Also joining the discussion is Laurie Garrett, Pulitzer Prize-winning science journalist and writer of two bestselling books, including The Coming Plague: Newly Emerging Diseases in a World Out of Balance. Ms. Garrett is now the senior fellow for global health Council on Foreign Relations and is well poised to understand this crisis.
John Hockenberry, The Takeaway: Good morning, everyone. All morning long, the numbers have stayed pretty steady. I'll repeat them now, but they are likely to rise as more health professionals weigh in later today. An outbreak of swine flu in Mexico City, first reported in Mexico city, has apparently killed 103 people in that city, although it's believed only 22 or so are confirmed to this specific strain of the virus. More than 1,600 people are believed to have contracted the swine flu virus in Mexico City, and around the world there are other cases as far as New Zealand, and other places around the world. Twenty confirmed cases here in the United States, five states: California to New York, Ohio and Texas. It's an outbreak at this point, and all of those places concerned, it's not an epidemic even in Mexico and it's too early to call it "a pandemic," which is of course, the worst-case scenario and the early fear of people like Laurie Garrett, Pulitzer-Prize-winning science journalist and writer of two bestselling books, one of which is called "The Coming Plague." She's now a senior fellow for global health issues with the Council on Foreign Relations. Laurie, thanks for joining us.
Laurie Garrett: Hi.
John Hockenberry: I imagine you spent all of your weekend answering questions of friends and also colleagues, "Is this the big one?" How did you answer them?
Laurie Garrett: Well, it's sort of too soon to tell. We don't know what the denominator is, which is to say, in Mexico, we don't know really how many people have been infected, and not taken seriously ill and not died. So we don't know Is it 103 deaths out of 2000? -- That would be terrible -- Is it 103 deaths out of 10 million? -- Well, it's sad for each family but it's not terrible for a pandemic, so we still have big black boxes.
John Hockenberry: And part of the concern here, and this is something I know you cover a lot, is the difficulty in assembling quality information at this stage of an outbreak like this. The reporting infrastructure is either not great or is just too complex a problem. Which do you think it is?
Laurie Garrett: Well, it's a little of both. Actually, the Mexican public health system is pretty darned good. They do better than the United States on a lot of public health things such as child vaccination. I know a lot of Americans are prone to think of Mexico as a second-class country, a poor country, but in fact, they have an excellent public health infrastructure and better access to health care for Mexicans than we have in the United States for Americans. That said, the problem they have now is that having rapid diagnostics for influenza and specifically, a very rapid way to diagnose who has this particular strain versus any other type of flu or other illnesses that cause similar symptoms. And we would have the same problem in the United States. This is not an easy thing to do. Any fever, any sort of nausea, feeling lousy, weak, fatigue, muscle aches -- well, that's pretty much how a wide range of diseases and infections start, with the same set of symptoms.
John Hockenberry: And is it the case that to figure out if its actually this strain, you have to send something, a blood test or something, to Atlanta? That's really the infrastructure in the U.S.?
Laurie Garrett: That is indeed the infrastructure in the U.S. Atlanta and a handful of other labs, and in fact, Mexico sent some of their early samples all the way up to Winnipeg, Canada, to a high-security laboratory there.
John Hockenberry: So Keith Bradsher, also joining us now, Hong Kong Bureau Chief for The New York Times. The infrastructure in Hong Kong, with more recent experience with Avian Flu and SARS is better prepared to do the notification. Any sort of indication that the reporting job on the front lines in Hong Kong has unearthed any cases that might be relevant here?
Keith Bradsher, The New York Times: So far, there are no confirmed cases in Hong Kong whatsoever. The city has been terrified of the possibility of some kind of a large outbreak of disease ever since SARS in 2003 and the bird flu fears, as you mentioned, in 2004 and 2005. So its very well equipped for this sort of thing. It will have not one but six different local public hospitals in the city all up and running doing tests very quickly by this Thursday. They did test two people today, both of whom were negative. One, a 77-year-old woman, grandmother who had been to Mexico and back, was immediately tested, found negative. Her 40-year-old daughter who had been exposed to her, also negative and there’s one possible. To give you an idea of how thorough the Hong Kong authorities are, they quarantine someone in the hospital because they had come through San Francisco, where there are no confirmed cases in that city specifically in California yet, but they quarantined someone for having any signs of respiratory distress and for having gone through San Francisco and that person is still being tested at the hospital.
