Dr. Martin Blaser, the past president of the Infectious Disease Society of America and the chair of the Department of Medicine at New York University’s School of Medicine, joins Martin Savidge to discuss the flu pandemic and the risks from a global perspective.

Below, read what bloggers in India had to say about the flu and the government’s response.

Blogger “Ivan Quadras” in India mocks the hype over the H1N1 virus:

As my good friend Kanul put it, “200 people get swine flu and the whole of India wants to wear surgical masks! 20 million people have AIDS and nobody wants to wear a condom!”

It’s really funny to see masks worth Rs. 20/- being sold at Rs. 200/-. It is funny to see Indians actually taking care of hygiene. It is funny to see everyone masked around me.

Rahul Agrawal in India argues that the government has to share in the blame for the spread of the disease, describing his flight into the country:

While I agree that this virus has come to India through passengers coming from overseas, I would say that the biggest blame lies with the Indian government for its negligent attitude which has led to this situation in India.

Before landing in Mumbai, each passenger was given a declaration form in which the person had to fill in some basic information like whether they had been to a flu affected country or had been in contact with a flu infected person. I filled this form in the flight and then landed at the airport. There was utter chaos at the terminal. There were some officials who wore face masks and asked each passenger to go to a particular room to get the form attested. I duly went to that room and got the form attested. After that I cleared immigration and entered into Mumbai with that form still with me; no official had looked at that form after I got it attested. So here I was, back in India, with a useless form in which I had mentioned that I had been to a swine flu infected country. No one had bothered to read that form and test me for any possible symptoms. And now the government blames travellers!

Blogger Arindam Chaudhuri, an editor with a news magazine, criticizes India’s health care system in his personal blog:

The impending pandemic of swine flu has once again brought to the fore the hapless condition of Indian healthcare, the under preparedness of the government as well as the indifference with which the babudom tends to treat such incidents that generally plague the common man to a large extent. Incidentally, just as the news of swine flu is spreading panic like wildfire, these days there are also reports of thousands being affected by cerebral malaria in Bihar. Yet, that doesn’t make prime news; and won’t make much news even if the casualties there were to happen in multiples of those dying due to swine flu.

What is visible all across is how the public healthcare system is woefully inadequate to take care of India’s burgeoning population. In the given environment, it is not just swine flu that needs to be arrested, but even the flu that ails the entire health infrastructure, i.e. the political mindset, needs to be corrected simultaneously.

Lines to vote in Argentina, with masks to protect against H1N1.

I once asked a doctor how to avoid catching a cold. He said to wash my hands and keep three feet away from everyone. Problem is — that’s no fun. Matters of politics, human relations and cultural mores operate at closer quarters.

Argentina is in the grip of what seems to be a full-blown swine flu epidemic, call it what you will — H1N1 or influenza A. The country’s health minister has announced 44 deaths as a result of the epidemic.

All the heightened awareness has been publicized in the week after President Cristina Kirchner and her husband, former president Nestor Kirchner, saw their governing Peronist Party lose badly in national elections, deemed a referendum on the Kirchners’ hold to power.

Some people wondered whether the elections should have been delayed as the flu epidemic started taking hold. The Buenos Aires newspaper, La Nacion, reports that the government cited 1,587 flu cases days before the Sunday elections, and may have been undercounting.

Suddenly, this week the count of infections is running much higher — perhaps as many as 100,000 cases so far. All along, one theory was that the Kirchners, facing low polling numbers, were trying to rush the election no matter what before their popularity got even worse.

Just after the election results, the health minister resigned. Her replacement, Dr. Juan Manzur, announced a series of measures to keep down the number of flu infections.

School trips were delayed, federal and state courts sessions were in recess, and sports and cultural events are postponed around Buenos Aires and the provinces. People have taken to wearing masks, pregnant women and the infirm can take time off from work and people with symptoms are encouraged to stay out of crowds. And officials say the national drink, yerba mate, may be a healthy choice — but avoid sharing and passing it around as is usually done, in ornate gourds with silver straws.

The economic fallout has been significant. Newspapers report fewer shoppers on the streets, restaurants are less crowded and tourists, particularly those from Brazil, are staying away.

The only good word about the worldwide flu epidemic is that pharmaceutical manufacturers are preparing supplies of vaccines that should be ready in two months. Until then, vote by absentee ballot and stay three feet away from everyone — or, at least, postpone any thoughts of visiting your soulmate in Argentina until the disease runs its course a bit.

- Peter Eisner

Photo courtesy of Flickr user blmurch under a Creative Commons license.

The USG talking points seem to be “reassure, reassure, reassure.”  Their take is basically right, for now — though it has spread rapidly, H1N1 is not a particularly lethal flu.

But the virus is affecting many young people who are otherwise healthy. More troubling is that its future course is completely unpredictable. With Tamiflu-resistant influenza circulating — as well as the H5N1 avian flu pathogen out there, which IS incredibly deadly — and the potential for recombinations, I worry. Practice the elbow cough and teach it to your kids. Wash your hands for a really long time. And stockpile food.

