De Édgar, de 5 años, al resto del mundo. New York Times


Hernández of La Gloria, Mexico, may have had the first case of swine flu this year.

Published: April 28, 2009
en el New York Times

LA GLORIA, Mexico — Édgar Hernández can rattle off the fierce flu symptoms he suffered a few weeks back, like a boy far beyond his five years: His head was hot. He coughed until his belly and his throat were sore. He did not want to eat, which was strange for him, someone who gobbles up everything he can.

“I was very bad,” he said Tuesday, with his worried parents looking on.

“I feel good now,” he said later, flashing a smile.

The government has identified Édgar as the first person in Mexico to have become infected with a virulent strain of swine flu, a notoriety that could raise questions about how Mexican officials reacted — or failed to react — to the early stages of what might become a global epidemic.

Édgar was one of hundreds of people in La Gloria who came down with flulike symptoms in an outbreak that federal officials say began March 9.

Local residents accuse public health officials of discounting the outbreak at the time, reassuring them that it was nothing grave.

la-gloria-en-el-nytFederal officials said they did respond quickly, though they acknowledged that they took the matter more seriously after the virus infected people in another part of the country, which was at least a week after Édgar developed symptoms.

Among the many unknowns about the flu that struck Édgar are whether it could have set off more alarms early on, and whether it could have been contained if it had.

La Gloria may not, in the end, be found to be the source of anything. The village has many immigrants in the United States. Mexican epidemiologists say one theory is that someone who had been in the United States brought the virus back to the community.

Before Édgar fell ill, another person in San Diego may have been affected, said Dr. Miguel Ángel Lezana, Mexico’s chief government epidemiologist.

Even now, Édgar’s mother, María del Carmen Hernández, said she received conflicting accounts of the exact illness that kept her son in bed for three days. No one has explained what she should be doing to keep him and the rest of the family healthy, she said, signs that Mexico’s response effort may be spotty, especially in rural areas.

“Some people are saying my boy is to blame for everyone else in the country getting sick,” said Mrs. Hernández, 34, a blank stare on her face as she recounted the family’s ordeal. “I don’t believe that. I don’t know what to think.”

There was a modest increase on Tuesday in new cases of swine flu reported around the world.

In the United States, the number of confirmed cases rose to 64, from Monday’s count of 50, according to a news briefing by Dr. Richard E. Besser, acting director of the Centers for Disease Control and Prevention. The total includes 45 cases in New York State. There have been no deaths from the disease in the United States, but five people have been hospitalized for treatment.

Mexico remains the hardest hit. Late Tuesday, the Health Ministry put the number of suspected cases at 2,498, and the suspected number of deaths at 159.

In La Gloria, a town that has a major pig farming industry, two children died of the flu in March and early April, though the authorities said they had yet to determine whether it was the same strain that infected Édgar and spread widely to other locales. That and other questions have left residents here unnerved and confused.

Each knock on the door brings a surprise to the Hernándezes: fumigators who sprayed her home but did not tell her for what; scientists who asked to take a swab of Édgar’s throat; even the governor of Veracruz, who arrived by helicopter on Monday with an entourage in tow and left Édgar with a soccer ball and a baseball cap.

On Monday, the local physician who treated Mrs. Hernández told her that her son had influenza, but that it was not the swine flu virus, she said. But a few hours before, Gov. Fidel Herrera Beltrán walked right into her home to check on Édgar. He had said publicly over the weekend that Édgar had tested positive for swine flu, and Health Secretary José Ángel Córdova had confirmed on Monday that a boy from La Gloria, whom he refused to identify, had tested positive and then recovered.

“Shouldn’t they tell the mother first?” Mrs. Hernández asked as her younger son, Jonathan, 3, let out a cough of his own.

In fact, it was not Édgar’s case that tipped off health officials to the emergency. It was the case of a 39-year-old woman, who went into a hospital in Oaxaca with an unusual viral infection, that prompted Mexico’s epidemiologists to act.

The woman, María Gutiérrez, had gone to the hospital after initially falling ill days before and visiting several doctors without getting help. After tests revealed an unusual illness, medical personnel isolated her and notified state and federal officials.

She died April 13. A week later, the Centers for Disease Control in Atlanta notified Mexican officials that swine flu cases had turned up in Southern California, and they sent samples from Ms. Gutiérrez, Édgar and a patient in Mexico City to a Canadian lab for testing.

The results came back last Thursday afternoon, and both Ms. Gutiérrez and Édgar were found to have tested positive for a new strain of virus.

“The situation changed dramatically,” Dr. Lezana said.

A crisis meeting was called at the office of President Felipe Calderón. By that evening, officials announced the closing of schools in and around the capital, where the bulk of the cases were seen. Now, as the cases continue to come in, all of Mexico’s schools are closed.

“My impression — as an external observer, and that’s what I am now — is that the response has been quite competent,” said Dr. Julio Frenk, a former Mexican health minister who is now dean of Harvard’s School of Public Health. “Not perfect,” he continued, “but quite competent.”

Mexico has acted swiftly since the new flu strain was confirmed.

But officials acknowledge that the country lacks enough health workers to do as much outreach as they would like, and that the country has been unable to even test for the new strain of virus.

It was only this week that two laboratories, one in Mexico City and one in Veracruz, obtained the reagents to do their own checks on the new virus, rather than having to rely solely on epidemiologists in the United States and Canada.

“We never had this kind of epidemic in the world,” Mr. Córdova, the health secretary, responded testily to reporters this week when questioned about the handling of the crisis.

Epidemiologists are likely to have many leads to follow in determining how and where the flu originated.

La Gloria was not alone in experiencing a fierce outbreak in recent weeks. Public health officials in other parts of Mexico said they had noticed an unusual spike in cases in the beginning of April, when the normal flu season would usually be ending.

More than a month before the government confirmed the outbreak of swine flu, Verónica Ramos already knew something was amiss in La Gloria, where she is a teacher at the elementary school.

First, she said, a fourth-grade girl became sick; then more than half of that class had symptoms. The girl’s sister came down with fever, a cough and aches. Soon, one-third of the school’s 300 students were ill.

“Children get sick, I know that,” Ms. Ramos said. “And they infect each other. But it’s not common for so many to get sick so fast.”

Published: April 28, 2009

LA GLORIA, Mexico — Édgar Hernández can rattle off the fierce flu symptoms he suffered a few weeks back, like a boy far beyond his five years: His head was hot. He coughed until his belly and his throat were sore. He did not want to eat, which was strange for him, someone who gobbles up everything he can.

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