Swine flu: why I'm not complaining

One good thing that might come out of this is for the public to be able to better discuss, in a rational manner, a pandemic without conjuring up images of "The Stand" or a Michael Crichton novel.

I work in an already overtaxed emergency room in a major city. Yesterday we were "out of" masks and therefore the nurses in triage went without. It is concerning to me as a nurse that has first contact with those that are ill, that basic resources are not available. I love my job yet I love my family more. Creating a potential reservoir within myself for a virus with so many unkown variables is not an option. You are right in your critique of our health care system. Understaffed and unable to handle the noramal changes in pt census we are truely vulnerable to an exponential increase in patient loads.

While the CDC and WHO are sending the right messages, I think we are on the brink of the media backlash (it started in that LA Times reference in the comments of another blog entry) since the body count hasn't started piling up in the US. Note: we may have a very low body count thanks to the CDC and WHO informing the public and making people fearful enough that they are getting checked out. What can be done to fight a media backlash is the real question?

If the 1918 pattern occurs, I think CDC and WHO's public image will be undermined and people will ignore them in the fall. The general public doesn't know the 1918 story - it needs to get out there so people will understand that a summer lull may not mean anything.

interesting cdc interview at the science magazine blog. they are getting better access than most. the entire flu thread is worth a look

http://blogs.sciencemag.org/scienceinsider/2009/04/exclusive-cdc-h.html…

GeorgeT: I'm a bit more cautious. This virus, so far, doesn't look like 1918 and comparing what is happening now to 1918 has no basis in current data. I think being as clear eyed and truthful as possible is what is needed. I neither believe in downplaying this to prevent anxiety nor portraying it in ways we don't know are accurate to prevent complacency. The issue is not the 1918 story but the plausible (at this ooint) 2009 story. You don't need that much imagination to see the problems that might ensue with a very bad flu outbreak. We don't need to invoke the (probably inapt) 1918 example for that.

Speaking of mobilizing resources, I have heard some people recommend stockpiling emergency supplies to prepare for the worst. (Canned food, bottled water, etc.) Do you think that may be a good idea at this point, or are people overreacting? Are there places where people should be stockpiling while people in other places should wait to see what develops?

My own inclination is to wait and see. We've had one confirmed case in my city and a second possible case, but I don't feel like panicking yet. Still, I'd hate to wait until it's too late...

Just to prove my point about the public not understanding 1918 ABCNews had this tidbit
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Based on his past work with the bird flu and SARS, Hsu said most infections decline in the summer months. If swine flu follows suit, then there are good signs a pandemic has been avoided.
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I know we don't know if this will follow the 1918 pattern, but I know human nature will not prepare us well for that.

Azulene, (chamomile?)
I remember when I lived near the coast of Lake Michigan. We'd hear about the winter storms hitting Wisconsin and the lake separating us would give us time to go to the store and stock up. I got snowed in for five days once. But I had plenty of food and supplies. I got out earlier than most (jeep and risky youth behavior) and was shocked at the empty store shelves. Of course. Truckers couldn't get through.

Preparing or prepping for a pandemic can be done in a calm environment where the stores have everything you want and the lines are normal, or you can do it when everyone else is doing it.

On that note: adrenaline stimulates the growth of bacterial biofilm. Melatonin and serotonin inhibit biofilm.

My 2 cents again:

1. As an ER physician at a teaching hospital, I am constantly frustrated by the lack of attention the govt has given in regard to the fact that most EDs in the USA function above capacity and we have little to NO surge capacity. A white House report in March 2008 called 31 EDs throughout the USA at the same time during a Monday afternoon and asked how many people they could take (simulated a mass casualty event that had same number of victims as the Madrid train bombings several years back--i.e. 215 victims) and most could either take 1 or 2 or none. Yes I wrote those numbers correct. One hospital in Wash DC was functioning at 250% over capacity during that nice phone chat! We have neglected our public health infrastructure and now that we have as Obama said last night not 1 or 2 major problems but 8 or 9--we dont have the money to fix it like it should be. Thankfully this pandemic wanna be were enjoying appears to be a wimp. And now that I am going What in the hell was the WHO thinking in putting so much money and resources on the pipe dream of source containment? That policy was based upon 2 computational models that were flawed and had unmeetable requirements for such as policy to work. Spend the money on prevention stupid!

