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  • Mexico's Health Minister's Situation Report

    May 11, 2009

    Stenographic version of the press conference chaired by Dr. Jose Angel Cordova Villalobos, Minister of Health Federal, Julio Sotelo Morales, head of the Coordinating Committee of National Institutes of Health and High Specialty Hospitals and Arzoz Jacqueline Parent, owner of Unit Economic Analysis, to provide information, to this day, regarding the virus AH1N1;

    thing done this morning in the courtyard of the Central Secretariat.

    GRADUATE CARLOS OLMOS Tomasini, COMMUNICATIONS DIRECTOR GENERAL OF THE MINISTRY OF SOCIAL HEALTH FEDERAL - Good morning, everyone. Chairing the press conference, Dr. Jose Angel Cordova Villalobos, Secretary of Health. Dr. Julio Sotelo Morales, head of the Coordinating Committee of National Institutes of Health and Hospitals High Especialidad.Y Dr. Jacqueline Arzoz Parent, head of the Economic Analysis Unit of the Ministry of Health.

    Dr. Jose Angel Cordova Villalobos, Minister of Health FEDERAL -: Good morning, as always, on everyone.

    I want to take, first, to send a greeting to all mothers of the country, including those found myself at the time were working in hospitals in Hidalgo and San Luis Potos?.La true professionalism of the people who working in the sector has been exceptional.

    Secondly, I would also point out that we continue to work in the processing of evidence and, well, she will have an apparent jump in the number. However, this is what we have progressed further and you will see that the curve in its distribution and has barely fallen.

    We have until yesterday 2 mil 59 confirmados.La curve still shows the same trend. This is the national curve in which most of the cases presented. On April 26, 281, and there has been progressively reduced as we approach the cases to the current date.

    Of those confirmed cases, 2 of 59 thousand, 28.4 percent is the total samples. Have already processed more than seven thousand samples in the country and the percentage of positive samples was lower in women than in men, 49.3 are from the total samples, against 50.7 for men.

    We also continue to see this trend to the greatest number of positive cases found in the first 19 years of life and gradually decreases under age.

    In the case of deaths, we have confirmed 56 deaths, corresponding to a 2.7 per cent of all confirmed cases with influenza AH1N1.

    Also, the ratio between women and men has been declining. We have 58.9 percent are women, and the remainder, 41.1 for men. And we continue to see this trend of increased number of deaths in people between 20 and 49 years of age.

    This is the distribution by sex and age. As we have already mentioned, most of the female, but is actually a trend towards equalization.

    Then, ages, where 82.1 percent are those between 20 and 54 years and the dates on which they were followed the deaths.

    You can also see here that matches the largest number of deaths on April 25 and tends to be a progressive decrease in the number of casos.Los last two were confirmed on May 6.

    Again comparing the probable cases, the dotted line against the confirmed cases in the red line, we see this downward trend.

    There is an apparent plateau on days 2 to 4, May 6, was included because other clinical data in order to register all these people with probable or suspected persons, which was the presence of odynophagia.

    This epidemiological and statistical grounds, but in reality was just a few days and came back down again The activities of the Caravan for Health, as you know, are devoted to visiting the homes where deaths have occurred and to locate strategic centers to provide access to information to any person requesting it, provide medical care and rapid testing.

    So far 174 have been dealt with 212 thousand people and have 18 thousand 998 consultations have been carried out; 628 rapid tests, of which 550 were negative and 78 positive.

    The distribution of cases by state is there. Remains roughly the same distribution. The states still have more cases are the Federal District, in the first place, Hidalgo, San Luis Potos?, Veracruz, Tabasco and Tlaxcala, with more than 50 cases.

    And then, well, there are other states with fewer cases. Now only three states where there has been no confirmed case. This weekend, Sinaloa, who did not have one, was a case was detected and confirmed a caso.Y Baja California Sur, Campeche, Coahuila and, so far there have been no confirmed case.

    You can see in this chart is how the world has spread the influenza virus. Which is already present in 29 countries where the United States already has 2 thousand 532 cases as of today and practically most of the Americas, the countries of the Americas, unfortunately afectados.Tambi?n are European countries and countries in the Middle East and Asia Pacific.

