Containing the rare strain of influenza virus that has caused 92 deaths in Mexico per the Mexican Secretary of Health – and up to 149 per media reports – is virtually impossible, Costa Rican officials said this week.
Dozens of possible cases are surfacing in countries around the world, including two confirmed cases here in Costa Rica, as countries scramble to initiate emergency preparedness plans.
“In a world as interconnected as our own, in which millions of people fly from one place to another every day, in which the daily life of everyone transpires in concurrent places like schools, work or public transport, controlling the proliferation of this virus is practically impossible,” President Oscar Arias said in a televised press conference on Wednesday, one day after his administration decreed the disease a national emergency.
On Wednesday, the World Health Organization (WHO) raised the influenza pandemic alert from Level 4 to Level 5, out of six possible levels, signaling that “a pandemic is imminent.”
Costa Rica health officials are responding by following steps outlined in an April 2008 pandemic influenza plan, which include heightened surveillance, early detection and treatment, and infection control.
Flu Surfaces in Costa Rica
On Tuesday evening, Costa Rica became the first Central American nation to preliminarily confirm two cases of the so-called swine flu. Yet, the Costa Rican Nutrition and Health Research Institute (INCIENSA), which is carrying out preliminary testing of suspected cases, lacks the primers needed to confirm whether a person is in fact infected with the Influenza A(H1N1) virus.
Health Vice Minister Ana Cecilia Morice said on Wednesday the Health Ministry is expecting to receive primer kits from the U.S. Centers for Disease Control and Prevention (CDC) by Friday to be able to better detect the disease in Costa Rica.
The country identified more than 50 suspected cases of the virus among individuals exhibiting its symptoms (high fever, stuffy nose, body aches), but are still investigating whether it’s the same strand that killed dozens in Mexico.
Both persons carrying the virus in Costa Rica – a 21-year-old woman and a 28-year-old man – are now in stable condition.
They have been instructed by health officials to isolate themselves and remain in their homes.
At press time, the results from these two suspected cases had not been officially confirmed by the CDC.
After health officials learned the two victims flew from Mexico to Costa Rica on two separate flights over the weekend, they asked that all passengers who traveled on those flights (Mexicana Airlines flight 387, which arrived Friday from Mexico, and TACA Airlines flight LR 631, which arrived from Mexico Saturday) to report to the nearest hospital or other health centers.
“We have contacted a great number of these passengers but not all of them,” Morice said on Wednesday morning.
By the Numbers
As doctors around the world identify flu symptoms and report suspected cases to their governments, the numbers fluctuate on an hourly basis.
Yet, with modern technology such as Internet and satellite phones, health organizations have been able to launch a worldwide effort in containing the disease.
“For the first time in history, we can track the evolution of a pandemic in real-time,” said WHO Director-General Dr. Margaret Chan in a statement Wednesday.
As of press time on Thursday, 11 countries had officially reported 257 confirmed cases of Influenza A(H1N1), also known as swine flu. The United States confirmed 109 cases with one fatality, while Mexico reported 97 confirmed cases, including seven deaths, according to WHO.
However, the Mexican Secretary of Health is reporting much higher numbers with nearly 2,000 suspected cases, 286 probable cases and 99 confirmed cases, including the 92 deaths.
WHO listed seven other countries with confirmed cases, but no deaths, including Austria (1), Canada (19), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8).
One Flu-id Response
Last Saturday, Costa Rican health and immigration officials began efforts to locate any suspected cases around the nation, primarily focusing their operations on flights arriving from Mexico at Juan Santamaría International Airport in Alajuela, northwest of San José, and at the Liberia International Airport, in the northwestern Guanacaste province.
Health officials have instructing aircrews to keep a close watch on passengers for any possible flu-like symptoms and report suspected cases to immigration authorities immediately after landing.
On Sunday, airport personal extended the measures to all international flights, not just ones arriving from Mexico, Immigration Director Mario Zamora told The Tico Times this week.
By Monday night, the Health Ministry had briefed all medical personnel around the country on the protocol to be followed when a suspected case is detected. Hospitals and clinics were instructed to have a designated area for suspected cases and to isolate such patients from the rest of the population.
“Today I want to assure you that I have full confidence in the capacity of our country to be a leader in this health emergency,” Arias said. “No nation in the world, even the most developed, can avoid (this) virus. But an organized country, a country with a health system like Costa Rica, can defeat this epidemic (and ensure) it doesn’t have severe consequences.”
Red Cross volunteers have been pulled in to examine passengers suspected to be carrying the virus.
Wearing protective gear – including bright yellow coverall, rubber boots, goggles, mask and two sets of gloves – these volunteers determine whether passengers should be transported to the hospital.
To further assist Red Cross volunteers, medical teams from the Costa Rican Social Security System (Caja), have been working at Juan Santamaría Airport in round-the-clock, 10-hour shifts since Tuesday.
Fighting Flu from the Home Front
Buffered by $5 million it hopes to draw from its own coffers, the Health Ministry is putting the structure in place to prevent a pandemic here.
The requested money, which has to be approved by the Comptroller General, will be used to pay staff overtime, cover transportation costs and reimburse other expenses incurred in the effort to contain the virus.
While no vaccines have been found that specifically prevent this strand of influenza, WHO officials say they’ve identified two classes of medicine to treat it once it surfaces.
In Costa Rica, medical personnel are equipped Tamiflu and Fluvir (the commercial names for the medication), with supplies to treat a little less than 5,000 persons.
Eduardo Doryan, executive president of the Social Security System (Caja), assured residents in a statement that this is a sufficient amount of antiviral medication to confront the sickness.
Medical personnel have also been equipped with the proper tools to keep themselves from becoming infected, he said.
What’s in a Name?
This rare strain of influenza has a human component, a swine component and an avian component, Morice told reporters this week. So even though the virus is widely called swine flu, it is not a virus that has been transmitted from pig to pig, but rather from human to human.
Although many health institutions, government agencies and other news organizations have dubbed this new virus strain “swine flu,” some agricultural and medical experts say the reference is simply inaccurate.
The push to correct the use of “swine flu” also stems from pork manufacturers or distributers, who want to prevent unwarranted, mass bans on their product.
Eric Hoffman, agricultural specialist for the U.S. Department of Agriculture (USDA) office in Costa Rica, said this (H1N1) virus is not a “swine flu” outbreak, but rather, “humans affected by a virus that has characteristics of swine, avian and human influenza.”
Morice agreed, saying the virus “has not been transmitted in the Americas from pig to pig, or from pig to human but rather from human to human.”
Some government officials, such as from Nicaragua and from Costa Rica’s Agriculture and Livestock Ministry, have referred to the virus as the “North American Influenza,” noting the geographic origin of the epidemic as the main reason for that latter name.
The WHO changed its official references to the virus as influenza A(H1N1) on Thursday.
Status of Animals
Costa Rica’s National Animal Health Service (SENASA) is conducting a strict surveillance of the avian and swine populations nationwide, Eduardo Vicente, SENASA director, told The Tico Times.
Over the weekend, this institution called and visited 1,200 farms across the country to confirm if any member of the swine and avian populations were showing symptoms for respiratory disease.
According to Vicente, there were no positive cases reported by farmers, while SENASA continues to monitor birds and pigs in the upcoming days.
“I can say with 95 percent certainty that the animal population has not been affected by this virus,” Vicente explained. “People in Costa Rica can eat their pork meat without any problems. If there were any risk, I would be the first one to say so.”
SENASA had no plans to stop pork meat imports from the affected countries such as the United States.
Tico Times reporter Meagan Robertson contributed to this story.