Outbreak

Hundreds are dead, and thousands are thought to be affected. Is the Gulf prepared for a swine flu pandemic?
The first known carrier of the swine flu virus was Edgar Hernandez, a four-year-old boy from Mexico. More than 3,000 people are now thought to have been infected with the virus.
By Joanne Bladd
Sun 03 May 2009 04:00 AM

Hundreds are dead, and thousands more are thought to have been infected across the globe. Is the Gulf prepared for a swine flu pandemic, and how grave is the risk?

Wide-eyed and shy, Edgar Hernandez looks like an ordinary four-year-old boy from his eastern Mexican village. Two weeks ago he was. Now, he is the centre of global attention after being named by Mexico's health minister as one of the first known carriers of a deadly strain of influenza that has erupted across the world.

His hometown, the village of La Gloria in the state of Veracruz, less than five miles away from a pig farm that raises close to one million animals a year, has become ‘ground zero' and the suspected epicentre of a swine flu epidemic that has now thought to have infected more than 3,000 people.

 

As if we didn’t have enough to contend with. We had finally seen a bottom for the global economy and that has been ruined by pigs.

Across the world, governments have swung into action in a bid to prevent a pandemic. In Mexico, panic has reached fever pitch. The government has ordered schools and universities to shut while Mexico City's traffic-snarled streets, usually heaving with tourists, now resemble a ghost town.

The panic rippled quickly around the world. Since the first death was confirmed in Mexico on Apr 12, it is thought swine flu has claimed at least another 150 victims, mostly healthy adults not usually considered vulnerable to the influenza virus.

Cases have since been confirmed in the UK, Spain, Canada, New Zealand and, in the Middle East, Israel; among other countries. The US has declared a national public health emergency, while the chief global health body, The World Health Organisation (WHO) has ratcheted up the alert level for the outbreak from phase three to an unprecedented phase five. It is, said UN secretary general Ban Ki-moon, teetering on a pandemic.

Already, the blue surgical masks dotting international airports are all too reminiscent of the lethal 2003 SARS outbreak, which infected 8,000 people and killed close to 800, and the avian flu (H5N1 virus), which has infected 421 people since 2003, and killed 61 percent of its victims.

Yet, swine flu is different. For one, it seems to respond to antiviral medications such as Tamiflu and Relenza. All victims outside Mexico have, to date, made a full recovery. Experts concur the virus originated in pigs and mutated into a form that jumped to humans. Unlike avian flu, however, which rarely passes from person to person, this H1N1 influenza strain seems to cross easily, ruling out any containment measures.

"We are very, very concerned," said WHO spokesman Thomas Abraham at an emergency briefing by the agency. "We have what appears to be a novel virus and it has spread from human to human. It's all hands on deck at the moment."

Countries within the GCC did not wait to be told twice. Health ministers scrambled to attend a hastily convened meeting in Doha last Saturday, to firm up plans to fight the potential pandemic. A second meeting is to be held this week, to coordinate screenings at air and sea ports between the countries.

The UAE was one of the first Gulf states off the block. At an emergency press briefing held on April 28, minister of health Humaid Mohammed Obeid Al Qutami told reporters the country is reaping the benefit of lessons learned from the avian flu scare. Fronting the national pandemic plan is the Avian Influenza Emergency Committee, which was set up in the wake of the outbreak.

"We have been planning this for three years," said Dr Mahmoud Fikri, executive director for health policies affairs at the ministry, told Arabian Business. "We are absolutely ready."

The ministry said it was awaiting instructions from the WHO before switching into crisis mode, but said it has already warned the country's airports and hospitals to be alert for flu-like symptoms.

"What we don't want to do is create a panic," Al Qutami said. "Our key message is that the country is virus-free and that everything is ok."

The ministry has stockpiled a "good number" of antiviral medications, including Tamiflu, he said, which has proved effective on patients in outbreak areas. However, he was unable to name the exact number of doses available.

Dubai Health Authority has said it has one million Tamiflu capsules in stock, enough to treat around 40,000 cases. A source from the Health Authority Abu Dhabi (HAAD) told Arabian Business it also had doses on standby, and that priority would be given to frontline medical workers. While not a vaccine, antivirals such as Tamiflu can lessen the strength and duration of the flu symptoms.

The UAE government has stopped short of issuing a direct travel ban, but Majid Al Mansour, secretary general of Abu Dhabi's environmental agency, which has consulted on the influenza alert, urged residents to postpone non-essential travel to Mexico and other affected areas.

 

Millions deadPandemics of the past

1918

The Spanish flu pandemic remains the most devastating outbreak of modern times. Caused by a form of the H1N1 strain of flu, it is estimated that up to 40% of the world's population were infected, and more than 50 million people died, with young adults particularly badly affected. 1957

Asian flu killed two million people. Caused by a human form of the virus, H2N2, combining with a mutated strain found in wild ducks. The impact of the pandemic was minimised by rapid action by health authorities like making vaccination available. The elderly were particularly vulnerable.

1968

An outbreak first detected in Hong Kong, and caused by a strain known as H3N2, killed up to one million people globally, with those over 65 most likely to die.

