With swine flu, we're all in this together

[May 11, 2009]  MEXICO CITY (AP) -- On the western edge of Mexico's capital, 10 new luxury apartment towers promise an antiseptically modern lifestyle with spas, private playgrounds and an exclusive shopping center. Blocks away, a world-class private hospital has opened.

But there's no escaping the view from these $1.5 million apartments: Just across a ravine is a slum where maids and construction workers make do in crowded, humid homes of raw concrete and spotty drinking water. For them, getting sick means medicating themselves at a discount pharmacy, or waiting for hours in an overcrowded public hospital.

Wealthy Mexicans aren't alone in trying -- and failing -- to distance themselves from deprivation and disease. People all over the world want to protect their families from the problems of the less fortunate.

But if there's anything we've learned from the swine flu epidemic, it is this: the virus doesn't discriminate.

"We're all in this together," President Barack Obama said as he urged public health agencies to reach all corners of America. "When one person gets sick, it has the potential of making us all sick."

The outbreak might not have become an epidemic if Mexico's first swine flu victims had been identified and treated quickly. We now know that for most, the virus causes only mild symptoms, and that nearly all of those who become quite sick can recover if they get proper treatment within 48 hours.

We also know that most of Mexico's dead didn't get that treatment in time.

But it feels awfully late to be pointing fingers over initial delays. And by ordering a nationwide shutdown last week of public gathering places where flu can spread, Mexico saved many more lives, experts say.

Now the world must face what Mexicans learned as they stayed home from schools and restaurants, venturing outside fearfully in face masks only to replenish their refrigerators: Rich and poor breathe the same air. The 53 people killed around the world so far range from poor day laborers to the grandson of one of the richest men in Mexico.

It's a moral challenge, as clear now as the view from those luxury living room windows: When vast numbers of poor people lack decent health care, no one is immune from disease.

A rural bricklayer with a bad cough, a kindergartner in a remote mountain village, a maintenance worker in a vast urban slum -- these swine flu cases might have seemed a world away from the United States and Europe.

But it takes just four hours by bus for workers to reach the capital from the pig-farming community of La Gloria, where hundreds of villagers were suffering from acute respiratory infections for weeks before one of their kindergartners became Mexico's earliest confirmed swine flu case.

It takes even less time to fly from Mexico City to the U.S., where this strange new strain of swine flu was first identified in a 10-year-old San Diego boy.

No one knows yet where this outbreak began. Despite calls to close the U.S. border, scientists say the deadly chimera -- a blend of bird, human and pig flu genes for which humans have limited natural immunity -- may have jumped from pigs to humans in North Carolina, about 10 years and 10,000 generations of virus ago.

Millions of dollars have been spent on pandemic preparedness since scientists realized flu could jump between species. Top flu experts even developed a detailed containment plan -- with an extremely limited window of opportunity.

World Health Organization experts determined that a virus with pandemic potential would have to be identified, the epicenter quarantined and 80 percent of the initially affected population blanketed with antiviral drugs within three weeks of the first symptoms.

Oh, and the outbreak would have to be limited to a small geographic area -- like a remote village of about 1,000 people.

This H1N1 virus was likely spreading all over Mexico and parts of the United States long before anyone got sick enough to be tested. By the time the wheezing, sneezing villagers of La Gloria complained enough for their samples to be taken, dozens had been commuting to Mexico City for weeks.

Before anyone knew this flu's name, cases were popping up all over the megalopolis of 20 million.

A Canadian lab quickly confirmed that swine flu had reached Mexico, and a global alarm was raised. But only hours later, the WHO said it was useless to close borders and ban flights. Travelers had already carried the virus from Mexico to New York and New Zealand. It has since spread to at least 29 countries around the world.

So now Mexico's challenge has become a truly global problem. Experts say even normal seasonal flu infects millions and kills about 500,000 people worldwide every year. With the WHO warning that a possible swine flu pandemic could infect 2 billion people, how on earth can we protect the whole world?

The drug makers say they can "most likely" produce 917 million doses in 10 months, a number considered overly ambitious by some experts.

Even the first vaccines won't be ready for months -- too late for the Southern Hemisphere, where flu season is about to start. And if the virus evolves into something more contagious or deadly -- possibly by mixing with regular flu or even H5N1 bird flu, which is endemic in parts of Asia and Africa -- these vaccines may not provide much protection in the end.

Antiviral drugs will be critical if it comes to that, but they are expensive, and there aren't enough to go around. The largest stockpiles are kept by the wealthiest nations, for their own citizens' protection.

But hoarding antivirals could backfire. A 2007 study modeled what would happen in a flu pandemic if wealthy nations hoard or share these drugs.

They concluded that the hardest-hit populations should be blanketed with antivirals, even if they are too poor to pay for them, and even if it means people with reliable health care in wealthier nations would go untreated.

Doing so would save many millions of lives, they found -- including in the wealthy countries that share.

Nobody knows where this current outbreak is headed as the swine flu virus evolves. It may lose its potency.

Or it may become a real killer. And if that happens, there will be some hard decisions to make.

[Associated Press; By MICHAEL WARREN]

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