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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.