Reporting from Oaxaca

Not me, but the AP's lovely Olga Rodriguez, who appears to have the first story about the world's first swine flu fatality, reprinted here:

OAXACA, Mexico - Doctors couldn't figure out what was wrong with the first person to die of swine flu. The 39-year-old woman arrived at their hospital gasping for air, her hands and feet blue from oxygen-starved blood.

They administered antibiotics, but she only got worse. They hooked her to a ventilator. They sent a saliva sample to a local private lab. On April 12, her third day in the intensive care unit, the test results indicated it might be coronavirus — a highly contagious disease associated with severe acute respiratory syndrome, or SARS.

Dr. Jesus Salcedo, director of the Dr. Aurelio Valdivieso General Hospital, realized he had a potential crisis on his hands. The ward Adela Maria Gutierrez shared with at least 20 seriously ill patients had to be quarantined. His terrified staff demanded better protective gear or a transfer.

"The religious ones said, 'This is a punishment from God and we're all going to die,'" Salcedo recalled Wednesday in an exclusive interview with The Associated Press.

A day later, Gutierrez died — just before a second round of tests came back negative for coronavirus.

Desperate hunt
Hospital and health workers then began a desperate hunt to find the source of the mystery disease and who else may have been contaminated. It has since been identified as a mutated swine flu suspected in 168 deaths in Mexico that has spread to at least eight other countries, triggering an unprecedented global alert.

The case vividly shows why the virus has been so difficult to contain in Mexico.

The medical teams did some of the sleuthing that epidemiologists recommend for tracking a killer bug, interviewing 472 people who may have come into contact with Gutierrez, a mother of three who had been going door-to-door in a temporary job with Mexico's tax collection agency.

They took more samples from Gutierrez and sent them to Mexico's National Institute of Epidemiological Diagnosis and Reference, which forwarded them to a lab in Canada.

They closed the ICU to new patients until the exposed ones were well enough to leave, telling them they should return immediately if they had flu symptoms. None did, Salcedo said.

But the follow-up appears to have been weak — just like the initial response to swine flu outbreaks in other parts of Mexico, where victims' families have yet to be contacted by health workers to see if they also contracted the illness.

In the end, only 18 people — all hospital workers — were tested for swine flu after Gutierrez's sample came back positive around April 20, said Dr. Ruben Coronado, director of Oaxaca's department of epidemiology.

In her last days, Gutierrez had worked closely with another temporary employee, interviewing taxpayers and filling out forms to update the tax registry. That woman had a bad cough, her family said, and was from Veracruz, the state where Mexico's earliest case of swine flu was confirmed: 5-year-old Edgar Hernandez, who survived.

About 450 people had been diagnosed in the Veracruz town of La Gloria with acute respiratory infections, but only 35 were tested for the new virus. Edgar's was the only test that came back positive.

Too frightened to attend wake
Gutierrez lived in a two-story home where the family runs a convenience store. Her husband, a welder, declined to be interviewed.

"They're really afraid and they don't know what's going on," state Health Secretary Dr. Martin Vasquez said of the family.

Gutierrez was buried the day she died, odd in Mexico where a wake is customarily held overnight, with burial held the next day. Already rumors were circulating that she died of a very contagious disease.

Four houses away, Hermelinda Leon was too frightened to attend the wake. She, her husband and three children had all been ill with similar symptoms starting April 7. Leon had a fever of 104 degrees Fahrenheit and spent several days in bed before her doctor gave her antiobiotic injections. Antibiotics don't kill viruses, although they may work against related bacterial infections that sometimes occur.

"When they told me the neighbor died from a sore throat, I was worried because I was so sick from a sore throat, I felt like I was going to die," she said.

Hospital didn't have Tamiflu
The Leon family recovered without the help of Tamiflu or other antiviral medicines. Salcedo said his hospital didn't have any at the time, but has since stocked up and is treating 11 people with Tamiflu.

Three days later, health workers came to interview Leon, who caters food to Oaxaca hotels. They asked about the family's illness, symptoms, their medications and said they would return to give them a special test. She said they never did.

A day after Salcedo learned from the Canadian lab that Gutierrez had swine flu, two other patients died of pneumonia in the Oaxaca hospital. They weren't tested for swine flu because they didn't show atypical symptoms, Salcedo said. Gutierrez's family also never showed any symptoms, he said.

Coronado said only 18 of all the people interviewed were tested for swine flu because the others didn't show signs of the disease — even though Leon's family had similar symptoms. Coronado told AP he wasn't familiar with the Leon case.

