Leaders In Medicine, Public Health Tackle Swine Flu

MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up in our international briefing, we'll talk about the presidential election in Afghanistan. Now, we know that the status and rights of women are often a matter of intense and even violent disagreement in Afghanistan. But did you know that not one but two women are on the ballot there today. We'll tell you about their chances in a few minutes.

But first, another matter that has claimed worldwide attention: the H1N1 virus, popularly known as swine flu. Medical industry leaders, public health officials, scientists, first responders and others are meeting in Washington, D.C. today to talk about how to deal with the virus: prevention, preparedness and recovery.

The event marks the first international swine flu conference. Swine flu dominates the world's health agenda largely because unlike regular seasonal flu, the H1N1 virus has not retreated during the hot and humid summer months. It's infected more than one million Americans so far followed by an outbreak in Argentina, where more than 300 deaths from the virus have been confirmed.

We wanted to hear more about what the scientists and health officials are talking about and finding out. So we called Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. And NPR's science correspondent Richard Knox. Welcome to you both. Thank you for speaking with us.

Ms. LAURIE GARRETT (Senior Fellow for Global Health, Council on Foreign Relations): Thank you.

RICHARD KNOX: Thanks, glad to be here.

MARTIN: Laurie, we heard so much about this earlier in the summer because in June the World Health Organization declared a worldwide pandemic. What's the status now?

Ms. GARRETT: The virus, of course, as is normal with influenza, moved largely to the Southern Hemisphere. It tracks winter around the world. So, it spread rampantly throughout the Southern Hemisphere. We only have good data, of course, on countries that have strong public health systems like Australia and Chile. So, the data is skewed and gives the impression that those countries have had the worst outbreaks.

But, of course, for countries all across sub-Saharan Africa, we have mere whispers, hints and allegations, as Bob Dylan would have said. And we don't really know what is going on in sub-Saharan Africa.

Meanwhile, the strange - two very strange things about this virus so far - one is that it has continued to circulate in the Northern Hemisphere, even though it's summer. And we've never really seen this kind of phenomenon with any influenza - certainly in my lifetime - but as far as I can tell, in recorded history.

The U.K. actually had its strongest flu season all occurring in the summer months. It's still rampant in Ireland, in Scotland, in Wales. Only began petering out in the U.K. overall about a week ago. And that's just bizarre. And we've never really seen it completely go away in the United States and Canada either. It's continued to circulate although at much lower levels than what we saw in April, May and June.

MARTIN: That's really interesting. And I take your point that the data is sort of bias, if you will, toward countries that have better recordkeeping. So, I completely take your point on that. But I was curious about Argentina and why the death toll has been as high as it has been there. Do we know? Do we have any idea?

Ms. GARRETT: Ah, well, Argentina is a big mess. First, there is some indication that the virus has undergone some mutation. A group at Colombia University has identified eight mutation point changes in the virus from samples taken from Argentina. But nobody has really been able to show that those mutations have any significance clinically. So, we don't really know if that's in anyway involved.

But what we do know is involved is that Argentina has had real governance problems, very serious, deep governance problems for the last, well, four or five years. And these have affected every single one in the country, including resurgence of yellow fever, which had completely disappeared from Latin America back in the days of Walter Reed and Carlos Finlay. And now we have resurgence for two years in a row of yellow fever in Argentina. We've seen resurgence of a number of other infectious diseases there. And it appears that a lot of the public health apparatus in Argentina has sort of fallen apart.

And it's in contrast, you go right next door to Chile, just the other flip side of the continent, if you will. They've had plenty of cases, but they've had tremendous public health management. No real crisis there at all. And that largely is because Bachelet, the president of Chile, is a PhD in public health and an M.D. and used to be the minister of health. And so, their government has managed it magnificently.

MARTIN: That's interesting. I want to hear more about that. Richard, I want to bring you into the conversation. You - speaking of discrete impact - you filed a report yesterday for NPR's ALL THINGS CONSIDERED, where you zeroed in on the affect swine flu could have on minorities in the U.S. based on a report out of a particular city, Boston. Can you tell us more about what you found?

KNOX: Yes. It is very interesting. And as far as I know it's a first data suggesting this. The CDC is looking into the issue, but they don't really have any national data yet. I'm based in Boston and it's a big medical community, big public health center. So, they have pretty good figures and they did an analysis about what the - what the swine flue did in these past few months here. And it turned out that there's a really disproportionate effect on minorities, on African-Americans and Latinos in particular. For instance, blacks represent about a quarter of the city's population. But 37 percent of the swine flu cases, the confirmed swine flu cases. Latinos are 14 percent of the population, but more than a third of swine flu cases.

So, you know, why is this? They're trying to puzzle it out. The biggest probable factor is that the Boston schools are Muslim minority, even though the Boston population isn't yet. And this virus prefers young targets, we know that. And then compounding that problem, the health officials say, this, you know, lower income parents have particular problems, staying home to take care of sick kids because they don't get paid off. And if they do - so there were many contagious kids in the classrooms this spring.

