As Fears Subside in Mexico, Health Experts Urge Continued Caution

One of the world’s largest cities has to get back to work, and still has to stay safe. The difficult pushes and pulls of democracy have given Mexican politicians a rough set of choices.

Not so long ago, the government would have acted unilaterally, without transparency, and without the consent of the governed. But here we are in 2009. If Mexican president Felipe Calderon had not acted quickly and thoroughly to contain the H1N1 flu virus, he would have been blamed for its spread and his failure to act. Since the combination of a weak virus and a tough and disciplined response meant the infection did not spread widely, the emergency measures look to some to be overreactions.

Until Wednesday night the mayor of Mexico City, Marcelo Ebrard, was under pressure from various business interests to lift the final restrictions on places like bars and sports stadiums. Then the mayor’s scientific committee decided the final bans were no longer needed.

People were urged to continue the personal hygiene habits and social distancing that appear to have worked so well, and Mexico City’s health secretary cited the burden on businesses the restrictions caused, and looked ahead to ringing cash registers this Mother’s Day weekend, which is as big a deal here in Mexico as it is in the U.S.

People are being urged to sit one-to-a-seat on the city’s vast fleet of public buses, though I can’t find any evidence there’s going to be twice as many buses plying the streets.

I spoke at length to Dr. Guillermo Ruiz Palacio, one of Mexico’s leading epidemiologists. He said all the information from the capital was that human transmission had slowed, nearly to a stop, so the more restrictive regime was no longer necessary. Here’s the other edge on that sword: Because people were so confident that human transmission had slowed to a stop, they were prepared to quickly drop many of the personal practices that had brought that terrific outcome.

Though political and scientific leaders have been clear about it from the very beginning, it’s one point that is difficult to hear over the din of the national hubbub. The people of this country have been told again and again that once the danger is past the H1N1 virus will not be eliminated. It will now be part of the natural world they live with, along with the chameleons clinging to the trees in their gardens, the jacarandas in the public parks, and the mules at work on the farms.

That message will have to be reinforced as the emergency recedes in the country’s rear view mirror, and as the annual flu season rises up in the distance.

Thursday morning results of a national poll were released that showed a quarter of Mexicans thought the epidemic was a myth. It’s a reminder of the residue of distrust, the well-earned cynicism that has marked the relationship between Mexicans and their governments.

In another animating reality revealed in another national poll, 94 percent of Mexicans told public opinion researchers they did not know anyone personally who had suffered from the flu. Turn on the TV, see a national crisis unfold. Walk out on the street, and everything’s the same. It’s not a long leap to conclude somebody’s not telling you everything.

When schools reopened Thursday after a top-to-bottom scrubbing, returning students found monitors at the front doors, ready to pull anyone aside who showed any flu systems. Not exactly scientific perhaps, but along with the cleaning up, a gesture clearly meant to reassure students and their families that the government took its responsibility to protect them seriously.

After the subdued street life of the emergency period it was remarkable how quickly necking returned. In the public parks, on street corners as crowds waited for the light to change, even in an ornate chapel in a breathtaking 17th century church, smooching came storming back onto the social scene. Handshaking still was not so much in evidence, and the social embrace upon meeting or parting may take a little while to come back too. People who neck apparently know each other on a different level from business associates. Or maybe the reward is more apparently worth the risk.

As life begins to get back to normal in the city, medical experts will be watching closely in the coming months and years for mutations in the H1N1 virus. Dr. Ruiz said this can happen on two different tracks.

One is an express lane called “shift,” in which changes in the genetic makeup of the bug can be observed over short periods of time as it is passed from person to person to person.

The other track is observed over months and years, and is called “drift.” Simply from living in various animal hosts, including humans, the virus is picking up and dropping off genetic material which, like a game of telephone, can reveal something very different after it’s passed through a long chain.

In the near term, it means a vaccine for the swine flu virus will continue to target an identified strain, but any formulation is going to have to be redone in coming years, just as the vaccines are for seasonal flu. Trying to hit that moving target means a vaccine is unlikely for the very near term, the coming weeks in which exposure will continue around the world.

Unfortunately, scientists will likely run out of time in the middle term. It would have been possible to add a swine flu component to the vaccine for the seasonal flu, which still kills thousands every year in Mexico. But the new vaccine would have to be ready by August in order to make its way to every part of the country for the start of the seasonal flu vaccine season in September.

Dr. Ruiz told me one thing working in their favor is that even with the establishment of the virus in more than a dozen countries, H1N1 2009 doesn’t appear to be a rapidly mutating strain. Advances in genomics makes it possible to rapidly compare the genetic material in virus samples from patients all over the world. They all have pretty much the same virus, so the medicine should continue to work for a while.

At the same time, this nationally-recognized epidemiologist worries about the widespread use of Tamiflu. Once it was observed that the drug was effective against this new virus strain, millions of doses were sent to every corner of the country, and nothing works to create a superbug like widespread use of a single drug.

There was one last hurdle to clear before getting out of the country. I was scanned along with my NewsHour colleagues, by a heat-sensitive camera to reveal the relative heat of exposed parts of the body. There I stood on the imaging screen, a big blue head, wearing a somewhat cooler beard and eyeglasses. No fever apparent. A declaration also had to be filled out with questions about body aches, fatigue, coughing and sneezing.

Now, certified by the government of the United States of Mexico to be no danger to my people, I am on my way back to the U.S.A.