Death toll mounts as flu hits Latvia

RIGA - Dr. Baiba Rozentale has spent her professional life studying
infectious diseases, but she has never seen a flu epidemic like the
one now sweeping Latvia, which has left eight dead, hundreds
hospitalized and thousands in a work-stopping malaise.

The flu, which began coursing through Latvia in late December, has
closed Riga's primary schools, hospitalized some of the Latvian army
and has left Rozentale, the director of Latvia's Center for
Infectious Diseases, bracing for the worse to come.

"This week and next week we think will be the height of the
epidemic,"said Rozentale. "It's the worst I've seen."

An estimated 8,000 people in Latvia have contracted the flu in recent
days, reaching everyone from children to the top levels of government.

Latvia is not alone

The World Health Organization has reported outbreaks in Finland,
Norway, France and Great Britain, where 600,000 people reportedly
flooded emergency rooms in the last three weeks.

Lithuania and Estonia have not filed flu reports with the WHO.

A typical flu epidemic, Rozentale said, affects the young and old
first before closing in on large groups like the military and schools
and finally the rest of the population.

This one is no different.

Early deaths included a 72-year-old woman and a 76-year-old man in
Riga last week. An outbreak among children prompted the closing of
primary schools until at least Jan. 20.

About 30 soldiers checked into the center last weekend complaining of
flu-like symptoms. As of Monday, the center was treating 155 flu
patients, including 20 who were moved to intensive care.

Government decrees flew out of the Prime Minister Andris Skele's
office this week as he sought replacements for ailing cabinet
ministers.

Rozentale saw firsthand the flu's fatal creep toward the population's
middle last weekend when a 37-year-old Riga man called for an
ambulance after showing flu symptoms for nearly a week.

He arrived at the center coughing blood and with a temperature of104
degrees. The man died two-and-a-half hours later.

Flu deaths are not rare. An estimated 20,000 people a year die in the
United States from flu complications and about 29,000 flu-related
deaths were reported in Britain during an epidemic in 1989-1990.

Though the bug floating around Latvia is a common influenza virus, it
is a strain slightly different enough to turn a typical seasonal
outbreak deadly.

"For virologists the situation is typical,"said Dr. Vaira Kalnina,
head of the government virology. "But this strain is very toxic and
that's why the clinical side is worse this year."

A flu virus kills by weakening blood vessels, causing internal
bleeding and exacerbating heart and respiratory problems. It is
easily transmitted through coughing and sneezing.

"But there is good news,"said Kalnina. "As of now there is only one
type of virus circulating through Latvia."

A flu bug can come in myriad types, and Latvia was braced for this
one, though not expecting such a severe strain.

Governments around the world, with the help of the World Health
Organization, each year assess the upcoming flu season and buy the
appropriate vaccine. This year Latvia guessed right and stocked
enough vaccine to immunize most of the country against the current
virus.

Each September doctors push vaccinations, publicizing their
availability in newspapers and on television.

"After that we wait,"said Rozentale.

Still, only four people in 100 are vaccinated.

"Everyone needs to pay for themselves,"Rozentale said. "And many
haven't got the money."

Shots cost about $5.

The country's medical community, Rozentale and Kalnina included, have
been lobbying the government to help cover the costs for the shots.

The government health insurance fund pays for some vaccines for the
elderly. Employers pay for some, as do private health insurance plans.

But most people go without vaccinations; and, through socialized
health care, the government pays to hospitalize them sometimes up to
a week.

"It's just logic,"said Rozentale, tapping her forehead with her index finger.

But government officials said a budget pinched in every ministry
can't afford to immunize everyone for free.

Kalnina knows it's an uphill battle.

"It's much better to do vaccinations than to pay for hospitalization,
of course,"she said. "But I don't know of a country in the world
where the government pays for vaccinations."

Meanwhile, all she and other doctors can do is wait until this year's
flu subsides and hope that the number of deaths doesn't increase.

But that too, Kalnina believes, will be a wish not granted.

"I suppose, unfortunately, in the next week there will be an increase
in the death rate,"she said.