    The behavior of the epidemic continues to decline at the national level. As I said, the peak was April 26. 2 We have the 59 thousand cases

    The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

  • #2
    Re: Mexico's Health Minister's Situation Report

    CARLOS MANUEL RODRIGUEZ (BLOOMBERG NEWS) -: Doctor Cordoba: And that we are seeing how has propagated to other countries, if it considers that the WHO would have to make a revision of the limitations of trip in its different stages, if it thinks that more was due early to have done, or if there is something there could be fit'

    DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: The WHO is continuous combat ready, just as all we. And the WHO has its group of world-wide experts, who meet with certain regularity and is where indeed they have determined the phases of the contingency for the world, because we know that this does not depend on the situation in one or the other country, but of the presence in one, or several countries, or continents.

    They analyze it continuously to this and they are they whom they establish or they determine the change of the phases and the complementary actions to take. Until now we have not known that a determination of restriction of trips to the foreigner on the part of the WHO has existed.

    CH?CTOR FIGUEROA (CHAIN 3) -: Today the return to classes occurs and it had said to us in another conference that could this cause certain piquitos, registering itself greater number of cases. When we will be able to know if this incidence occurs; at what moment; the next week; at the end of this one; if those piquitos by the return to classes and dice have been registered also that was the Day of the Mothers yesterday?

    And, by another part, how not to also politicize this. In Jalisco, concretely, the PRD, in that state is accusing the secretary of state health, even of fraudulent homicide by the three cases that supposedly would be by influenza human. How not to politicize this of one or another side, in the political scope?

    DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: , First good, all the strategy, the return to classes has been implemented H?ctor. We are working it with Lujambio Secretary. We were yesterday here until almost the average night, reviewing the manuals and everything what implies, mainly the monitoring epidemiologist, who is most important.

    That is, the familiar filter is going here to be fundamental and soon the scholastic filter. The small ones that is detected that they have respiratory sintomatolog?a, are going to be directed with their parents to the nearer center of health, than they depend on a sanitary jurisdiction in all the country and who they are going there to be taken care of and according to the clinical criterion of the guides who have distributed themselves to all the doctors of Mexico, it can the doctor make a decision between trying or not trying; the picture corresponds or it does not correspond; to take sample or not to take sample and to be able to give a pursuit to us those small ones that they have been referred the units of health - or greater, all are not small, those of preparatory and the university ones already returned--, I talk about all the students who have been referred, to see in what percentage this is happening and if there are new cases that they have been confirmed.

    Then this, in the next days, is going to indicate, to give a tendency to us of how he is this conforming.

    I was the Saturday last in Guadalajara. We were reviewing the cases. We were in the laboratory of public health. We were also in the General Hospital of the West, that is in Guadalajara.

    And I consider, just as she happened, yesterday who I visited San Luis and Noble, that the states have worked very well. The problem that was at the outset, was the information flow nothing else.

    Now, in many cases one has accused to them that they had not reported the cases. Good, which happens is that, just as as happened to us, at the outset it was spoken of provable suspicious cases. And they are receiving the information daily.

    And certainly in Jalisco a little began later, the maximum tip; or the maximum tip of the bud occurred a little later.

    More nevertheless, we have already studied the majority of the cases that have sent us the samples, they have 31 confirmed cases and is in study process if the cause of the death of the three people were this who passed away.

    I want to remember to them that every year unfortunately they die around 9 thousand 500 people by neumon?a in Mexico and that many of these neumon?as are associates, or they were associate to influenza seasonal. Now, some of these are associated to influenza by virus AH1N1.

    Then I believe that there is to be very cautious until all the scientific evidences are not had, to be able to make some affirmations. And we will continue advancing in these studies and presenting them the public opinion. Thanks.

    LUIS ALBERTO MEDINA (IMPARTIAL DE SONORA) -: In Sonant a case in the sense that is occurring the governor and the authorities of health they are doubting the confirmations that you have given days in the last them.

    Specifically of the six cases of Sonant, the governor says who has serious doubts that they exist in Sonant, because they left negatives there and they send when them here, left positives. He would want to know his opinion on the matter and yes also to see if the authorities have communicated with you or to see what is happening in this case specifically in Sonant?

    DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: Yes Luis Alberto. I believe that it is very important to remember that the laboratories that have settled in the City of Mexico, have been altogether with the world-wide authorities. That is, it has not been we put the laboratory and we sent the results to them.

    One of the requirements for the validation of the tests is the certification that they must make the civil servants international.

    And from the first day that began to settle the machines and to run the tests, that it was Sunday 26 of April, from that day are with us companions of Canada, of the CDC of Atlanta and OPS/OMS.

