Current events rarely stray too far from political issues and swine flu is no exception. By taking a detailed look at the following three issues over the next several days I hope to draw some lines between politics and health illustrated by the current crisis.

• What conclusions can we draw about public health care and/or a national health preparedness infrastructure from the state of the swine flu outbreak so far?
• What conclusions can we draw about congressional political battles over spending on pandemic flu perparations in light of current public health needs?
• What implications do the political goals of those in power at home and abroad  have for public health? (NOTE: folded this into the second question)
  

Today I'll take a look at the first issue.

"Two weeks after the first known swine flu death, Mexico still hasn't given medicine to the families of the dead. It hasn't determined where the outbreak began or how it spread. And while the government urges anyone who feels sick to go to hospitals, feverish people complain ambulance workers are scared to pick them up.

A portrait is emerging of a slow and confused response by Mexico to the gathering swine flu epidemic. And that could mean the world is flying blind into a global health storm.

Despite an annual budget of more than $5 billion, Mexico's health secretary said Monday that his agency hasn't had the resources to visit the families of the dead. That means doctors haven't begun treatment for the population most exposed to swine flu, and most apt to spread it.

It also means medical sleuths don't know how the victims were infected — key to understanding how the epidemic began and how it can be contained.

[...]

In the town of Xonacatlan, just west of Mexico City, Antonia Cortes Borbolla told The Associated Press that nobody has given her medicine in the week since her husband succumbed to raging fever and weakened lungs that a lab has confirmed as swine flu.

No health workers have inspected her home, asked how her husband might have contracted the illness or tested the neighbors' pigs, she said.

[...]

Elias Camacho, a 31-year-old truck driver with fever, cough and body aches, was ordered out of a government ambulance Sunday because paramedics complained he might be contagious, his father-in-law told the AP. When family members took him to a hospital in a taxi, Jorge Martinez Cruz said, a doctor told him he wasn't sick.

Camacho was finally admitted to the hospital — and placed in an area marked "restricted" — after a doctor at a private clinic notified state health authorities, Martinez said.

In Mexico City, Jose Isaac Cepeda said two hospitals refused to treat his fever, diarrhea and joint pains. The first turned him away because he wasn't registered in the public health system, he said.

The second, he said, didn't let him in "because they say they're too busy."  "

 

This article identifies two major causes of Mexico's current public health disaster. The first is a serious weakness in Mexican national health emergency preparations - there was little planning, little coordination, and high levels of mismanagement. Mexico is showing a Katrina-like level of incompetence. The second problem is a lack of resources. Mexico is a poor country and the lack of financial resources has exacerbated the effects of the outbreak. There is not enough funding for more epidemiological staff, more and better-trained medical staff, and more hospital beds.  While Mexico has national health care which means that theoretically, anyone who was infected could receive prompt medical attention, Mexico's financial shortcomings and failure to adequately prepare for a public health emergency meant that it could not quickly identify and contain the virus. These institutional failures confounded the positive effects of universal medical access in this case.

By comparison, the US faces the opposite situation. We do not have universal medical access, but due to measures implemented after Katrina, our emergency preparedness is high. Our immense financial resources mean that we can also afford the equipment and staffing required to deal with a major outbreak. So the crisis is being handled well (so far). There have been no fatalities,  fast identification of potential cases, and adequate communication with the public. Unfortunately to get to our current level of preparedness, we had to suffer a major catastrophe in 2005. Katrina tragically demonstrated that while resources are important in containing public emergencies, even the richest country on earth can suffer from poor planning, poor coordination, and basic incompetence.

So because of our current high level of preparedness, the US is currently dealing well with the outbreak. But we were already on alert and looking for cases of swine flu since the Mexican cases first became public. What would have happened if the initial outbreak began in the US and not in Mexico? CDC has confirmed that swine flu is susceptible to anti-viral treatment, but only if administered within 48 hours of infection. There is much discussion about why the flu could be killing people in Mexico and not anywhere else. But what if the answer is as simple as "Mexico did not take the possibility of a new strain of flu seriously enough. Due to institutional failure it was slow to identify the outbreak. As a result, most of the early cases did not receive anti-viral treatment within 48 hours of infection and their health deteriorated." If this is the case, it becomes easy to see how a similar crisis could have occurred in the US. If one of the 50 million uninsured Americans had initially gotten the virus and was unable to visit a doctor until the flu had reached a serious level, we could have experienced fatalities and more widespread infections here as well.

This is where we see the intersection between affordable access to basic care (which millions of Americans currently do not have) and public safety in an emergency. Opponents of national health care argue that if an American doesn't have access to health care, it's an issue of individual responsibility and individual risk. So in a painful example, whether you can or can't get treatment for your cancer is your own problem. And while this is (in my opinion) a crass argument, it is fairly common and in fact the driving principle behind our current private health care infrastructure. Setting aside the ethical issues involved, there are public health implications to this perspective. As this outbreak has demonstrated, prompt access to medical attention (in addition to national emergency preparedness and adequate funding) can mean the difference between properly managing an outbreak and letting it spread like wildfire.