Hungarian news sites report (HUN) on the “vaccine tourism” from Slovakia to the pharmacies at the border and news agencies confirm that Hungary doesn't plan to seal its borders with the neighboring Ukraine (see the latest GV post about Ukraine and swine flu here).

Observer, a Hungarian blogger living in Kyiv, wrote a post (HUN) about her trip to Budapest:

In Pest, I came home for one week. Arriving to Borispol Airport, I put on a mask: I got it in store from a Hungarian colleague and kept it for the airport. There were fewer people at the airport than on an ordinary Friday. […] The number of passengers has decreased, it can be seen from the traffic of the border crossing points, the number of those leaving the country decreased by 23%, and of foreigners entering by 40%.

The ground service crew was working in “maskara”, but most of the passengers weren't wearing masks. It had been part of our preparations, that we'd vaccinated ourselves with Hungarian serum (yes, I have read the enormous debate on the net about the Hungarian vaccine, I had called up two doctors in Hungary - none of them had dissuaded me - in my judgment the risk there [in Ukraine] is bigger than the risk of the Hungarian vaccine - I thought rather to face the latter). […]

One part of the “enormous debate” mentioned by Observer is between the authorities and general practitioner doctors. One of them, Gyula Keszthelyi MD, a family practitioner in eastern Hungary, attracted the attention by his blog (HUN) where next to writing about prevention (HUN), and informing parents (HUN) about their right of not answering the letters they get from their children's school - which imply they're obliged to vaccinate their children while in Hungary it's not in the category of obligatory vaccination - in several posts he pointed at the mistakes ÁNTSZ is committing in its vaccination campaign. This generated a movement against his functioning. A Hungarian weekly Heti Válasz published an article on his case:

[…] 50 years ago, Mr Keszthelyi would just have been a village doctor, quietly grumbling under his breath and complaining to the elderly ladies among his patients. Today - thanks to giulio.freeblog.hu, the debating website he set up - his influence on people is comparable to that of the Hungarian Pandemic Commission. Tens of thousands of laymen read his fuming remarks on the site. In addition, he is also a regular visitor adding comments to several internet forums visited by other members of the profession, where the contradictory actions of the government are critically analysed to the tiniest detail. Keszthelyi found himself in the middle of a whole movement, when Ferenc Falus, the National Medical Officer threatened him with a fine of HUF 1 million and the withdrawal of his license, because he refused to administer the state-provided flu vaccines for free. […]

It wasn't only Dr. Keszthelyi who raised the question of administration and of the origin of the Hungarian-made vaccines, but also a consumer protection-blog Tékozló homár had a post (HUN) on it:

[…] The hospitals and pharmacies, anyway, didn't want to receive the vaccines delivered without an expiration date, since it's illegal like that, but the stuff should be sold out if the state had already paid for it. […]

Dr. Gergely (Greg) Bognar, assistant professor at the Center for Bioethics at New York University also reacted (HUN) through his blog dealing with bioethics questions on the swine flu debate turned to party politics, and raised the thought of a big experimentation:

[…] According to fresh research, voters supporting the governing party are rather on the side of vaccination than those of the opposition. […]

Politicians helped a lot for the population in knowing the way about the question: while the prime minister and the minister of health care vaccinated themselves in public, Péter Szijjártó, the deputy-floor leader of FIDESZ [party in opposition now], “considering every circumstance” won't vaccinate himself. […]

Why is the set-up of things like this lucky? Well, the situation is that there's a big question mark related to vaccines against flu. The question is not whether they're harmful - experts agree that they're harmless - but whether they're useful, and if yes, then how far. Does the defense against the new flu really worth 6 billion forints for a society? How efficient are the vaccines against flu financially? […]

We can try with not doing a clinical examination, but vaccinating half of the population, and the other half not, and then keeping the tabs on how many are getting ill, or dying from these two groups. […]

But this kind of research is not free of ethical problems either. […]

I suppose, it's already clear where I'm leading up to. The Hungarian society voluntarily, with enormous self-devotion, by the wise encouragement of politicians started an experiment similar to the one in Tuskegee. The population is dividing itself into two groups by political party sympathy: one group is getting the vaccine, the other, as a volunteer control group, is not.

