Signs of Swine Flu Abatement in Mexico?

Yesterday I commented that it looks as if the swine flu might be recessing here in Mexico.  News today seems to support that hypothesis.

On Friday, the first day of the emergency, newspapers reported there had been 30 deaths.  By Saturday, the totals jumped to 100.  In the three days following, there were roughly another 50 reported deaths, mostly in rural areas and cities outside of the D.F.  And, today (Wednesday), El Universal reports that the total number of suspected deaths rose last night by only one person, to 159.  These numbers show that deaths spiked as the initial reports came in, but that in recent days, the perceived mortality of the virus has dropped significantly.  

If true, it could be better health care, greater public awareness, or even a change in the pathology of the virus.  However, while it’s probably too early to draw any real conclusions, the news this morning seems to be very positive.  

 

México, D.F.

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Why Swine Flu Appears to be More Deadly in Mexico

In this article on slate.com, David Dobbs notes that the only swine flu deaths that have occurred are here in Mexico and suggests four reasons why the virus seems to have a much, much lower mortality up north.  All of Dobbs’ reasons hinge on the idea that there is some key pathological difference — the possibility of a different virus, other secondary bugs, genetic differences (given the immigrant population in the U.S., that’s likely to be a non-starter), etc., here in Mexico.  But I’m thinking the real difference is the quality of health care that those with the swine flu received three weeks ago vs. those today.

As Dobbs’ notes, two weeks ago, no one had heard of the swine flu.  Yet there were plenty of people here in Mexico who were sick with the flu (swine or not).  Swine flu happens to be particularly contagious and more severe that the common flu; if those with the swine flu were not aware of the potential for this bug to be a bit worse than other viruses, it’s likely that they did not seek medical attention in time to avoid fatal dehydration and breathing complications.  Furthermore, although health care in Mexico City tends to be very good, health care in rural areas is much less so, meaning that patients may not have received the attention they needed at the start of the outbreak.

Why do I think this?  One simple reason: the deaths from the swine flu seem to be tapering off (my interpretation of NY Times reports) since the government declared an emergency here.  Given the time needed for the swine flu to incubate, the isolation caused by the four-day-old emergency is not enough to have abated the number of patients with advanced stages of the flu.  Instead, it suggests that greater awareness by the public and by public health officials is resulting in better and more timely health care for those who are in distress with the swine flu and, thus, a sharp reduction in mortality.  We’ll see over the next few days whether this interpretation is supported by the evidence.

 

México, D.F.

(Swine Flu and) an Earthquake, too

Apparently, Mexico City was just struck by an earthquake, measuring 5.7 (or 6.0) on the Richter Scale.  That’s pretty sizable, as far as earthquakes go, but not a monster.  Preliminary reports — the news was on in a store I passed — indicate the temblor was centered in the state of Guerrero, possibly near the city of Chilpancingo, closer to Acapulco, three hours by car to the southwest of the city.

Of course, like a true California native, I didn’t feel a thing.  I only found out when, 15 minutes later, I passed a huge group of office workers gathered on a corner.  They all had masks on, so I thought there might have been some flu announcement.  Anyways, the power’s on and workers have returned to their buildings.

That said, the flu, earthquakes… what comes next?  This hasn’t been a good weekend for the chilangos of Mexico City.  And, including the drug war, it’s been a terrible year for Mexico’s tourism.  I think I need to take a trip to the beach.

 

México, D.F.

Swine Flu, Isolation, and Signs of Paranoia

Last Thursday evening, the president of Mexico met with senior advisors to discuss and plan their response to the reported outbreak of swine flu here in Mexico.  They closed schools, ordered the cancellation of every public gathering, and dispatched members of the army to hand out face masks at metro stations.  I’ve heard rumors that they shut down some of the areas of town popular for their night life, though I tend to think this is rumor started by unfounded speculation.  It’s not yet clear to me whether the danger posed by swine flu merits this response, though I certainly cannot fault a government that proactively and aggressively confronts threats with the possible potential of being an epidemic.  Frankly, given the absence of any news on swine flu as of Wednesday, I am amazed at how swiftly the government decided on action.

