A 5-year-old Mexican boy takes ill in his dusty village. He coughs, he sneezes, he gasps for breath.

Hundreds of Edgar Hernandez’s neighbors in La Gloria – villagers who live among smelly pig-breeding farms that attract swarms of flies – already have flu-like symptoms. After they complain repeatedly, government workers arrive to conduct medical tests.

Edgar recovers, but his illness remains a mystery to his family – at least for a while.

Fast forward about a month, to late April.

A 9-year-old boy arrives at a medical clinic in Elyria, Ohio, an industrial city 20 miles southwest of Cleveland. He has a sore throat, body aches, fever and dizziness.

His mother consults a pediatric nurse practitioner, Sally Fenik; she thinks it’s strep throat or an allergy. She also mentions to the nurse they’ve just returned from visiting relatives in Mexico but doesn’t think it’s swine flu because no one else in the family is sick.

But on her way to work, Fenik has heard a radio news report about swine flu turning up in states bordering Mexico. She’s far away, in the industrial Midwest, but remembers thinking, “Boy, I hope that doesn’t start spreading and getting worse.”

After a rapid strep test on the boy comes back negative, Fenik does a nasal swab.

A half-hour later, the lab calls. It’s the type of influenza linked to swine flu virus.

Two boys in communities 1,700 miles apart – two pieces of a vast epidemiological puzzle.

In this age of global trade and travel, the swine flu epidemic has proven itself a global illness – a fast-moving virus that respects no border as it hopscotches from the dirt roads of Mexican villages to the concrete canyons of big-city America to a glittering Hong Kong hotel.

Swine flu has been confirmed in 16 deaths, all from Mexico (one Mexican toddler died in Houston). It has sickened nearly 350 people in Mexico, and about 200 others from New York to New Zealand, including children, teens, adults, students and tourists.

No one knows precisely where the swine flu virus will pop up next.

All they know is that it will.



Where and how it all began is a medical mystery.

But one of the first hints of trouble surfaced toward the end of winter, just when the flu season should be wrapping up. It came from the Mexican state of Veracruz – a region that includes a high plain that supplies Mexico with much of its cured pork products and has many villages that are surrounded by pig-breeding farms.

Edgar Hernandez lives in one of them, La Gloria, a hillside hamlet (population 3,000) where people started complaining of bad colds at the end of February. On March 23, Veracruz health officials arrived to take saliva samples.

About a third of some 1,300 townspeople who sought medical attention – 450 or so – were diagnosed with acute respiratory infections and given surgical masks and antibiotics.

Edgar fell ill a bit later; the energetic 5-year-old retreated to his bed with a high fever. Other kids in his school already were sick.

Two children from La Gloria died before being tested; their parents refused to let them be exhumed.

Mexico’s chief epidemiologist, Dr. Miguel Angel Lezana, says officials haven’t ruled out Mexico, the United States, Asia or Europe as the origin of the swine flu virus.

The CDC has no firm answers, either.

“We have no idea where it came from,” says Michael Shaw, the CDC’s associate director for laboratory science. “Everybody’s calling it swine flu, but the better term is swine-like. It’s like viruses we have seen in pigs – it’s not something we know was in pigs. It doesn’t really have any close relative.”

On April 12, Mexican health authorities notified the CDC and the Pan American Health Organization of the unexplained cases of severe respiratory illness.

One day later, people started dying.



Adela Maria Gutierrez was the first.

She arrived at a hospital in Oaxaca, in far southern Mexico, gasping for air, her oxygen-starved hands and legs a ghastly shade of blue. Antibiotics only made it worse.

The hospital quickly put Gutierrez in isolation and began searching for any other people infected among her family and neighbors. A second round of tests showed it was not the SARS-related virus, leaving doctors puzzled.

By then, the 39-year-old mother of three was dead.

Soon, health departments elsewhere reported more swine flu cases. They fit no particular geographic pattern: Arizona and Indiana. Massachusetts and Kansas. Texas and Michigan.

And no distinct profile: toddlers, high schoolers, college students. A baggage handler, a businessman, a doctor. Some had traveled to Mexico; others hadn’t ventured outside their communities.

That isn’t surprising, says Gray, the Iowa infectious disease expert.

“People can be carrying the virus and have no symptoms at all and be passing it on to others,” he says. “The virus can live on surfaces and on inanimate objects – such as door handles or dirty tissues. It doesn’t live that long. It’s also transmitted through coughing and sneezing. The bottom line is there are lots of ways this virus can go from human to human. It’s difficult to defeat all of them.”

But, Gray says, “it’s not a cause for panic. … It does not seem to be inordinately lethal. Time will tell. It’s certainly not anything like SARS.”



As the epidemic spread across the world’s time zones, one fact became glaringly apparent: The only deaths were in Mexico, with the exception of a 23-month-old from Mexico City who died in Houston.

Why?

“That is the $64,000 question,” says Dr. Ronald Hershow, associate professor of epidemiology at the University of Illinois-Chicago School of Public Health.

No one knows for certain how many people have been sickened in the United States; state lab operators say they are not testing all suspected cases and are focused on spotting new outbreak hot spots or ways to limit its spread.

But as more cases are reported, schools are closing across the country, and sporting events are being canceled. So, too, was Fort Worth’s annual Mayfest, which usually attracts 200,000 people over four days.

Mexico City, which already had closed its schools and museums, took a larger step: It ordered a five-day national shutdown, starting Friday, of all but “essential” businesses and urged people to stay inside.

The bustling capital of about 20 million is eerily quiet.

The few people still outside are wearing masks.


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