The experiment plan is very promising, since ten million subject in a research is fair enough to exclude every kind of disturbing circumstances, and the distribution following party sympathy is more or less random. So everything is given to get serious scientific results from the Great Hungarian Experiment!

So it's not by chance that the world is looking at us with great attention. Observers will be sent by the World Health Organization and the Centers for Disease Control and Prevention, prestigious periodicals as the New England Journal of Medicine, or the Nature, will report on the newest results. […]

According to Ukraine's Health Ministry (UKR), 1,031,597 people in Ukraine have fallen ill with “flu, acute respiratory illness and their complications (pneumonia, etc.)” between Oct. 29 and Nov. 9 - and 174 of them have died.

According to World Health Organization, whose experts are currently working in Ukraine, “public health measures recommended by the Ministry of Health of Ukraine across the entire country include: social distancing (school closures and cancellation of mass gatherings); enhancement of surveillance activities; increased respiratory hygiene; and continuation of the vaccination campaign against seasonal influenza targeting at risk groups.”

In the Ukrainian blogosphere, much of the discussion of the current medical emergency focuses on whether there are enough reasons to panic or not.

Maryna Reshetnyak, GV's Russian Language Health Editor, has just translated excerpts from one of the most widely read and discussed Ukrainian blog posts of the past week, written by Kharkiv-based pediatrician and author Yevgeny Komarovsky on Nov. 2. In his post (RUS), according to Maryna, Dr. Komarovsky has provided, among other things, “a balanced professional analysis of the flu epidemic” - and “shared his opinion concerning the hysteria surrounding the flu, the irresponsible appeals of politicians and the errors of public health officials.” Here is one of Dr. Komarovsky's assessments:

[…] If we double the number of people sick with the swine flu (since no more than half the people with the flu go to a doctor) and compare it with other death rates, we will see that the death rate is even lower than with the regular flu. Pneumonia is the most common cause of death in every country at any time. Pneumonia often accompanies many other diseases and traumas. If each case of pneumonia was reported by the media, nothing good will happen. […]

On Oct. 29, the day the epidemic was announced by Ukraine's Health Ministry, Lviv-based LJ user orestk carried out similar calculations (UKR) in an attempt to counter the panic:

In 2007, 205 adults died of pneumonia in Lviv region, in 2008 - 182 people. In the first nine months of 2009 - 105 people. There are 92 days in the last three months of the year. For the number of deaths to be no lower than last year, 182-105=77 more people have to die. That is, six people every week. And here we are having a panic attack because of four deaths (of adults, and there is one more - an 11-year-old girl) in the past week. Perhaps it's time to stop panicking? […]

Two weeks later, Lviv region has 74 flu/acute respiratory illness/pneumonia-related deaths, which makes it the hardest-hit region of Ukraine so far.

On Nov. 5, Natalia Zhuravlova announced (UKR) the launch of an interactive map of flu dynamics in Ukraine, as well as a number of other related widgets, on the blog of the Ukrainian branch of the Russian web portal Yandex. Here is an excerpt from her introductory post:

Because of the epidemic, various scary rumors have been spreading rapidly in Ukraine - that we are having atypical pneumonia, or that we are having lung plague, or that there are more lethal cases due to swine flu than due to regular flu. The data on the dynamics of the disease often varies [significantly].

We at Yandex choose to look at things with calm. Yes, of course, we do not want to fall ill ourselves and are worry a lot about our dear ones. But we get flu epidemics every year, and each time we are told that there hasn't been a more horrible strain, but we are still alive and healthy (knock on wood). The most important thing is that actually the numbers of those sick with flu and acute respiratory infection aren't really high, they haven't reached last year's level yet. Unfortunately, people were dying from these diseases in the previous years, too, only no one was making the statistics public. So we should not panic. And, moreover, we should not trust the unconfirmed data.

So that our users could follow the official statistics of the spread of the disease and knew where to go to for consultation and help, we've developed several useful devices.

[…]

With the help of the map and the widgets, you'll see when the epidemic begins to subside. We hope that this will happen as soon as possible.

Stay healthy! And if you're feeling sick, call the doctor. And everything will be okay.