Of course, life still continues here.  The metro and public transport are still running, public services are still working, many businesses are open.  The one thing that is clear is that the government’s response affects all of us, even those of us who aren’t sick, don’t know anyone who is sick, nor know anyone who knows anyone….  Perhaps one of the most ubiquitous changes are the presence of the ever-popular face masks.  I’m still convinced that they don’t do very much, but if they keep people from rubbing their faces and (hopefully but doubtfully) encourage more hand-washing, then it’s a good thing.  

On the other hand, the presence of the masks have a very negative affect on Mexican social behavior, Continue reading

Mexican soccer in empty stadiums

This afternoon, Sunday 26 April, Pumas and Chivas played to a 1-1 tie at the Pumas’ stadium here in Mexico City.  Fans were not permitted to attend given the current concerns in Mexico City regarding the swine flu.

Check out the pictures from this article on the Pumas’ website.  Almost like a practice……

 

México, D.F.

Does wearing a mask prevent one from getting swine flu?

The answer: Yes and no and the jury is still out.

Mexico City is full of people wearing small, gauze or paper facemasks.  I saw plenty of drivers in cars, a few bicyclists, most of the waiters at the local taquerías, and even a guy going for a run all wearing a blue or white tapaboca (literally “covers mouth”).  So I thought it would be a good idea to figure out if they actually do any good.  Here’s the results of a brief foray into medical science:

 

The hypothesis: It seemed to me that, in most situations, wearing a mask doesn’t help… after all, flu germs are viruses and way too small to be stopped by a gauze mask.  (In reality, you’d need a very special filter to completely stop them.)  Masks do stop big droplets in the air, such as those you exhale when you sneeze.  However, by being big, these droplets tend to fall out of the air very quickly, so there isn’t much for a mask to stop when you inhale.  On the other hand, masks do stop droplets from sneezes when you exhale, so it might be very helpful for a sick person to wear one; surgeons wears masks to reduce their risks of contaminating a patient.  

The method: I did some checking by first googling “does wearing a mask prevent you from getting the flu”.  There are a ton of answers out there, most of which are on those sometimes useful “wiki-type answer” blogs.  However, in this case, I found a lot of smart-ass answers like “only if you wear it” and “more than not wearing one.”  Wow, talk about a waste of e-space.   

But there is a real answer: Since I’m the type of doctor that reads journal articles, I next decided to go straight to the source: I searched for recent scholarly publications on face masks and the flu.  What I found is that there have been few scientific studies on whether wearing a mask helps (to be specific, one).  Researchers have found that a person is 80% less likely to catch the flu from a sick (and, presumably snotty) child in their own home if they wear a mask.  But the researchers aren’t sure why.  It may be that, by wearing a mask, a person is less likely to touch their own face with their hands (or their child’s), thus preventing the spread of flu by physical contact, and that it has very little to do with breathing in germs.

2008 Article: CITE: The First Randomized, Controlled Clinical Trial of Mask Use in Households to Prevent Respiratory Virus Transmission, MacIntyre et al., International Journal of Infectious Diseases, Volume 12, Supplement 1, December 2008, Page e328 — LINK: Science Direct (a pay site – grrr!), or find a nice summary on the Imperial College of London’s website.

The conclusion: The latest scientific studies show that masks help reduce the chances of getting the flu from someone in your own home but they do not suggest that the benefits of wearing a mask extend outdoors, or are better that being good about washing your hands.  If, indeed, it turns out that wearing a mask helps because it prevents a person from touching their face, the smartass comments could be wrong.  In fact, it might be better if you took your mask and put it on your sick child.  

Of course, we all might be better off if people just washed their hands more.  (An informal survey at ITAM finds that there are a lot of Mexican college-age males who need to learn this.)

 

México, D.F.

 

 

The conclusion, part 2: I’m not sure which is more annoying, the useless and smart-ass wikis, the accountants at science direct, or the undergrads at ITAM who don’t wash their hands.

Raw Egg and OJ

Just a note today: The guy in front of me a the juice bar this morning ordered a glass of orange juice and then had them drop two raw egg yolks into it.  Gulp!

Perhaps in a day or three I’ll have a little more to say about the (over?)reaction to the piggy flu.  Mmmmmm, piggy.  What today needs is some carnitas tacos.

 

México, D.F.