As spring 2009 arrived, there was nothing uncommon about the flu season. For weeks, the Mexican government had stated, "this year's higher flu caseload was nothing unusual."[1]
On April 2nd, a 5 year-old boy, Edgar Hernandez in Perote (Veracruz State), home of many pig farms including a mega farm of a million pigs-hogs fell ill experiencing flu-like symptoms. He quickly recovered, drawing no attention.
On April 13th, Gerardo Leyva-Lolis, a 39-year-old brick layer who lived in a two-room wood and cinderblock home in Xonacatlan (a Mexico City suburb) near three pig farms, with his wife and three teenaged sons fell ill. He went to a local clinic where no one was available to provide a check-up and diagnosis. After receiving a precautionary penicillin shot, he returned home. On the same day, a resident of Oaxaca State died from pneumonia-like symptoms.
Feeling better after a night's rest, Mr. Leyva-Lolis went to work on the following day despite a persistent cough. He made the 40-mile commute to and from Mexico City via bus and subway potentially exposing thousands.
By April 15th, Mr. Leyva-Lolis felt too miserable to return to work. Four days later, he experienced difficulty breathing and an irregular heartbeat. Concerned family members immediately took him to a public hospital for the poor in Toluca. By 8 AM on April 20th, Mr. Leyla-Lolis was dead. Cause of death was attributed to a pneumonia-induced heart attack.
Unbeknownst to him, his family, and the world, other suspicious deaths had been occurring over the last several days prompting Mexican health officials to send 14 mucous swab samples to the Center for Disease Control (CDC) in Atlanta, GA. on April 18th.
The results did not come back until April 24th when the CDC determined that a disturbing new form of influenza that had never been seen before (combining human, swine, and avian genetic material) was the cause of the outbreak. By then deaths were mounting and hundreds had fallen ill across Mexico.
When the alarm was raised, prompt action began. Mexican schools, museums, tourist spots, entertainment and sporting events were shutdown to contain the spread. The streets were deserted and cities became ghost towns. However, despite the efforts, scattered cases began to pop up in the United States (first in California and Texas followed by New York and Ohio) and in Europe.
With the dead ranging in age from their 20s to 50s, people in the prime of their lives (similar to the start of the 1918-19 pandemic), the A/H1N1 swine flu being a new version (whose lethality is not known) to which humans have no natural immunity, and the outbreak of human-to-human transmission, concerns grew that the world could be on the cusp of its first pandemic in 40 years. Memories of past pandemics quickly surfaced:
• 1918-19: A/H1N1 Spanish Flu resulted in about 50 million deaths and infected up to 40% of the world population.
• 1957: A/H2N2 Asian Flu resulted in about 2 million deaths
• 1968: A/H3N2 Hong Kong Flu resulted in about 1 million deaths
As the world mobilized on April 25th, the World Health Organization (WHO) maintained a level 3 reading (No or very limited human-to-human transmission was occurring) on its pandemic alert scale stating that more information was needed. However, the organization warned that the A/H1N1 outbreak was of serious concern. In response, the United States declared a public health emergency on April 26th to allow release of 25% of flu-treatment stockpiles consisting of medicines, ventilators, and masks.
By April 28th, with the number of cases growing and spreading to more countries, the WHO raised its alert level to a 4 rating indicating that evidence of increased human-to-human transmission was taking place with regard to the new virus. At the same time, the WHO declared that containment was no longer an option since "the virus is already quite widespread in different locations."[2] Consequently, the organization declared, "no region in the world is safe from the swine flu virus."
On April 29th, the WHO raised its alert level to 5. Such a level indicates that human-to-human transmission is taking place in at least two countries in one WHO region and a pandemic is possibly imminent. Thus it is urgent that countries enact their pandemic plans in preparation.
With that said, per WHO Deputy Director-General, Dr. Keiji Fukuda, a pandemic is not inevitable. However, even if a pandemic does occur, medical technology, distribution networks, and communications capabilities (for the first time, the spread of a pandemic can be tracked in real-time) have evolved greatly since 1968 when the last pandemic occurred. In addition, international governments are better prepared in light of the SARs (Severe Acute Respiratory Syndrome, 2002-03) and avian flu (1997 and 1999) scares, a fact mentioned by WHO Director-General, Dr. Margaret Chan during the organization's April 29th announcement raising the alert level.
However, even in a worst-case scenario, the overall global death toll does not have to be massive or come remotely close to levels of past pandemics for the following reasons:
1. Basic hygiene - the washing of hands with soap, use of a tissue to cover sneezes and coughs - can limit the spread of air-borne particles responsible for the spread of this flu virus.
2. Proactive coordinated national and local responses, which appear to be taking place in most countries. Such measures have resulted in the release of medical stockpiles, distribution of face masks in hard-hit areas, and public relations bulletins including the importance of basic hygiene, description of the symptoms (the presence of a fever, headache, aching muscles, cough, sore throat, runny nose, and fatigue) to recognize infection and steps to take to avoid contagion when one is infected.
3. Maintenance of calm so that hospitals and health organizations are not overwhelmed due to hysteria, delaying or diverting treatment from patients in real need.
4. Existence of flu-treatment drugs, Tamiflu® and Relenza® that are highly effective against this strain of swine flu.
5. Mechanical ventilators (that did not exist in 1918), that greatly reduce the mortality rate from pneumonia-related complications that arise from a strong immune response that elicits elevated cytokine production that fills the lungs with water.
However to minimize loss of life, the CDC, WHO, and other international health organizations will need to monitor cases closely watching for mutations that could create a more lethal strain and/or impair the effectiveness of existing anti-flu drugs. Furthermore, international financial, humanitarian, and medical organizations must be prepared to act swiftly in the developing world since outbreaks in much of the African continent and parts of Latin America and Asia will present significant financial and logistical challenges.
Although there can be no guarantee that the 2009 A/H1N1 Swine Flu outbreak will not become a pandemic, the consequences can be mitigated. With a continued absence of bureaucratic red tape, dissemination of pertinent information, exercise of precautionary steps, prompt isolation and effective treatment of infected victims, utilization and sharing of the latest medical technology, and constant vigilance, massive loss of life consistent with past pandemics and significant economic upheaval to a global economy already reeling from its worst downturn since the Great Depression of 1929, need not occur.
[1] Why Is Swine Flu A Killer Only In Mexico? CBS News. 27 April 2009. 27 April 2009.
http://www.cbsnews.com/stories/2009/04/27/health/main4970352.shtml
[2] Donald G. McNeil, Jr. W.H.O. Issues Higher Alert on Swine Flu, With Advice. The New York Times. 28 April 2009. 28 April 2009. http://www.nytimes.com/2009/04/28/health/28flu.html?_r=1&ref=europe
William Sutherland is a published poet and writer. He is the author of three books, "Poetry, Prayers & Haiku" (1999), "Russian Spring" (2003) and "Aaliyah Remembered: Her Life & The Person behind the Mystique" (2005) and has been published in poetry anthologies around the world. He has been featured in "Who's Who in New Poets" (1996), "The International Who's Who in Poetry" (2004), and is a member of the "International Poetry Hall of Fame." He is also a contributor to Wikipedia, the number one online encyclopedia and has had an article featured in "Genetic Disorders" Greenhaven Press (2009).
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