In a post about the flu info service offered by Yandex (UKR), Ukrainian Watcher - a blog covering “social networks, blogs and internet business” - also mentions Google.org's Flu Trends portal, which “uses aggregated Google search data to estimate flu activity.” According to this resource, “flu activity” is currently assessed as “high” in Ukraine, Hungary and Poland, and as “intense” in Russia and Bulgaria.

While Belarus is not being monitored by Google.org's Flu Trends, here is what LJ user budimir wrote (RUS) on Nov. 3 about the situation there in a comments thread on a post by Kyiv-based LJ user kermanich:

[Here] they are using good old methods in their attempts to fight [the flu outbreak] - by hushing it up. They are not allowing any information whatsoever, even the most necessary.

And the panic is raging here already. Maybe even more than in Ukraine.

[…]

EVERYTHING that is even distantly related to the treatment of flu has been swept away from the pharmacies.

And yes, Minsk is wearing masks. No one is explaining to Minsk residents, however, that it is not necessary to wear masks outdoors.

[…]

In my work-related [RSS feed] that I got myself when I started doing reviews of the Belarusian blogosphere, nearly every second post is about swine flu.

There are also plenty of reports from friends and friends' friends, who are saying that “people are burning down like candles.”

And there is some first-hand info - from hospitals. [The situation is grave] there, as far as I understand.

[…]

They aren't blogging about Ukraine here, are focused on local matters instead. […]

But the government, it seems to me, is trying to portray Ukraine as the source of the infection - the first officially confirmed swine flu death of a Belarusian citizen turned out to have its origin [in Ukraine].

But this is a lie - there have been more deaths. Not from flu, of course - because they don't die of it, but of its complications - pneumonia, etc.

[…]

Here's how blogger Ivanko of Fructus temporum described the situation in the Ukrainian city of Kramatorsk (pop. 173,700; Donetsk region, where, as of Nov. 8, 48,263 people have been officially confirmed to have flu) in this Oct. 31 entry (UKR):

[…] First of all, lines in pharmacies. Not too long, some ten people on the average, but considering that we have a pharmacy every 20 meters, and sometimes pharmacy kiosks stand right next to each other, it was hard not to notice such a sharp increase in demand.

After my question, “What's happened?”, people looked at me as if I… well, they looked at me unkindly.

After I learned the reason of the anxiety, I decided to buy Amizonum and Oxoline ointment [anti-viral drugs popular in Ukraine], because I didn't remember if we had them at home.

But I was too late. Amizonum had been sold out the day before, they've run out of gauze masks today, and bandages were almost gone, too. The pharmacist was dispensing her expert opinion on how to make two gauze masks out of one bandage.

I stopped by at a few more pharmacies - same thing everywhere.

[…]

Today, people were even lining up to buy medicinal herbs from an elderly lady [at the local market].

I don't know, maybe things are really that bad?

Then again, my neighbor still has a sack of overpriced salt that she bought during the latest salt anxiety. [At some point, there were false rumors in Ukraine that salt would disappear from the stores, which urged many people to store up on it in advance.]

And here is what LJ user e_grishkovets (Russian writer Evgeny Grishkovets) wrote on Nov. 5 about Kyiv, Ukraine's capital, where his shows were canceled due to the flu situation:

[…] In general, I can't recall Kyiv ever being in such a gloomy, suppressed and exhausted state. Though, of course, it would have been hard for me to perceive the city differently, considering the problems that have occurred.

[…] Theaters are closed. Ministry of culture has made this decision. But events scheduled to take place in sports facilities have not been canceled… The concert of Todes dance group at some palace of sports hasn't been canceled, a football game took place at a huge stadium yesterday, and today there is Aleksandr Rozenbaum's concert […], at the Ukraina Palace (4,000 seats). […] If someone could explain to me why these events are taking place while the theaters are closed… Where is the logic here, where is the truly thoughtful and well-justified fight against the epidemic?… […]

[…]

On my way to the airport, the driver said that for the fourth day in a row there were no traffic jams in Kyiv, and there are a lot fewer cars and people in the streets. “Everyone looks kind of beaten,” the driver said and smiled bitterly. […]

On a lighter note, Ukrainian women's organization Femen held an “anti-stress” event at Kyiv's Independence Square on Nov. 9: to cheer Kyiv residents up, a group of activists put on self-made gauze lingerie and masks. LJ user drugoi (RUS) has posted three photos from the event, and there are six more photos at Femen's LJ blog (RUS). (Natalia Antonova's Sept. 11 interview with Femen's leader Anna Gutsol is here.)