John Hockenberry: Now does that sense of precaution and unilateral quarantines in Hong Kong make people feel better or is it really a case where fears on the part of the population based on these experiences you’ve described caused governments to do things that could have bad political implications down the line.
Keith Bradsher: That’s a tricky one. In Hong Kong the government is very much inclined on the side of being too cautious. The predecessor for the current health minister here in Hong Kong lost his job for not being aggressive enough in responding to SARS in 2003. The government was nearly toppled by very large street demonstrations after SARS that were partly in response to SARS and partly in response to some other issues. There has been a general strong demand from the population here. Never again do people want to end up wearing facemasks in empty streets. Now it might happen again—it is hard to avoid it in the case of flu—but there’s a tendency to err on the side of caution here.
John Hockenberry: Laurie Garrett, Keith Bradsher describes that for its own survival reasons, the government is erring on the side of caution. Is that a good public health strategy as well?
Laurie Garrett: Well I think everybody should pay attention to Hong Kong because when I was there during the SARS epidemic, Hong Kong was on a steep and rapid learning curve. They’ve made a lot of changes in Hong Kong, that, well, I do think a lot of other countries, including the United States, would do well to learn from the changes that Hong Kong has made, including building more isolation/ventilation rooms for people with contagious infections. We don’t have such rooms in most hospitals in most of the United States right now.
John Hockenberry: So, can I ask you a couple of sort of down home, listener questions, Laurie?
Laurie Garrett: Sure.
John Hockenberry: Jeremy in Detroit asks, “What impact do the huge amount of antibiotics being fed to our livestock have in the crossing of these illnesses over to human beings?”
Laurie Garrett: Zero for viruses, but a great deal for bacterial infections and we now have ample evidence that abuse of antibiotics as growth promoters in the livestock industry, not just in pigs, but also in chickens, aquaculture for farmed fish and so on, is indeed promoting drug resistant bacterial infections that are indeed transmissible to humans.
John Hockenberry: What about viruses? Anything about our human/animal interactions in the food chain, etc. that could be a vector for virus transmission?
Laurie Garrett: Well, indirectly. One of the things that’s going on with all aspects of livestock production is concentrating it into larger and larger and larger production centers and disbursing different segments of the slaughter process so that, for example, when E coli 0157 emerged—the “jack in the box infection” as it was called at that time—we couldn’t track down exactly what cow and what ranch it came from because all hamburger is pooled into giant centers where it’s all ground together, so when you eat a hamburger, you’re eating bits of maybe 20, 50, 200 different cows. It makes it really hard to track things and it also means that workers, who are on these giant pig farms, really pork factories, are exposed to thousands and thousands of pigs everyday. So you just have to get out of your mind the notion of the small family farmer with six oinkers running around with 25 cluck-cluckers. That’s not what we’re dealing with here.
John Hockenberry: Alright, a quick question I want to end with Keith, Laurie. Can I eat pork? A bunch of listeners have asked that question.
Laurie Garrett: Yes. Well, you may have other issues with pork, but as far as flu goes, no problem.
John Hockenberry: Laurie Garret, Pulitzer prize-winning science journalist and writer of two best-selling books including The Coming Plague, she’s a senior fellow for global health issues for the Council on Foreign Relations. Keith Bradsher, before we go, what changes in the food chain did they make in Asia to deal with the same kinds of concerns that Laurie is talking about there of transmission in cross species.
Keith Bradsher: They have made some changes here towards trying to consolidate production into fewer farms. Here the issue has been, as Laurie put it so well, the six oinkers and 25 cluck-cluckers living in the house with the farmer in large areas of Asia and that’s still an issue. In Hong Kong, there’s now extensive surveillance and monitoring of the health of the live stock populations, but Hong Kong is the exception. I remember going down to Vietnam in 2004, 2005 and seeing a couple of pilot projects to try to introduce somewhat larger farms where you had the animals fenced off from the people and so forth. But then you get miles after miles of farms on the way to and from it where you still have livestock in close proximity to people and potentially mingling viruses.
John Hockenberry: Object lessons from Asia as we focus on what’s going on in Mexico City with the swine flue outbreak, also in the United States. Keith Bradsher, Hong Kong bureau chief for our partner, The New York Times. A couple of things we should let you know about. There are actual school closings in the United States in Queens because of suspected Swine flu cases. Also in Fair Oaks near Sacramento and at the Schertz-Cibolo-Universal City Independent School District in San Antonio, Texas. Just an indication of early steps being taken.