Wednesday, April 29, 2009

The Swine Flu in Mexico and in the U.S.

There are a lot of questions about Swine Flu, but a really big one is "Why is the death rate from the flu so high in Mexico and not anywhere else? The Wall Street Journal offers an interesting analysis. Here's a fast summary of the factors the Journal reports:
  • The virus is the same in both Mexico and in the U.S., so the difference is NOT the virus itself.
  • The virus started in Mexico, so that country is further into the development of the spread of the flu.
  • Mexico city sits at a high altitude and has smoggy air. The early development and spread of the flu was masked by normal frequent winter colds with fever and throat infections that occur there.
  • A lot of flu victims thought they had a normal winter cold, so they delayed a day or so going to the doctor. Then the doctors, with no warning that a flu was going around, often misdiagnosed the illness. The delays allowed it to develop into pneumonia.
  • Since the medical profession in Mexico did not have advance warning that there was a flu going around, it was not diagnosed early. The U.S. has the advantage that our medical professions have had an earlier warning of the flu, so it will likely be diagnosed earlier. The higher mortality rate in Mexico may be largely because neither the medical profession nor the patients were aware of the level of the threat
  • The problem may also be cultural. Many Mexican, especially the poor, depend on public hospitals, so they wait for a few days after getting ill to see of it really is severe enough to require going to a doctor. In the meantime they medicate themselves. This is easier since antibiotics are available without a prescription. This allowed the flu to develop and spread more widely before being recognized.
  • Then there is the fact that going to one of Mexico's public hospitals takes hours or even days to get to see a doctor. The public health care simply isn't funded as well as it would be in a more developed country.
  • Once inside a hospital, the hospital workers complain that they don't have the safety equipment necessary to deal with highly infectious patients.
It's an interesting analysis of the problem. Overall the set of problems that have led to the size of the flu problem in Mexico is a combination of the fact that Mexico is the first nation to be struck by it, the public health care system in Mexico is poorly funded so it did not quickly recognized the problem (the public health Intelligence system is clearly not as developed as in a developed nation with decently funded universal health care) nor did it have all the resources needed to contain it, and the general public simply does not have a close attachment to the medical system except in clear cases of more extreme illnesses for both cultural and financial reasons.

I notice that the Wall Street Journal's article does NOT address the fact that the death rate among working age individuals age 16 to 45 is especially high. This is worrisome, since these individuals are expected to be the most healthy, and this is a pattern followed by the extremely deadly 1918 Hong Kong flu.

It's my speculation that here in the U.s. we have the advantage of the a early warning that came out of Mexico about the existence of the flu, the further advantage that our public health Intelligence system is much better funded and quite a bit larger with respect to our population, and the U.S. has stronger medical regulations so that patients are more certain where and how they can get medical help when they feel they need it.

We will probably see the flu strike largely in the uninsured American population first, incubate there because patients don't have the funds or the time to seek medical help, then it will spread to the more affluent population. Texas, with it's border on that of Mexico and with its 25% of the population without health care will be hit worse by the flu than other states with better medical systems. But just as the flu spreads from Mexico into the American border states and finds unprotected populations there, it will then spread within the U.S. to the more medically advanced states. That's the development pattern I will expect.

If that sounds like I am making an argument for universal U.S. healthcare, you read it correctly. But I don't think it is so much me making that argument as it is the Swine Flu.

Some additional information about the Swine Flu.
  • MSNBC reports that there are presently 91 cases of swine flu reported in 10 states. One toddler has died from the flu. The CDC is considering raising the pandemic alert to phase 5. The pandemic alert is a measure of how rapidly an infectious disease is spreading. The highest level is phase 6.

  • MSN Health reports that the possibility that Swine flu is incubated in factory farms is being taken seriously by the experts and is being investigated.

  • MSN Health also has an article posted that debunks some common rumors floating around about the Swine Flu. It's worth reading.

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