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Sorting it Out
From Effect Measure:

Mexico City has 1614 "cases" and 103 deaths. Not all, or even most, of the cases have been confirmed by laboratory. They are really suspect cases [emphasis mine. ~b.]. Some have been confirmed, most not. Confused? Expect that, too. In the opening days and weeks of an outbreak, everyone is confused. That's why we pool our information and try to sort it out.

This is the first I've heard anyone suggest that not all the H1N1 cases in Mexico City are confirmed. But that would make a lot of sense, under the confusing circumstances. Hot zones are not well organized places, with all the important info handy, and health care officials acting calmly and rationally.

bardofawen's suggestion that more than one pathogen is at play in Mexico would answer a number of hanging questions, especially in this confusing scenario.


What IS swine flu?
An intelligent description of what swine flu is, how it works on a cellular level, and how it spreads.

Of note:

Influenza virus A [like the current A/H1N1.  ~b.] causes yearly epidemics that result in illness for humans, pigs, and domestic poultry. We now know that intra-species transmission is the norm. Indeed, pandemics are global epidemics among humans caused by the transmission of novel influenza A viruses generated via inter-species transmission. Pandemics are no longer thought of as tornadoes that suddenly thrust themselves upon human populations. Rather, we now know that herald epidemics in non-human and human species occur for variable amounts of time before a pandemic takes root. Thus, surveillance among human, swine and bird populations has become essential for early detection of viruses with pandemic potential and for initiation of prevention efforts, particularly vaccine development.

Two Halves of Barth's Brain Gather Their Talking Points
OK, brains, here's the question: Is H1N1 swine flu something to get scared about? Arrange your talking points!

The Cynical BS Detector Half's Talking Points

*Seasonal flu mortality is, on average, 36,000 deaths per year in the US. So far? No deaths for le pig in America -- though over 100 in Mexico is nothing to sneeze at. (Sorry about the pun. Hey, I'm a cynic!)

* No deaths outside Mexico means that H1N1 is probably shifting or drifting itself into impotency.

* No deaths outside Mexico means that the alerts are working: the combo of forewarned health care providers and early, serious care is  saving lives.

* I'm not completely convinced that H1N1 is really spreading human-to-human, and if it is, its communicability is incredibly low.

* We've got enough effective vaccine to protect the population.

The Patron Saint of Plagues Half's Talking Points

* We don't know anything about this virus. For all we know, it has already spread beyond control in America and the first wave of fatalities is still on its way.

* We don't know what H1N1 will do once it starts bouncing around, spreading from human to human. That's when flu viruses can go through a rapid change (antigenic shift or drift) and spread more easily, become more virulent.

* Even if a wave of fatalities is staved off, the Zeitgest of Fear will set off panicked food buying, causing shortages and mayhem.

* We don't have enough effective vaccine to protect the population. Even if we did, this virus could mutate into something unstoppable quite easily. (It already jumped from birds to pigs to humans, after all.)

Right now, the cynic is winning.

Only 20 Confirmed H1N1 Cases in Mexico City
The Washington Post is making interesting distinctions in its most recent article about swine flu in Mexico City. In the lede, they report:

The suspected death toll from the outbreak of swine flu in Mexico rose Monday to 149 people as health authorities cancelled all schools across the country until May 6.

Then, two grafs later, the writer says:

[Mexico's Minister of Health Jose Cordova] said 20 of the deaths so far have been confirmed as swine flu, but that just two laboratories in the country, one in Mexico City and one in the state of Veracruz, are able to confirm this new strain.

149 suspected deaths. 20 confirmations. I hadn't heard that before. One has to wonder how many of those 149 cases are really the result of H1N1, especially in a chaotic and stressful situation that Cordova describes as "the most critical moment of this epidemic." 

So. What kills H1N1 sufferers?

Most of the fatal cases involved extensive lung damage, requiring doctors to prescribe mechanical breathing assistance. Exactly what caused the lung damage is not known.

Extensive lung damage -- that's what happens in the advanced stages of infections from flu. It's hard to imagine that isn't H1N1, lab confirmations aside.

But who lives and why? It does seem to rest on who receives care early:

Mexican officials said there is no shortage of antiviral medication. The difference between who lives and dies seems largely linked to how quickly patients receive treatment, officials said.

That would seem to mark the difference between an alerted American health care system and a surprised, overwhelmed Mexican system. The H1N1 sufferers up here are getting a head start on treatment that their Mexican counterparts did not receive.

Vintage PSA re Swine Flu (1976)