Swine flu is quickly establishing itself in Egypt, reports Reem Leila More than 700 cases of swine flu have been reported since June. Most recently, the average number of new cases per week has climbed from 90 to 105. In a bid to contain the virus the Ministry of Education has banned schools and universities from opening before 26 September. Normally private schools and universities begin the academic year ahead of the state sector. Teachers, students and administrators arriving from abroad have been instructed to wait for eight days before going to their various institutions, says Reda Abu Serei, deputy to the minister of education. The Ministry of Education wants to ensure that teachers and students coming from abroad are free of the virus, which has an incubation period of up to seven days. Headmasters will be responsible for implementing the decision and anyone found to have violated the restriction will, says Abu Serei, face charges. Swine flu in Egypt has stolen the headlines from the increasing number of H5N1 avian flu victims despite the fact that health authorities consider bird flu to pose the greater danger. Abdel-Rahman Shahin, official spokesman at the Ministry of Health, stresses that despite the growing number of confirmed cases of swine flu they represent a tiny fraction of Egypt's population of 80 million. Such reassurances appear to do little to stop public panic. Sporting clubs are the latest focus of public attention after it was reported that 26 members of the Zamalek Club's young swimming team, together with four of their mothers, had been confirmed to be infected with swine flu. The WHO advised only days ago that the pandemic will persist in the coming months as the virus moves through susceptible populations. MP Gamal Zahran, who expressed cynicism over attempts to combat the spread, probably spoke for many when he said "officials will fail just as they have failed with bird flu." The WHO, says Zahran, has repeatedly expressed concern and is advising countries in the northern hemisphere to prepare for a second wave of the pandemic. "Regrettably," he adds, "Egypt is adamant that everything is well and under control." Close monitoring of the virus by the WHO's network of laboratories, Shahin points out, shows that viruses from all outbreaks remain virtually identical. There are no signs that the virus has mutated to a more virulent or lethal form. "The clinical picture of pandemic influenza is largely consistent across all countries," says Shahin. "The overwhelming majority of patients continue to experience mild illness. Although the virus can cause very severe and fatal illness, even in young and healthy people, the number of such cases remains small and Egypt is still in the green zone." Zahran argues that even if the current pattern of usually mild illness continues, the impact of the pandemic during the second wave could worsen as larger numbers of people become infected. Growing numbers of severely ill patients requiring intensive care will place an intolerable burden on health services, he says, "creating pressures that could overwhelm intensive care units and possibly disrupt the provision of care for other diseases". Mustafa Bakri, a member of the People Assembly's Health Committee, agrees with Zahran, adding that current data about the pandemic comes from wealthy and middle-income countries and there are few indications how the situation might develop in developing nations. Swine flu, which can cause manageable disruption in affluent countries, could have a devastating impact in many parts of the poorer countries, Bakri argues. In its daily report the Cabinet Information and Decision Support Centre has revealed the Ministry of Health has requested the H1N1 vaccine from five different pharmaceutical companies, asking them to deliver before the hajj season begins in November. "At the moment the virus is very mild and can be treated with an aspirin and a few days of bed rest," says Shahin. "We will not buy a vaccine that costs the country millions of dollars unless it is needed." The first 250,000 doses expected to arrive in the country soon will be distributed according to a priority list approved by the WHO and Control Disease Centre. The remaining amount is to be available within a period of maximum six months. Doctors, nurses and other health workers will receive priority access, followed by transport employees, sanitary workers, electricity workers and the police. On Sunday health officials announced that Egypt will start treating H1N1 patients on an at-home basis with only the most severe cases being admitted to hospitals. The Ministry of Health will launch a new media awareness campaign to inform the public about which cases will be transferred to hospitals and how patients can receive treatment at home. "We are expecting more swine flu cases, especially after the end of the omra season and the beginning of the hajj. Egypt's hospitals cannot accommodate such numbers," says Shahin. Accordingly, only patients under five years of age or of 65 and above will be admitted to hospital. "Pregnant women and those with medical conditions such as asthma, cardiovascular diseases and diabetes will also be hospitalised in order to avoid complications," Shahin added. The Health Ministry has, in addition, formulated contingency plans to set up quarantine camps in collaboration with the army. The camps will be located close to Egypt's borders and in the sea port of Safaga.
