It can be difficult to separate the important from unimportant on any given day.
Reflections mean to do exactly that — by thinking about what happened today, we can consider
what might happen tomorrow.
On Monday we continued to monitor the spread and effects of swine flu, as the World Health Organization raised its pandemic alert level from 3 to 4 (6 is the level for a full-blown pandemic). Though many aspects of this flu outbreak have become clearer, several questions remain unanswered. First and foremost among these is: Why have deaths from this outbreak been limited to Mexico? The country’s death toll, which stood at 103 when Mexico and the rest of North America woke up Monday morning, had risen to about 149 deaths by the afternoon. In the United States, the number of confirmed swine flu cases rose to at least 40 —with one person hospitalized — and reports of isolated cases have popped up around the world, from New Zealand to Spain. Mexico is a country with obvious infrastructure challenges, including access to health care and water in Mexico City (water supplies recently have been cut off for days at a time in many parts of the capital). However, the government has mounted a significant response to the outbreak and has substantial resources at its disposal. In other words, infrastructure alone is not a satisfactory explanation as to why so many people have died in Mexico in such a short time, while no deaths have been reported yet in other countries. As the apparent location of first infection, Mexico was at a serious disadvantage in terms of information needed to combat the virus. The illness was first noted as early as February in Mexico, but at the time there was no reason to suspect that it was anything other than an isolated, severe case of the normal flu. Mexican health officials attributed an increase in respiratory infections in mid- to late March to seasonal weather changes. It has become clear that most of the people who have been hospitalized in Mexico arrived at the hospital with pneumonia — a common complication of the flu that stems from a bacterial infection of the lungs. That these patients already were suffering from complications leads us to some very tentative conclusions. First, those who arrived at the hospital with symptoms of pneumonia certainly do not qualify as cases of "early detection" in the swine flu outbreak. This makes it much more likely that the swine flu cases that are appearing in the Mexican health system will result in fatalities. Second, Mexico's method of testing has focused on patients who have been hospitalized; therefore, those testing positive for the new flu strain already are much more susceptible to severe and possibly fatal complications. Finally, because Mexico has had time to absorb the effects of the outbreak, there has been a great deal of back-checking on the records — including plans to exhume the bodies of suspected swine flu victims from February — which allows for post-hoc discovery of flu victims. Medical sources have told STRATFOR that, unlike their counterparts in Mexico, officials in the United States have been testing patients who are still ambulatory (and they seem to be trending toward testing those with risk factors such as having traveled recently to Mexico). This means that the diagnosed swine flu patients are more likely to receive proper medical care and recover. It also means that the United States has not necessarily been in a position to identify cases of the new virus that already have caused people to be hospitalized; authorities instead might have assumed that swine flu cases were simply severe cases of the seasonal flu. The distinction between the U.S. and Mexican testing methods means there is no way to clearly assess how many people have been infected, and it is impossible to gauge the rate of mortality associated with this new strain of flu with any certainty. In Mexico, there is a bias toward a higher morbidity rate, while the U.S. method is biased toward a much lower rate. But numerous other factors exist that could account for the nil death rate in the United States (and elsewhere) as compared to Mexico thus far, ranging from the timing of the flu infections to demographic issues. For example, there simply might not have been enough time yet for the flu to take its full effect in the United States and elsewhere. Additionally, according to the Centers for Disease Control and Prevention (CDC), the median age for infection in the United States is 16. Because younger people appear to be recovering from this disease more quickly than older people, the low median age for the United States could result in more rapid rates of apparent recovery. Very little is known about the nature of this virus. Until the CDC has finished its analysis, there is no real way to know even whether it is a single illness that the world is dealing with, or whether the flu has mutated sufficiently to mitigate the effects for populations outside Mexico. A distinct possibility remains that mortality rates could increase outside Mexico, or perhaps that the early warning from Mexico will be sufficient for the global medical community to mount an effective response. At present, however, the aggregate knowledge that passes as situational awareness on this topic is mercurial at best, and the medical community is making educated guesses. This issue is outside of STRATFOR's expertise, but we will continue to watch the situation as it evolves, including the outbreak's effects on global markets, which were shaky enough to begin with.