Healthcare Town Hall

The recent outbreak of H1N1¹ virus seized worldwide attention and raised concerns about a potential pandemic.

We spoke with Eduardo Lara di Lauro, principal and managing director of Milliman’s consulting practice in Mexico, about the situation and about some of the implications for the insurance industry in that country and elsewhere.

Q: At this point, how much do we know about the progress of the H1N1 strain of the influenza A virus in Mexico?

Eduardo Lara di Lauro: This is very much an evolving situation and we still don’t have the answers to many questions. One of the questions in the air is, “Why Mexico? Why did this flu have more deadly presence in Mexico?” I think that the way the public sector is recording the cases could well be critical. What first brought the outbreak to attention was when physicians began to notice a higher rate than normal of pneumonia in young adults. Every year almost 10,000 Mexicans die from the effects of seasonal flu that complicate producing pneumonia. Usually they are the elderly and the very young, people whose immune systems are not robust enough to fight off the virus. As actuaries, we know how important it can be to determine the best sources of information that provide the greatest amount of detail, in order to accurately determine origins and first causes. We had been having some fatal cases of pneumonia in Mexico previously, but we didn’t know the first causes of those cases until now. Now the physicians are making additional tests in order to determine what the cause of the pneumonia in each case may have been. This flu may actually have been going on for awhile.

I think it’s also important to note that the number of cases so far appears to be relatively small—as of May 6, some 1,112 positive cases, with 42 deaths out of a population of 110 million. The rate is pretty low. Obviously we are still attempting to determine the overall timeframe of the progress of this outbreak, and that will be key to helping us understand where we are. We don’t know yet if this outbreak is just starting, or at the middle, or nearing the end. The number of deaths seems to be stabilizing, perhaps indicating that the first wave of this influenza has peaked. It takes from one to five days from a person getting the virus until the symptoms begin to present, and then tests must be run to determine exactly what it is, which also take time. There are a lot of things we really don’t know yet. The government may have overreacted in terms of the measures taken, telling everyone to stay at home, closing schools, no public events, and so on until May 6. But I would say it’s better to do whatever is necessary to stop the spread of this virus first. As people in Mexico now get back to resuming their normal economic activities it is likely we will see new moderated flu outbreaks in some areas. In order to say the illness is contained we need to have at least 15 days without new cases, according to Mexico’s health authorities.

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When we blogged about the swine flu outbreak on Wednesday, the story was hardly front page material. Obviously, that has all changed. With that in mind, we’re revisiting the concepts from “A human capital perspective on pandemic influenza” with a bit more urgency.

While the governments in both Mexico and the US are still very much in containment mode, it’s hard not to look ahead to more aggressive tactics, should they become necessary. What, for example, are the implications for developing a vaccine? The “Human capital” approach offers some perspective:

In a pandemic influenza outbreak, drug companies could convert their seasonal influenza vaccine programs to produce a vaccine for the pandemic influenza strain. The current seasonal influenza vaccine process requires about six to nine months from start to finish and that process can’t start until the pandemic influenza strain has been identified—which means the pandemic has begun. Emerging technologies may dramatically shorten that process. However, vaccines take about two weeks to become effective after inoculation. Even if vaccination technology leaps forward, a basic strategy for limiting the impact of pandemic influenza must involve delaying the spread of the disease. Delaying infections means reducing the concentration of economic and human impact—and buying time until a vaccine that prevents the infection can be developed and disseminated. Based on historical data, epidemiologists expect two or more waves of the virus; not all susceptible people will catch the virus at the same time, so delaying tactics would seem to be effective.

Not exactly encouraging news should this outbreak continue to advance…

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We have heard much talk recently of “stress tests” for financial entities. What would a stress test of the healthcare system reveal? Are we ready to withstand a major health event?

The question becomes more immediate in light of news this week out of San Diego, where two children were diagnosed with swine flu. There are reportedly other cases confirmed in Mexico.

Is the US healthcare system ready for a pandemic? The difficulty of managing through such a crisis is outlined in a piece by Phil Borba, Kate Fitch, and Bruce Pyenson.

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