MEXICO CITY – 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.
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Minggu, 10 Mei 2009
With swine flu, we're all in this together
US, Costa Rica swine flu deaths reported
SEATTLE – The number of swine flu-related deaths outside Mexico has inched up to five with the U.S. reporting its third fatality and Costa Rica its first, both involving men who also had underlying illnesses.
The number of confirmed cases of the infection in the U.S. has risen to 2,532 in 44 states, the Centers for Disease Control and Prevention reported Sunday.
Washington state health officials said the victim there was a man in his 30s who had underlying heart conditions and viral pneumonia when he died Thursday from what appeared to be complications from swine flu. The state Department of Health said in a statement Saturday that swine flu was considered a factor in his death.
"We're working with local and federal partners to track this outbreak," said Washington State Secretary of Health Mary Selecky.
The man was not further identified. He began showing symptoms on April 30, and was treated with anti-viral medication. Dr. Gary Goldbaum, Snohomish Health District medical director, said medical officials hadn't been able to isolate any "risk factors" for the man to identify where he might have been exposed.
The death of a 53-year-old man in Costa Rica on Saturday was the first involving swine flu outside North America. He also suffered from diabetes and chronic lung disease, the Health Ministry said.
Most of the victims in Mexico, the center of the outbreak where 48 people with swine flu have died, have been adults aged 20 to 49, and many had no reported complicating factors.
Previously, U.S. authorities reported swine flu deaths of a toddler with a heart defect and a woman with rheumatoid arthritis, and Canadian officials said the woman who died there also had other health problems but gave no details.
Mexico, which raised its count of confirmed cases to 1,626 based on tests of earlier patients, has been gradually lifting a nationwide shutdown of schools, businesses, churches and soccer stadiums.
But an upswing in suspected — though not confirmed — cases in parts of Mexico prompted authorities in at least six of the country's 31 states to delay plans to let primary school students return to class Monday after a two-week break.
"It has been very stable ... except for those states," Health Department spokesman Carlos Olmos said, referring to states in central and southern Mexico.
Mexican health authorities released a breakdown of the first 45 of the country's 48 flu deaths that showed that 84 percent of the victims were between the ages of 20 and 54. Only 2.2 percent were immune-depressed, and none had a history of respiratory disease.
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Marshall reported from Seattle; Jimenez reported from San Jose, Costa Rica.
news source www.news.yahoo.com
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Health overhaul draws groups' competing demands
WASHINGTON – Patients and doctors. Small businesses and multinationals. Retirees, workers and insurance companies.
Some have more money and clout. All have something in common when it comes to overhauling health care: a huge stake in the outcome.
Their competing demands will help determine what happens as Congress writes legislation to reshape the nation's $2.5 trillion health care system to bring down costs and cover 50 million uninsured people. If the whole undertaking starts to fall apart, look to opposition from one or more of these groups as the reason why.
All say their goal is for everyone to have access to quality and affordable care. Beyond that, consensus breaks down.
A look at 10 groups with the most influence, or most at stake, in the health debate, and what they want and are trying to avoid:
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Workers:
Some 60 percent of people under age 65 get health care through an employer. But employers don't have to offer health insurance, and as the economy frays, some are dropping it. Labor unions want to require employers to help pay for coverage for their employees.
Unions also believe the path to affordable care runs through a new public insurance plan that would compete with private plans. Middle-class workers, for the first time, would have the option of government insurance. Proponents of this approach, already embraced by President Barack Obama and many Democrats, believe it would drive down costs for all.
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People with health conditions:
A common complaint about insurers is that they won't cover people with existing health conditions or that they charge them too much. Patients' advocacy groups want to require insurers to cover all comers, not just the healthy, and limit what they can charge the sick. They contend that would spread risk and costs throughout the population.
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Older people:
Among the top goals for AARP is ensuring health coverage for people age 50-64 (at 65 they can get Medicare). That could be done by allowing middle-aged people to buy into Medicare. AARP also is eager for Congress to fix the coverage gap in the Medicare drug benefit that patients fall into once their prescription expenses exceed about $2,700.
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Uninsured people:
The estimated 50 million uninsured people in the U.S. don't have lobbyists, but various advocacy groups aim to speak on their behalf. The liberal group Health Care for America Now says any health overhaul should mean coverage for everyone by including a public plan, basing out-of-pocket costs on ability to pay and providing a standard benefit with preventive care and treatment for serious and chronic diseases.
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Insurance companies:
For private insurers, the bogeyman is competition from the government. They contend a public plan would drive them out of business. To stave that off, the industry is offering to curb its practice of charging higher premiums to people with a history of medical problems, as long as Congress requires all Americans to get insurance.
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Small businesses:
Opposition from small business helped kill a health care overhaul during the Clinton years. Their top goal remains the same: to avoid any kind of requirement for employers to provide health care. The National Federation of Independent Business says that is unacceptable and favors subsidies to help people buy insurance. Small businesses want to make the same tax breaks for health insurance available to all, not just those who get coverage through an employer.
