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Swine flu: Report from a doctor in Mexico City

Submitted by Antonio Avina

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About: I am a rheumatologist, currently doing a PhD at the University of British Columbia. I am also a Research Scientist at the Mexican Institute of Social Security (IMSS) here in Mexico. I was on leave to conclude my PhD studies in Canada.

My story: I arrived in Mexico City last Friday morning at 8 a.m. from Vancouver. The previous night, Mexico's Health authorities announced that they had received confirmation from the CDC in Atlanta that a new virus, coming from swine to human contact was causing respiratory infections that might have caused at least 25 deaths at that moment. The first action they ordered was to suspend school activities at all levels in Mexico City and the State of Mexico.

On Friday I attended a meeting in a hotel with congressmen to discuss research public policy. We were about 150 people in a closed room.

That night media started to inform about the symptoms of the swine flu and recommend not to attend crowded places unless necessary and to wear a hospital mask.

On Saturday I went with a group of friends to a baptism away from Mexico City, and one of them insisted that everything was a big fake made by the government and the media (the next day, he repented). Masks were given out everywhere, especially in subways and public transport. The worry that day was what was going to happen with Sunday soccer matches. All cultural activities had already been cancelled.

The reports of more deaths and the spread to other states and possible cases in the U.S. and Canada increased awareness. Soccer matches were played "behind closed doors" with no audience. Religious services were suspended. On Sunday night health authorities widened preventive measures, stopping school activities nationwide and announced that the infected responded to an antiviral medication in the early stages.

Monday morning it was informed that all restaurants and public events are closed/cancelled and measures seemed to be being respected in Mexico City valley. The situation in the rest of the country is not clear.

What's been happening in Mexico City is a progressive build-up of fear in the community. At the beginning things were uncertain, with a lot of misinformation floating around. However, once the WHO (World Health Organization) took control of the situation, the community feels clear that there is a treatment for this problem and clear guidelines on what to do, when, and where. As this was something that was not known in the first days, things have calmed.

Currently people are asking why Mexicans are dying, but not individuals in Canada or the U.S. This of course has increased mistrust in the authority. Until today only doctors know that self-medication, which is very common in Mexico, results in a delay to seek medical attention. Initial cases arrived at the hospital when they were already very sick. The evidence until now it seems that the antivirals used in the treatment of this type of influenza are effective only if they are used within the first two days after the symptoms appear.

As of today, all cases with symptoms are being tested with a quick test (swab) and results are available within 1 hour (test is 75% sensitive). A positive screening test receives treatment immediately upon referral to hospitals, regardless of the results of confirmatory tests. Confirmatory tests are available in two days. The swab test is done here in Mexico and is a quick test, the confirmatory tests are sent to the U.S. and Canada. However, today there are two labs currently doing the tests here in Mexico (one in Mexico City and one more in Veracruz). A third lab will be set up soon.

People have stopped believing the authorities. Yesterday, authorities asked everyone not to rush out to buy groceries because stores would continue to work as usual. However, people rushed to stores this morning. This is a cultural behaviour based on a chronic lack of trust in authorities.

Today all small, local restaurants (called fondas) that sell food for people working in offices will not be allowed to sell food in their restaurants, they can only sell food to take home. In addition, all public events are cancelled including museums, movie theaters, mass, public libraries, and schools at all levels, in the whole country (initially it was only in Mexico City.) Individuals that can work from home are being allowed to do so. It is estimated that Mexico City alone is losing 728 million pesos per day ($78 million Cdn.) This may lead to a social crisis if it continues after May 5th (conditions have been set to continue until this date), especially if individuals loss their jobs, since this crisis is building on top of the financial crisis.

Cases are being referred to specific hospitals, mainly those that have respirology departments or infectious disease departments or secondary or tertiary hospitals if available. People have started visiting hospitals if they think they have the disease, because they know they cannot buy medication at the pharmacy (especially antivirals). Last night there was a report that the number of cases are decreasing, as well as the mortality rate, if this trend continues then there is hope for a quicker recovery. We will see.

In Mexico City yesterday 12,000 patients attended as an outpatient visits. From these, 6000 were as respiratory diseases, from these 29 were referred to hospitals under the suspect of swine influenza. This is the most recent evidence that individuals are finally following the instructions to seek medical attention prior to receive self-medication.

I do not know what is happening in the rural areas, since access to information and medical care have bigger gaps like in any country. Events in the next few days will determine social behavior, something that any sociologist will be very interested for future research.

I am not attending any patients, since I am following the recommendation of not travelling within the city if I don't have to. However, I am receiving many phone calls from family members, friends, friends from my friends asking for advise and specially asking about what do I think?

For announcements, Spanish speakers can view the official site of the Mexican Ministry of Health.

Are you or someone you know affected by swine flu? Share your stories.

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