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Verging on Collapse in Argentina
The above comments on the state of health care health care in Argentina in general and Buenos Aires in particular due to the exploding number of pandemic H1N1 infections are widely reported. The number of confirmed fatal cases has risen to 29, in the past several days, including two reported today in Rosario, and reports suggest at least 15 additional fatalities are suspect cases. The Buenos Aires website localized 15 fatalities, as well as 180 confirmed cases and over 500 suspect cases (see map), but these cases represent a small percentage of the actual infections. The state numbers identify almost 1400 confirmed cases, including 25 fatalities in the metropolitan area. Similarly, in the adjacent Santa Fe province the number of confirmed is 34, although private labs have confirmed 40 additional cases. However, these are not included because they have not yet been officially confirmed. Moreover, 200 suspect samples have been collected from patiewnts in Rosario (see map) and sent for testing and media reorts suggest there are over 800 cases in Santa Fe province. Similarly, Brazil announced its first confirmed fatality today, who was a truck driver who developed symptoms while in Argentina.
Thus, the state numbers are depressed by a sample backlog at the state for testing suspect cases or confirming positives identified at private labs. Moreover export of cases signal significant under-reporting.
The collected samples are also likely to represent a small percentage of the total. This undercount is common worldwide. In the United States that surveillance system for season flu only tests about 0.1% of samples and it is likely that pandemic flu is similarly undercounted, most cases are relatively mild and most labs are now limiting testing to severe cases or clusters, but even clusters such as outbreaks at schools or summer camps only test a small representative sample from the outbreak.
In Agentina, like some regions in the US, testing has halted and a pandemic H1N1 diagnosis is made based on clinical presentation.
Consequently the number of infections is orders of magnitude higher than confirmed cases, but the concerns in Argentina center both on the state of the health care system in general, as well as the rapid increase in fatal infections, including those that rapidly deteriorate while develping symptoms similar to infected patients in the 1918 pandemic. Moreover, like the 1918 pandemic, the vast majority of infections and fatalities are in previously healthy young adults, and the H1N1 is a swine flu that has recently begun to spread throughout the human population.
Sequence data on the H1N1 spreading in Argentina would be useful.