While the undressing part of Femen's prank may or may not have been an allusion to the Nov. 2 protest against Ukraine's anti-pornography law (WARNING: graphic content), carried out by the Voina radical art group, the masks do seem to be turning into a fashion item in Ukraine: here, for example, is a selection of user-designed masks on sale at one of the Ukrainian online shops. And here's a link to LJ user ellustrator's gauze mask cartoon, which may or may not allude to this photo of PM Yulia Tymoshenko wearing a mask.

As Global Voices Russian Language Health Editor, Maryna Reshetnyak spends most of her time covering the Kiev-based Rising Voices grantee project, The Drop-In Center. She also blogs on Global Voices about discussions in the Russian-language blogosphere related to health, most recently about the swine flu hysteria in Ukraine. In this video she describes her first meeting with Rising Voices grantee, Pavel Kutsev, and recalls her life as a graduate student in Delaware, USA.

Transcript

I am Maryna Reshetnyak and I live in Odessa, Ukraine.

David: And what do you do for Global Voices?

Maryna: I am the Russian Language Health Editor for the Rising Voices project. Basically, I cover the Drop-In Center project. This project unites a group of people who are leaders in the Ukrainian harm reduction movement. They are living with drug addiction themselves. They are on substitution therapy so each day to live a normal life they need to take methadone. And they blog about this. They blog about the problems they have. And actually the blog helps them to lobby and advocate to the health care authorities in government and I cover this project.

David: Today, for the first time, you met Pavel of the Drop-In Center … this blog that you've been translating for almost a year now, right? What was it like to meet in person for the first time after you had met him online?

Maryna: Surprisingly, when I met him, I met the person I expected to meet. It seems that by reading everything that he writes, it allowed me to know him very very well. It seems like, you know, that I met an old friend. I spent two years in the United States of America doing my Master's program in Public Administration at the University of Delaware. So I spent two years of my life in the fantastic place of Delaware which I miss a lot. Also I spent three months doing my internship in Washington D.C. And I also like this place a lot.

David: So when you were living in America, what were some of the impressions that Americans had of Ukraine?

Maryna: They have the impression that it is very cold. I don't know why, but everybody though that it is very cold.

David: It is very cold!

Maryna: One pretty educated person … asked me once if I miss the northern lights. I was like, no. I live in Odessa. It is really warm there and we have nice beaches. Yeah, this is the only think they knew about Ukraine is that it is very cold but I did my best to explain to them that Ukraine is also a very beautiful country full of culture.

David: What are your impressions of Global Voices?

Maryna: Well, it's a fantastic project. It's really great to feel myself to be a part of a network of more than 200 people from all over the world doing the same job. And I'm really proud to be a part of that team. It means a lot to me.

Initially, health care officials denied the fact that people were dying because of swine flu, saying that the deaths had been caused by an unknown infection, which led to pneumonia. But the thought of an “unknown infection” scared the public even more. Later on, officials admitted that there was an H1N1 epidemic starting in Ukraine. The result? People rushed to drug stores and soon after pharmacies were out of stock of face masks, vitamins and immunity-boosting supplements.

Inconsistency in health officials’ reports, plus a lack of information, created many rumors and much gossip. And Ukrainian politicians saw the epidemic as another opportunity to appear on TV and boost their image. Major TV channels ran 5-hour talk shows focused on the flu that were filled with politicians, many of which featured not a single person with a medical education.

In this environment of “collective madness,” the Internet has served as a medium for unbiased information about the epidemic, as well as professional advice on what to do and how to protect yourself and your family from the virus.

A balanced professional analysis of the flu epidemic by Dr Komarovskyy, a well-known pediatrician with more than 30 years of professional experience, was posted on his personal Web blog. This was perhaps something people were waiting for, as the post was widely sent around and has appeared on popular forums and social networks. It was also republished by major Ukrainian Internet media such as Ukrayinska Pravda. In a few days, the post got about 900 comments from readers.

