Medical staff at the Kandahar Air Field fear the pandemic influenza has infiltrated the base where Canadian soldiers are stationed in south Afghanistan.
The illness, which has spread to most countries of the world and has infected thousands of people in Canada, has been mild so far. But the brewing pot that is the military hub for NATO force in this part of the country presents special challenges.
The population is largely of the age that has proven susceptible to the virus, there is a transient work force that is constantly bringing disease in and out of the region, and the medical resources - while state of the art - are finite.
"I can't prove that it's here, but I suspect that it's here. Afghanistan has already recorded some novel H1N1 cases, so we can assume that it's here," said Lieutenant-Colonel Ron Wojtyk, a Canadian military surgeon and the head physician at the base's NATO hospital.
People who live within the wire confines will tell you that there is a bad bug going around. Those who fall ill develop a fever and a cough, the defining symptoms of the pandemic H1N1 virus.
The epidemiological program used by NATO forces around the world has shown no increase in the incidence of influenza. But medical workers say they are seeing more people with respiratory infections.
"We don't have the testing capability here to determine whether it's the novel strain [of influenza]or not," Dr. Wojtyk said. "We have sent samples of some of the cases of H1N1 that turned our quick test positive for Type A influenza [to Germany for verification]but we haven't got any positive results back. That could be because they were not in fact novel 2009 H1N1. Or it could be that the samples just didn't make it intact enough to render the test positive."
The mortality rate from the pandemic disease is about the same as the seasonal flu, but medical experts fear it could mutate into something more deadly this fall. That's what happened in 1918 when another H1N1 virus, called the Spanish Flu, killed 50 million to 100 million people worldwide.
That flu swept the globe at the same time nations were fighting the First World War. And, like the current disease, younger people were especially prone.
As a result, the 1918 virus was easily transmitted among soldiers living in trenches. And it returned home with them from the front, accelerating the spread of the deadly virus.
When the current pandemic virus was first discovered in Mexico in March, the medical experts here in Kandahar imposed restrictions to keep it outside the base.
People coming into the air field were surveyed for the disease, those who developed suspect symptoms were isolated, and Mexico was banned as a destination for troops on leave.
But those precautions have since been abandoned.
"Once it spread to Canada, the U.S. and Europe and pretty well everywhere else, we got rid of that. So we have been changing the plan," Dr. Wotjyk said.
The base has instead adopted the precautions recommended by the Public Health Agency of Canada - frequent hand-washing and self-isolation for those who fall ill - and Dr. Wotjyk is rewriting the protocols that he will soon submit to the base commander for approval.
Since most of the military personnel share rooms with someone else, roommates will be warned to wear masks if the person in the next bunk falls ill. Mass gatherings may eventually be curtailed. And the education program will be stepped up.
If someone develops symptoms so severe that they require hospitalization, they will be treated at the Role 3 medical facility on the base and then evacuated to their home country. The hospital has a fully equipped intensive unit and can look after influenza patient until they are shipped out.
But "if it really gets nasty, like the Spanish influenza, then we would have to consider some very difficult decisions on who gets the ventilators," Dr. Wotjyk said.
In the meantime, he is not overly worried by the fact that the people living on the base are of the age that has been hardest hit by the virus in Canada.
"Our population is very healthy in the main," Dr. Wotjyk said, "so they would probably be less susceptible to it than people with chronic illness who are the ones that seem to suffer with it the most and the ones who end up dying from it."