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The situation in Mexico City continues to escalate. In an unprecedented move, President Felipe Calderon has declared a public health emergency, activating a sweeping array of powers.

From the Bloomberg.com news story:

Authorities have canceled school at all levels in Mexico City and the state of Mexico until further notice, and the government has shut most public and government activities in the area. The emergency decree, published today in the state gazette, gives the president authority to take more action.

“The federal government under my charge will not hesitate a moment to take all, all the measures necessary to respond with efficiency and opportunity to this respiratory epidemic,” Calderon said today during a speech to inaugurate a hospital in the southern state of Oaxaca.

Museums, theaters and other venues in the Mexico City area, where large crowds gather, have shut down voluntarily and concerts and other events canceled to help contain the disease. Two professional soccer games will be played tomorrow in different Mexico City stadiums without any fans, El Universal newspaper reported. Catholic masses will be held, the newspaper said, although church officials urged worshipers to wear breath masks and to avoid contact.

Schools will likely remain closed next week, Calderon said in the Oaxaca speech. The decree allows Calderon to regulate transportation, enter any home or building for inspection, order quarantines and assign any task to all federal, state and local authorities as well as health professionals to combat the disease.

“The health of Mexicans is a cause that we’re defending with unity and responsibility,” Calderon said. “I know that although it’s a grave problem, a serious problem, we’re going to overcome it.”

Also, there is now an Obama link to the epidemic. On April 13th, the apparent first day of the epidemic, well--- you read it yourself. Also from the Bloomberg story:

The first case was seen in Mexico on April 13. The outbreak coincided with the President Barack Obama’s trip to Mexico City on April 16. Obama was received at Mexico’s anthropology museum in Mexico City by Felipe Solis, a distinguished archeologist who died the following day from symptoms similar to flu, Reforma newspaper reported. The newspaper didn’t confirm if Solis had swine flu or not.

So the President of the United States -- the leader of the Free World -- was possibly exposed to a pathogen without his knowledge.  It's almost like an episode of 24. 

You can't miss this.  I'll let their words speak.

http://news.bbc.co.uk/2/hi/talking_point/8018428.stm

I have been looking at the geographic dispersion of Mexican confirmed and suspected swine flu outbreaks.  From Mexico City to Baja back to central Mexico and down to the southwestern Pacific corner of the nation, there are literally hundreds of suspected cases of respiratory distress. 

Of course, not all of these will be confirmed swine H1N1.  But as the California flu hunter said yesterday, the more they look, the more cases they will find.

And as has been dutifully blogged by me and by others, the CDC has already thrown up its arms and declared the virus is beyond its capability to contain -- even with only (so far, soon to be obsolete) eight US cases in its portfolio.

So here's the situation, put as clearly as I can possibly put it:  Either this virus will burn itself out, or it will go pandemic.  It is that simple, and those are the only two options available.

If it burns out, it will be due to a combination of factors, including trying to slow it down and getting in front of it.  But keep in mind that 75% of all influenza pandemics start outside of regular flu season.  Part of that reason is because there is no competition for hosts with other, more established flu strains.

As I have said many, many times before:  Influenza plays "king of the mountain."  It is Darwinian struggle at its clearest.  Flu bugs fight each other for supremacy.  Eventually, one wins out.  Of course, this model was disrupted, perhaps permanently, in 1977 by a Soviet lab accident that released a descendant of the 1918 Spanish flu upon the world, creating that "age-specific pandemic" that affected anyone born after 1956.  Prior to 1957, H1N1 was the dominant flu strain.  In 1957, H2N2 knocked H1N1 off the mountain.  And it was in turn knocked down, in 1968, by H3N2.

Back to today: In the Northern Hemisphere, H1N1 swine flu today has dramatically reduced competition for hosts.  Flu season is essentially over, and seasonal influenza is retreating to wherever it is that it retreats to.  This leaves a clear path for swine flu to find susceptible hosts and infect them en masse.

To its credit, the Mexican government, it appears, has done a commendable job getting masks to its citizens and antivirals to the epicenters of the outbreaks.  Its surveillance capabilities may be called into question in retrospect, but its response seems to be well-planned and immediate.

It is now fish-or-cut-bait time for American flu planners.  And as many risk communication experts will tell you, now is not the time for mixed messages.  We cannot tell people to prepare for a pandemic with an Asian origin and then not tell them to get prepared for one with a Latin origin.  The waiting game won't work, especially when the virus has penetrated our defenses.  It's time to tell people how to get ready and what to do, if we are to have any hope of burning this out before it jumps the oceans -- unless we're too late already.

But it's worth a try. 

Reuters has reported what we already suspected: The horse is out of the barn for swine flu in the United States.

The only question now is what will happen. And how quickly will this novel influenza virus burn through the country? Alright, that is two questions.

Here is the Reuters story:

CDC says too late to contain U.S. flu outbreak

WASHINGTON, April 24 (Reuters) - The U.S. Centers for Disease Control and Prevention said on Friday it was too late to contain the swine flu outbreak in the United States.

CDC acting director Dr. Richard Besser told reporters in a telephone briefing it was likely too late to try to contain the outbreak, by vaccinating, treating or isolating people.

"There are things that we see that suggest that containment is not very likely," he said.

He said the U.S. cases and Mexican cases are likely the same virus. "So far the genetic elements that we have looked at are the same." But Besser said it was unclear why the virus was causing so many deaths in deaths in Mexico and such mild disease in the United States.

What were we thinking? that we could actually contain something that passed directly under our noses and exposed the Maginot Line that is US influenza surveillance?

Back in January, 2008, a great thinker and patriotic American strongly suggested we turn our attention to the south when monitoring for novel influenza viruses. Oh wait, that was -- me! I refer to my blog, http://www.scottmcpherson.net/journal/2008/1/15/us-government-validates-the-need-to-look-south-for-bird-flu.html , AKA "Government validates the need to look south for bird flu."  In that blog, I mentioned that experts were growing increasingly concerned with our inability to monitor what went on south of us. 

And that is really indicative of how we treat Latin America.  While we spend all our time looking east and west, we leave our soft underbelly exposed.

The speed with which this story is moving is nothing short of amazing!  What an opportunity to "go to school" on this issue.  When we thought we had three weeks, we now have no earthly idea how much time we have until the virus either burns out or burns through our communities.

Stay tuned.

The press is taking the time to remind people that in 1976 the United States went overboard in its preparations for a possible swine flu pandemic.  The reason for this is obvious.  However, these comparisons are inappropriate and reveal a not-surprising lack of depth on behalf of the people reporting the news.

A few quick points:

In 1976, a single American soldier died of swine H1N1 at Fort Dix, New Jersey.  Some 500 other GIs had swine antibodies, but no other GI had contracted the virus.  

In April 2009, to date the WHO believes at least 60 Mexicans have died of the disease and almost a thousand cases are suspected.

In 1976, a vaccine was developed in a record period of time.  In 2009, there is no vaccine commercially available to combat H1N1 swine flu.  However, it is absolutely critical that Mexicans and people in the American Southwest get vaccinated against seasonal H1N1, so the swine virus does not get the chance to reassort with human H1N1 and produce a Tamiflu-resistant strain any faster than is possible.

In 1976, then-President Gerald Ford had the support of the entire scientific community in his quest to quickly develop a vaccine.  In 2009, we will see how quickly concensus can be formed on a similar course of action.

We have a bona-fide situation on our hands, and only time will tell if this virus can be contained or if it will spread.  It has already spread across the Mexican border and into two American states.  We do not have any idea at this time how many American cases there truly are.  Only the naive would assume that the US is capped at seven cases.