    They themselves have participated the personnel yet who works in the INDRE, the installation of the machines, the process of extraction of the RNA of the virus, in the handling of the samples and the validation of the same.

    This process went away consolidating and it has been consolidated and it has had all the recognition of the WHO as far as his results.

    With the purpose of to be able to have a greater regional capacity for the diagnosis, laboratory assistants, chemicals or technicians of several parts of the country became qualified. And Sonant has been a state of which it has been privileged with this situation.

    Sometimes evidently like any laboratory test, it has some data that can fall simply in the uncertainty by the handling process.

    If a test is not taken suitably, the extraction of the RNA is not processed suitably, or it is not read suitably, can be read wrongly.

    Then already it is had here making this procedure, practically 15 days, and I insist, with the daily presence of all these people who come from the outside and which every day they make a quality control and that those cases where there is doubt are repeated and gets to be until 10 - 12 percent and is associated generally to the form as the sample were taken.

    Then it would be necessary to also see the form as this is being realized back in the state, even though certific?, already good, this are also employee of the people.

    ANGELS CROSS (PERIODIC THE DAY) -: Speech of suspicious cases, or one alarms, perhaps renewed in several states, particularly in Jalisco, but that are still not reflected in the statistics. And since days have commented us repeatedly in the last, because the tendency is to the loss.

    How we can be explained that back in the states where they have decided to maintain the suspension of workings, these measures of emergencia, if as I reiterate to him, there are no those data in the statistics? What is what it is happening there? I do not know if the information is no fluid, as you say; but also of for there is still no the confidence there here of which the measures of social distension have worked in the weeks in which he was effective.

    And to doctor Sotelo: It could comment to us with what amount is created east bottom of investigation and which are the initial goals that have considered in time terms to have results?

    DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: For that reason we have indeed initiated already this series of visits to the states. You know, like whom here they are present, that from 1998 centralized the services of health to the states.

    And each state, and this has occurred, and I mean it by far taste in more of the 95 percent to the states of the country, it has installed his Security Council in Salud.Ese Advice occurs with the managers or in charge of the public and deprived institutions of health of each one of the states. They make an analysis, as we do it here in the Council of General Salubrity and determinations are taken, trying follow the recommendations national.

    Nevertheless, it is certain, in many of the cases the increase of the suspicious cases, that there will be to see if really they are confirmed, of to some took them form to prolong these containment measures, that are the measures of social spacing, which by the way I believe that of a quite objective way the world-wide expert of the WHO showed you his efficiency and its effectiveness to them in all the country.

    Then this is what it has happened. They take to the statistics of the suspicious and probable cases and the statistics of the confirmed cases.

    And in some of these states, good, they have seen that in particular the suspects, have been no that so important reduction, although in the confirmed ones there has been yes it. And they have made this associated decision that we have respected, because they are really isolate cases; it is less than one third part of the states of the country.

    And, good, been also we have yesterday reunited, and the day before yesterday, with these advice to explain to them that we respected its decisions, but that we think that in the next days the analysis of the confirmed cases, they will give scientific evidences them to be focusing these measures in some municipalities, localities or zones even, of cities where he has all the validity and the justification that applies in these measures, but that probably in other municipalities no longer is so necessary to have these measures, but not to much less lower to the guard as far as the measures of prevention and to the monitoring epidemiologist and the medical attention.

    DOCTOR JULIO SOTELO MORALS, TO TITLE OF THE COORDINATING COMMISSION OF NATIONAL INSTITUTES OF HEALTH AND HOSPITALS OF HIGH SPECIALTY -: Angels: at heart, it is a splendid bottom. Perm?tanme to notify some to them, that I create are going to be very excellent for this scientific situation which our community has faced.

    The previous night to that east Committee was created, the Secretariat of Health then contributed to 5 million weights and the following morning the CONACYT other 5, to nominally create the Committee and that indeed worked like so.

    The past week that became the call, the concurrent bottoms that handles the health system simultaneously, with the participation of the great institutions of health and the CONACYT, with resources that are called matched up. By each weight that puts the institutions, it matches up it to the CONACYT with another weight.

    We have 83 million at this moment and the heading to communicate the community to him that is going to have what it is called, in an anglicism, “fast track”, its proposals and their protocols.

    Simultaneously they are being abriendo in all the bottoms of investigation that exist. As you know, you are several and of different amounts, special chapters on the part of the CONACYT to receive investigation proposals.

