Swine Flu Containment Unlikely; Alleviation Should Be Focus

Since the swine flu outbreak has now spread to several countries, it’s probably no longer possible to contain it, a leading public health expert said, so anti-flu efforts should emphasize mitigation of the situation.     In an editorial in the British Medical Journal, Richard Coker, a professor of public health at the London School of Hygiene and Tropical Medicine, suggested the best way to slow the spread of the virus and alleviate the severity of its impact is to use antiviral drugs. The H1N1 swine flu virus is still susceptible to these drugs, which are well stockpiled in most developed countries, such as the United States, Canada and the nations of Western Europe.

Many of the world’s developing countries, however, may not have good stockpiles of antiviral medications. And although most of them have contingency plans for a flu pandemic, many may find it impossible to get an effective anti-flu program off the ground. Even if they possess enough antivirals, they may have difficulty distributing them, due to poor organization and infrastructure. And if a good vaccine is created, it may only be gotten to low-income nations too late to have a seriously beneficial impact.
   
Evidence shows that border screening is a poor way of controlling the spread of a contagion, Coker said, so it’s not surprising that the World Health Organization is reluctant to propose travel restrictions. (Some European Union countries, however, have made such proposals.)

The infection could be brewing and spreading in countries we don’t yet know about, the professor said, noting that almost all cases reported to date have been in developed countries with mature surveillance systems. Coker cites two possible reasons for this: 1) At-risk people have preferred to travel from Mexico to the affected nations, and 2) The virus may be spreading unbeknownst to the rest of the world in countries with poorly developed surveillance systems. (Many immigrants come to Mexico, for example, from Central America, either to settle there or to transit to the United States.)
   
With the H1N1 swine flu virus coming into prominence, we shouldn’t ignore the continuing threat from the H5N1 bird flu virus, Coker warned. If we find a route to immunize people to the swine flu virus, they will still be vulnerable to the bird flu virus if it should one day mutate to easily pass from person to person.
   
The professor also speculated that the swine flu and bird flu viruses might someday meet and exchange genetic material. This might mean, he thought, that a new virus would emerge that could pose yet another pandemic threat.


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