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

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 in Algeria

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…