Tom Skinner [on tape]: Here in the United States we fully expect to see more cases in more states. Some of those cases might be severe, and we probably will not be surprised if we actually see some deaths associated with this.
John Hockenberry: That's Tom Skinner, spokesperson for the Centers of Disease Control, who spoke to The Takeaway earlier this morning. The numbers, as we know them right now, haven't changed much since late Sunday night. The outbreak has killed more than 100 people in Mexico, 22 confirmed from the swine flu according to the New York Times, more than 1600 people believed to have contracted the virus around the world, or 1600 people in Mexico, around the world there are more cases, it's not clear how they're connected. Spain's health ministry has confirmed the nation's first case of Swine flu, and there are 20 confirmed cases here in the United States, in five states, from California to New York, Ohio, and Texas. So, world health officials looking at these numbers are bracing for a potential, let's just say potential worldwide pandemic of the Swine flu, and the number of fatalities in Mexico means it's definitely something that's infectious disease experts are keeping an eye on. Dr. Richard Wenzel, epidemiologist, immediate past President of the International Society for Infectious Diseases and Chairman of the department of Internal Medicine of Virginia Commonwealth University joins us once again from Richmond. Doctor Wenzel, thanks so much for being with us.
Dr. Richard Wenzel: Good morning, a pleasure.
John Hockenberry: And let's talk about, first of all, the issue of these particular numbers here. Does the number of fatalities in Mexico and the fact that the fatalities seem to be isolated in Mexico concern you in any way?
Dr. Richard Wenzel: It does. I think we have to look at that very carefully. It says a couple of things. One is it's likely that the number of cases is underestimated in Mexico, 'cause if this is a very severe virus with a 1% mortality, than the 100 deaths really represent 10,000 cases.
John Hockenberry: Wow.
Dr. Richard Wenzel: If the, in fact it's a run-of-the-mill virus, and for some reason we just see the tip of the iceberg, that means with a .1% mortality, what we see in our country annually, that means the real numbers could be as high as 100,000. Whatever the scenario, the number of cases is bigger in Mexico than 1,200.
John Hockenberry: So you're talking about sort of the statistical snapshot that's represented by these numbers and how incomplete a picture we have so far. Let's take a look at what's actually going on in individual cases inside Mexico City. And I know you heard our colleague from Time Magazine, Ioan Grillo, mentioned this earlier this morning, and I want to get your direct response to it.
Ioan Grillo [on tape]: Most of them are young men and women, particularly young men in their prime, people 30 years old, 35 years old who seem to me to be very healthy.
John Hockenberry: Now those are the people who are dying, according to Ioan Grillo, people in the prime of life, in their 30's, particularly men. What's your response when you hear that statistic?
Dr. Richard Wenzel: Well, first of all, why young people are getting this at all, rather than older people, the suspicion would be that older people, older then 50, may have developed some sort of partial immunity as a result of prior exposure to a related virus, therefore young people are proportionally susceptible. Now once they get infected why are young people dying? This is really a mystery. One of the possibilities is as we saw in H5N1, the Avian flu, young people have a very robust immune system, and it may be that it overreacted to the virus and actually damages the body's repair system.
John Hockenberry: Hmm. So the question also of transmission is also really, really interesting here. In Avian flu, transmission was difficult. I mean the humans that died of Avian flu, it's my understanding, had to have really intense contact with birds. What's the indication on the mode of transmission for this Swine flu, as far as you can understand it?
Dr. Richard Wenzel: Well this is clearly going person to person, and how sustained it'll be I don't think anyone knows. But now we know it's on three continents. We've got Europe involved, New Zealand, the United States, Canada and Mexico, so I think this is quite serious, it's clearly person to person transmission, it's probably close transmission, three to four feet away from someone who's coughing or speaking loudly or singing.
John Hockenberry: Wow. Let's talk about the clock that ticks on any of these viruses that are involved with the flu for mutation. You would expect, an epidemiologist would expect that mutations would begin to occur. Assuming we're catching this in the beginning, at what point do we begin to look for mutations, either that could be more severe or that would make the disease relatively harmless?
Dr. Richard Wenzel: Well, we're continually looking at that, and with flu, what I've said before, anyone who boldly tries to predict influenza does so at his own peril. This virus loves to change and has the ability to adapt quickly. It could get worse, as the 1918 strain of influenza that was a real pandemic, or it could fizzle out perhaps a little more like the 1976 Swine flu epidemic in the United States that really never materialized.