MARTIN: So, you think it's something - so researchers think it's both the nature of the virus and also it's the social factors that…

KNOX: It's really the nature, excuse me, there's no evidence so far that there's anything biological or anything either virological - the nature of the virus or biological, in terms of the susceptibility of minorities to the virus. I think these are social factors. They have to do with, you know, economics. They have to do with demographics like who's, you know, who's in the school system. And they have to do with, you know, people's living situation.

MARTIN: But why, you said earlier that younger people are - young people are more at risk of getting it. Why is that?

KNOX: Probably because people born before, about 1947, anyway, people under 52 - 57, I guess it would be, have never encountered anything like this virus before. Their immune systems are totally naive to it. And so, they don't have any protection at all against it. People my age - I'm over 52 - do have some kind of protection.

So, something like 60 percent of all of the confirmed and probable cases of swine flu so far are under 50 years old and half are under 24. So, that's probably the main reason.

MARTIN: If you're just joining us - I'm sorry Laurie - just - let me jump in just briefly to tell listeners that if you're just joining us, you're listening to TELL ME MORE from NPR News. We're talking about swine flu and efforts to contain a widespread outbreak this fall of H1N1 virus. And we're talking about how the virus is proceeding around the world. And our guests are Laurie Garrett, senior fellow for global health at the Council on Foreign Relations and NPR's science correspondent Richard Knox. Laurie?

Ms. GARRETT: So, I wanted to ask Richard a question if I may.

MARTIN: Sure.

Ms. GARRETT: Richard did they - when I heard your report on NPR yesterday, I wonder this immediately. We know the CDC has told us repeatedly and so as WHO that we see this virus having its most virulent impact on people who either are obese, have diabetes or are pregnant. Since all three of those things track heavily with the socioeconomics and poor people are more likely to be in all three states, did they control for that in the Boston study?

KNOX: I don't think they controlled for this. This was, you know, they were making observations about who got sick. But I think going directly to your point is that they did find that hospitalizations were about twice as frequent - the rates of hospitalizations for swine flu among blacks and Latinos. And they think - they think that's, well, one striking thing is half of the hospitalizations involved people with asthma. And we know that asthma in particular is rampant in the African-American communities and also in Hispanic communities.

So, it's very much a kind of a double whammy. They're more likely to get it because of their situation and the demographics. And when they get it, they're more likely to end up in the hospital or to die.

MARTIN: Laurie, you had mentioned earlier - that you had pointed earlier to the efforts of the Chilean government led by Michelle Bachelet in addressing the virus there. Have we learned anything else about best practices in containing this virus that you can share with us?

Ms. GARRETT: Oh, I think all around the world we're learning a lot actually. And I would say that the biggest take home message I would give to our listeners right now is that at this moment H1N1 in its current form is the state that it has evolved to at this point is not a terribly dangerous virus. It's not in any place in the world killing lots of people, thank goodness. But it is a real test of globalization, a real test of our capacity to respond as a global community versus, you know, circling the wagons and responding as a country and not caring about what happens to anybody else.

And in that sense, the lessons we're learning right now are very, very distressing. What we're learning is that when a pandemic hits. And just think about what this would mean if we were looking at a really lethal pandemic on the scale of 1918.

When a pandemic hits nations take care of their own - rich nations take care of rich nation residents. Poor nations suffer deeply. There are commitments made. They are hot air. Nothing gets to the poor countries. Nobody cares about the poor countries. Nobody is doing surveillance. Nobody is taking care of those people. Africa is a giant black box. We have HIV rampant across Africa. We have tuberculosis rampant across Africa. Richard mentioned asthma as a risk factor. We know any respiratory illness is a risk factor. We're having more dangerous outcome with influenza, but nobody is doing a darned thing about it. And that's the take home message of this pandemic. It was…

MARTIN: Laurie, I'm sorry. I need to interrupt because I also need - I also need to let Richard give the last word from his take home from the briefing he attended on the (unintelligible) that what was discovered on Boston. What were health officials telling us there, as briefly as you can please?

KNOX: Well, following up on what Laurie was just saying. I think we're going to see some really difficult problems coming up with regard to who gets the vaccine for this new disease when it becomes available later this fall. At the recent meeting at the CDC, there was really no discussion about special targeting of minority populations because this data hadn't come out. But that's going to be a problem.

MARTIN: Richard Knox is NPR's science correspondent. He joined us from his home office in Boston. We were also pleased to be joined by Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. She was kind enough to join us from her home office in New York. Thanks to you both.

KNOX: You're welcome.

Ms. GARRETT: Thank you.

(Soundbite of music)

MARTIN: Still to come, move over Hillary. Not one but two women are aiming to be Afghanistan's next president.

Unidentified Woman: Afghan women are also making the statement that they have a voice and that they are part of the political society in Afghanistan.

MARTIN: Afghan women and the political process. That's next on TELL ME MORE from NPR News. I'm Michel Martin.

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