Mexico's epidemiology boss faults WHO

A top Mexican medical officer accused the World Health Organization of being slow to respond to the country's warning about a health crisis that turned into a global swine flu scare. The WHO disputed the claim.

Dr Miguel Angel Lezana, Mexico's chief epidemiologist, told The Associated Press late last night his center alerted the Pan American Health Organization, a regional arm of WHO, on April 16 about an unusually late rash of flu and pneumonia cases in Mexico.

But he said no action was taken until eight days later, when the WHO announced it was worried the outbreak could become a pandemic.

"It seems it should have been more immediate," Lezana, director of the National Epidemiology Center, told AP in a telephone interview. He called for an investigation into WHO's handling of the crisis.

WHO officials today said the agency learned April 9 of cases of "suspicious influenza" from Mexico and responded quickly on April 24 when US and Canadian laboratories identified the virus as a new strain of flu.

"We moved into operation within a matter of hours," WHO spokesman Thomas Abraham told reporters.

Mexican health authorities came under criticism, particularly from frustrated citizens, for a slow and bumbling early response to the outbreak.

Hong Kong's leader today said the territory has a confirmed case of swine flu, Asia's first. In the United States, the confirmed case count stood at 132, and state laboratories believe the numbers are even higher. Hundreds of US schools were closed yesterday.

In Mexico, the outbreak's epicenter, new cases and the death rate were leveling off, the country's top medical officer said. Health authorities said they have confirmed 300 swine flu cases and 12 deaths due to the virus.

"The fact that we have a stabilization in the daily numbers, even a drop, makes us optimistic," Mexican Health Secretary Jose Angel Cordova said. "Because what we'd expect is geometric or exponential growth. And that hasn't been the situation."

The only confirmed swine flu death outside Mexico was a Mexican toddler who died in a Texas hospital on Monday.

The United States is buying 13 million courses of anti-flu drugs to replenish its stockpile and sending 400,000 courses to Mexico. US health officials say a swine flu vaccine could not be ready until fall at the earliest.

Mexico shut down all but essential government services and private businesses today, the start of a five-day shutdown that includes a holiday weekend. Schools are also closed through to Tuesday.

Mexico City's notoriously clogged avenues were clear, crime was down and the smog dropped to levels normally seen only on holidays. Mexico is using the shutdown to determine whether to extend or ease emergency measures.

Lezana, the chief epidemiologist, said his department was alarmed by flu and pneumonia cases in Mexico earlier in April and notified the local office of PAHO by e-mail, following international protocol.

He said the illnesses raised a red flag because the flu was occurring at least a month after flu season normally ends in Mexico.

Four days later, PAHO still had not responded, so the National Epidemiology Center asked PAHO whether it needed more, Lezana said. He said PAHO responded the alert was being handled.

Lezana said that as far as he knew, the PAHO regional office in Washington and WHO took no action until April 24, when WHO announced an epidemic was under way.

Lezana had learned just the day before, from a testing of a sample that Mexico sent to a lab in Canada, that people were coming down with a new, mutated and lethal swine flu virus. By then, more than 1,000 people had been sickened in Mexico.

Daniel Epstein, a PAHO spokesman in Washington, told The Washington Post the agency received a message from Mexican authorities April 16 about an unusual outbreak. He described a system that sends messages to WHO headquarters in Geneva automatically.

WHO officials in Geneva confirmed Friday that the organization had received reports from Mexico of cases of suspicious influenza and that the organization reacted quickly when the new flu virus was identified on April 24.

WHO chief Dr. Margaret Chan was aboard a flight to the United States at the time but was briefed immediately when she landed, Abraham said. She canceled her appointments, met with U.S. and Mexican authorities and flew back to Geneva on April 25. That evening, WHO told the world it faced a possible flu pandemic.

"I think that is a pretty rapid response," Abraham said.

WHO flu chief Dr. Keiji Fukuda, speaking before the Mexican epidemiologist issued his criticism, told reporters last night there is always some delay when unusual illnesses are detected, particularly during flu season.

"Most diseases do not come out with people walking around with 'new disease' written on their forehead and 'we need to call an international response,'" he said. "And in this case the countries which were affected earlier, they really were communicating in a very appropriate way."

While Mexico waited for WHO to help, Lezana said, Mexican authorities tried to identify the outbreak and stop it. Mexican medical teams interviewed 472 people who may have come into contact with the first known swine flu fatality, a 39-year-old woman.

But only 18 of the 472, all hospital workers, were tested for swine flu. And in other parts of Mexico, health workers only this week started visiting the families of victims to find out whether they contracted it as well.

The Red Cross said it was readying an army of 60 million volunteers who could be deployed around the world to help slow the virus' spread. Besides the U.S. and Mexico, nine nations have confirmed cases, most in Europe.