2. I wrote an (I know self promotion--but this is important) Op ED for CNN on travel and swine flu that folks on this site may find useful when they fly during an outbreak. Please check it out http://www.cnn.com/2009/HEALTH/04/30/gendreau.swine.flu/index.html

Take care everyone and remember sanitize those hands.
Mark

The UN Food and Agriculture Organization apparently doesn't think pigs are the origin of this new virus. What should we make of that? http://english.chosun.com/site/data/html_dir/2009/04/30/2009043000765.h…

There's a communication problem with CDC/WHO raising the pandemic alert level to 5 and sharing this information with the general public while level 5 mainly addresses Public Health concerns. Doctors, labs, hospitals all know what level 5 means and they can make use of that information.

The general public is at a loss, however. WHO doesn't inform the general public urging them to stockpile food and prepare in a reasonable way which I believe they should. Also, the general public should be informed as to how the flu patient should best be treated at home - which will be the most likely way to deal with sick people during the pandemic. Right now, I would go to a hospital but that's not possible when there's a real outbreak on a larger scale. It's not very reassuring that Roche France, e.g. doesn't deliver Tamiflu to doctors or pharmacies anymore - only to hospitals. It can only be guessed that many home-treated patients will not get the drugs they need when they will need them.

Masks: The general public gets informed that they are not needed because they may not have any effect. Then, the same general public can read WHO's advice to health care workers about personal protective equipment consisting of a protective mask (minimum requirement)and frequent hand washing.

In a real outbreak, many untrained civilians will treat sick people at home.

Someone should put someone in charge of informing the general public of what lies ahead.
"Level 5" causes panic or indifference.
Maybe, hopefully, that will change.

Mark I'm just another poster, like you, but it seems folk around here don't mind much if you're promoting an article that is pertinent, accurate (not a conspiracy theory), and free. It's just if your info-sharing is for-profit or promoting a non-health political agenda that people get cranky.

Lily: WHO is an intergovernmental agency, not the health agency to the world's people. It advises its member nations. Phase 5 is the signal to those states/nations that it's time to prepare their communities. I am mainly interested in community preparations as I don't think that the ultimate solution to this is individuals acting alone on their own behalf but in neighbor helping neighbor. I don't object to prepping. It's just now what we talk about here on the front page.

This a partial repeat of a comment on another post, but it's relevant to the discussion here. I believe that in addition to "avoid communicating the flu" messages, the public needs to hear "preparation" messages:

Accumulate food and water at home in case supplies are interrupted.

Download and print out the Centers for Disease Control and Prevention's home care advice (just as the stores might be empty if this hits hard, the hospitals will definitely be full) - it's at the CDC site, or search for the terms "swine influenza" "taking care of a sick person in your home"

www.cdc.gov/swineflu/guidance_homecare.htm

While antivirals and antibiotics require prescriptions, CDC says over-the-counter cold and flu medications will give symptomatic relief (but don't give them to children under the age of two; don't give aspirin-containing drugs to teenagers or younger). You might check that you have some of these on hand, just in case. Aches and fever can be helped with acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®, Nuprin®), and naproxen (Aleve).

A more balanced and cautiously worded article raising the question, Is it swine flu? Same source, though: Joseph Domenech, chief veterinarian at FAO. http://www.medicalnewstoday.com/articles/148015.php

To every single person who faced hostility and opposition but pushed and prodded anyway to help move the world's health/government infrastructure to a place that allows it to be even moderately responsive and effective to an epidemic or pandemic: Thank you, bless you. A million times over.

revere,

Thank you. Individuals acting on their own behalf or neighbor helping neighbor boils down to the same: non-professional health care.
I hope there is still enough time to prepare for the worst on the communal level.

Aleve warning - you really must have food in your stomach to take this or you risk pain and a stomach bleed.

For that reason, I always have some acetaminophen/Tylenol in my medicine cabinet. If i can't keep food down I take that instead.

The only problem I've had with the "panic mongering" is with CNN, MSNBC, and other major news outlets. They're taking soundbytes from WHO and the CDC and not really providing context. If this was three years ago, before I entered the sciences and started actually learning to read and think, I'd be terrified right about now. People who rely on the major news aren't being given the full picture or how to even view the full picture.

If anybody wants to see the crap flying around in the general public, take a gander at this discussion: http://breakingnewsblog.dallasnews.com/archives/2009/04/dallas-elementa…

I've been trying to address some of the idiotic statements but it is beyond me how to try to knock some sense into that one.

