Adrian Gonzalez on swine flu in Mexico

Adrian Gonzales
In 2003 I was at the BMJ’s offices in Tavistock Square, London, when China’s SARS (severe acute respiratory syndrome) epidemic was at its peak. At that time the risk of infection seemed far away. Today is different; I’m living and working in Tlalpan, the district of Mexico City that holds the largest concentration of hospitals and healthcare professionals.

I first heard that something was happening on Monday last week. During the afternoon visit to patients from the interventional radiology clinic, a member of the infectious diseases staff was telling us that there were some cases of disease similar to influenza in the National Institute for Respiratory Diseases, and some of the patients were on assisted mechanical ventilation.

On Thursday 23 April, authorities informed us that we were living amid an influenza epidemic, outside of seasonal outbreaks, and that all cases should be reported. Television, radio, newspapers, and websites all carried information about general measures to avoid spread.

Still we didn’t know which virus was responsible for the outbreak; and people being admitted to wards were mostly aged between 20 and 50 years. Most of them had no previous medical history and were not vaccinated against flu, since health authorities recommend annual vaccination only for those younger than three and older than 50 years.
People began looking for the influenza vaccine, and enormous queues formed outside many hospitals in all districts of Mexico City. By the next day people couldn’t find the vaccine and masks were all sold out.

On Friday we were informed that a new virus was responsible for the outbreak, and that this had the characteristics of the avian flu and swine flu, and that the role of immunisation was unknown. Immunisation was therefore no longer recommended.
Panic broke out, and most electronic media, with their usual sensationalism, started to create a pre-apocalyptic scenario. Supermarkets experienced an increase in sales and shortages. The president of Mexico and the health authority cancelled all public meetings, schools from elementary to postgraduate level were closed, and sports events are being held behind closed doors. Also cinemas and restaurants are closed, and church masses and crowd pulling events are being cancelled.

In our hospital, which has been declared a national referral center, people stared to come seeking diagnosis and treatment. Internal medicine residents are doing triage, giving masks to all people with respiratory symptoms.

The emergency department has been redesigned to keep patients with suspected cases in an isolated area with negative pressure while establishing a diagnosis. The beds used commonly for elective procedures that require one or two days of stay are now empty, and are being transformed into an intensive care unit, in readiness for people with severe complications of the disease.

The second floor of the hospital is sending home patients with no severe diseases, in order to have beds ready for the contingency.

In the face of emergency everyone has to give their best. We know that we will be risking our own health – to date four residents from my hospital have tested positive for H1N1 virus, all of them with mild disease and getting well at home.
This is a new health challenge for the region and maybe for the world. We don’t know where it will to end, but lessons learnt from other epidemics will help us. I’m sure we will work hard, everyone on their own spot to deliver the best medical care to our patients.

Adrian J Gonzalez Aguirre is a fellow in interventional radiology, National Institute of Medical Sciences and Nutrition “Salvador Zubiran,” Tlalpan, Mexico City