Panic nonetheless

Egypt lags behind much of the world when it comes to rates of swine flu infection and fatalities from the virus. Yet the public, aided and abetted by the media, is increasingly fearful, reports Reem Leila

---

The Ministry of Health announced last week that from 25 November it will stop issuing daily updates on the number of confirmed swine flu cases in Egypt. It has also made public the maximum price that private clinics will be able to charge for conducting swine flu tests.

"To protect the public against exploitation the ceiling for swine flu tests has been set at LE1,200," said Abdel-Rahman Shahin, official spokesman at the Health Ministry.

Private laboratories licensed to test members of the public will comply with all relevant World Health Organisation (WHO) recommendations. Testing for the virus will be done only with calibrated PCR machines that are regularly inspected by the Egyptian General Authority for Standardisation and Quality Control. Labs will be required to preserve any positive swabs in a viral transport media and at 4-8 degrees Celsius for three days so that they are available for inspection by Health Ministry teams. Any medical reports issued by private laboratories will be deemed valid only in the original. Duplicate copies are prohibited, and laboratories are required to retain details of all positive tests for a period of 12 months.

"These measures are necessary to prevent anyone attempting to secure more than the required dosage of Tamiflu," says Shahin. "In addition, private labs approved by the Health Ministry will not be allowed to advertise without written permission."

Although the WHO reports that the vast majority of people infected with H1N1 recover with no medical intervention, the number of infections is increasing daily. On 13 November Egypt reported its seventh death from swine flu, a 37-year-old female from Sharqiya governorate who developed pneumonia after contracting the virus. Two days later, the Health Ministry released details of the eighth fatality, a 26- year-old woman from Alexandria.

The death rate, Shahin stresses, hardly amounts to an epidemic. He points out that levels of infection, as well as fatalities, are far higher in many parts of Asia, Europe and the Americas. "One has to question not only the panic among the public but the kind of media hype swine flu is receiving in Egypt," says Shahin.

The latest WHO figures reveal 440,000 confirmed cases of the H1N1 virus worldwide so far. The real number, though, may well be higher, given that many countries have stopped counting individual cases.

Deaths from the virus climbed to at least 281 in Europe, and 1,070 in the Asia- Pacific region. Ahmed Abdel-Latif, the WHO's Regional Advisor in Cairo, points out that rates of infection in many European, Asian and American countries are more than 100 fold higher than in Egypt. In the United Kingdom alone, he says, there were 84,000 swine flu infections last week, up from 78,000 the week before.

According to the WHO the virus has been contracted by 22 million Americans and claimed the lives of more than 4,175, including 540 children. Such seemingly alarming figures, however, do not mean the virus is more virulent, and most patients recover without any medical care. Abdel-Latif stresses that there is no indication the virus has mutated or changed.

Over half of the deaths recorded by the WHO have been among people under the age of 45. Research has suggested that older people appear to have some residual immunity against the H1N1 virus from previous pandemics involving similar strains. As a consequence swine flu is hitting younger age groups hardest. Children under the age of 15 account for one in five deaths, with a further 34 per cent occurring in patients aged between 16 and 44.

"We have a long flu season ahead of us," says Abdel-Latif. "But with 2,700 infections and few fatalities in Egypt, all of them with underlying health problems... Egypt has a death rate of 0.3 per cent, much lower than the global average of 1.3 per cent."

Meanwhile, it is suspected that a number of Egyptian hajj pilgrims travelled to Saudi Arabia -- which has made certification of swine flu vaccination a prerequisite for obtaining a visa -- on the basis of forged vaccination certificates.

"The Health Ministry is investigating the incident which seems to have been restricted to Sharqiya governorate. Should what have been reported actually happened the severest penalties will be imposed on those responsible," said Shahin.

The Ministry of Health has also published guidelines outlining the conditions that must be in place before it orders a suspension of the academic year.

The Cabinet's Information and Decision Support Centre's daily press releases reveal that school attendance stands at 84 per cent and that the rate of pupil illness is within the normal range. The number of schools temporarily closed because of swine flu has reached 103, and the number of classes suspended 341. The average daily infection rate has ranged between 110 and 150 cases a day over the past week.