Health ministry and Doctors syndicate divided on 'Swine Flu' in Egypt

Mariam Rizk , Wednesday 5 Feb 2014

Egypt's health ministry acknowledges death of 24 people from the H1N1 virus; Doctors' Syndicate calls for more studies and a transparent count but ministry says union harbours ulterior motives

Mona mena and Health minister Maha Elrabat
Mona mena and Health minister Maha Elrabat

As possible cases of swine flu spread in different parts of the country, the Ministry of Health and the Doctors' Syndicate continue to argue the scale and the nature of the viral disease.

Two months after repeated warnings from the Doctors’ Syndicate that an epidemic of influenza is coming, Egypt's Ministry of Health has finally acknowledged 24 deaths from swine flu over the last two months. In a press conference Tuesday, the ministry said a total of 195 had suffered severe respiratory symptoms diagnosed as H1N1, known since 2009 as swine flu.

The death of four doctors, at least two from complications of respiratory illnesses, and the infection of two others with swine flu in the past month alarmed the Doctors’ Syndicate, which asked the ministry to form an independent fact-finding committee to look into the cases and determine whether the cause was swine flu, a mutated version of the disease, or another epidemic.

The ministry said that the four doctors who died were not diagnosed by H1N1 while acknowledging that two other doctors were actually infected with H1N1. The ministry also said the 24 death cases it confirmed involved various risk factors: being elderly, pregnant, or those with immune or respiratory diseases.

Meanwhile, the ministry assured the public that the last case of bird flu was reported in April 2013, brushing off fears that the epidemic that hit Egypt in 2006 and can be transimitted through close contact with birds had come back.

However, doctors believe that the ministry denied for a long time a possible new epidemic, and that the "rush" into assuring that "everything is ok" without clear screening and a transparent process of sampling allows for the ministry's announced numbers to be questioned.

"We are facing a pneumonia that kills even at a young age, which is not common, and this needs a serious effort to deal with it. We need statistics. Only the ministry is capable of doing it. We are not an executive entity," Mona Mina, secretary general of the Doctors' Syndicate told Ahram Online.

"The ministry has been instead in denial," Mina added.


Doctors say the cases might not be H1N1 but another viral mutation, something that the ministry insists is not true.

"It’s the same virus. The genetic mark is the same. There’s no mutation and the response to Tamiflu (medication) is the same," Ahmed Kamel, the health ministry spokesman told Ahram Online.

To be sure of the nature of the disease, a sample has to be taken from suspected cases and sent to ministry laboratories, the WHO, and the Naval Medical Research Unit (NAMRU), a biomedical research laboratory of the US Navy conducting infectious disease research in North Africa and the Middle East, Ahmed Kamel added.

As per the summary issued on 72 countries by the World Health Organisation (WHO) late last month, nearly 24,500 cases were positive for influenza viruses, of which nearly 25 percent were influenza H1N1 cases.

The report also said that Egypt was one of the countries experiencing an increase in influenza viral activity.

“The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold, and 10 paediatric deaths were attributed to influenza," the report stated. The report also said that intensive care unit admissions for influenza increased to 19.4 percent, up three percent on previous seasons.

Worldwide, annual influenza epidemics result in about three to five million cases of severe illness, and about 250,000 to 500,000 deaths.

Swine flu: The last time

In 2009, Egypt was plagued by the H1N1 virus. 

The disease spread across the country, infecting thousands and killing scores. Schools and universities were closed for several weeks as anxiety spread in the densely populated country.

Pigs across the country were culled because the virus was initially discovered in pigs, but later mutated, while the WHO at the time said there was no evidence of animals transmitting the virus to humans.Fears of a possible comeback increased as another respiratory disease, known as coronavirus, was seen spreading in nearby Gulf country Saudi Arabia.

With a population of around 90 million, Egypt's crowded transportation and lack of precautionary measures could lead to a disaster and a quick spread of respiratory diseases.

"The numbers [this time] are within the normal range. We don’t want people to panic. But at the same time we don’t want to underestimate [the risk] ... there's no clustering to the infection ... that’s not an epidemicological status," Kamel said.

Trading accusations

Tension between the syndicate and the ministry over union demands has not helped in resolving the H1N1 controversy.

Doctors have undertaken on-off partial strikes against the ministry since months following the 2011 uprising the toppled longtime autocrat Hosni Mubarak.

The providers have recently engaged in a series of one-day partial strikes over low salaries and a lack of safety in hospitals.

Hossam Kamal, media spokesman of the Doctors' Syndicate, said any epidemic would need a special budget to supply state-run hospitals, but that the "government is insisting not to put health on its priority list."

However, the ministry has accused the Syndicate of using the possible epidemic as a pressure tool for union  causes.

The ministry's spokesman, Ahmed Kamel, says the syndicate wants to spread "rumours" to support their “categorical demand,” which is to increase a cash allowance for infection.

"They [the syndicate] have a direct benefit from a rumour like this. They have a financial demand and they know quite well what we have now is what the government could provide in the meantime," Ahmed Kamel said.

The current cash allowance is around LE20 ($3).

Minister of Health Maha El-Rabat dismisses that the ministry would not announce an epidemic so as not to spend money, confirming that the supplies needed for hospitals are available, and that they just “have to ask.”

"There no intention or benefit from covering it up, and there’s no intent to [mislead in the numbers]," El-Rabat told Ahram Online.

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