Qatar and Saudi Arabia's health ministries have been quick to follow with travel warnings, while the kingdom of Bahrain has gone a step further and suspended any imports of live pigs or pork products.

Among Middle Eastern countries, the UAE is particularly vulnerable to the spread of airborne diseases, courtesy of its position as a transit city. Dubai is home to the region's busiest airborne hub for international travel: in the first quarter of this year, more than 9.5 million travellers passed through its terminals, an average of 105,555 a day.

Several of the region's flagship carriers, including Emirates, Etihad and Qatar Airways, are still operating flights to affected areas. However, they are known to be monitoring developments closely.

Dr Mansour Al Zarouni, head of pathology and laboratory medicine and chairman of the infection control committee at Al Qassimi Hospital, Sharjah's largest hospital, said that while the UAE is better placed to monitor its borders than larger, more sprawling countries, its busy airports place it at greater risk of an epidemic.

"They are extremely difficult to contain as thousands of people pass through them every day," he said. "If [travellers'] flu symptoms are mild, they're unlikely to be noticed, and it may be days before the virus is confirmed.

"By that time it is too late, because they have already infected others and moved on."

We are, Dr Al Zarouni said bluntly, "overdue a pandemic".

 

Swine flu Q&ASome basics facts that you should know about the swine flu disease that is affecting thousands of lives around the world.

What is swine flu?

Caused by influenza type A, swine flu is a respiratory disease which infects pigs.

There are regular outbreaks among herds of pigs, and although the virus causes high levels of illness, it is rarely fatal.

Can humans catch swine flu?

Like human flu, there are many different types of swine flu, and the infection is constantly changing. It does not usually infect humans, although sporadic cases have occured, often through people who have had close contact with pigs.

Contrary to rumour, swine flu cannot be passed from pigs to humans through eating pork or pork products, so long as they are properly cooked.

The World Health Organisation (WHO) recommends cooking pork products at 160˚C (320F).

Prior to the latest outbreak, there had been rare documented cases of the virus being passed from person to person.

Now it is apparent that the disease is being passed from human to human, in the same way as seasonal flu, through coughing and sneezing.

Is this a new virus?

When any new strain of flu emerges that has the ability to pass from person to person, it is monitored very closely in case it has the potential to spark a global pandemic.

In this case, the WHO has confirmed that at least some of the cases are a never-before-seen version of the H1N1 strain of influenza type A.

H1N1 is the same strain that causes seasonal outbreaks of flu in humans, but this latest version is different: it contains genetic material that is typically found in strains of the virus that affects humans, birds and swine.

It seems likely that this new version resulted from a mixing of different versions of the virus, in the same animal host.

So is this a pandemic?

The WHO has warned that taken together, the Mexican and US cases could potentially trigger a global pandemic.

We are currently closer to a pandemic than at any point since 1968; the threat is rated at five on a six-point scale.

The Spanish flu pandemic, which began in 1918 and was also caused by an H1N1 strain, killed more than 50 million people around the world. How can it be avoided?

Anyone in an infected area is advised to avoid close contact, including shaking hands.

If possible you should stay at least six feet from other people, cover your mouth and nose, wash your hands frequently, avoid touching your eyes, mouth or nose, and avoid hospitals and clinics except in an emergency. How can it be treated?

The US authorities have said that two drugs commonly used to treat flu, oseltamivir (Tamiflu) and zanamivir (Relenza), seem to be effective at treating cases that have occurred there so far.

The fact that all the cases in the US have so far produced mild symptoms is encouraging, according to doctors.

However, the fact that many of the victims are young does point to something unusual, as seasonal flu tends to affect the elderly disproportionally.

Asia's busiest travel hub, Hong Kong, the epicentre of a SARS outbreak six years ago, is taking no risks. Travellers from affected countries are screened using thermographic technology, which spots any fever, and anyone displaying symptoms is detained immediately to await testing.

Saudi Arabia is also rushing to install thermal cameras at entry points, and has set up a hotline for concerned residents. By comparison, the UAE has so far promised to have airport and airline staff on "high alert".

Dr Zarouni said that in the event of a pandemic, the UAE's chief concern would be its lack of ICU (intensive care unit) beds.

"Like most countries, our ICU units are already stretched. Based on the current count, we would not have enough beds or isolation units in the event of a widespread epidemic," he said. "An early reaction is the most important thing, along with good drug stocks."

Many countries fear the economic impact of the health scare as much as the prospect of swine flu itself. For investors already reeling from the global economic crash, news of a potential pandemic has snuffed out any signs of a recovery.

Already, the markets can be added to the list of swine flu victims. As the WHO ramped up its pandemic alert, shares dived worldwide. Dubai Financial Market shares dropped the most among global equity markets, losing 4.3 percent on Apr 26 alone.

Amid the sell-off, travel and leisure firms were hit the hardest. Industry bellwether British Airways dropped eight percent while Lufthansa, Europe's second largest airline, fell more than 12 percent. Air China fell 13 percent. Royal Caribbean Cruises, the operator poised to begin operations in the Gulf, rose 2.2 percent on news it had scrapped stops in Mexico.