Mexico’s Social Democrats Party has a strong online presence.

As the confirmed number of H1N1 flu cases worldwide surpasses 2,000, Mexico is returning to normal as businesses and schools reopen.

But as a Worldfocus contributing blogger writes, the epidemic may have a lasting impact on internal Mexican politics, as the country approaches congressional elections in July.

With the opposition Institutional Revolutionary Party (PRI) in control of Mexico’s Congress, President Felipe Calderón may try to use his handling of the flu crisis to promote his National Action Party (PAN).

At the height of the H1N1 outbreak, with public gatherings banned, many politicians turned to the Web, using Twitter, Facebook and other social networking tools to spread their message.

Richard Grabman is an American author living in Mexico. He writes at “The Mex Files“ blog to explore how “flu-fallout” will impact the country’s political scene.

Viral campaigning in a time of viruses

The official campaign season for the 2009 elections started last Sunday, and there has been concern that the Calderon Administration is using the “sanitary contingency” to control either control the opposition parties ability to reach the voters, or to surpress voter turnout — which would presumably benefit PAN.

PAN Party Chair German Martinez had floated the suggestion of delaying the election, but found little support for such an obvious ploy.  Most parties agreed to certain “temporary” restrictions — supposedly voluntary — that limit candidate meetings to small gatherings between 10 A.M. and 3 P.M. (which basically means workers wouldn’t be attending) and limiting campaigning to a media campaign.

While election and media laws require the television and radio broadcasters to run campaign material during prime time for all the parties, and even the minor parties are given equal access, it does limit the effectiveness of some campaigning, which has always been more hands-on in Mexico.

BUT… There are no restrictions on Internet advertising.

The Social Democrats (SD), a very small party and always in danger of losing their registration, seems to be “winning” the on-line campaign.  At least it’s SD advertising which pops up most regularly on my screen when I look at a site with random advertising.  The SD ads push a “progressive” social agenda (drug legalization, abortion rights, gay and lesbian equality) and pays less attention to economic policy, perhaps appealing for the geek vote — which may be enough to keep their party registration.

[...] I expect more “flu-fallout” will emerge in the next few days as the campaigns get more heated.  And, I expect that the broad support for the Calderon administration’s proactive approach to the flu will somewhat limit the expected fall in PAN support, but it may not all be to the advantage of PRI… though with a stronger left, the Administration will be forced to make more concessions to the left in legislative iniatives.

To read more, see the original post.

The views expressed by contributing bloggers do not reflect the views of Worldfocus or its partners.

Ask an expert your questions on the H1N1 flu virus.

Laurie Garrett, a senior fellow at the Council on Foreign Relations, discusses how quickly the H1N1 virus is spreading, how world governments have responded to the crisis and the potential for a vaccine.

Eric Klinenberg, a professor at New York University and author of “Fighting for air: The battle to control America’s media,” discusses how U.S. and foreign media have fared in terms of covering the H1N1 outbreak.

Asia has suffered through a series of health crises in recent years — most recently the SARS outbreak in 2002 and 2003. Simon Tay, the chairman of the Singapore Institute of International Affairs and member of the Asia Society, discusses how the crisis is playing out in Hong Kong, Singapore, Vietnam and China and looks at which countries are best prepared to deal with the H1N1 outbreak.

Of course, no country has been affected by the H1NI outbreak so deeply as Mexico. Mexico has also suffered a great deal of economic damage, and it has concerns about how other countries are reacting to the epidemic. Christopher Sabatini, the senior policy director of the Council of the Americas, discusses economic damage from the flu, complaints that Mexicans are being discriminated against and how Mexico’s southern neighbors view its handling of the crisis.

Stephen Morse, a professor of clinical epidemiology at Columbia University’s Mailman School of Public Health, discusses how he sees the H1N1 flu epidemic playing out over the next few months in Mexico, the U.S. and the world.

Below, Professor Morse answers viewer questions. Thank you for your submissions.

Q&A:

William in New York asks: How do people become infected with the swine flu? Is it airborne, is it
contact with a person or an object an infected person has touched, or both?

Professor Morse: Probably mostly airborne. The swine flu is exactly like the regular flu we’re all familiar with in its physical properties and transmission.

It’s hard to believe, but after all these years of studying –- and experiencing — the flu, we still aren’t absolutely sure about all the mechanisms of transmission. But we can make some good estimates. I suspect that most infections are probably airborne, especially when people cough or sneeze nearby. Contact or inanimate objects are probably much less important as ways to become infected, although it’s still an open question and may account for some cases.

Because of the airborne spread, cover your coughs and sneezes (and if you can, throw away the tissue and wash your hands afterwards), and if possible stay at least several feet away from people who are coughing or sneezing. Because of the possibility of contact transmission, we also recommend good “hand hygiene” –- washing your hands (or using a hand sanitizer) regularly. We’re not sure whether or not handwashing makes a big difference with flu transmission, but it has clearly been shown to prevent many other infections and is a good simple precaution.

