In Pictures: Coyoacan

During the city-wide shut down for piggy flu, I had taken a few long walks, including this one to Coyoacan.  These pictures were taken along Calle Sosa, on the way from Plaza San Jacinto to the center of Coyoacan.

and one road...

The streets of Mexico City were quiet... a unique experience.

México, D.F.

Overcoming Cabin Fever

The last few days of the shut down here in Mexico City have led to some significant bouts of boredom.  Across the city, many people have been dealing with the effects of cabin fever and life is starting to stir, with a subtle energy on the street that wasn’t present during the frist few days.

Suffering my own bouts of boredom, I took off for a series of long walks the past few days, winding my way from San Angel and Coyoacan in the south (7.6 miles) to the Basilica de Guadalupe in the north (8.0 miles).  It was, in some sense, the perfect time to head out, with fewer people and fewer cars on the roads.

Given the free time I’ve got, I bothered to add both to the (now quite busy) map up top.  Despite and because of the chaos, Mexico City is a great walking town.

 

México, D.F.

Face Masks, Paranoia, and the Mexican Overreaction

This is hopefully the second-to-last post on the outbreak of AH1N1.  I’ve been following two main themes, the first of which is the use of face masks and the second a discussion of AH1N1 mortality in Mexico.  Yesterday, I had a few links on the lack of mortality; as the “outbreak” subsides — the term is in quotes because it seems that many suspected cases were just seasonal flu — I’m more and more confident that AH1N1 isn’t any more dangerous than a seasonal flu.  And today I want to finish the discussion on face masks, which I now believe were a complete overreaction.

At the start of the crisis, the Mexican government had members of the army distribute face masks at metro stations and for a few days, there were many people walking around wearing them.  I was hesitant to criticize the initiative, but I had some significant reservations about the practice (such as here and here).  Why?  Simply put, I don’t believe the benefit outweighs the costs.  Not only are masks ineffective on the street, where most people wear them (they’ve only been shown to work at home, where most people wouldn’t), but they promote fear, paranoia, panic, and lead to a sense of isolation and, in my opinion, lead to depression and restlessness.  I’m not going to delve into the details of these points, but having spent the last week here, I have little doubt.

The use of masks also has a second, much more measurable cost: economics.  The use of masks promotes paranoia both in Mexico and abroad, especially in the U.S., where pictures of face mask clad Chilangos have inundated the print, broadcast, and internet media.  Frankly, from reading the media, in the reactions of family, and in talking with friends and other becarios down here in Mexico, it’s clear that there really was a sense of panic in the U.S.  And, since panic is rarely based on logic, it’s only a matter of time before people’s reaction to fears of AH1N1 translates into a reduction in the purchase of Mexican and other products.

From today’s headlines:

  • “Mexico appeals for fair treatment for its citizens and products…”  (BBC News, 3 May 2009)
  • “Trato discriminatorio e injusto a Mexicanos”  (El Universal, 3 May 2009)
  • “Mexico’s Economy Gets Slammed by Flu Epidemic” (SF Gate, 3 May 2009)

So what does this all mean?  Well, I think Mexico should have reacted slightly differently.  Yes, I agree that closing schools and events was a good step given the uncertainty of the event.  However, the use of (useless) face masks only promoted paranoia and, through the international media, a sharp public reaction against Mexican products and travel to Mexico.  I’d suggest that giving out hand sanitizer and promoting good hygiene practices like covering coughs and washing hands would have been a better strategy — it could have been just as effective, if not more so, than masks, but would have prevented the media frenzy over showing people wearing them.

Of course, Mexico isn’t the only country to overreact — the Egyptian pig cull and China’s decision to ban the import of pig products are two examples of policies that defy logic and science.  But before we pat ourselves on the back…. the U.S. reaction is also way overdone.  It seemed like the media was slobbering all over itself to get pictures and quotes showing fear that they didn’t really notice what was really going on (the uselessness of masks, swine flu’s expedient abatement, the isolation here in Mexico City, and economic impacts) until several days after the fact.  If you want proof, just check the dates on the posts here on these topics vs. those in major papers (such as the BBC on face masks or the NY Times on Cabin Fever).  

