Living with Swine Flu: Mexico City Under the Cloud

It's hard to read Reyna Hernandez's distress behind her blue surgical mask. But you can hear it. "This is a very difficult time especially for our children," the Mexico City housewife says as she waits outside the National Institute for Respiratory Diseases (INER) on the metropolis' south side. Inside the hospital, her 38-year-old husband, a taxi driver and father of their three kids, lies in a bed, unconscious and barely alive, she says, battling what doctors have told Hernandez may well be swine flu — but which was originally misdiagnosed. More than two weeks ago, her husband developed a severe cough and sore throat; and since those were the final days of Mexico's flu season, doctors gave him common influenza medicine. When he only got worse, he was admitted to a standard hospital for pneumonia treatment.

But then last week the Mexican government realized it had the more rarefied swine flu (or A/H1N1 virus) epidemic on its hands. Hernandez's husband — who like so many Mexicans suspected of contracting swine flu is of a relatively young age not usually waylaid so severely by flu viruses — was transferred to the INER. "I believe the doctors and nurses are doing the best they can," says Hernandez, 42. "This is just a very painful ordeal for all of us, and it's hard for everyone to cope." (See the Top 5 Swine Flu Don'ts)

Mexico isn't just dealing with the motherlode of the global swine-flu epidemic cases — 358 confirmed as of Friday. It's also wrestling with questions about what, if anything, it could have done to curtail the crisis more swiftly and effectively. On the one hand, Mexico's response has been largely effective: measures taken by President Felipe Calderon and his health officials, as well as Mexico City Mayor Marcelo Ebrard, appear to have stabilized the outbreak. Those measures included the closure of all but the most essential businesses and government services Friday through Tuesday, the nation's long Cinco de Mayo holiday weekend. On Thursday, for example, the government reported that the daily number of new suspected cases is now about a fifth of what it was less than a week ago. That "makes us optimistic," said Health Secretary Jose Angel Cordova. "We had expected geometric or even exponential growth. So we think we're on the right track." (See photos of the swine flu hitting Mexico.)

But Hernandez's story, and hundreds of others like her family's, indicate that the first-response apparatus of Mexico's public health system, if not the entire system, could stand a significant upgrade. Dr. Miguel Angel Lezana, director of the National Epidemiological Center, tried a bit of buck-passing this week, suggesting the response by the U.N.'s World Health Organization in Geneva, Switzerland, "should have been more immediate" after Mexico informed WHO officials on April 16 of a possibly uncommon flu virus, one whose symptoms also include splitting headaches as well as the pneumonia-related problems. What Lezana seems to have conveniently left out is that Mexico as of then still did not have a proper laboratory to test for that viral strain; and that the WHO may not have been able to move with full force until a Canadian and then a U.S. lab confirmed the A/H1N1 variety eight days later.

Granted, Mexican doctors and health officials understandably imagined early on that they were simply seeing a late surge of flu-season activity or, at worst, an unusual spate of pneumonia cases. But the faulty or tardy diagnoses that marked those early moments of the Mexican epidemic reflects what Oswaldo Medina, head of the Mexican Epidemiological Association, told reporters this week is an inadequately funded and bureaucratically sclerotic diagnosis infrastructure. It's one in which the private and public components, he added, too often miscommunicate, when they communicate at all. "Identification of diseases," Medina said, "comes too late."

That appears to have been the case in the town of Xonocatlan, about an hour west of Mexico City, where Gerardo Leyva, 39, a mason, may have contracted a flu whose strain medical officials still haven't definitively identified. According to Leyva's niece, Yazmin Cortes, 30, her uncle began experiencing symptoms in the second week of April, and she says they may have exacerbated heart problems he was having after an electrical shock he'd suffered shortly before on the job. Local doctors diagnosed pneumonia, and Cortes says she gave her uncle regular antibiotic injections, but by the third week of April his irregular breathing and heartbeat were worse. He died in a hospital in nearby Toluca on April 20 of what doctors initially called a pneumonia-related heart attack.

There is a dispute over whether or not the cause was swine flu, as some medical officials now claim, or a more common flu, as Cortes and the rest of Leyva's family just as adamantly insist. What's clear is that if Mexican officials were concerned about a new flu virus as early as April 16, word either wasn't getting to towns like Xonocatlan — and patients like Leyva — or doctors in those towns weren't reporting symptoms like Leyva's to health officials as assiduously as they should have. Either way, a cloud of confusion still hangs over Leyva's neighborhood, where his family bitterly accuses both officials and the media of "sensationalizing" his death as a swine-flu fatality, says Leyva's niece, and stigmatizing his wife and three children, who've been left with little if any income. "This is a peaceful, hard-working family hit by something utterly unexpected," says Cortes, "and now the media want to hit them again with discrimination."

Controversies like the Leyva death could prod Mexico to improve its general public health system once the epidemic has passed. The country of 110 million people still has fewer than two doctors per 1,000 inhabitants, almost half the average of countries belonging to the Paris-based Organization of Economic Cooperation and Development (OECD). In rural states and Oaxaca and Veracruz, where Mexico's first swine-flu cases (and first death) are believed to have emerged in late March and early April, access to physicians and nurses is even more threadbare. The nation's public health budget is about 3% of GDP, again about half the OECD average; and its per capita health spending of $675 is a quarter of that average. Mexicans regularly complain about (and often try to avoid) overcrowded and understaffed public clinics and hospitals, where patients sometimes have to bring their own medicines and bandages if they want treatment. It's one reason partly why Mexicans tend to wait too long to seek treatment — another reason Mexico seemed slow off the swine-flu mark — and why they tend to rely on home-made treatments instead of doctor's orders.

Health officials say it could take weeks to determine the swine flu's origin — and some now suggest it just as easily could have been somewhere outside Mexico, perhaps California. But even if Mexico's first-response report card is mixed, its follow-through since then has won praise from health officials both at the WHO and in developed countries like the U.S. As of Friday, the country had begun setting up reliable testing labs; and of the first 776 suspected cases they'd analyzed (there are about 1,500 total), 358 were confirmed as swine flu, with 16 deaths confirmed for now specifically from the virus, almost half in Mexico City.

On Friday the sprawling and overpopulated Mexican capital seemed barely inhabited as residents stayed at home. One couple, Benjamin Perez and Andrea Arriaga, both 34, ventured out only to see their doctor, to make sure the flu-like symptoms Andrea had been feeling recently weren't A/H1N1 — and that she, more than eight months pregnant, wouldn't infect the baby, which is due any day now. As they climbed out of the Tacubaya metro station, they stopped to wash their hands with disinfectant and drink fluids provided at stations set up all over town by the government. "Sometimes it feels like just one more thing going out of control for us in this country," says Benjamin. "The drug war, the economic crisis and now this. But I think in the long run we've got a handle on this one, and that makes you feel good."

Perez's baby will be luckier, however, than another Mexico City-born infant, 21-month-old Miguel Tejada Vasquez. The boy died this week of swine flu, most likely contracted in Mexico, while on a visit to Texas with his family. Miguel was the grandson of one of Mexico's most prominent citizens, publishing baron Mario Vasquez Rana — proof, anyway, that in a country with one of the world's widest gaps between rich and poor, this plague made no class distinctions. With reporting by Ioan Grillo and Dolly Mascarenas/Mexico City