If you've been following the news, you know that U.S. officials are much more worried about the second and third wave of swine flu, which should hit here sometime in the fall. And if that happens - since we have so many people unemployed and without health insurance - I predict we will have people dying here, too:

"In Mexico, we are very unaccustomed to going to the hospital. Here, if someone has a cold or anything else, they buy something in the pharmacy, or they leave it be," Flores said. "This is why Mexicans are dying. Because we are very indecisive about going to a hospital until it's too late."

Several theories have emerged as to why all but one of the confirmed deaths from swine flu have occurred in Mexico. Much of it is speculation -- that Mexico City's 7,300-foot elevation exacerbates respiratory illnesses, that there may be a slight variation between the viral strain prevalent in Mexico and swine flu elsewhere, that Mexico is further along in disease transmission and other countries will eventually see severe cases.

But a critical factor, according to specialists here, is that flu victims have delayed checking into hospitals until their condition has deteriorated so much they cannot be saved. While medicines are plentiful and cheap at Mexican pharmacies, swine flu antiviral medication was often not available or prohibitively expensive.

"Some patients arrive late at the hospitals, and to a certain degree this is a problem of education," José Sifuentes-Osorio, an infectious-disease specialist at the National Institute of Medical Sciences and Nutrition, said in a radio interview Monday. "Many of our people, independent of their socioeconomic situation, self-medicate for three or four days, and they lose precious time."

What is clear about the outbreak is that the epicenter is Mexico City, a megalopolis of more than 20 million people where about a third of the population lives in poverty. As of April 30, when there were 397 confirmed swine flu cases, 285 of those people lived in Mexico City, according to the most recent available statistics from the Health Ministry. Of the 26 people it said had died of the virus, 20 lived in the capital.