With the number of swine flu cases in Egypt reaching some ??90?? and steadily rising, and with the notorious mismanagement which characterised the Egyptian government’s initial response to the virus threat, Dr Isis Mikhail medical epidemiologist working in the United States, reviews the issue.
The world has been following the spread of the H1N1 flu virus since its emergence in mid-April 2009. Almost immediately there was tremendous media hype and speculation about the spread of this new type of flu. This hype, which some criticised as an overreaction, created some confusion and misinformation in the eyes of the public in Egypt. There was lack of clarity regarding the mode of transmission of this particular virus, and whether it was related to swine, as its name indicates. This helped instil fears of a potential world pandemic.
Swine flu hype
Two main public health authorities, the Center of Disease Control (CDC) in the United States and the World Health Organisation (WHO), began their investigations and took charge of providing evidence-based knowledge about this emerging new influenza virus. Once the Public Health authorities had assumed a role of providing epidemiologic reports about the infection, the media respected their leadership role as the sole source of trustworthy public health information.
The continual up-to-date information and clarification provided by the WHO and disseminated via different media outlets were instrumental in calming public fears worldwide. By the end of April, the world had learnt that this new virus was spread from person-to-person and not by swine; and that the name “swine” reflected its origination and not its present mode of transmission. This was a valuable piece of information, since some people had even questioned the safety of pork consumption. It also had an impact on the health care system as pig tissue, which is closest to human tissue, and used in many medical procedures such as heart valve replacement, surgery stitching fibre and insulin for diabetics.
The pig cull fiasco
By the end of April, just as the swine flu hype began to settle down, Egypt surprised the world by announcing its unilateral decision to cull all its pigs. In effect, the WHO considered that the name ‘swine flu’ might have contributed to some confusion among Egyptian health authorities about the mode of transmission of this virus. It therefore decided to change the official name to its scientific term of H1N1 flu. It also wrote to the Egyptian minister of health to reiterate that the mode of transmission of H1N1 influenza was not related to swine and informed him that the decision to cull pigs was unnecessary and wasteful. To the WHO’s surprise, these actions were not sufficient to deter the Egyptian government and health authorities from proceeding with the culling. At that point, Egypt’s decision was ridiculed the world over and its health authorities perceived as stubborn and ignorant.
Swiftly thereafter began the implementation phase of this unnecessary decision. The pig culling procedure turned out to be a haphazard process, a public health and animal rights fiasco of unprecedented measures. There was an apparent lack in public health oversight to prevent new health problems from erupting due to the unhygienic processes used in killing these large numbers of pigs. Moreover, the cruel measures used to kill these pigs and bury them in mass graves, as seen by the whole world on the Internet, were simply horrific. This incited animal rights demonstrations inside Egypt and abroad. Petitions by International animal rights organisations began pouring in, pleading with Egypt’s Prime Minister and other authorities to stop this inhumane mass killing of innocent animals. Moreover, rather than learning about vaccination plans, statements by health officials about potential mass graves for humans in case of an epidemic were made, instilling even more fear and concern among the Egyptian public.
Health services responsibility
It is notable that, while the killing of healthy pigs was taking place despite absence of any H1N1 cases in Egypt, the WHO reported several new documented cases of “Bird Flu” or H5N1 influenza in Egypt. It is important to note that Egypt is the only country in the world, aside from Southeast Asia, where avian flu has become endemic. Egypt has the third highest death rate in the world of avian flu after Indonesia and Vietnam (WHO 6/2/09 report). Despite the vast importance of this report to Egypt’s public health, the media did not give it any attention.
On June 11, the WHO formally declared the H1N1 influenza virus a pandemic. However, WHO clarified that this did not mean the virus was any more lethal, but simply that it was spreading from person to person in more parts of the world. The virus has shown to be of relatively weak virulence so far and has proved lethal only in certain situations such as individuals with underlying health conditions.
Now that the situation has settled down, it is important for Egyptian public health experts to protect the health of the nation through their efforts in various areas such as epidemiologic surveillance, monitoring, research, education, communication, and dissemination of reliable, evidence-based public health information. Public health officers need continuous education and training so as to be prepared to deal with potential emerging infections or any public health issues or emergencies. The Egyptian health ministry has declared it is already moving in this direction tenaciously, which is the only hope Egypt can adhere to if the swine flu is to be conquered.