Ulrike Schmidt on swine flu fear and loathing in Mexico…and London

My flight to Cancun, Mexico, to attend the Conference of the Academy for Eating Disorders (AED) was scheduled for Sunday, 26th of April. The day before there were several anxious emails about the swine flu outbreak in Mexico City, but a reassuring response from the AED president followed: of course the conference would go ahead.The organisers had taken advice from the Mexican Ministry of Health and Cancun was, after all, a very long way (1300km) from Mexico City. But panic spread quickly. A colleague called me to ask what she should do – she was scheduled to fly to Cancun via flu-infested Mexico City. Was this wise? She decided to cancel. I decided to go anyway. After all, I was on the organising committee and had numerous presentations and chairing duties at the meeting.

A group of us, from UK teaching hospitals and universities, were on the same flight. There was much joking about the possibility of the meeting being cancelled, but everyone thought this a remote possibility. From the airport some of us went to the small resort of Tulum, about 130 kms south of Cancun, for some sight-seeing before the start of the meeting. After visiting the stunning Mayan ruins of Coba on Monday April 27th, we heard that the conference was cancelled. Shock and disbelief were followed by disappointment. What were we to do? We soon discovered that there was no chance of an early repatriation, unless at exorbitant expense. So we decided to hole up for the rest of the week in our small hotel on the beach. We debated whether we should hold our own mini-conference. After all, we had several conference presenters in our midst and we all felt rather guilty at the thought of a week’s enforced holiday.

However, this early enthusiasm melted in the warmth of the Mexican sun and gave way to a gentle routine of swimming in the sea several times daily, optimistically deemed to be flu prophylaxis, alternating with checking emails and lively discussions about research. Other stranded conference-goers joined us in our increasingly empty hotel and marveled at the beauty of the deserted beach. Hidden talents of colleagues were revealed. Readings of short stories were followed by guitar recitals and singing, and tablefootball, pool and ping-pong sessions. Gradually the flu seemed to get closer. By mid-week we learnt that all schools in the country had been closed, as had all restaurants in Mexico City. Then the first two flu cases occurred in Cancun. Much time was spent online reassuring friends and family and swapping swine flu travel tales with other would-be conference attendees. Swine flu jokes, heavily featuring Piglet and Winnie the Pooh, were received, as were emails from more gloomily disposed colleagues suggesting that we stockpile food.

Paradoxically, the problems really started when we returned to London on 4 May. I discovered that I had flown into the epicentre of the flu epidemic in Britain, with several cases at a school just round the corner from where I live. Responses to our return were varied and inconsistent. Those of us working in the NHS were allowed to return to work, provided we did not have flu-like symptoms. But one colleague, at a university was told to prophylactically stay off work for a week. His wife, a teacher, also had to take the week off.

One of my tasks at the conference would have been to chair a session on stigma and eating disorders. The term stigmatisation has acquired a new meaning for me now. A survey of our little group suggested that several spouses were less than welcoming. When I returned to work, everyone seemed surprised to see me, and some colleagues kept their distance. Neighbours won’t stop to talk. Some of my husband’s neurobiologist colleagues will now not sit in the same room with him because of his wife’s likely infection, and he has to give them a daily bulletin on my health. This selective aversion to apparently healthy travellers from Mexico occurred despite the fact that several colleagues who had stayed in the UK were, in any case, ill with flu-like symptoms while we were away. My Mexican PhD student, who has not recently visited her home country nor been in contact with travellers from Mexico, currently keeps her nationality a secret for fear of reprisals.

Amid continuing worries about how severe the current outbreak will be, questions remain: Was the H1N1 virus already here, rather than being a recent import from Mexico? Why did many young Mexicans die supposedly of this virus? Where was I more likely to get swine flu: on the beach in Tulum where everyone seemed healthy, or in London where the school round the corner has been closed and over 1/4 of the UK swine flu cases are located? Since, in earlier flu pandemics, viruses mutated from an initial mild form into a nastier form, might people begin to seek out my company in the hope of acquiring immunity?! The diversity of responses, in light of the uncertainty of the situation, piques my professional interest as a psychiatrist: what determines a panicky or untroubled response to coming into contact with a carrier of risk like me?

Ulrike Schmidt is Professor of Eating Disorders at the Institute of Psychiatry in London