John Hockenberry: Dr. Wenzel, how's your bedside manner this morning?
Dr. Richard Wenzel: Uhh, it's terrific.
John Hockenberry: Got a question from one of our listeners: "We have vacation plans for the L.A./San Diego area for the week of May 9th. I was worried about the Swine flu outbreak in Southern California, and was wondering if I should cancel the plans." What would you advise our listener?
Dr. Richard Wenzel: Well, I don't think I would cancel plans for flights in the United States at this point. There are still a limited number of cases there, and if you wanted to wait until the last second, that'd be reasonable.
John Hockenberry: From our listener Scott: "Does immunization matter?" Dr. Wenzel, do the people who have been affected, have they already been given the seasonal flu virus? Do we know that information? And is there any indication that if you've had a flu vaccine that it can help you here?
Dr. Richard Wenzel: I don't think we know yet. I've seen people on both sides of the argument say that there might be or there's no indication, but I think that it would be wise to think that we have no compelling information that it will be protective.
John Hockenberry: Dr. Wenzel, thanks so much as always. Now we go live to Mexico City, Ros Atkins, our colleague at the BBC joins us from World Have Your Say. Ros, you're down in Mexico City at a time when we've heard that the mentality of the entire, huge city has been gripped by this. What have you seen?
Ros Atkins: Hi, good to speak to you. I think it's fair to say that people are gripped, but in a very calm and cautious way. I haven't seen any evidence of panic in the few days that I've been here. People seem very keen to get advice, whether from the health authorities or the President, many people are opting not to go to work, maybe not to go outside. There've been soaring rates of takeaway food and video rentals because some people are just opting not to go anywhere, so it's more caution than any sort of panic. And I'm joined here, sitting on our hotel roof as a very, very slow Monday morning gets underway, by Dr. Francisco Morena. Sir, good to speak to you. You're here very early because it didn't take you any time to get here.
Dr. Francisco Morena: No, the city is very quiet, this seems to be something very unusual. Usually Monday takes about a 50 minute ride to get from where I live to get here, then it took me about 15 minutes.
Ros Atkins: Many people listening to The Takeaway will be incredibly concerned about Swine flu. What can you tell Americans about this virus? Should they be worried?
Dr. Francisco Morena: Well, there are three things that concern me. First, this is a new virus. This is something that we don't know how it's going to be progressing. Secondly, we're talking about the most crowded city in the world. And third, there have been people, young people, affected. So, it's not the virus that just affects the people that are older ages or the very young ages, this seems to be affecting young, healthy people, and this is very concerning.
Ros Atkins: So those of you listening to The Takeaway, the main headline here this morning is that the authorities are considering shutting down all businesses in Mexico City. Already the schools and many offices are shut, but they're considering closing everything down. Do you think that would be justified?
John Hockenberry: Well Ros, can I just add to that question? Because the clinicians we've been talking to all morning are suggesting that, based on these numbers, there could really be more like 100,000 cases, that we're really seeing the tip of the iceberg. Just fold that into your question, Ros.
Dr. Francisco Morena: Yes, well the thing is that we are reporting most of the severe cases, the cases that have required being hospitalized and probably being in an intensive care unit. And there are many cases, mild cases, that have been seem like just a normal respiratory disease, and they have been in fact influenza. So this is possibly true.
Ros Atkins: For all of you listening, we're posting videos all the time. If you'd like to see us report from Mexico City, you can do so on the blog at worldhaveyoursay.com, good to speak to you on the Takeaway again.
John Hockenberry: And we'll be linked to that blog at thetakeaway.org as well, so if you want to follow the developments in Mexico City, or any of the developments taking place around the United States, we are following the Swine flu that has broken out in Mexico City and as you're hearing there in Mexico City they are considering some very, very serious efforts to shut down activities in the city as a precautionary measure. Ros Atkins was talking about how things are calm in Mexico City at this point, but Dr. Richard Wenzel who was here just a moment ago, immediate past President of the International Society for Infectious Diseases and Chairman of the department of Internal Medicine of Virginia Commonwealth University was saying we don't know the numbers at this point.