 

México, D.F.

NY Times on Mexican H1N1 Mortality

The NY Times had an article (First Flu Death Provides Clues to Mexico Toll) posted this afternoon on the mortality of H1N1 in Mexico for which they interviewed several doctors at a hospital in Oaxaca.  The running theory discussed by the authors and the medical staff is that the initial patients waited too long before they sought treatment… they make a compelling case.  (There are several more posts on this topic; check the swine flu link to the left.)

 

México, D.F.

More on the mortality (or lack thereof) of H1N1

One of the themes that I’ve been following is to understand why Influenza A (H1N1) appears more deadly here in Mexico.  I last wrote about how the Mexican mortality rate had dropped significantly.  Now, today’s BBC has an article discussing the science of the virus — that it is very similar in its composition and its effects on the human body to “regular-ole” seasonal flu (H1N1) and dissimilar to the much more serious avian flu (H5N1).  It begins:

“Preliminary analysis of the swine flu virus suggests that it is a fairly mild strain…”  

If this (not just the quote… read the article) is indeed the case, I would argue that this further supports the hypothesis that mortality appeared high because of the initial availability of health care to those who were sick.  That said, the number of fatalities “jumped” by 15 last night after a short reprieve, albeit in rural Mexico, so time has yet to tell.

 

México, D.F.

Preliminary Data on the Economic Costs of H1N1

Although the epidemic of swine flu continues to evolve here in Mexico, preliminary reports are starting to come out in regards to the economic costs of the swine flu epidemic.  Why care about economics?  Certainly, in the case of an epidemic, short-term priorities should be to prevent the spread of a disease.  However, in the long-term, the effects of this outbreak are likely to be overwhelmingly economic and measured in in terms of ruined businesses and lost opportunities.  In developed countries, where social safety nets are available, these economic human costs are less important because people can rebuild their lives, but here in Mexico, and in other developing economies, the lack of such safety nets mens that Influenza A (H1N1) could kill more people through poverty than by direct infection — and that is very important.  Furthermore, thinking in the absolute long-term, the ability to study diseases and produce vaccines in large quantities is ultimately a function of economic growth. 

Estimates and updates are changing frequently, so I took these links from today’s El Universal.

  • Preliminary costs of the economic shut-down here in the D.F. have ranged between $70M and $150M (USD) per day
  • Local businesses are arguing that there are signs of panic buying (El Universal)
  • Moody’s is reporting (El Universal) that they believe the outbreak will lead to a “severe and prolonged” economic crisis, causing a contraction of the economy by 4%  in 2009 and continuing trouble through at least 2010.
  • Fears abound that workers (the poor) will pay the brunt of the economic costs of the mandatory business shut-downs (El Universal)

The key take-away, in my opinion, is that a combined, tempered response that considers both short and long term objectives is important.  Some steps, such as the “renaming” of swine flu to Influenza A (H1N1), can address economic issues without affecting the health care response; others will require identifying the right balance of policies to stop the spread of disease without enacting draconian and unnecessary social shut-downs.  To stop the spread of a feared pandemic, quick action is essential.  However, to avoid economic harms, it is essential to act equally quickly to identify patients, provide health services, and then evaluate new evidence as it becomes available to the utility of the various response tools.  

The Mexican government did act quickly, in my opinion, to stop the virus, but by encouraging people to wear masks in public (a mostly futile gesture), they have caused significant damage to the tourism industry.  Similarly, as new reports regarding the mortality and contagiousness of Influenza A (H1N1) become available, the Mexican government should begin re-examining its response.  Time will tel if they have made the right choices.

 

México, D.F.

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.

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