H1N1 In Algeria: More Panic

H1N1 infections(red) and deaths (black) as of December 7th 2009

UPDATE: Just prior to publishing this post the Ministry of Health published a new communiqué, it puts the number of confirmed deaths at 10,  one in Setif and one in Oran  (both large urban centres) , with 3 more to investigate. There are no announcements on the number of infections.

This blog continues to cover the recent rise in Swine flu in Algeria with great concern. In the last post, infections and deaths were mapped (there were 362/8 then, there are anywhere between 400 and 600 infections and 12 confirmed deaths as of today), with a great number of casualties happening in relatively remote areas. More panic is gripping the streets because of doubts about the readiness of the health infrastructure. Frustration is rising about the lack of communication from the Ministry of Health. There is little effort to educate the public about the flu. The effects of the flu panic are spilling into other sectors such as education and transport.

The Algerian public is notoriously panicky in the face of natural threats such as this. Recall that during previous solar eclipses there was so much media hype and warnings from the authorities that people feared to even go out to the streets on the day. As is the case of H1N1, the problem stems from the panic of the authorities, a lack of understanding, very weak communication channels for popular science and a weak leadership of the scientific community.

Official communication is reduced to a few declarations by the Minister of Health here and there with not much details. This is unacceptable in the face of so much panic and news from the popular newspapers. Two days ago the Minister of Health Mr Said Barkat announced from Annaba the death of 3 more people in the previous 24 hours. He wouldn’t elaborate on the locations of the deaths or the number of infections throughout the country. The last communiqué from the Ministry of Health via their website is dated the 3rd of December. There are no official numbers broken down by region in the country, which is why this blog will still try to track them via independent news sources.

There are reports of people as far as Biskra, Djelfa, Batna and the great Sahara driving over 600 miles to the capital because they don’t trust the local hospitals. Naturally the hospitals of Algiers became overcrowded, tempers flared and their administrations had to resort to permanent police presence to continue operating. Trust in the authorities is very low and that fuels even more panic – some took the chance to capitalise on selling dubious medicines.

A victim sector of this outbreak is education. Already many schools are being closed in the bourgeois region of Haidra and in the remote province of MSila which has suffered a relatively high rate of infections. After the recent teacher strikes, the outbreak couldn’t have come at a worst time with schools widely expected to close again for a few days – perhaps this will offer the best excuse to actually confirm the winter holidays which were in doubt because of the time lost during the strikes.

In other sectors, some court proceedings were adjourned, universities are unsure of how to deal with the flu, and panic did not spare even mosques, where Imams were instructed by the authorities to “educate the public about the illness”, according to Elkhabar. The newspaper reports that less people are going to the mosques as well (The tendency of the authorities to use this space is well known – previously the imams were instructed to lecture on the need “to vote for your country” to face the low voter turnouts).

The Ministry of Health reported buying 20 million flu vaccine shots, with the first batch of 900000 arriving yesterday. However, Elkhabar reported yesterday that the 900000 shots will not be available for weeks to come. There are serious doubts about the logistics involved to transport the vaccines across the vast country. The authorities should stop treating the vaccine as a silver bullet and should try to educate the public and communicate to them as much information as possible.

Swine Flu in Algeria: The cases so far

Swine flu (H1N1) is just about making the rounds and the news in Algeria. Most of the inhabitants of the country live in the North, mostly  in a Mediterranean climate. The climate is sometimes notable by the speed of weather change, during which seasonal influenzas affect a high percentage of the population. For the last few months the country has mostly been sparred the recent rise of Swine flu, surprisingly avoiding a widespread epidemic through the summer and the return of many Algerian immigrants for their annual holidays. However, with the fall of winter, that is sadly quickly changing with a quick increase of swine flu cases in the last few days. This appears to be happening in the face of a global slow down of the  rate of infection. The authorities are trying hard to calm fears, boasting that the first batches of the H1N1 vaccine are arriving to the country, as well as trying to appear on TV as much as possible. But the wide speculation in the media and the uncertainty about the actual numbers of cases and deaths will undoubtedly result in increased hysteria.

Swine flu cases by Wilaya (region) in Algeria. Scaled logarithmically. The digits are the government set Wilaya numbers.

Indeed, reliable information is scarce: the ministry of health‘s figures are not broken down by region and are scarcely updated. Yesterday a bulletin has been posted that puts the national confirmed figure at about 362, with 8 confirmed deaths, putting the mortality rate at a very worrying 2%.  About 30 of the cases have been reported in the last 2 days, with the rate of infection expected to increase quickly in the next few days. 5 of the deaths have been reported in the last 5 days.

The statistics shown to the left have been assembled by wading through the recent news reports on national newspapers. The reports are often conflicting, hyperbolic or scarce in details.

Immediately, it is apparent that the three big cities, Algiers, Oran and Constantine have expectedly had some of the highest case counts. What’s worrying however, is the high infection count in the more inner Wilayas: Medea, MSila, Batna and the surrounding areas. These provinces have historically had low investment from the government and are severely lacking in infrastructure, including hospitals. Their readiness for the challenge of an epidemic is not reassuring. This is aggravated by the fact that a large percentage of people in these areas live in remote places and seldom decide to see a doctor. They span through the areas between the Atlas Mountains and the Saharan Atlas, a notoriously geologically difficult region that has been the hotbed of the Algerian revolution against French occupation, as well as a hiding place during the civil war of the 90s. The civil war has had its toll on the population and the infrastructure,  the provinces are recovering very slowly because of low investment and people moving north to the more populous and economically viable cities such as Oran, Algeria, Annaba and Constantine.

Swine flu deaths and cases in Algeria. Red indicated known confirmed cases. Black indicates confirmed deaths.

The map to the right shows the confirmed deaths: 8 deaths confirmed so far, in the capital Algiers(2), Ghelizane, Biskra, Ghardaia (2), Oum Bouaqi and Laghouat. Again, it is worrying that more deaths are happening in remote Wilayas: Ghelizane, Biskra, Laghouat and Ghardaia. The newspapers report 5 deaths of pregnant women (I could only verify 4).

The map also shows that the number of infections is almost certainly under-reported: there are Wilayas for which deaths have been reported but no infections confirmed yet. This may also reflect the tendency of the sick to treat the flu just like any seasonal flu and never go see a doctor. Although not officially allowed, most pharmacies in Algeria sell antibiotics over the counter, increasing the risk of antibiotic resistance and allowing the sick to avoid the doctor visit, even though antibiotics do not treat H1N1 and all other influenzas because they are viral.

The strategy of the Algerian authorities at first seemed to go hand in hand with the strategy facing the Global economic downturn: at first indicating that the population is safe from the illness, then slowly realising that the threat is real, and now in full gear against the illness. The ministry of health has put up more documents online on how to avoid the illness, both in Arabic and French, as well as more interviews and media appearances.

Speaking of media, in my recent post I commented on the tendency of the newspaper Echorouk to report sensationally. The chance has not been missed with the illness: the prospect of a conspiracy theory as to the origins of the illness are too great to miss by the newspaper (article is meta about Echorouk).  It is seriously commenting about the theory that the illness is human made by pharmaceuticals and western politicians, supposedly citing various journalists in Hungary, Austria and other places…