VZCZCXYZ0000
RR RUEHWEB

DE RUEHBU #0851/01 2031413
ZNR UUUUU ZZH
R 221413Z JUL 09
FM AMEMBASSY BUENOS AIRES
TO RUEHC/SECSTATE WASHDC 4108
INFO RUCNMER/MERCOSUR COLLECTIVE
RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC

UNCLAS BUENOS AIRES 000851 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR OES/IHB - P. MURPHY AND D. WILUSZ 
 
E.O. 12958: N/A 
TAGS: TBIO SOCI PGOV PREL AMED ELB CASC AR
SUBJECT: ARGENTINA: DATA COLLECTION OF GOVERNMENT INTERVENTIONS RE 
H1N1 
 
REF: STATE 73971 
 
¶1.  Through contacts with Argentine officials and healthcare 
professionals, Post developed the following timeline of public 
health interventions, as requested in reftel: 
 
-- First cases:  The first case of H1N1 in Argentina was detected on 
May 7, 2009, in Buenos Aires and the second on May 22 in Mendoza. 
Both cases involved travelers returning from trips abroad, the first 
from Mexico, the second from the United States.  On May 26, 
Argentine health authorities detected the first 
domestically-acquired case of H1N1, in Buenos Aires. 
 
-- Making influenza a notifiable disease:  On April 29, 2009, the 
Argentine Ministry of Health (MoH) issued an official order putting 
into effect Law 15,465, which establishes the Regime of Vigilance 
and Control of Diseases of Obligatory Notification, and Ministerial 
Decree 1715/07, which mandates notification of human influenza for 
new virus subtypes. 
 
-- Emergency declarations:  On June 30, the governments of the City 
of Buenos Aires and the provinces of Buenos Aires, Chaco, Rio Negro, 
and Corrientes declared a health emergency.  Since 2002, a decree of 
national health emergency has been in force.  This decree was 
originally issued to deal with the economic crisis that the country 
was then facing.  It was never rescinded, and its existence was the 
argument that new Health Minister Manzur used to justify why the GoA 
had not declared a national health emergency to face the H1N1 
influenza outbreak. 
 
-- Border measures:  Between the end of April and the first days in 
May, several measures were put into place.  All incoming flights 
from the United States, Canada, and Mexico were processed through 
Terminal B at Ezeiza International Airport to better screen and 
control passengers.  The GOA also suspended direct flights from 
Mexico on Mexican airlines from April 28 to May 18.  A thermal 
screening device was installed to scan all passengers on these 
flights, and the MoH set up medical-sanitary teams to receive every 
flight.  These teams included personnel from the Border Health 
Agency, DINESA (National Direction of Health Emergencies), and 
Hospital Alejandro Posadas, all entities reporting to the MoH.  The 
Free Shop and cafeteria in Terminal B were closed.  Medical-sanitary 
measures were also implemented at the Jorge Newberry Airport 
terminal, the Retiro bus terminal, and the Buquebus ferry terminal, 
all in downtown Buenos Aires.  Thermal scanners were also installed 
at the airports in Mendoza and Cordoba.  On May 9, Border Health 
Agency units were reinforced with equipment and information packets 
in the provinces of Jujuy, Formosa, Mendoza, Corrientes, Salta, and 
Rio Negro. 
 
-- Isolation policies and quarantine of households where infection 
was identified:  A week-long voluntary isolation of the patient and 
household was implemented with the first case on May 7.  Thereafter, 
the MoH recommended to the population voluntary auto-isolation and 
social distancing. 
 
-- School closures:  Epidemiological research in the Esquiu, North 
Hills, and Caminante de Palermo schools (all of them in the Greater 
Buenos Aires metropolitan area) was completed on May 24, and on May 
26 all three schools were closed for one week.  Thereafter, in 
consultation with the health authorities of the City and Province of 
Buenos Aires and as a measure of prevention and control, the MoH 
directed that any school with a confirmed case would be closed for 
seven days.  This measure was later revised to require closure for 
seven days in the event of a suspicious case and for 14 days in the 
event of a confirmed case.  On June 30, again in consultation with 
local health authorities, the MoH announced the closure of all 
schools in Metropolitan Buenos Aires from July 6 through July 17, 
immediately followed by the normal winter vacations, lasting until 
August 3. 
 
-- Theater closures:  The Argentine Association of Theater 
Entrepreneurs decided on July 7 to close all theaters for 10 days. 
The measure was rescinded on July 17. 
 
-- Dance hall closure:  No measures were taken to this effect. 
 
-- Other closure:  On May 27, the MoH participated in a 
teleconference organized by the World Health Organization (WHO), 
focused on international experience regarding non-pharmacological 
measures such as the suspension of classes and events.  A couple of 
large shopping malls prohibited access to minor children in early 
July but rescinded the measure after four days. 
 
-- Staggered business hours to reduce congestion in stores and on 
transit systems:  There have been no recommendations to this 
effect. 
 