What a great discussion! In this phenomenon I look who stands to gain and who stands to lose. Perhaps big pharma has conspired, but I doubt it. Perhaps WHO and the like are trying to overstate their importance and thus their budgets and influence, but I doubt it.

I think instead that there's a lot of CYA (cover your a**) going on and the penalty for overreaction is a lot less, which would be more difficult to prove. But in a major outbreak, heads would roll.

Frankly, I like the idea that we're forced to think about what we really demand from our governments (public health management e.g.) and not cultivation of fear over terrorism or socialism.

I am disturbed that there's little profitability anymore in fighting disease, but instead all the 'value add' is in lifestyle enhancement. Isn't it true that children's vaccines are less available because of the low profit margins?

Since readers of this thread seem to know something, I have a question: Is hand sanitizer useful against swine flu? I thought that since viruses aren't 'alive' they can't be killed by the alcohol in hand sanitizer. I notice no mention of its efficacy here anywhere.

I use them, but my job is a medical profession that sees a very large volume in short periods of time. As well, university computer labs seem like nice little breeding grounds.

However, it's mostly just an overall hygiene practice when you can't stop and wash your hands. And no! to antibacterial sanitizers!

tenpenny: These are thought-provoking links. I hope someone will be able to reply.

Are healthcare providers getting and using proper respirators (N95 or better) or surgical/procedure masks, which do not protect against airborne transmission?

Revere, as always, thought provoking. Thank you.

Mark: where do you think all those masks and respirators are going to come from? In every country around the world, the same response is occurring. I wonder how many healthcare professionals there are in the world? And what about the millions of everyday workers who use them for protection at work? What will happen to those supplies? I am sure there is not a huge warehouse somewhere full. If manufacturers of these are like every other business hit by the GFC, then I am sure inventory and raw material supplies will be reduced.

"...if your info-sharing is for-profit or promoting a non-health political agenda" (Lisa the GP on Mark)

I'm also just another blogger and I appreciated your article, Mark. Thank you for sharing your opinion.

Lisa, what do you mean by "non-health political agenda"? Don't ALL our opinions have some political value? We're all grown-ups and should be able to deal with references to a variety of news sources.

Having bend on the side of Ethics in a pandemic in last few months I became surprised that despite our preppings, we do not publicly adress to much the issue of the Ethics and Priorities in the allocation of Medical of Ressources in a pandemic.

After taken knowledge of over 40 Nationals pandemic preparedness plan from different Cultures, Languages and Political/Religion background, I am worrying about something that has not been talk too much even within Flublogia in the last 6 years Revere.

It had become obvious to me, that the citizens have to understand the set of priorities in a major Public Health crisis.

From my studies, I came to the conclusion that;

We must First assure ourselves that the continuity of Humanitarian Governance is assured via the allocations of Health Resources, then come to my opinion, the security forces (army, police, fireman), then comes the First Responders, the people in service in the Public Health Infrastructures.

People have to understand that without first taking care of all the above, they will be vulnurable at the extreme.

Thanks again for your lasting work full of tenacity and Professionalism Revere, you have all my respect.

Snowy Owl

CDC and their comments re: alcohol hand sanitizer are scary..they prepared a white paper 12 years ago on the topic and haven't changed it since. Here's a fact..the manufacturer of at least one non-alcohol hand sanitizers using benzalkonium chloride has independent lab tests demonstrating efficacy against Swine Flu... (MGS Soapopular)If one manufacturer has the documentation, it would suggest that quats are effective...and non-flammable, non-irritating, non-toxic.....see info at their website www.soapyusa.com

Does the risk of H5N2 increase because of the latest events?

Brian, these risks are independent and not related except in a very indirect way. The simple answer to your question is "no."

H5N2 has not yet become human-to-human (H2H) transmissible, with a couple of cases as exceptions where someone had very close family contact with someone who was infected. The danger of H5N2 is that it could at some point mutate to become H2H transmissible.

One way that could happen is if someone catches H5N2 (for exmaple, from poultry) at the same time as they have H1N1. At that point they would be a "mixing vessel" where the two types of virus could interact and share genetic material. If this led to H5N2 becoming H2H transmissible, that would be a very bad situation indeed. However the probability of that occurring is very very low, since the number of human cases of H5N2 each year is very low to begin with.

