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Why Is Swine Flu A Killer Only In Mexico?

The 39-year-old bricklayer fell ill two weeks ago and became one of the first Mexicans to die of swine flu. But no health worker has come to his home outside Mexico City to offer medicine or ask about the neighbors' pigs.

In fact, Gerardo Leyva Lolis' widow says nobody even told her he died of swine flu until The Associated Press informed her the case had been confirmed by the director of the hospital where he was rushed last week.

The family's experience raises troubling questions about Mexico's response to the epidemic and one of its greatest mysteries: why the disease is killing people in Mexico, but so far nowhere else.

"I don't know what to think," Antonia Cortes Borbolla said Sunday, holding back tears in the two-room wood and cinderblock home she shared with her husband and their three teenage sons in this rural town of 18,000 located 40 miles outside Mexico City.

Their neighbors - three of whom keep pigs in their yards - had harsher things to say about the failure of Mexican health officials to provide medicine to protect those closest to the swine flu victim.

"Not even they know what's going on," Sandra Estrada said of the dead man's family. "If it was (swine flu), why haven't they taken measures to protect the family?"

Epidemiologists need details about victims to locate the source of a viral outbreak and to understand how it spreads. There are antiviral drugs, including Tamiflu, that have been shown to be effective, but they need to be taken within days of the first symptoms. Experts also suggest they be given to those in close contact with flu victims, even if they don't show symptoms, to make sure they don't unwittingly spread the virus.

Meanwhile, in the U.S., the White House says "don't panic," yet the race is on to contain the outbreak of swine flu that has proven to be deadly in Mexico where there are now more than 140 deaths, with more than 1,600 suspected cases. The Mexican government ordered all schools closed until May 6.

An official said New York City has 20 more confirmed cases of swine flu, raising the city's total to 28. The official says there are another 17 probable cases in New York City. The World Health Organization said there were 40 confirmed cases in the U.S. but no deaths.

Speaking before the National Academy of Sciences, President Obama said he is "closely monitoring" the swine flu situation, getting regular updates from the various public health agencies grappling with the problem. Mr. Obama said Americans can expect regular updates from these agencies as well.

President Felipe Calderon announced an emergency decree Saturday authorizing health workers to isolate patients and enter and search their homes to combat this flu.

But no such effort has been made with Leyva's family. His widow said she has been asked little and told even less since his death on April 20.

The president's office referred all inquiries about the case to the federal health department, where a spokeswoman said she had no information. Victor Torres, assistant epidemiology director at the state health institute, told the AP he needed another day before he could talk about the case.

But details provided by his family suggest Leyva could have been infecting people all over the crowded capital and the surrounding state of Mexico.

Leyva's widow said he first noticed flu symptoms on April 13, and went to the local clinic in Xonacatlan. No one was available to give him a checkup, but he was given a shot and felt well enough the next day to make the 40-mile bus trip to Mexico City, taking subways to work despite a nasty cough.

Too sick to work again after that, he still had no medical care except for a penicillin injection his niece gave him. By the night of April 19, he was having trouble breaking and had an irregular heartbeat, and so his family took him to the nearby city of Toluca, where the poor can get discounted care at a large public hospital.

By 8 a.m. the next day, he was dead. His family was told the cause was a heart attack brought on by pneumonia.

Four days later, the Centers for Disease Control and Prevention in Atlanta announced that the flu killing people in Mexico matched a disturbing new virus detected in the U.S. that combines genetic material from humans, birds and pigs in a way scientists have never seen before - and that can be passed from human to human.

The news rocked Mexico's government, which had said for weeks that this year's higher flu caseload was nothing unusual. Mexico's government is ordering closed schools nationwide as the suspected death toll from swine flu climbed to 149.

Health Secretary Jose Angel Cordova says only 20 of the deaths have been confirmed to be from swine flu and the government was awaiting tests results on the rest. He says 1,995 people have been hospitalized with serious cases of pneumonia since the first case of swine flu was reported on April 13. The government does not yet know how many were swine flu.

Of those hospitalized, 1,070 have been released.

As news spread about the dangerous new strain, two nurses from the local clinic visited the family's home last Thursday to say Leyva may not have died from pneumonia after all, and that an epidemiologist at the hospital wanted to see his widow.

She went in on Friday, but said the doctor did not tell her that her husband's death had been confirmed as swine flu. She said he gave her a hug of condolence and urged her to buy an antiflu drug and vitamin C if anyone in her family felt sick.

As of Sunday, she hadn't heard from any other health worker. The local pharmacy had no such drugs to sell, and she didn't have money to buy them anyway. Since her family seemed healthy, she left it at that.

Dr. Carlos Aranza, director of the Adolfo Lopez Mateos hospital where Leyva died, said state laboratory tests confirmed that swine flu killed him, as well as another patient there, a 42-year-old woman identified only as Gregoria.

Aranza also said that while the hospital had no antiflu medication to give the widow at the time, it now has Tamiflu in stock for those who need it.

Experts on epidemics suggest Mexican health officials should be more proactive in seeking out people who came into close contact with the victims, and in insisting they take antiviral drugs to prevent the spread of contagion.

"No matter whether the patients lived or died, their families should be offered prophylactic antibiotics," said Dr. Richard Wenzel, past president of the International Society for Infectious Diseases. "There would be an expectation that should happen anywhere in the world. And if they have trouble getting the drug they should ask for it."

Meanwhile, Cortes is struggling more than ever to make ends meet. Without her husband, her only income is from a plywood stand in front of her house where she sells candy and soda. She said sales are slow because her neighbors fear she might have swine flu and are staying away.

"I sleep on the same mattress under the same covers that my husband used. What contagion are they talking about?" she said. "I don't want anyone singling me out, as some already have, saying, 'The Leyva Corteces have the virus."'

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