Of the 18 saliva samples taken from medical staff, 12 did not have enough cells to be tested. The other six came back negative for swine flu, Coronado said.

Health officials say Ooxaca's 11 current cases of suspected swine flu are unrelated to the tax workers, but the lack of followup with the Leon family suggests they haven't tracked down every connection. Three victims remain hospitalized and eight went home after receiving anti-viral drugs. No other cases in Oaxaca have been confirmed.

Salcedo guessed that no one else in the Gutierrez and Hernandez families got sick because their immune systems were simply strong enough to withstand the swine flu virus. But Mexico's Health Secretary Jose Cordova said Thursday that this remains a mystery.

"We still don't know why it's more aggressive in some people and not in others," Cordova said.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

URL: http://www.msnbc.msn.com/id/30492441/

No More Kissin'

Mexican telenovelas are gutting the kiss-scenes from their scripts. It's end of the world now for sure.

Living Hand to Mask

Gregorio Saucedas, center, of the Gulf Cartel

Good to know everybody's taking the proper precautions.

Swine Flu Hype Does Some Good

While no one was looking yesterday, Mexican senators passed a bill decriminalizing possession of narcotics. Soon it could be legal to carry up to 5 grams each of weed and opium and small amounts of heroin, meth and cocaine. The legislation still has to go through the lower house, but yesterday's 87-in-favor vote indicates it should pass. Thanks for distracting us, swine flu!

The last time Mexico tried to pull this off, Washington freaked out and forced then-President Vicente Fox to veto the legalization bill he himself had proposed.

Before She Died, Dotty Gave It to the Mailman

Speaks for itself

It's been hard to keep up with the cascade of bad news today, but here are some of the main points (more to come):

• Health officials said they'd traced the source of the outbreak to the southeastern state of Veracruz. But the governor is denying that. He's blaming it on Asia, because that sounds about right, huh?
  
  
• The European Union declared a travel warning against North America. Hours later, the CDC said non-essential travel to Mexico was a bad idea.
  
  
• In Mexico, the death toll from probable cases climbed. It's now at 149, with suspected ones popping up everywhere from Brazil to Sweden. Forty-two were confirmed in the United States and six in Canada.

As the City Shuts Down

This afternoon people around La Condesa were
out playing with their kids, no masks on,
as if they hadn't heard the news.
But a general eeriness in the city prevailed.

El Universal is reporting total deaths has reached 103 and the number of people hospitalized 1,614. The U.S. Embassy in Mexico City suspended visa appointments. Restaurants with a 50 person-plus capacity have been shuttered, and all others are closing doors at 6 p.m. until at least May 4. People are lining up at the grocery store, preparing for days home from work and school. This afternoon a football match was played to empty seats. And self-proclaimed doctors were leaving unsettling comments on the BBC's website:

I'm a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.

There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.

And yet it's too early to tell how this will all turn out. For now, expecting Monday morning to have a whole new look.

Scenes from an Epidemic II

Video on spread of infectious diseases via Dot Earth

Woke up late this morning to more news of the apocalypse. Five more people in Mexico are dead. The total is now 81, with more sick "young adults" turning up all the time. Spain and New Zealand have joined the register of possible cases. Hong Kong has issued a travel advisory against Mexico, which other countries will probably follow. And the United States has declared a public health emergency. Strangely, the only people dying from this are Mexicans. Is that from incompetent care, or proximity to the source of the outbreak? Nobody knows. Or they're just not saying.

In the meantime, Mexico City in its infinite wisdom is still planning to continue its water conservation program next weekend and shut off valves that service large parts of the city. (This seems so insane I'm sure it won't actually happen.) The federal government has granted itself broad new powers to search homes and quarantine at will. And pretty much everyone I know is staying indoors.

More on this later.

Scenes from an Epidemic

Photos from swine flu-addled Mexico City last night, where despite the closure of schools and museums, dire warnings from health officials, and the sight of thousands of people wearing masks, life continued on pretty much as usual. It's hard to work up a healthy paranoia about a flu that responds to regular antiviral treatments, but who knows. The WHO is skiddish, and New York City is now investigating the case of 75 sick students at a Queens high school. Maybe we're looking at the Spanish flu of the Internet age.

More on the Mexico angle from local outlets El Universal and The News.

*Update. Things are getting hairy: The city is shutting down bars and discos. The relentless Catholic Church, though, has decided to hold mass anyway.

**Things really are getting hairy: Cases likely confirmed in New York.