    To the question indicates that me of which they are the goals that have in this first stage, mentioned I to them, first, for the questions that are urgent to him to the Secretariat of Health which they are solved by the scientific community, were done the investigators to them and to all of them they are going away to sustain its projects logistically financial and.

    Which is the pathogenicity of this virus. Which is its infectivity, in specific immunological terms. Which is its antigenicidad, for the possible production of a vaccine. Which are the characteristics of immune response of the most susceptible guests to the infection.

    Which is the difference enters both antiviral that is effective, and we know that they are effective because tests have become test-tube. Obvious we do not know its therapeutic determinants in people who are a few of to be put under this therapy.

    The question that we are doing the pharmacologists to them, is which of both antiviral we are putting - them to compete-for that they say to us which is indeed its rank of therapeutic efficiency and in what cases works one, in what cases work another one.

    Like all the therapeutic world-wide one, as you know, once effective farmacol?gicos elements are had, is crucial to determine which is the effectiveness degree; the ministraciones, the therapeutic speed of resistance, alternatives. Any answer is not had until the moment on these questions and we are going surely it to have in a moment, thanks to the farmacol?gicos groups.

    Finally, one of questions that emerges constantly and that not exists answer, which is the degree of effectiveness of the vaccines that are elaborated against the virus of influenza, particularly against this agent. We do not have nor idea. We know that several of ep?tofes and antigenic determinants of the virus of influenza share and the vaccines produce immunogenicity against these ep?tofes.

    Nevertheless, we do not know in the configuration of a new agent, what as much can serve a vaccine.

    This is one of the most excellent answers of international the scientific community, to have departure points not only against this epidemic, but with any other emergencia of a variant of the virus.

    The last question that we are urgently doing the scientists to him, is which is the stability of this virus.

    Very unstable and very mutagenic virus RNA is virus. You will remember “H” and “B quickly” who have a good amount of variants. Variable and unstable, still much more much more much more mutagenic, they are all the virus of influenza.

    This particular virus of influenza, is urgent to know how to us what so unstable is, to be able to know if it is going away to maintain in the world, or is going to possibly disappear, since it has been the case of a good amount of congenes of influenza.

    These answers are urgent. All the scientific community is waiting for world-wide it. They are approaching also it and we hope that the Mexican scientists put their answer on these urgent questions.
    The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

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    • #3
      Re: Mexico's Health Minister's Situation Report

      ADRI?N FIGUEROA (CHRONIC) -: What day was the one of greater numbers of confirmed cases and until today, which is the reduction in percentage: 20, 30, 40 percent? I ask this to him, Mr. Secretario, because apparently yes it is certain, according to the scientific studies that have become of comparison, of which it can not have a sprout again of the virus by the measures. This could explain me and the second part of why there would not be a sprout again'

      DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: Yes Adri?n. The day that greater number of cases confirmed in the country, of global way, which I insist this has behaved different in some states, because it began here in the Federal District, the Valley of Mexico, was day 26 of April, with 281 confirmed cases until now. And the 6 of April appeared cases only confirmed three. Then this can give an idea of the proportion.

      The pursuit of the cases is the one that is going to allow the power to us to see if there is that tendency, is going to have a sprout again or no. As it mentioned to them, in several organizations of the Republic these tests are already being made, which facilitates the diagnosis.

      And by the way also I am useful to mention to them that the first time that was diagnosed in the United States was 15 and 17 of April. That is, they, only 10 days before were testing this for diagnosis, before M?xico.M?xico, in 10 days, could have the capacity that had the United States for the diagnosis of this virus.

      It is important because the first cases that were in the imperial valley, these children were referred towards the naval hospital of San Diego. In the naval hospital of San Diego - this was more by the end of March-to than they arrived went to say “is a virus “To”, just as what we were doing.

      And it also must have the work of the CDC, to be able to inform, I insist, 15 and 17 of April of this year, that was a virus different.

      Then, in relation to which it is had been mentioning, that if we do not have technology, that if the delay is enormous, the delay in relation to the diagnosis is 10 days; in relation to the diagnosis with the United States.

      And why this? Because one of the centers of reference and more important centers of reference for the investigation of new pathogens is the CDC, at world-wide level. Then it is necessary to develop, when it appears a new virus, the model that is called “to praimer”. Without this model the tests cannot be read that are appeared.

      But immediately, 10 days later, we were doing already it here.

      EDUARDO CASTILLO (AP)
      -: Could comment us how many accumulated suspicious cases have and how many suspicious is day to day adding this? A little to have reference to that it said to us that in agreement they pass the days the states will have more information, more evidence of than could change.

      DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: I believe that this is a data that in fact it does not have as far as the number, the importance that has the confirmed ones.

      You yourself, in one of the graphs that I put to them, see how they have been diminishing the probable ones, in the same sense that has been diminishing the confirmed ones.

      Then the tendency of the reduction of the graph of both types of cases is similar, absolutely similar. That is evidently a greater amount between those than is only suspicious and that is important to recognize them, because there is to treat them immediately and that or later it will see if they are or not confirmed.

      JANNY VALENCIA (RADIO FORMULA) -: It would seem that already people forgot the contingency and also the recommendations are not taken care of absolutely the 100 percent. Consider you that will be necessary already to implement it like obligatory so that because the contagion can be contained? And also to ask to him that, good, as he is occurred an increase in the number of contagions to world-wide level, in case level 6 occurred, what would imply this for M?xico=

      DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: We have been trying to insist that although the containment measures have been made flexible, I mean, has started again the industrial activity, the economic activity and the scholastic activity in most of the country, this of no way means that the risk already happened and that the measures of prevention and promotion of the health must be avoided, like which there are been indicating systematically.

      The washing of hands, not to escupir to the floor, not to greet itself of kiss or hand. In aim all the measures that there are been insisting and that we are going to continue insisting because evidently this cannot be made by Decree or obligation for 107 million of Mexican.

      In this case, it is needed to create a new culture, salary brings back to consciousness and to obtain the cooperation of all.

      Yes we have spoken also on the use or it does not use of the muzzle plug in areas of agglomerations noncontrolled, as it can be a public transport, or closed spaces, yes are recommendable.

      In areas of controlled concentration, as it can be a hall classes, where they are the same children, the truth does not have as much importance because in addition if it is used bad, instead of to benefit, it can be detrimental.

      Level 6 determines the WHO to it in fund?n of which human transmission to persistent human in two continents is demonstrated. Then this can happen at any time, since Spain has already near 100 cases. And at the moment determines that it, the unique thing that it implies is the reinforcing of the measures that already have been reinforced here in Mexico.

      I insist: it is not to say to him: “country, you have qualification 6 and then you must make X or Z thing”, but she is, everybody, must reinforce its measures, including obvious the countries that we have a greater number of cases.

      But these measures already are had been doing and they are continued doing of permanent way until we enter control.

      BLANCA VALAD?S (MILENIO) -: Because the contingency already has spent several days, I want to know the transmisibilidad index that has this RO at the moment, this virus? Also, if it can need to us if there were or nonconcealment of data on the part of the states, or the rezagos to what states are belonging?

      Also, if a balance with respect to the days can do us that, since the contingency rose, how the virus has behaved? And, finally: what call does the politicians to him? I know that this corresponds to the IFE, but what call you to him to the politicians do who are using neckties, that are doing m?tines, greeting of kiss the people, ignoring totally these lineamientos?

      DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: Good, the index of transmisibilidad, Blanquita, are calculated based on the same evolution; based on the efficiency of the undertaken actions.

      We have reviewed it; the three types of action are those of containment, that basically talk about social spacing; those of prevention and promotion of the health, plus which we finished mentioning and those of medical attention.

      The objective is to take that index below one. This is changing and it is determined in function, based on the new cases that they are appearing.

      When there is east reduction, it is very probable that or it is below one and it is what gives a little the optimism indeed to think that we could be or in a phase of decrement towards the extinction of the epidemic, that anyway does not imply to relax the measures totally.

      Also we have indicated, the virus to it arrived to remain because it acquired this capacity of transmisibilidad of human to human.

      Doctor Sotelo mentioned does a little while. This virus could be the one that appeared the greater amount of cases during the next winter that it comes, replacing the virus of influenza partly seasonal, which by the way we have had until a 13 percent of cases, that it has not been AH1N1; he has been simply influenza seasonal “A”.

      I in no marry I have seen, verified much less, concealment of data. I believe that the states have informed into absolutely responsible way, of the suspicious cases that they have had, whereas they did not have another number what to inform.

      And now that is having or the confirmed data, where in some states either the 80 percent of the reported samples has 70, or, are moving towards that number, that is what is giving the more objectivity.

      But I do not have any element to think that there has been concealment of information far from it.

      I yes have insisted on which hopefully, hopefully! , and this like a political weapon is not used. We have been going to all the states that we have been able until now. We are going to continue visiting the others.

