Rumor and Reality

Business is brisk at the Happy Home Nutrition Center, where
proprietor Elvia Marquez is grabbing natural anti-flu supplements such
as Immune Action and Herbal Defense Complex from her crowded shelves.
Located just a block north of the border in Nogales, Happy Home is also
a bustling sounding board of binational concerns.

So what is Marquez hearing from her clientele about the swine flu?
Well, not much. Despite the frantic news coverage, she says border
folks like her are mostly taking the situation in stride.

“Of course, everybody is using precautions. Some people in Sonora
are covering their mouths with masks, and others think we should close
the border. But I say, why?”

Still, that doesn’t mean government wheels aren’t turning to keep
those concerns—and the threat—at bay. Just 10 minutes away
from Marquez’ shop, Kevin Irvine’s phone is ringing from morning to
night. Normally, Irvine wears two hectic hats: He is head of Santa Cruz
County’s health services department and its emergency-management
director. But with the potential of a pandemic on the horizon, he now
wears a third: He the official squasher of unfounded rumors.

For example, “I’ve had people from Mexico saying that they’ve
already got the vaccine there, and they were happy as clams,” Irvine
says. “Well, there is no vaccine for the swine flu.”

He’s hardly alone. Ever since Mexico’s health secretary announced an
outbreak of the swine flu on April 23, health officials have been
scrambling to define the scope and potential of this outbreak. With the
possibility of a pandemic looming large, it’s also been their mission
to provide current, valid information—and keep misinformation at
a minimum.

Nowhere is that task more delicate than on the U.S.-Mexico border,
which in the best of times can quickly twist fiction into supposed
fact. Still, whether this bout of swine flu goes hog-wild or fizzles
into history, it has allowed officials to test an emerging
communications network that reaches from the U.S. Centers for Disease
Control and Prevention down to Kevin Irvine in little Nogales,
Ariz.—and then leaps the border into Mexico.

At the local level, Irvine is in steady contact with the county
epidemiologist, who is in steady contact with area hospitals and
clinics. “We’re also listening to the state,” he says, “and they’re
listening to the CDC. We just had our first conference call with the
(Arizona) Department of Health Services, the Arizona Division of
Emergency Management and a lot of other people.”

A linchpin in this network is the Office of Border Health, which,
under the auspices of the Arizona Department of Health Services,
coordinates directly with officials in Sonora. Robert Guerrero heads
the Tucson-based office. But when we caught up with him, he was at the
Dallas airport, heading back to town after a parley with Texas health
officials.

Creepy as it may be, Guerrero says the swine flu has provided a
precious opportunity to test the Early Warning Infectious Disease
Surveillance program, or EWIDs. This collaborative effort between the
United States, Canada and Mexico identifies, monitors and otherwise
grapples with outbreaks of contagion.

“As a liaison between Arizona and Sonora, I maintain 24-7 contact
with our colleagues in Sonora,” says Guerrero. Under EWIDS, he’s also
in constant communication with Arizona’s four border counties and the
Tohono O’odham Nation.

The federal EWIDS program began in 2003 with a focus on
bioterrorism, “but it’s since turned into more of an all-events type
program,” he says. A major part of that expansion occurred in 2006,
when Arizona and Sonora became the only border states to develop a
regional pandemic-influenza response plan.

Three years later, constant EWIDS communications are primarily
carried by secure computer links. With the swine flu, “we have a
call-down list so that I’m communicating directly with the person at
the secretary of health in Sonora who’s in charge of epidemiology and
infectious-disease surveillance,” Guerrero says.

Establishing direct communication lines between the sister states of
Arizona and Sonora seems like a no-brainer. But linking two remarkably
different systems was no small feat.

“In the U.S., we have the Department of Health and Human Services
and the Centers for Disease Control and Prevention,” Guerrero says,
“and our states have more autonomy in what we can communicate to
Mexico.”

By contrast, the Mexican federal government exercises much more
control over its states. That significantly muddies the chain of
command. For instance, the federal secretary of health “mandates down
to the states what they can and can’t do,” he says. “But we’ve worked
it out with our counterparts so that the information I’m getting from
Sonora, I’m able to share directly with the Arizona Department of
Health Services.”

With all this back and forth, information comes in a steady stream,
rather than in bits and pieces. That allows Guerrero to have a full,
real-time understanding of situations such as the swine-flu situation
in Sonora. His information is then dispatched up the ladder to state
officials in Phoenix, and down the ladder to Kevin Irvine in Santa Cruz
County.

In turn, Irvine constantly parleys with local officials such as
Shawn Arévalo McCollough, superintendent of the Nogales Unified
School District. And McCollough’s district is a particularly important
barometer, since an estimated 200 of his district’s 6,000 students live
across the line in Sonora. “We’ve advised our school nurses and
principals who work closely with the kids that if they see flu-like
symptoms, to send them home or on to the doctor,” he says. “We’ve
received no confirmation from any of the hospitals and clinics in town
that they’ve identified anything at all.”

He says his students would be screened like anyone else when
crossing the border. “We’ve had a number of conference calls with
Homeland Security, and they are taking every precaution at the port of
entry to check people as they come through. If there are concerns about
kids coming across the border to our schools, believe me, Homeland
Security is doing a fantastic job at the checkpoint.”

Back at the Happy Home Nutrition Center, Marquez isn’t so sure that
the checkpoint will catch much. “Here on the border, I don’t really see
anything,” she says. “But I did have one customer, he was just here,
who wanted Immune Action. And he took quite a few of them, just as a
precaution.”

Of course, even the greatest safeguard won’t stanch all the
borderland rumors: “Yeah, I did hear that there was a case of the flu
reported in Sonora,” Marquez says. “But it turned out to be
nothing.”

This article appears in May 7-13, 2009.