Our Flu A (highly likely swine flu) count is now up to 8, 2 more coming in yesterday and being diagnosed by a rapid test, and the more I think about the Mexico death toll, the more likely it seems that a perfect storm of risk factors is responsible.  The most dramatic example of a perfect storm is a cancer called Burkitt’s lymphoma, common in Equatorial Africa but rare in African Americans.  It turned out that a combination of a gene mutation, malaria and Epstein-Barr virus infection is necessary to trigger it, and only in Africa do the 3 factors (each common elsewhere) come together.  The 1976 Swine flu outbreak went nowhere outside a basic training cadre in a military base — it is theorized that a packed-in crowd of stressed-out individuals created the fertile environment not duplicated elsewhere (outside of most middle schools I know).  And, the great mathematician Srinivasan Ramanujan, deprived of vitamins A and D by his dark skin, living in sun-starved England, and vegetarian diet, succumbed to tuberculosis after being thus weakened.  I have already mentioned my thoughts on risk factors possibly prevalent in Mexico; iron deficiency, in particular, is common in my patients from Mexican families, and may contribute as well.  I am sure that is being thoroughly investigated, and more than one risk factor may be responsible, delineating areas of concern for other countries.  In the meantime, we should go about out lives, washing our hands perhaps more often and going into crowds perhaps a bit less, and as for vitamin supplements — make sure A and D are in them.