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Big businesses:
Even though most big businesses offer health care to their employees, they strongly oppose an employer mandate, fearing the government would start dictating what kind of policies they could offer. Businesses want to avoid taxes on the health insurance benefits.
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Hospitals:
Hospitals worry that a new government insurance plan would reduce the fees they can collect. They support requirements for individuals and employers to purchase insurance so "everyone plays a role in making sure that there's coverage," says Tom Nickels, a senior vice president at the American Hospital Association.
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Doctors: Doctors have similar concerns as hospitals about a public plan. They also want to prevent insurers from raising rates on patients with health problems. They would cap or eliminate tax breaks for employer-provided benefits, using the revenue to subsidize care for low-income people. Doctors want curbs on medical malpractice awards so they don't face the threat of huge jury awards. They contend that leads to "defensive medicine" — performing unnecessary procedures to avoid getting sued.
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Drug companies:
The drug lobby opposes a government insurance plan and has joined the advocacy group Families USA in proposing to cover more of the uninsured by expanding Medicaid, the federal-state insurance program for the poor. Pharmaceutical companies support federal subsidies to help middle-class people unable to afford insurance. Drug companies oppose efforts to squeeze bigger discounts from them under Medicaid.
"We don't want bureaucrats making the decisions about what medicines can be used by the patients of our country and that's the end result of a pure public plan," says Billy Tauzin, head of the Pharmaceutical Research and Manufacturers of America.
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On the Net:
Pharmaceutical Research and Manufacturers of America: http://www.phrma.org/
American Hospital Association: http://www.aha.org/
National Federation of Independent Business: http://www.nfib.com/
AFL-CIO: http://www.aflcio.org/
AARP: http://www.aarp.org/
America's Health Insurance Plans: http://www.ahip.org
American Medical Association: http://www.ama-assn.org/
Families USA: http://www.familiesusa.org/
Health Care for America Now: http://www.healthcareforamericanow.org/
news source www.news.yahoo.com
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Flu exposes flaws in Mexico's health care system
MEXICO CITY – Mexicans will do almost anything to avoid a public hospital emergency room, where ailing patients may languish for hours slumped on cracked linoleum floors that smell of sweat, sickness and pine-scented disinfectant.
Many don't see doctors at all, heading instead to the clerk at the corner pharmacy for advice on coping with a cold or a flu.
So it's no surprise that when a dangerous new swine flu virus began to sweep across Mexico, many waited too long to seek medical help — more than a week on average, according to federal Health Secretary Jose Angel Cordova.
These initial delays complicated treatment, possibly explaining why 48 of the world's 52 confirmed swine flu-linked deaths occurred in Mexico.
It also made it more difficult for Mexico to recognize the outbreak for what it was. By the time Cordova announced a swine flu epidemic on April 23, the virus had already spread across the country and beyond.
Mexico's big cities have fancy private hospitals stocked with modern equipment and staffed with U.S. board-certified specialists. Americans increasingly come to Mexico for good care at low prices. The best of the public system is world-class too, with top doctors at elite centers for specialized diseases.
But Mexico's everyday public hospital system is in crisis.
Some patients suspected of having swine flu told The Associated Press that public hospitals turned them away or forced them to wait for hours for treatment even after the government declared a national emergency.
Those who sought help before the alert — often arriving with headaches, high fevers and difficulty breathing — encountered baffled doctors who had not been warned to watch for a new virus.
Mexicans navigate a patchwork of public and private hospital systems. There are hospitals for government employees and hospitals for workers enrolled in government health plans through private employers. Most patients have to go to a hospital tied to a specific agency.
"If someone is sick, he can't simply say, 'I'm going to the doctor' or 'I'm going to the hospital,' because it depends on whether he has Social Security or if he has to go to another institution," said Dr. Malaquias Lopez Cervantes, a leading epidemiologist at Mexico's National Autonomous University.
"And if he comes (to the wrong hospital), somebody is going to tell him that he doesn't have the right to be treated."
While access to health care is a right enshrined in the Mexican constitution, millions of Mexicans have no health insurance at all.
Mexico spends only 6.6 percent of its gross domestic product on health care — less than half the U.S. figure. No country in the 30-nation Organization for Economic Cooperation and Development puts a smaller share of public money into its health care system.
That means the hospitals serving most of Mexico's 44 million poor are often crowded, ill-equipped and staffed with harried, underpaid staff working for a dizzying array of bureaucracies.
It's so crowded, confusing and bureaucratic that the poor are more likely to head for a pharmacy, hoping to find a cheap remedy for "gripe" (pronounced GREE-pay) — a word that can cover anything from a mild cold to a deadly flu.
Most pharmacies dole out antibiotics and a host of other powerful drugs without a prescription. That encourages Mexicans to self-medicate, relying on a counter clerk's suggestion, dosing themselves with whatever worked the last time they had a fever and waiting a day or two to see what happens.