James in Michigan asks: The virus has three different strains of D.N.A — human, avian and pig. Can it jump from species to species, if the virus is compatible with the species? If so, shouldn’t we be concerned about that?

Professor Morse: Influenza viruses are exchanging genes all the time, often without our noticing until disease occurs. Influenza Type A — the one we usually are referring to — has its genome divided into eight segments of RNA (you can think of them as “mini-chromosomes”). The segments make it easier for the influenza viruses to exchange genes, a process we call reassortment. This is the process that usually gives us new pandemic strains. The widest variety of influenza viruses live in waterfowl, such as wild ducks or geese, and the novel gene in a pandemic usually ultimately comes from this source. However, humans are generally very resistant to infection by these avian (bird) influenza viruses. Pigs may be more easily infected and serve as a sort of “mixing vessel,” because they can also get infected with flu viruses from mammals, including pigs and humans. When two influenza viruses infect the same host (individual), they produce new descendants that may swap gene segments at random as they’re being produced, resulting in many different combinations. Some of them, as a result, just happen to have the right combination of genes to infect other species (like humans) that the parent viruses couldn’t infect.

This particular  ”triple reassortant” we’ve been hearing about as the ancestor of this virus was first identified over 10 years ago, in U.S. pigs, and has been in swine for at least the last decade.

Lynda in Texas asks: Will the pneumonia shot help with a secondary infection from H1N1?

Professor Morse: Yes. This shot protects against a type of bacterial pneumonia that used to be a major secondary infection, and a common cause of death in those elderly who had serious medical conditions. This vaccine prevents “pneumococcal pneumonia”, caused by a particular species of bacteria that is very common in the human population and has been a real killer in the past. So it will help. However, there are other causes of secondary infection that are not covered by the vaccine, so call your doctor if you get the flu and don’t start improving in a few days, or if you think you might have a secondary infection.

Spirit in New York asks: How concerned should I be about traveling on the subway, bus or train to another state? Is public transportation safe?

Professor Morse: No reason to worry at this time. There isn’t much risk from public transportation within the U.S., and that’s not likely to change until the flu becomes much more widespread. As of now, the virus is simply not widespread enough and there are not enough cases to make public transportation a major concern for infection. Public transportation, in general, is probably about the same risk as most places where people gather for similar periods of time.

Gerald in Connecticut asks: Our daughter is scheduled to leave for Mexico this Saturday on her honeymoon. Would you recommend she not go?

Professor Morse: This is really a personal choice, and I can empathize with her dilemma.

The CDC (Centers for Disease Control & Prevention) recommends avoiding all non-essential travel to Mexico if possible. Additional information and the latest updates are on the CDC Web site.

The risk is probably very small, but the newlyweds may well enjoy their honeymoon more if they aren’t distracted by the concerns about catching the flu. If your they do decide to go, they should check on their transportation arrangements. Many U.S. airlines are still flying to Mexico, but with reduced schedules because there are fewer passengers. Most airlines appear willing to give refunds or cfredits for those who want to delay the trip.

Aside from Mexico, travel restrictions to other places are generally not warranted at this time. There is a natural tendency to want to close borders or limit travel everywhere when these disease reports come up, but restrictions are often too late, after the disease has already spread into the country. By then, travel restrictions are usually too late to really prevent spread.

Nathan in California asks: Is it possible there will be an increased spread of the H1N1 virus later this year during flu season?

Professor Morse: Yes, it is possible, although truthfully we don’t know what it will do. Flu is notoriously hard to predict, so those of us who work with the virus have a healthy respect for its variety and unpredictability. The possibility of the virus coming back in another wave (possibly even causing more severe disease) later in the year is one possible scenario. But this is unpredictable, and that’s why it’s very important for epidemiologists and public health people to watch influenza activity carefully and be prepared to act appropriately if something happens. Keep watching the media for new developments.

Vernell in Texas asks: What can be done to prepare in advance of a possible return of the
disease in the fall?

Professor Morse: First, stay well informed in case there’s a major change or sudden development in the flu situation. If the situation is unusual, there may be special recommendations.

Otherwise, basically prepare the way you usually do for the flu. The hygiene measures we’re recommending — basics such as “respiratory etiquette” (covering coughs and sneezes), regular handwashing, staying away as much as possible from people sick with the flu, and staying home if you think you have the flu — will apply whatever happens. Call your doctor or health department information line immediately if you’re having difficulty breathing, feeling a lot sicker than you think you’d normally be with the flu, or if you start getting worse instead of better. You may want to have some extra supplies of food and other basics at home in case you have to stay in for a while.

A vaccine may be available by next fall, and you should seriously consider whether you want to take it. Your doctor can help with this decision.

Many people ask about antivirals, like “Tamiflu”. In general, these drugs can be lifesaving in severe cases if we give them fairly early in the course of disease (within the first 48 hours), but have relatively little benefit in mild or moderate flu (which will get better without medication). We don’t encourage these drugs for mild cases, because we’re concerned that wide use might cause more rapid development of viral resistance to the drug.

Wishing you good health!

Disclaimer: Stephen Morse provides information and informed opinion, not medical advice.