-- Mask ordinances:  There are no ordinances to this effect.  On May 
4, the MoH's Expert Committee recommended against the use of masks 
for healthy individuals but recommended their use for health 
personnel assisting respiratory patients, and for patients with 
respiratory illnesses who were being moved for diagnostic or 
treatment.  At the very beginning, masks were also recommended for 
people accompanying suspicious cases, but this was later restricted 
to just people belonging to groups at risk (pregnant women, 
hyper-obese, cancer patients.) 
 
-- Rules forbidding crowding of streetcars:  The MoH issued general 
advice about the use of public transport, but no regulations to 
affect or prohibit the use of public transport.  Our contacts at the 
MoH tell us that rules specifically designed to prevent overcrowding 
are currently being considered. 
 
-- Private funerals:  The MoH decreed that all H1N1 fatalities must 
be removed from the hospital in a plastic bag, and wakes involving 
H1N1 victims must be conducted with the coffin closed. 
 
-- Ban on door-to-door sales:  There has been no such ban. 
 
-- Interventions designed to reduce transmission in the workplace: 
The measures implemented by businesses have been voluntary and 
individual, with each workplace designing its own strategy of 
hygiene, cleaning and disinfection, in accordance with the 
recommendations made by health authorities.  On July 6, the Ministry 
of Labor granted two weeks of paid leave to public sector employees 
that are pregnant or belong to other groups at risk (respiratory 
illnesses, morbidly obese, immune-depression, cancer cases.)  The 
great majority of private sector businesses have done the same 
voluntarily.  On July 20, the Ministry of Labor Ministry renewed the 
measure until the end of the month. 
 
-- Protective sequestration of children:  After the closure of 
schools, the MoH recommended that children stay at home as much as 
possible and avoid crowded areas such as cinemas and shopping malls. 
 
 
-- Ban on public gatherings:  The MoH recommended that persons at 
risk avoid public gatherings.  The organizing committees of each 
public event (reception, conference, celebration, etc.) decided 
whether or not to suspend the event.  While most events still took 
place, attendance was generally lower than normal. 
 
-- Non-crowding rules in locations other than transit systems:  The 
MoH recommended that persons at risk avoid crowds. 
 
-- Community-wide business closures:  A few localities in the 
Province of Buenos Aires and in other provinces decided to close 
some types of businesses for a limited time. 
 
¶2.  As requested in reftel, Post also investigated and discussed 
with front-line health professionals the state of the health care 
system in Argentina, which overall appears to be holding up well. 
There is still a backlog on the diagnostic side throughout the 
country.  On the treatment side, ERs and ICUs were initially 
overwhelmed, especially in children's hospitals, as most of the 
early cases occurred in school age children.  Most cases are now 
adults, and hospitals seem to be coping better with patients' 
inflow, though logistics are still challenging for ERs.  More and 
more cases are now dealt with as outpatients, as people come in 
early and their symptoms are less severe.  The situation is much 
better in the City and the Province of Buenos Aires than in the 
other provinces, where there tends to be lower access to health care 
and less centralized guidelines for managing patients.  Because of 
the lack of timely information and lesser quality healthcare, 
patients in the provinces have tended to seek assistance later in 
the development of their illness, thus presenting more advanced and 
difficult cases that are taxing to the provinces' health system. 
 
 
¶3.  Flu cases were originally treated like the seasonal flu and 
treated with Tamiflu only when suspected or confirmed to have been 
H1N1.  The guidelines have been expanded to include all flu cases 
with certain minimal characteristics (high fever, respiratory 
difficulties), which are immediately treated with Tamiflu from the 
start.  Health professionals believe that this has helped to reduce 
the number of more serious cases.  The MoH initially planned to 
procure a supply of Tamiflu to treat five percent of the general 
population of about 36 million, but the goal has now been raised to 
10 percent.  MoH officials tell us that they have already 
distributed 800,000 treatment units, have another one million at 
hand, and are awaiting arrival within the next few weeks of an 
additional two million treatment units.  The MoH will soon announce 
that it will again supply pharmacies with Tamiflu.  (Note:  The lack 
of enforcement for prescriptions in Argentina makes it very easy for 
anyone to buy antibiotics or antiviral drugs at a pharmacy without a 
 
prescription.  As a result, auto-medication and widespread abuse of 
antibiotics and antiviral drugs are prevalent.  Health authorities 
readily admit that this has caused the Argentine population to have 
a lesser resistance to infections.  It is one of the reasons why the 
MoH initially centralized control of Tamiflu stocks.  End Note.) 
 
¶4.  Healthcare professionals are still trying to identify predicting 
factors for increased risks of mortality.  Physicians note that, in 
some otherwise healthy individuals, the virus triggers a severe 
immune response, provoking a sort of overload on the body.  This may 
explain why many of the fatalities have been young, healthy adult 
males.  Pneumonias develop quickly in certain patients, who can be 
critical after just three or four days.  Epidemiologists believe 
that the first 6-8 weeks of the infectious cycle has neared 
completion.  A second cycle may follow in early August, but hopes 
are that it may be less virulent than the first. 
 
KELLY