apart from the dirty sheets and walls of their room, Mr. Doormann said the bathroom had no soap or toilet paper.

After the personal intervention of Ambassador Guajardo, the family was moved to the Guo Men Hotel. Like their fellow Mexican guests, they have had no contact with Chinese government officials, except health workers, and have no idea how long they will have to stay. "We're held hostage here," said Mr. Doormann.

The Guo Men Hotel is a sprawling complex of aging buildings with green-tiled roofs surrounded by lawns and trees. Police and uniformed guards patrol the grounds. Twice each day, nurses leave thermometers outside the Mexicans' rooms. No other medical testing is carried out. The quarantined guests are allowed into the hotel grounds, although the hotel has "recommended" they stay in their rooms.

Myrna Elisa Berlanga Morales, a 31-year-old administrative assistant from Mexico City, arrived in Beijing on the Continental flight on Saturday with two American friends. She asked why Chinese consular officials in Mexico issued her and other Mexicans visas when they were heading straight into quarantine in China. "They could have warned me," she said.

Her two friends had told her that her holiday in China "would be the most unforgettable 15 days of my life". She added: "Now I believe them."

Flu death toll 'less than feared'

Flu death toll 'less than feared'

Mexicans are being advised to stay at home during the shutdown

Mexico has revised down the suspected death toll from swine flu from 176 to 101, indicating that the outbreak may not be as bad as was initially feared.

Health Minister Jose Angel Cordova told the BBC that, based on samples tested, the mortality rate was comparable with that of seasonal flu.

Mexico has ordered a five-day shutdown in a bid to contain the virus.

A World Health Organization official said there was no evidence of sustained virus spread outside North America.

WHO Director of Global Alert and Response Dr Michael Ryan said the emergence of more cases in Europe did not mean the WHO would necessarily need to raise its global pandemic alert level.

"I think it would be, at this stage, unwise to suggest that, in any way, those events are out of control or spreading in an uncontrolled fashion," he told a daily press briefing.

"I think the next few days will tell as this develops."

CONFIRMED CASES Mexico: 101 suspected deaths - 16 confirmed US: One death, at least 141 confirmed cases New Zealand: 4 confirmed, 12 probable cases Canada: 35 confirmed cases UK, Spain: 15 confirmed cases Germany: 4 confirmed cases France, Israel, Costa Rica: 2 confirmed cases Netherlands, Switzerland, Austria, Denmark, Hong Kong, South Korea, Italy: 1 confirmed case Countries with confirmed cases of secondary transmission Mexico US Canada Spain Germany UK Mapping the outbreak Price hikes in Mexico amid flu panic

The WHO is sending 2.4m courses of antiviral treatment to 72 nations around the world, Dr Ryan said, among them many developing countries.

The WHO was still trying to establish the severity of the swine flu virus, he added.

Italy reported its first case on Saturday, bringing the number of countries affected to 17.

In Egypt, authorities have begun in earnest the slaughter of more than 300,000 pigs, in what was originally described as a precaution against swine flu.

Officials now say the move is a general health measure aimed at restoring order to Egypt's pig-rearing industry.

Experts say the virus cannot be caught from eating pork and there is no scientific rationale for the cull.

Five countries outside Mexico have confirmed person-to-person transmission.

China is trying to stop the spread of the virus, after getting its first case on Friday.

It says it will quarantine all those who travelled on a flight from Mexico with a man suffering from swine flu.

Flights from Mexico have been suspended, and fellow guests and staff at the Hong Kong hotel where he was staying have been quarantined.

South Korea has also now confirmed a case of the virus.

Risk remains

In cases outside Mexico, the effects do not appear to be severe.

Dr Anne Schuchat, acting deputy director of America's Centers for Disease Control and Prevention (CDC), said that although experts were concerned about the possibility of severe cases, the majority so far had been "mild, self-limited illness".

SYMPTOMS - WHAT TO DO Swine flu symptoms are similar to those produced by ordinary seasonal flu - fever, cough, sore throat, body aches, chills and fatigue If you have flu symptoms and recently visited affected areas of Mexico, you should seek medical advice If you suspect you are infected, you should stay at home and take advice by telephone initially, in order to minimise the risk of infection Q&A: What is swine flu? Mexican economy squeezed by flu In pictures: Flu concern grows The quest for a swine flu vaccine

The new virus lacked the traits that made the 1918 flu pandemic so deadly, another CDC official said.

Mr Cordova appeared to agree, saying that the Mexican authorities may, on reflection, have overestimated the danger.

He said 43.7% of samples from suspected cases so far tested had come back positive, a total of 397. Sixteen in this group had died.

"All the samples that were taken give us an idea of the percentage of the ones testing positive," he said.

"That means that apparently, the rate of attack is not as wide as was thought."

But he stressed that the risk of a rise in infection remains and some elements of the five-day shutdown might be extended.

Restaurants, public buildings and businesses have been closed as Mexico tries to bring the virus under control, and people are being urged to stay at home.

Mexico City Mayor Marcelo Ebrard said the emergency measures were bringing results, with the numbers "getting better every day".

There is growing concern about the effect the virus could have on Mexico's economy.

Several US air carriers say they will cut flights to Mexico as demand falls amid concerns over the crisis. Tourism has plummeted since the outbreak was declared a week ago.

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