Some pharmacies even drum up business by tacking a doctor's office onto the side — offering basic checkups for as little as 25 pesos ($2) — still roughly half a day's pay for a minimum-wage worker.
In Mexico City's working-class Padierna neighborhood, Dr. Oscar Aguilera sees patients in a small office at the back of a discount pharmacy, with an open-air waiting room behind a row of graffiti-tagged taco stands.
Even in normal times, most of his patients come in with a cold or a flu. Most now show no signs of swine flu, he said, but "20 percent show some symptoms and we send them to the hospital."
Following the public alert on April 23, fear has driven patients to his office even at the slightest symptom.
Mexicans with flu symptoms might have sought better care far earlier if the public health care system had done the same kind of flu surveillance common in the U.S. and other developed nations.
Mexico keeps close watch on dangerous tropical diseases such as dengue, but epidemiologists pay less attention to flu, just one class of viruses contributing to Mexico's 23 million annual cases of respiratory illness.
Mexican doctors "really were not trained thinking of the existence of influenza" as a specific threat, Lopez Cervantes said.
In all of 2008, Mexico's official epidemiological bulletin reported only 151 confirmed cases of flu. By comparison, U.S. officials ran tests that confirmed nearly 40,000 flu cases last season. Mexico has about a third the population of the United States.
Research suggests children can recover from autism
CHICAGO – Leo Lytel was diagnosed with autism as a toddler. But by age 9 he had overcome the disorder.
His progress is part of a growing body of research that suggests at least 10 percent of children with autism can "recover" from it — most of them after undergoing years of intensive behavioral therapy.
Skeptics question the phenomenon, but University of Connecticut psychology professor Deborah Fein is among those convinced it's real.
She presented research this week at an autism conference in Chicago that included 20 children who, according to rigorous analysis, got a correct diagnosis but years later were no longer considered autistic.
Among them was Leo, a boy in Washington, D.C., who once made no eye contact, who echoed words said to him and often spun around in circles — all classic autism symptoms. Now he is an articulate, social third-grader. His mother, Jayne Lytel, says his teachers call Leo a leader.
The study, funded by the National Institute of Mental Health, involves children ages 9 to 18.
Autism researcher Geraldine Dawson, chief science officer of the advocacy group Autism Speaks, called Fein's research a breakthrough.
"Even though a number of us out in the clinical field have seen kids who appear to recover," it has never been documented as thoroughly as Fein's work, Dawson said.
"We're at a very early stage in terms of understanding" the phenomenon, Dawson said.
Previous studies have suggested between 3 percent and 25 percent of autistic kids recover. Fein says her studies have shown the range is 10 percent to 20 percent.
But even after lots of therapy — often carefully designed educational and social activities with rewards — most autistic children remain autistic.
Recovery is "not a realistic expectation for the majority of kids," but parents should know it can happen, Fein said.
Doubters say "either they really weren't autistic to begin with ... or they're still socially odd and obsessive, but they don't exactly meet criteria" for autism, she said.
Fein said the children in her study "really were" autistic and now they're "really not."
University of Michigan autism expert Catherine Lord said she also has seen autistic patients who recover. Most had parents who spent long hours working with them on behavior improvement.
But, Lord added, "I don't think we can predict who this will happen for." And she does not think it's possible to make it happen.
The children in Fein's study, which is still ongoing, were diagnosed by an autism specialist before age 5 but no longer meet diagnostic criteria for autism. The initial diagnoses were verified through early medical records.
Because the phenomenon is so rare, Fein is still seeking children to help bolster evidence on what traits formerly autistic kids may have in common. Her team is also comparing these children with autistic and non-autistic kids.
So far, the "recovered" kids "are turning out very normal" on neuropsychological exams and verbal and nonverbal tests, she said.
The researchers are also doing imaging tests to see if the recovered kids' brains look more like those of autistic or nonautistic children. Autistic children's brains tend to be slightly larger than normal.
Imaging scans also are being done to examine brain function in formerly autistic kids. Researchers want to know if their "normal" behavior is a result of "normal" brain activity, or if their brains process information in a non-typical way to compensate for any deficits.
Results from those tests are still being analyzed.
Most of the formerly autistic kids got long-term behavior treatment soon after diagnosis, in some cases for 30 or 40 hours weekly.
Many also have above-average IQs and had been diagnosed with relatively mild cases of autism. At age 2, many were within the normal range for motor development, able to walk, climb and hold a pencil.
Significant improvement suggesting recovery was evident by around age 7 in most cases, Fein said.
None of the children has shown any sign of relapse. But nearly three-fourths of the formerly autistic kids have had other disorders, including attention-deficit problems, tics and phobias; eight still are affected.
Jayne Lytel says Leo sometimes still gets upset easily but is much more flexible than before.
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On the Net
National Institute of Mental Health: http://www.nimh.nih.gov
Autism Speaks: http://www.autismspeaks.org/
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