ARGENTINA: Experts Put H1N1 Flu Outbreak in Perspective

• by Marcela Valente (buenos aires)
• Friday, June 26, 2009
• Inter Press Service

The Health Ministry is still issuing a daily report on the number of cases of what is popularly known as swine flu, and the number of deaths. The latest statistics are 1,488 confirmed cases and 23 deaths, representing a mortality rate of 1.3 percent.

The media seize on these numbers with alarm, comparing them with the statistics from other countries.

'As of 20:32 on Jun. 24 there are already 21 cases of H1N1 flu,' said the nightly news anchor for Channel 13 – one of Argentina’s leading TV stations – glancing at his watch.

The reporter emphasised that Argentina had the third largest number of swine flu deaths, after Mexico and the United States.

These reports strike fear into people’s hearts, prompting them to flock to health clinics and hospitals at the slightest symptom of the flu or the common cold, or even in the absence of symptoms, which has pushed the health system to the brink of collapse.

'There are people who come in to say they suspect a neighbour has the H1N1 virus,' one doctor told IPS after the tape recorder was turned off.

Infectious disease experts say the actual number of cases is much higher than the official statistics indicate – a fact that should calm people’s fears, rather than create further alarm.

Some say the official figures should be multiplied by a factor of 10, while others say that would still 'fall short,' in the words of one expert who spoke to IPS on condition of anonymity.

'The official statistics do not reflect reality. Many more people are infected, which means the mortality rate is lower than people suppose,' said Dr. Daniel Priluka with the Argentine Society of Infectious Diseases (SADI).

The total of 23 deaths in Argentina since the outbreak began in late April does not worry experts, who point out that seasonal flu kills between 3,000 and 4,000 people a year in this country of 40 million, mainly individuals from at-risk population groups like the elderly, newborns or patients with chronic health conditions.

Because the immense majority of swine flu cases are mild, requiring no medical treatment, there is no need to confirm all of them, the experts explain.

That is in line with the recommendations issued by the World Health Organisation (WHO) when it announced earlier this month that it was raising the pandemic alert from level five to six, the highest.

'Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities,' WHO Director General Margaret Chan said at the time.

Chan said 'the virus is contagious, spreading easily from one person to another, and from one country to another,' and that the 'spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission.'

But she clarified that 'the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.'

The southern hemisphere winter is just starting, which means that in Argentina, as in neighbouring Chile and Uruguay, the flu season is in full swing.

In Chile, the Public Health Institute now issues twice-weekly, rather than daily, updates. The latest, released on Tuesday, Jun. 23, reported 5,186 cases and eight deaths.

And in Uruguay, the Public Health Ministry reported a total of 195 cases as of Tuesday.

In Mexico, where flu season is over, the spread of the disease has slowed. The total number of confirmed cases stands at 8,279, 116 of which were fatal. In the United States there have been 87 deaths.

When the outbreak was first reported in Mexico, Argentina temporarily suspended flights from that country.

'Now, samples are only taken to confirm the diagnosis of patients who have been hospitalised, but the number of people who have had the flu in their homes, with or without medical treatment, could easily be multiplied by 10,' Dr. Pablo Elmassián of FUNCEI (the Infectious Diseases Foundation), told IPS.

'It no longer makes sense to carry out the test, because the virus is here to stay,' he said. 'What we have to do is carry out prevention and damage control efforts.'

Along those lines, he warned that 'malnutrition is a risk factor,' and recommended that efforts be focused on prevention among the most vulnerable sectors of the population.

He added, however, that there is always a risk of complications in cases of influenza, even for healthy individuals.

But he underlined that the mortality rate is based on the total number of cases, and said that if it were possible to obtain precise figures for all cases, the rate would stand at 0.3 to 0.5 percent – the same as for seasonal flu.

Priluka, meanwhile, said it was 'absurd' to continue publishing daily updates. 'It makes no sense; the virus is circulating and many, many people must already be infected,' he said. He estimated that half of the youngsters missing school could be swine flu cases.

The experts say their aim is to neither dramatise nor minimise the problem, but to put it in proper perspective.

'We have the seasonal flu and the H1N1 virus. So, if normally between five and 15 percent of the population has the flu, and some of the cases are serious, we now have to add another proportion of patients with the new virus, and its own complicated cases,' said Priluka. As a result of the increase in cases, along with the swine flu fears, hospitals have been overwhelmed.

'The hospital beds are full, and that IS a health problem,' according to Priluka, who said a health emergency should be declared in the Buenos Aires metropolitan area in order to strengthen the health system and increase the number of doctors and purchases of respiratory care equipment.

Non-emergency operations have been postponed in the city of Buenos Aires and special wings have been set up for H1N1 influenza cases. In addition, entire hospitals have been dedicated to swine flu cases in populous working-class neighbourhoods and slums on the outskirts of the capital.

With respect to the most severe cases, Priluka said that in regard to both the seasonal flu and the H1N1 virus, they have mainly occurred among at-risk groups. He added, however, that complications also arise in other patients, and always have, but that now these cases are receiving much more attention.

In Priluka’s view, it is still much too early to determine whether many of the severe or fatal cases involve young, healthy adults, as was apparently the trend in Mexico.

Samples taken by disease monitoring centres will indicate how many cases there are and what proportion of the cases are serious, he said.

The infectious disease expert predicted that this information will show that the proportion of serious or fatal cases among people considered to be at low risk is smaller than currently believed.

© Inter Press Service (2009) — All Rights ReservedOriginal source: Inter Press Service

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