Analysts have reacted furiously.

"We had finally seen a bottom for the global economy and that has been ruined by pigs," said Tsuyoshi Segawa of Shinko Securities.

"As if we didn't have enough to contend with," strategists at the Royal Bank of Scotland wrote drily in a note to clients, "a flu pandemic in the midst of the biggest financial crisis since the Great Depression."

 

SARSSevere Acute Respiratory Syndrome (SARS), is a respiratory disease in humans which is caused by the SARS coronavirus. There has been one near-pandemic to date, between November 2002 and July 2003, with 8,096 known infected cases and 77 deaths worldwide, according to the WHO's concluding report.

The epidemic appears to have started in Guangdong Province, China, in November 2002. It quickly spread but the Chinese government neglected to inform the WHO until February 2003, restricting media coverage in a bid to preserve public confidence. The Chinese government was widely criticised for this decision, as it hindered efforts to control the epidemic.

The epidemic made global headlines when an American businessman travelling from China developed pneumonia-like symptoms on a flight to Singapore, dying shortly afterwards. Several medical staff that treated the man soon developed the same disease, and in March 2003 the WHO issued a global alert.

Local transmission of SARS took place in Toronto, Ottawa, San Francisco, Ulan Bator, Manila, Singapore, Taiwan, Hanoi and Hong Kong whereas within mainland China it spread to Guangdong, Jilin, Hebei, Hubei, Shaanxi, Jiangsu, Shanxi, Tianjin and Inner Mongolia. Overall, it infected individuals in some 37 countries around the world.

In December 2004 it was reported that Chinese researchers had produced a SARS vaccine. However, a 2006 systematic review of all the studies done on the 2003 SARS epidemic found no evidence that antivirals, steroids or other therapies helped patients.

Unsurprisingly, the lone winner has been pharmaceutical firms. Roche, the Swiss maker of Tamiflu, climbed almost six percent as news spread of the virus. Rival GlaxoSmithKline, which makes the influenza treatment Relenza, gained 7.6 percent.

The World Bank estimated last year that a flu pandemic could cost $3 trillion, and shave nearly five percent off world GDP. The 2003 SARS outbreak, which devastated travel, trade and workplaces in the Asia Pacific region, lasted six months and cost an estimated $40bn.

Poor nations are especially vulnerable, said Guy Ellena, director of health and education at the International Finance Corporate (IFC), part of the World Bank Group.

"There is obviously a very big gap in developing countries on the availability of adequate medical services," he told Arabian Business. "If swine flu were to hit Bangladesh, for example, which has a very large, dense population, the spread would be rapid."

In the GCC, labourer populations are particularly at risk, Ellena added. Workers are typically housed in cramped labour camps, with several men to a room.

"Migrant workers are among those most at risk, as they live in such close proximity," he said. "Large concentrations of people, living in less than adequate hygiene will be exposed much more than those living in a better environment. It would spread like wildfire."

Hit by the economic crash, rich nations will struggle to fork out funds to provide aid for poorer countries. As UN secretary general Ban Ki-moon conceded, the flu pandemic is likely to be "a test of global solidarity".

Still, wealthy countries have a powerful reason to pitch in. "The virus is airborne and cannot be contained easily," Ellena noted. "There is a very strong incentive for developed nations to help, because if they don't they can't protect their own population."

Swine flu is an unfolding story. The number of suspected cases is increasing hourly and experts say it is impossible to predict the potential impact of the epidemic.

"It is entirely possible... that we may see a very mild pandemic," said Keiji Fukuda, WHO acting assistant director-general. "[But] the worst pandemic of the 20th century occurred... in 1918 and it also started out as a relatively mild pandemic.

"Influenza moves in ways that we just can't predict."

 

Bird Flu (H5N1)The strain of swine flu is a different strain to that responsible for the bird flu which has caused scores of human deaths in South East Asia in recent years.

The latest form of swine flu is a new type of the H1N1 strain, while bird, or avian flu, is H5N1.

Experts fear H5N1 holds the potential to trigger a pandemic because of its ability to mutate rapidly. However, up until now it has remained very much a disease of birds. Those humans who have been infected have, without exception, worked closely with birds, and cases of human-to-human transmission are extremely rare - there is no suggestion that H5N1 has gained the ability to pass easily from one person to another.

H5N1 has killed millions of poultry in a growing number of countries throughout Asia, Europe and Africa.

Health experts are concerned that the coexistence of human flu viruses and avian flu viruses (especially H5N1) will provide an opportunity for genetic material to be exchanged between species-specific viruses, possibly creating a new virulent influenza strain that is easily transmissible and lethal to humans.

Since the first H5N1 outbreak occurred in 1997, there have been an increasing number of HPAI H5N1 bird-to-human transmissions leading to clinically severe and usually fatal human infections.

However, since there is a significant species barrier that exists between birds and humans, the virus does not easily cross over to humans.

But researchers are studying some cases of infection to investigate and find out whether human to human transmission is actually occurring.

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