Despite Friday's World Health Organisation meeting to decide whether to raise the alert phase, the Dutch remain unperturbed by the Mexican flu epidemic. Even though the number of cases in the Netherlands doubled to ten this week, the response remains philosophical.

After a visit to Mexico or Japan, passengers travelling through Amsterdam's Schiphol airport might believe they are in another world. There are no facemasks in sight, and people kiss and shake hands as they pick up friends and family. Does the Netherlands have its eyes shut to the dangers of Mexican flu? Or is this country just less sensitive to media hypes?

Radio Netherlands Worldwide reporter Eric Beauchemin was absolutely flabbergasted. On his way to Mexico he received a letter from the local health authority at the airport containing a list of recommendations for people travelling to Mexico. Recommendation 1: Avoid contact with people who have flu. "What nonsense," says Beauchemin. "I can't tell whether someone has got the virus, can I?" As far as he is concerned, the letter is absurdly obsolete. After all, the virus has now spread all over the world.
 

Wash your hands
At the airport in the Mexican resort of Cancún, medical staff check passengers using a special heat sensitive camera. Anyone with a temperature is put in quarantine. The worst of the panic has ebbed away in the country itself. Hardly anyone is wearing a facemask and again it is polite to get close to people when you greet them.

"All I did was wash my hands a little more often, as the health authorities recommended,A" says the RNW reporter. According to medical virologist Huub Schellekens of Utrecht University, this is a good precaution to take. "Most infections don’t happen via the air but via the hands, for example via a doorknob or a handshake."
 
Optical measures
Professor Schellekens has just returned from a conference in the United States, where there are already more than ten thousand cases of Mexican flu. Seventeen people have died of the disease. "There they are taking measures too," he says. "I was only allowed in after I had declared in writing that I didn’t have flu symptoms. I don't mind signing the declaration, but I could be carrying the virus without having any symptoms." Professor Schellekens calls these ‘optical measures’. "It shows you’re doing something, putting people's minds at rest."
 
RNW reporter Thijs Papôt travelled through Japan and was surprised to see people wearing facemasks on the street. When he asked about it, he got a range of responses. Of course some people were wearing masks because of Mexican flu, but others were wearing them to prevent hay fever, against the smog, or because they had a cold. "They were already wearing masks before the flu outbreak. Purely out of politeness," says Papôt. 
 
No worries
Professor Schellekens of Utrecht University is critical of the way the flu is being kept under control just for the sake of appearances. “You can quarantine a plane because there’s a flu patient on board. But at the same time, ten planes can be taking off with passengers who are carrying the flu virus but have no symptoms.” 
 
The Netherlands hasn’t gone along with the trend. There are no fever checks at Schiphol, no facemasks in the streets of Amsterdam. At the beginning of this week, the Netherlands had four H1N1 flu patients, but by Friday the number had risen to 10. However, all off them contracted the virus in Mexico or the United States. The flu isn’t spreading in the Netherlands and no one has died of it. “It’s logical that the Netherlands shouldn’t be worrying about it,” says virologist Ab Osterhaus of Rotterdam’s Erasmus Medical Centre.

Medicines
At the start of the epidemic, there was a growing demand for facemasks and the antiviral drug Tamiflu, but this has now receded. And rightly so, says Schellekens. “There’s nothing to worry about in the Netherlands. If there’s one thing the World Health Organisation is well prepared for, it’s a flu epidemic. You safely say that everything is ready to deal with it.”

The Netherlands is in a luxurious position. Apart from common sense, there’s enough money available for vaccines and antiviral drugs. The panic reaction in Mexico and the United States is understandable. People have died of the virus, the healthcare system is less well organised and not everyone has money for medicines.
 

Warning system
Within the World Health Organisation doubts have arisen about the effectiveness of the warning system. According to the present criteria, the time is ripe for alert phase six. The virus has appeared in Egypt, and that means there are cases of flu on every continent. At a recent WHO meeting there were calls for the criteria to be adjusted. Apart from the dissemination of the virus, its severity should also be taken into consideration in determining the alert phase.
 

Virologist Ab Osterhaus supports such an adjustment. “In fact we’re already acting according to alert phase 6. We’re dealing with a virus that is spreading around the world very effectively. Only there isn’t an extremely high level of illness or mortality, while people perceive a link between the two.”

“The chances of a new pandemic being comparable to the Spanish flu – at the beginning of the last century with 40 million deaths – is zero. The present H1N1 virus is a mild variant, only the WHO warning phases don’t reflect that,” says Professor Schellekens. “I think the Dutch are perfectly aware of this.”

Despite his scepticism, Professor Schellekens understands that Health Minister Ab Klink has no choice but to keep the public on the alert. With a gibe at virologist Ab Osterhaus of the Erasmus Medical Centre, who in recent months has constantly been calling for stockpiles of vaccine and antiviral drugs, he says, “If a media virologist on television bangs his fist on the table and says there’s got to be enough vaccine, than Klink can’t sit back and do nothing.”

Photo: FaceMePLS at Flickr