At the beginning of the post, Dr Komarovskyy explains what forced him to turn to the Internet to tell the truth about the flu. He says:

I had planned to write about the flu in a few days, after I'd received adequate and objective information. But then, I received a phone call from my fellow nurse…Her boss had ordered her to bring three face masks the next day. When she asked where she could find the masks [drug stores were out of stock], the boss gave a response that reflects the Ukrainian reality “The night is long, so you can sew them.” This was the last straw for me, I realized that I cannot stay silent anymore, I need to talk.

In fact, on Friday and Saturday the only thing I did was talk. My cell phone registered about 850 phone calls on these days. I responded to questions, calmed people down, explained things…I understood that if my friends and patients (people with theoretical and practical knowledge in the treatment of viruses) were in panic, the general situation was a total disaster.

On Friday I talked to one of the managers of a TV channel from Kharkiv. I found out that there was not a single chance to talk to the people of the city. All the air time was filled with politicians. At night there was a Savik Shuster political talk-show focused on the flu epidemic. Perhaps, for me it was one of the biggest shocks of the last few years. I do not remember myself being so much ashamed of my country…On Saturday, naïve me called Kiev. I said that I am ready to come, that I am ashamed, that we need to calm people down, that what is going on is a national shame… People tried to help but were not able to. For me it is clear. The flu and elections are not compatible, like the flu and Aspirin – it might cause many side effects.

A significant part of Dr. Komarovskyy's post was devoted to medical aspects of the flu. He professionally summarized facts about the ways it is transmitted, its symptoms and treatment. With a good sense of humor he went through the common misconceptions about treatment of the flu. In addition, Dr. Komarovskyy gave tips on how to prevent the flu.

In the next part of the post Dr. Komarovskyy shared his opinion concerning the hysteria surrounding the flu, the irresponsible appeals of politicians and the errors of public health officials. He pointed out:

During the first two days of the hysteria, the main advisers and teachers for the nation were politicians – parliament members, ministers, former ministers, etc. When a doctor appeared on TV, it just so happened that the politicians could talk better…The highest point of the panic was after a claim by a presidential candidate (!) that the deaths of Ukrainians were being caused not by a flu, but by a pneumonia-inducing plague. I want to highlight, this was not said by an old lady selling sunflower seeds at the market, but by a presidential candidate of a European country.

Another presidential candidate complained that drug stores did not have enough Oxolin ointment in stock [which in Ukraine is believed to be effective in prevention of the flu] and blamed this on “criminal pharmacists.” For some reason, nobody was able to explain to the candidate that the effectiveness of this ointment is not clinically proven and has never been used in the USA or France or any other country.

OK, there are no doctors among the presidential candidates and perhaps they cannot afford a public health adviser. But a few of our politicians have a medical degree! One of them mixed up Theraflu with Tamiflu [the only medication proven to be effective against H1N1]. The other one did not see any difference between regular and viral pneumonia…But when I heard a doctor – a Parliament member and a secretary of the Parliament's Public Health Committee - say that Tamiflu is just an immunity booster and that at a meeting of National Security Council they decided to purchase Oseltamyvir instead I became really scared and ashamed. When major public health decisions in this country are being made by people who do not know that Tamiflu and Oseltamyvir are two names for one medication – what can we expect? …Thus, we should not be surprised by the fact that the government is purchasing medication that are not used anywhere in the world.

My advice to the government: Ask WHO [World Health Organization] experts to provide you with a list of required medications.

Dr Komarovskyy finished his post with a general assessment of the flu situation in Ukraine:

If we double the number of people sick with the swine flu (since no more than half the people with the flu go to a doctor) and compare it with other death rates, we will see that the death rate is even lower than with the regular flu. Pneumonia is the most common cause of death in every country at any time. Pneumonia often accompanies many other diseases and traumas. If each case of pneumonia was reported by the media, nothing good will happen.

We are unlucky to have these together: the [economic] crisis, the elections, the fall season and the flu. But we know for sure that sniffing, coughing and a high body temperature is influenza [the flu], a common disease that is relatively easy to treat. It requires self control and certain actions, which everybody can afford.