Another risk is that the current H1N1 pandemic turns out to be relatively mild with a low CFR (case fatality ratio), and causes people to become complacent about the next pandemic. Then when H5N2 goes H2H, people may under-react because the expect it would be as mild as N1H1.

What's needed is to act calmly and take appropriate precautions in any of these pandemics. Even if a virus is relatively mild, getting sick with any kind of flu is unpleasant, so take precautions and stay well.

Lilly on one of the recent threads around here some troll posted something involving religious repentance and the uncleanliness of folk from 'other nations'. That's the sort of thing I meant by a non-healthcare political agenda.

"Never before have we watched a flu outbreak of global dimensions unfold in real time."

Every year, seasonal flu spreads across the globe and kills from 250,000 to 500,000 people according to the WHO. But because it happens every year, nobody pays attention including you. On the other hand avian flu, which last year killed 44 people, that really fires your rocket. Now so too with swine flu. It's pathetically obvious you WANT a pandemic in which millions die. It gives meaning and purpose to an otherwise worthless life. Too bad you aren't going to get your wish. Read these and weep.

http://www.latimes.com/features/health/la-sci-swine-reality30-2009apr30…

http://fumento.com/disease/flu2009.html

All of this activity surrounding this flu event costs money -- and IMHO, this is the first time in a while where I feel that my tax dollars are being well-spent and efficiently spent. This is the way govt is supposed to work -- be on top of things, be visible, COMMUNICATE.

Unfortunately, not everyone agrees that this is money well-spent. Here's a quote from a congressman in my home state, who also happens to be a physician:

"Rep. Philip Gingrey, a Georgia Republican, said he worried the U.S. may spend money unnecessarily and asked whether health officials will go ahead with a vaccine if the flu outbreak diminishes."

Now I consider myself *very* fiscally conservative and often rail at government spending. In this case, however, this is the LAST thing I'd be thinking about right now. So what if the government spends a few extra million on the possibility (and a good one) that we'll need extra vaccine does? Or that, perhaps, they learn something from the exercise so that they're better prepared next time? Considering the government spending spree of the last 8 months, this comment is beyond ridiculous.

Lest it appear that I'm being partisan and only taking one political party to task for a member's lack of understanding of this situation, I'll just remind everyone about Joe Biden and his public transportation paranoia from today. :)

Oops, my bad. I meant to say avian flu led to 44 CASES last year. Which is another reason for you to try to stoke panic over this new virus. You've kind of got an embarrassing record concerning the last "pandemic" and are hoping that if you swap "swine" for "avian" nobody will notice. But if they haven't, it's because you're not worth paying attention to.

Lisa, you use the Troll word and then another one appears. :P Just ignore him - no response to his comments and he'll go back under his bridge.

MildSkeptic: I agree with you on the spending on this.

Mr. Fumento,

My, what an angry comment. Where a simple statement of your difference of opinion would have been sufficient and welcome, you instead chose to levy a series of personal attacks against the editors of a site that, regardless of your opinion on their motives, provides accurate and copious information on the *science* of viruses and genetics.

If you expect folks on this site to be surprised and appalled by the statistics you've quoted, you'll be sadly disappointed -- everyone knows this already. The problem is, you've missed the point of these discussions and of why the current situation is different from seasonal flu. Had you done some thorough reading of this site, perhaps you'd better understand this.

I promise you, neither the editors of this site, nor its readers, want to watch millions of people die -- quite the contrary. It's more like gathering an arsenal of knowledge and understanding, such that, when the inevitable "killer flu" pandemic does finally threaten us, we've done all we can to prepare to fight back.

What puzzles me most is why you believe you can even make such statements with any authority? Being a lawyer or showing-up on various news shows does not give you any scientific credibility, nor even credibility with regard to statistics interpretation -- unless I missed seeing your degree in Mathematics or Social Sciences on your website.

I would encourage you to read through this site, and other sources, more thoroughly and do your "homework" on this issue, and the purpose of such discussions, before issuing comments of this nature. Otherwise, one might interpret your comments as nothing more than a desperate attempt for attention.

Boy, it's amazing to me that anyone is concerned that people are trying to stoke panic. I think the opposite desire reigns, and is severely reducing the overall verity of the picture we're getting via talking heads. In particular I think Mexico is lying to us far more than i've seen ANYONE speculate.