      And for us, Mexico we see common mind it without colors and without parties, because the worse thing than can happen to us is to politicize, to use this, or to send signals that are mistaken, simply to attack the government, since the recommendations and the instructions are had agreed with the group of the investigators and the scientists.

      Then yes I believe here that we must work all together ones with a same aim to manage to finish with this contingency.

      LAURA TORIBIO (PERIODIC EXC?LSIOR) -: Two precisions nothing else: One: in the graphs that have been showing days in the last to us, it appears the death of the 13 of April of the Mrs. of Oaxaca. But before there is a case the 10 of April and three the 11 of April. It would want to see if it could need to us from where are these four cases altogether?

      And, the following one. Right now being useful said that us that to the year 9 thousand 500 people by neumon?as die, she has the exact number of how many people die by neumon?a, but in this period of April to May, we say'

      DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: Yes Laura. I am going to give the data to him in relation to the first death by this virus that appeared. He was the 11 of April, as you to it indicate, in one of the national institutes of health.

      It was a pacientita of feminine sex, the Federal District, 9 years of age. This was first, where in already retrospective when doing the studies of all the samples, we could know that it was also by that cause. The 10 of April, are a feminine patient of 24 years who was seen in the D.F., in the IMSS.

      GERALD MARTINEZ (EFFECT TV) -: I want to ask two things very to him in particular: we have been 18 days of this contingency, since announcement 23 was made the past of April. Then I want to ask to him very in particular: To how much they promote the expenses that the Secretariat has done of Health and what it has happened with this bottom of emergencia of 5 thousand 200 million, how much it has been reduced to him?

      And, on the other hand, if what finishes confirming the Secretary of Property, Agust?n Carstens, the economic recession is going to beat to him, we say, to all these projects that the Secretariat of Health has to fight this epidemic?

      DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: The data are updating day to day. I would appeal to his generosity so that she allowed me to have the information, this one that now asks to me, and to be engaged in it at some future date, or to communicate it in the course of the day.

      Logically when there is a diminution of the income, because there is a diminution of the debits. And evidently in that sense I believe that the Secretary of Property talks about.

      What yes I want to emphasize is that the President of the Republic has not scrimped effort and nor support some to be able to give the elements us for the fight against this epidemic.

      I believe that we are going to continue having all this support until this is solved, as it is of satisfactory way.

      SILVIA GARDU?O (PERI?DICO REFORMA) -: Already exist confirmed cases of foreigners between these cases that we have? If it could give detail us on his nationality and in what state was when they were detected'

      And another question: It would be possible to be said that all the states already passed the tip of the epidemic? You said that, good, one third part of them suspended, for example, the classes. It would be possible to be tolerating of different way the curved epidemiologist in a state that in another one? What you must take certain measures in a locality that in another one and that are not all at national level?

      DOCTOR JOSE ANGEL CORDOBA VILLALOBOS, SECRETARY OF FEDERAL HEALTH -: Silvia: we have reported three cases in foreigners. Right now I do not have here the specific information, but they are three cases of which it has processed the INDRE here, that has been studied here.

      Evidently there have been more cases than they have returned to its countries and there it is where the diagnoses and the studies have become. Of those we do not have an precise information.

      We cannot still inform that all the states have passed the tip maximum because there are since it been commenting, the epidemic began in center of the country with greater intensity by the densidad of population, not on the other thing.

      That is, evidently the cities that have a greater population, because they have more risk. And later it has been extended towards other states.

      This depends on many factors, which can cause that in there is more and than in others is less and than the tip a little can be taken more or less.

      For that reason it is that it is so important that the monitoring occurs in all the country; that yes, at an excellence level practically because that is what it is going to allow to them the states to take some measures that are not generalized for all the country and which they are perfectly justifiable.

      If in a state, for example, they have a bud in X municipality, because they will have to analyze it, to see if they are several schools, or several zones and to decide if they close a school, two or three, or close all the schools of that place.

      Then here more since measurement general, that was a recommendation that we did at the outset when still we did not know the behavior of the virus, to those measures subjugates the local measures that can occur based on the evolution which they have in the states.

      They passed the information to me: they were two people of the United States and one of Scotland. Two of these cases took the samples in Canc?n and one in Noble.

      CARLOS LAWYER ELM TREES TOMASINI, CHIEF OF A MAIN DIRECTORATE OF SOCIAL COMMUNICATION OF THE SECRETARIAT OF FEDERAL HEALTH -: Thank you very much by its presence. Good morning.
      The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

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