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Winter in the time of swine flu

For a small country, Chile has a large number of swine flu cases. The reason? Easy diagnoses, winter and smog.

SANTIAGO — Almost a third of healthcare workers around the country are on sick leave, traditional religious celebrations are being cancelled and everyone has a friend, relative, co-worker or neighbor on Tamiflu. And naturally, the pig jokes abound.
Yes, it’s the unrelenting spread of the H1N1 pandemic in Chile, fourth on the World Health Organization’s list of confirmed cases of the virus, with 7,376 infected, after the United States (33,902), Mexico (10,262) and Canada (7,983). New figures from Chile's own health ministry show that 40 have died and 10,926 have been infected in this country.
Why does this country of only 16 million inhabitants have such a disproportionally high number of people infected with the virus?
“The question is: are we diagnosing correctly in Chile, or are other countries not doing it adequately?” asked Jaime Honores, director of a public health clinic in Quilicura, a low-income district in northern Santiago.
It is probably the latter, said Enrique Paris, director of the Center for Toxicological Information and member of a government-appointed experts committee on the H1N1 virus.
“Compared to many other countries, the public and private health systems and university clinics in Chile have very advanced laboratories, so confirming the diagnosis is relatively easy. Other countries have to send their samples to Atlanta and wait for the results even for weeks, or don’t have the money to pay for them,” he said.
In Argentina, for instance, if there were more than 90 deaths caused by the virus, it is impossible for the number of people infected to be only 2,500 as has been reported, Paris said. “If the general mortality rate for this virus is 0.2 percent, the real number of people with the virus in Argentina should be over 45,000. They are just not confirming it with lab exams.”
Another reason for the massive contagion in Chile is simple: It’s winter, and in the capital, where about a third of the population is concentrated, the cold and dampness is aggravated by heavy air pollution. Respiratory illnesses including the seasonal influenza and the syncitial virus, which strikes young children, are always a serious strain on the health system during the winter months.
However, with this new virus, the situation has turned into a “sanitary emergency,” in the words of President Michelle Bachelet, especially when considering that the official figure includes only cases confirmed by laboratories. By now, the virus has become so widespread, that unless a patient specifically requests the expensive lab exam, doctors are diagnosing based only on symptoms.
Although the Health Ministry has ordered public and private health centers to record every dose of antiviral medicine they prescribe, and pharmacies must tally what they sell, there are still no official figures for the number of H1N1 patients based on the prescription of antivirals. Unofficially, it is estimated to be in the tens of thousands.