A lower bound on the # of Mexico cases follows. Then a conservative estimate, followed by what i believe to be a likely estimate.

If we had a lower bound on infection rate, we could compute a lower bound on the # of Mexico swine flu cases, assuming exposure to the virus has been uniformly spread. I'm going to make that last assumption in what follows, because (fairly uniformly Catholic) Mexico just had Holy Week, where people travel and visit their families, and because the virus has been spreading there for 2 months. Remember this assumption (call it assumption X, because it's the weakest part of my argument, I think. ) Just to be safe, let's allow for nearly 10% of Mexico's population not being exposed to the virus at all, by calling the country's population 1 billion (denoted as 1 x 10^9, so we can all count on our fingers) instead of the actual 1.1 billion.

To get a lower bound on the infection rate, all we need is an upper bound on a large population in an animal model, exposed to whatever Mexico has been exposed to, and a lower bound on the number of infections that resulted.

Hmm. Where would we get such a population?

How about all the furless primates who travelled to Mexico in April? Quick, somebody call the Mexican airports, seaports, and borders.

Meanwhile, let's make a conservatively high guess of the number of foreign travellers to Mexico in April.

Here's what we know:

In recent years almost 24 million people travel to Mexico each year. Tourism this last year and first quarter of this year were depressed, due to a violent war between drug lords there, increasingly corrupt police, and the global economic crisis. Areas where the drug wars are worst were complaining of a 60-90% reduction in tourism, while others were complaining of reductions around 10-35%. If April were similar to the monthly average, and the industry depression were ignored, we could guess that 2 million people visited Mexico in April . However, April is a busy month for Mexico tourism because of spring break, as well as holy week, so April's traffic will be higher than average. Two million is a lower bound on April's tourist traffic, we need an upper bound. 24 Million is one upper bound, but Mexico's entire tourist season does not fall into April, of course, so we can get a tighter upper bound than that.

Another way to guess total tourist traffic is to look at the US border traffic. Those statistics are easy to get. About 80,000 Americans cross that border per year in recent years, and over 75 percent of them just make a day trip out of it. American tourism is believed to be about 30% of the Mexican total, which would estimate the annual total to be about 24 million tourists. This tells us bupkis about April's share--we already know it's less than 24 million, but it does tell us that we're on track so far.

Yet another way to guess total tourist traffic is to look at # of hotel rooms, occupancy rates, avg # of room occupants, avg lenth of stay. There are about .5 million hotel rooms. IN recent years, occupancy rates have been about 90%. They were considerably lower for reasons described above in the months preceding April. But let's say they were all 100% full--that's good for an upper bound's conservatism. For the rest i have to guess. To keep things as conservative as possible, let's say that an average april stay is 3 nights, average occupancy is 2 per room, and ALL inhabitants are foreign. Thus each hotel room houses no more than 10 occupant changes x 2 occupants = 20 foreign tourists over the the month of April. Multiplying 10 times the 500,000 hotel rooms gives us about 10 million as an upper bound on foreign tourists in april.

Given that the annual total foreign tourist traffic is under 24 million, due to the industry's recession, I feel very comfortable with 10 million as an upper bound on the number of foreign travelers exposed to Mexico in April. If you're thinking "no way could it be that much" then i have successfully given a conservative upper bound. The validity of my conclusion depends on these numbers being conservative.

Next we need a lower bound on the number of those April travelers to Mexico who got swine flu.

Here's one lower bound: the number of confirmed cases outside of Mexico, right now. That's 205. Let's call it 200 (2 * 10^2). Almost all of these cases were contracted as a result of the patient's exposure to Mexico. Some future cases will be too, since tourists are still returning from Mexico. But the future confirmed cases will increasingly include people who did not travel to Mexico in April. Those statistics cannot be used for this lower bound, without the risk of creating bias. I want this lower bound to really be a lower bound.

So, a conservative lower bound on the infection rate (given assumption X above) is (2 * 10^2) / (2 * 10^7) = 2 * 10^-5 = .00002

And thus an extremely conservative lower bound on the # of infections in Mexico is: (2 *10^-5) * (2 * 10^9) = 2 * 10^4 = 20,000 cases.

***

Now, let's lessen some of that conservatism, to get an estimate of Mexican cases, instead of a lower bound:

I doubt that there were even 5 million tourists to Mexico in April, and I doubt that many who were there in the first week were exposed to the virus.
My conservative guess at the maximum number of tourists possibly exposed to the new virus: 4 million is my conservative estimate. It was probably more like 2 or 3 million.

