Reem Leila wonders what to make of suggestions that the academic year be suspended to halt the spread of swine flu No one seems to know how severe the swine flu epidemic will be, leaving the Egyptian government scrambling to respond. Thousands of parents have been left clueless as the number of infections and fatalities increases and the Ministry of Health has announced it may close schools nationwide if cases of pneumonia and H1N1 continue to rise. The return of 73,000 Egyptian pilgrims from Saudi Arabia is increasing public anxiety. Many already doubt the end of term exams, scheduled for the end of January, will take place. By 1 December, 2000 Egyptian pilgrims had already arrived in Cairo, with only one suspected case of swine flu among them. The 36-year-old was immediately transferred to Abbasiya Fever Hospital. Captain Hassan Rashed, head of Cairo Airport, says each group of returning pilgrims is accompanied by two doctors to check on them. "On their arrival at the airport pilgrims are thermally scanned in groups. Anyone displaying flu-like symptoms or suffering from a fever is sent to the airport's quarantine area and from there to hospital." In the same context, Amr Qandil, deputy minister of health for preventive affairs, pointed out that pilgrims are required to undergo medical check ups and to take a mandatory eight-day vacation after they return from Saudi Arabia. "Pilgrims arriving through any of Egypt's 33 different ports will undergo a medical check up and will be required to provide a valid certificate to prove it," Qandil said. Five pilgrims have died from swine flu and 73 others are reported to have contracted the virus during the hajj. None of the cases involves Egyptians. Awad Mahgour, director of communicable diseases at the WHO, points out the level of infection is low so far given that the hajj is the largest annual gathering in the world. But Mahgour warns true levels of infection will not be clear until pilgrims return to their home countries. "Although most pilgrims were vaccinated they could still carry the virus and infect others," he said. On 26 November the Health Ministry announced the death of a 28-year-old man in Luxor who was suffering from severe flu symptoms as well as asthma. The following day two more deaths were announced, from the governorate of Minya: a 52-year-old woman who had diabetes; and a 55-year-old man with chronic lung diseases. On 28 November three deaths were announced: a 17-year-old boy from 6 October governorate who was admitted to hospital suffering from severe pneumonia and who tested positive for H1N1 virus; a 28-year-old man from Alexandria and a 25-year-old woman from Beheira governorate, who had given birth just two days earlier. A seventh death was reported on the afternoon of 28 November, a 30-year-old man from Cairo who was admitted to the Chest Hospital in Giza two days earlier and placed on a ventilator. As well as breathing difficulties, he was suffering from the chronic skin disease psoriasis, and had been on cortisone treatment. On 29 November, Egypt recorded its 21st death from the virus, a 28-year-old man from Helwan. A press release issued by Health Minister Hatem El-Gabali outlines plans to vaccinate the first 1.5 million of Egypt's 16 million students. "The ministry will receive 1.2 million doses of H1N1 vaccine in January, the third batch Egypt has received. Pupils at schools with the highest densities will be given priority," said El-Gabali. Cabinet Information and Decision Support Centre (IDSC) figures show that of the 3,216 cases of swine flu reported, 1,881 were in schools and 169 in universities. As the suspension of a whole academic year to check the spread of swine flu among school children is being considered there is a growing feeling that officials responsible for measures to contain the H1N1 virus -- which so far has proved less dangerous than seasonal flu -- are overreacting. "The H1N1 virus in its current form is weak when compared to seasonal flu, with a fatality rate in Egypt of less than one per cent," says Mohamed Awad Tageddin, professor of respiratory diseases at Ain Shams University. "Some 94 per cent of those who contracted the virus in Egypt have recovered." "We really don't know what will happen. We have paid our children's fees for the current school year and we are scared the ministry might end up not closing down the schools. It's our children's lives we are talking about here," said a father of two boys enrolled in an international school in Cairo. While private international schools provide students with daily curriculums and assignments on the Internet students at less equipped institutions have been left with no other choice than costly private classes, which are being held at homes or in non- governmental education centres, to supplement the Education Ministry's site and the six terrestrial channels that broadcast the curricula from primary one until the end of the secondary stage. "My children never depended on private classes. They are too expensive but now I feel I must enroll my kids at one of the private centres in case the school is closed," says one parent whose son and daughter study at a public school in Giza. Tageddin, who served as minister of health from 2002 to 2005, blamed the media for "exaggerating the crisis and causing unnecessary panic among the public". "The WHO declared H1N1 to be a 'geographic epidemic', based on its geographic proliferation -- and not the number of fatalities associated with it," explained Tageddin. "The virus does not and will not represent a serious threat unless it mutates into something more dangerous. Only a few people have died from the disease, which doesn't represent a real health crisis. It's less deadly than seasonal influenza, which has a three to four per cent fatality rate. Those who are dying of H1N1 are either the elderly or very young children or were already suffering from chronic health problems. Other people are recovering quickly -- usually in four or five days -- often without any medical treatment." Even though the ratio of death to infection is less than one per cent, the increasing number of infections is cause for concern. Qandil, stresses that a rise in the number of infected people during December and January is expected and suggests that the swine flu outbreak "might calm with the start of February". "Although the death rate in Egypt has increased from 0.03 per cent to 0.06 per cent the global average is 1.3 per cent." All deaths recorded from swine flu in Egypt have been among patients suffering serious underlying complications, including pneumonia, asthma, hepatitis, tumors and obesity. Seven of the deaths have been of pregnant women, seeming to confirm warnings from the World Health Organisation's (WHO) Middle East office that pregnant women are most vulnerable to the disease. Those over 65-year are also at risk, as are children under five, "especially those who suffer from chronic medical conditions such as diabetes, heart disease, asthma as well as those suffering from obesity, kidney failure or chronic liver problems and those suffering from HIV". Qandil stressed that the increased rate of infection per day is not indicative of a mutation. Mahgour, however, points out that the virus has already mutated in a number of countries, "but slowly and in a restricted context". "It is progressing slowly and is not resistant to available drugs and vaccines such as Tamiflu except in a few cases reported in China, Brazil, the UK, US and Norway," he says. The WHO has issued a press release stating that it expects to witness a rise in the infection rate during winter season, which are traditionally flu months. Given the relatively low fatality rate associated with the virus, many critics say measures now being mooted by the government are excessive. "Only 21 people in Egypt have died so far from H1N1," argues Tageddin. "The precautionary measures the government is taking, with the stated aim of combating the virus, seem to be out of proportion with its seriousness. On Wednesday, the Governors' Council met with Prime Minister Ahmed Nazif to discuss a partial or total suspension of the current academic year. The council decided to resume the academic year on Saturday.
