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Questions abound about Mexico's response to the crisis

SWINE FLU

Did officials move slowly to contain the swine flu outbreak? The government denies it did, saying it acted as soon as the virus was identified -- in a Canadian lab because Mexico lacks the facilities.

April 27, 2009|Tracy Wilkinson

MEXICO CITY — On Wednesday, a top Health Ministry official, Mauricio Hernandez, deputy secretary for prevention, told Mexicans that a small uptick in flu deaths "by no means indicates an epidemic." Scarcely 24 hours later, the government went on late-night television to issue an emergency decree closing all schools, from day care through university, in Mexico City and the state of Mexico, affecting nearly 7 million students.

By Sunday, a public health emergency had been declared from Mexico to the United States and beyond. Did Mexican authorities move too slowly to attempt to contain the swine flu outbreak, contributing to a death toll believed to be more than 100 and still rising?

President Felipe Calderon on Sunday defended his government's actions. He said the unique virus was not identified by a Canadian laboratory until Thursday afternoon and the government leaped into action immediately.

By Sunday evening, the number of people thought to have swine flu had risen to 1,614, with 103 dead, Health Minister Jose Angel Cordova said on national TV. Only 22 deaths have been confirmed as being caused by swine flu.

In an effort to assuage public anger, Calderon promised to provide regular updates to the country.

"We are convinced the best strategy in this type of situation is transparency and truthful information," he said.

The World Health Organization on Sunday vouched for Mexico's actions. Dr. Keiji Fukuda, assistant director-general of the agency, said Mexico had reported the swine flu cases "in a timely manner. They were having influenza season when the cases started . . . and we don't typically ask countries to report such cases. When they noticed increases in pneumonia and serious pneumonia, they initiated investigations, began testing and sent samples out to other labs.

"They have done a really good job in doing what a country should do."

But other experts say Mexico's overwhelmed health system is underfunded and bogged down by useless regulations and layers of bureaucracy that will always impede a swift response to emergencies.

Oswaldo Medina, president of the Mexican Epidemiological Assn., said the system slows down identification of diseases, prevents fast response and hinders communication across hospitals, cities and states in the event of an epidemic.

"These are people who are sick and are dying, and they are the main ones affected," Medina told the Reforma newspaper. "Identification of the disease comes late, the response is delayed, and the diseases cannot be controlled."

The Times asked the Health Ministry to respond to criticisms that it acted too slowly, but officials declined.

The government has released scant information on who has died and on the exact path the outbreak has taken.

Most of those who died were of "productive age," that is, between 20 and 50, Cordova said, a group that usually doesn't get flu shots and doesn't think it can get sick.

The medical community noticed a jump in flu cases, some lethal, in mid-March, when the flu season normally would be winding down.

Cordova said the first fatality tied to the swine flu occurred April 13 in Oaxaca in southern Mexico. It took 10 days to get confirmation.

Mexico does not have laboratories that can perform the sophisticated testing to identify unknown strains, as in this case. Calderon said he expected Mexico to have newer labs that are up to the task operating within 72 hours.

Sunday was another day when Mexico City residents stayed home in an effort to protect themselves. Soccer teams played to empty stadiums; priests prayed to empty pews (sermons were broadcast via radio).

Mexico City Mayor Marcelo Ebrard had said earlier that five more people had died in the capital overnight.

Six million face masks have been distributed, Calderon said. The body overseeing national elections scheduled for July told parties to suspend rallies and public meetings.

Still, there was widespread concern that the outbreak might be even worse than has been described. Mexicans, and especially residents of the capital, are generally mistrustful of the government. There is a long history here of less-than-truthful official pronouncements, mysterious plane crashes, assassinations and massacres, which gives rise to conspiracy theories and profound doubt.

"I want to know who died, and why this came about so suddenly, creating panic," said Elena Delgado, a doctor visiting Mexico City from Puebla.

"Without more explanations, this is a farce," said Delgado, who does not work for the state healthcare system.

One newspaper editorial suggested that the handling of this crisis by the Calderon government could become its Hurricane Katrina, referring to the Bush administration's badly botched disaster relief effort after the destruction of New Orleans.

"New or not, the disease was manifesting itself more than a week ago . . . enough for authorities to pay attention and come up with a plan of action," the leftist daily La Jornada said in its principal editorial. "Instead, the government discourse has been characterized by imprecisions and fooleries that, like it or not, created confusion, uncertainty and anxiety in the public."

--

wilkinson@latimes.com

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