As for the # of those tourists infected, it's obviously way more than 200. Hell, thousands of the April tourists aren't even home yet.
My guess at a minimum number of April tourists infected by the new virus = current confirmed + current probable cases = 425. Let's call it 400. (remember, lower is more conservative).

So a *conservative* guess of the infection rate is 400/4,000,000 = 10^-4, making a conservative estimate of the # of Mexican flu cases of (10^-4 * 10^9) = 10^5 cases.

So my conservative estimate is 100,000 cases!

***

and finally, here's my real estimate. The one i personally believe will turn out to be closest to the truth.

3 million April tourists in Mexico is more like it, and at least 600 those tourists will confirm, assuming at least 10% of the not "probable" suspected cases do confirm and nearly all of the probable ones do. This gives an infection rate of ( 6 * 10^2) / (3 * 10^6) = 2 * 10^-4, and my final Mexican case estimate of 200,000 cases.

***

I think Mexico's behavior is much more consistent with being saddled with 200,000 flu cases all at once, rather than the 1/100th of that they admit to. Also, a caseload of this magnitude completely explains away the mysteriously high Mexican CFR.

There. Please poke holes in this ---all you have to do find any place where my lower bounds are too high, my upper bounds are too low, or any reason why "assumption X" is ridiculous.

@ mistah charley, ph.d.

Stock up on water? Do you think infrastructure will be affected? I don't see how. I did fill up our water buckets though - I've been meaning to do it for months, for earthquake preparation.

GeorgeT, thanks for your agreement. Maybe this can be the start of govt working for us again. :)

Suzanne, as "what if" scenarios, they seem pretty reasonable to me. I can't corroborate all of the tourism numbers, but the end results seem in line with some theories attempting to explain the seemingly high CFR in Mexico compared to that elsewhere.

Fullerene, don't forget if you have a tank-style water heater that you can shut off the heat (first!), inlet, and outlet valves, and have a whatever-tens-of-gallons of water emergency supply.
I don't think infrastructure's going to take much hit with this particular virus. If something else whacks the infrastructure during an outbreak, it might take a little longer to come back up of the worker pool is temporarily smaller due to illnesses.
Susan--at first glance sounds reasonable to me.
Is anyone else getting sick of CNN saying 'deadly swine flu'? Make it a drinking game--'drinkin' wine flu'. Take a swig whenever they say 'deadly swine flu'.
Really. Those guys are getting ridiculous.

Suzanne
Interesting analysis but I think wrong by a factor of 10 - the population of Mexico is 10^8 not 10^9

Stan,

Good grief, you're right! That blows my whole argument, which relied upon a solid lower bound, which is now below the reported # of cases, and thus totally consistent with media figures. Actually i'm relieved.

Thanks for noticing, and i'm sorry everybody for posting such a waste of your time. Sheesh.

Suzanne,
I don't think it blows your entire argument. Your estimates become 10-20,000 which is 10 times greater than the reports I have seen.

I'm really tired of hearing both that the government/UN over-reacted and under-reacted. Maybe that is a sign it was handled about right.

CNN.com highlights the issue right now.

Headline 1: "Navarrette: Time to end flu hysteria"
Headline 2: "WHO slow to respond, critics say"

but I can cite numerous examples from elsewhere.

Stan,

I mostly agree with you--i do believe in my revised (lowered by an order of magnitude!) infection estimates of 10-20K, but the main point of my initial argument--that Mexico was committing an enormous lie, as well as its basis (that lower bound in probable cases far above what they are reporting) is fatally weakened by my axiomatic error in getting Mexico's population wrong by a factor of ten.

I guess one idea from my post survives my error, however, and that is that there is a source of information for making educated guesses at the actual # of cases in Mexico: the number of international tourists in April, and the number of confirmed cases among them. These exact numbers are/will be available to the right people, though i was getting approximations from tourism statistics off the web.

thanks again for reading and noticing.

Suzanne - Of course there is a BIG honking ginormous discrepancy.

Mexico has stated, several times isn Spanish and English, that they were reporting only hospitalized cases of suspected swine flu. The USA was actively looking for and reporting cases that were not hospitalized.

Until very recently, Mexico did not have the ability to look for mild infections.