Monday, April 27, 2009

Global race is on to contain swine flu outbreak

U.S. declares emergency as 20 cases confirmed; flu appears in Europe

Possible swine flu cases in New York
Workers cleaned St. Francis Preparatory School in New York on April 26, 2009 after the swine flu was confirmed in eight students, prompting the federal government to declare a public health emergency across the United States.
Daniel Barry / EPA
updated 6:42 a.m. ET April 27, 2009

WASHINGTON - The world’s governments raced to avoid both a pandemic and global hysteria as more possible swine flu cases surfaced from Spain to New Zealand and the United States declared a public health emergency. “It’s not a time to panic,” the White House said Sunday.

On Monday, Spain confirmed the country's first case of swine flu and said another 17 people were suspected of having the disease. Mexico, the outbreak’s epicenter with up to 103 suspected deaths, canceled some church services and closed markets and restaurants. Few people ventured onto the streets, and some wore face masks. Canada confirmed cases in six people, including some students who — like some New York City spring-breakers — got mildly ill in Mexico. Countries across Asia promised to quarantine feverish travelers returning from flu-affected areas.

The U.S. declared the health emergency so it could ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually need them — although, with 20 confirmed cases in five states recovering easily, they don’t appear to for now.

Eight high school students from St. Francis Preparatory School in New York are among those who fell ill in five states, including New York, Ohio, California, Texas and Kansas. Patients have ranged in age from 7 to 54.

Officials said several schools, including St. Francis, would be closed for days. In California, St. Mel's Catholic School will be closed until at least Thursday while health officials determine if a seventh grader has a flu linked to the outbreak. Near San Antonio, a high school in Cibolo will remain closed for at least the next week after two students caught the virus.

Government health officials expect to see more cases of swine flu here, including possibly serious infections, a senior official with the U.S. Centers for Disease Control and Prevention said.

“We expect there to be a broader spectrum of disease here in the U.S.,” said Dr. Anne Schuchat, interim deputy director for the agency’s Science and Public Health Program. “I do fear that we will have deaths here.”

But make no mistake: There is not a global pandemic — at least not yet. It’s not clear how many people truly have this particular strain, or why all countries but Mexico are seeing mild disease. Nor is it clear if the new virus spreads easily, one milestone that distinguishes a bad flu from a global crisis. But waiting to take protective steps until after a pandemic is declared would be too late.

“We do think this will continue to spread but we are taking aggressive actions to minimize the impact on people’s health,” said Dr. Richard Besser, acting chief of the CDC.

President Barack Obama’s administration sought to look both calm and in command, striking a balance between informing Americans without panicking them. Obama himself was playing golf while U.S. officials used a White House news conference to compare the emergency declaration with preparing for an approaching hurricane.

  Swine flu at a glance

Key developments Sunday on swine flu outbreaks:

— Deaths: 103 suspected, all in Mexico.
— Sickened: 1,614 in Mexico, suspected or confirmed; 20 confirmed in U.S.; 13 suspected in New Zealand; 6 confirmed in Canada; 7 suspected in Spain; 1 suspected in France; 1 suspected in Israel.
— Locations in Mexico: 17 states, including Mexico City, Mexico State, Veracruz, Oaxaca, Baja California and San Luis Potosi. Some, including Oaxaca, Mexico City and Baja California, have tourist areas, but authorities have not said where in these states the outbreaks occurred.
— Locations in U.S.: California, Kansas, New York, Ohio and Texas.
— Safety measures in Mexico: In Mexico City, surgical masks being given away on the subway system, public events canceled, schools and public venues closed and church services postponed. President Felipe Calderon has assumed new powers to isolate infected people.
— Safety measures worldwide: Airports screening travelers from Mexico for flu symptoms. China, Russia and Taiwan plan to put anyone with symptoms under quarantine. Hong Kong and South Korea warn against travel to Mexico City and three provinces. Italy, Poland and Venezuela advised citizens to postpone travel to affected areas of Mexico and the United States.
— Safety measures in U.S: Roughly 12 million doses of Tamiflu being moved from federal stockpile for delivery to states. Travelers at border being asked about travel to flu-stricken areas. St. Francis Preparatory School in New York, where eight cases are confirmed, will be closed Monday and Tuesday.

Source: The Associated Press

“Really, that’s what we’re doing right now. We’re preparing in an environment where we really don’t know ultimately what the size or seriousness of this outbreak is going to be,” Homeland Security Secretary Janet Napolitano told reporters.

Earlier, White House press secretary Robert Gibbs said the outbreak was serious, but that the public should know “it’s not a time to panic.” He told NBC’s “Meet the Press” that Obama was getting updates “every few hours” on the situation.

The CDC's Besser said that compared to cases in Mexico, “what we’re seeing in this country is mild disease,” noting that the U.S. cases would not have been detected without increased surveillance.

CDC officials said they don’t yet have basic information about how the virus spreads, including how many cases each primary case might create, or how long it might take for them to be infected. However, agency officials believe the virus is spreading person-to-person. In the U.S., all the patients have recovered and only one patient was hospitalized.

School officials at St. Francis in New York realized something was wrong Thursday when about 75 students showed up at the nurse's office complaining of fevers, upset stomachs and achy bones. The overwhelmed nurse's office had to make students wait on chairs in the hallway for care.

St. Francis is the largest private Catholic high school in the nation, with 2,700 students.

The school notified the city Health Department, and more students became sick Friday. Many were taken to a nearby hospital, but none had to be admitted.

Students began falling ill after a group of friends returned April 19 from Mexico, where they spent six days lounging around the beach and pool during the day and hanging out in Cancun at night.

Esti Lamonaca, an 18-year-old senior who made the Cancun trip, could hardly speak Sunday because her voice was so hoarse. She spent several days battling a fever of nearly 103 (39.5 Celsius) and was wearing a mask to prevent the virus from spreading.

"I haven't been out of my house since Wednesday and am just hoping to make a full recovery soon," Lamonaca said. "I am glad school is closed because it supposedly is very contagious and I don't want this to spread like it has in Mexico."

In Ohio, a 9-year-old boy was infected with the same strain suspected of killing dozens in Mexico, authorities said. The third-grader had visited several Mexican cities on a family vacation, said Clifton Barnes, spokesman for the Lorain County Emergency Management Agency.

"He went to a fair, he went to a farm, he went to visit family around Mexico," Barnes said.

The boy has a mild case and is recovering at his home in Elyria, in northern Ohio, authorities said.

Besser said he still can’t say why cases in U.S. are so much milder than the deadly cases in Mexico. There, the disease has killed up to 103 people and likely sickened more than 1,600 since April 13.

The World Bank said it would send Mexico $25 million in loans for immediate aid and $180 million in long-term assistance to address the outbreak, along with advice on how other nations have dealt with similar crises.

WHO to consider raising pandemic threat level
The World Health Organization and the U.S. were following a playbook of precautions developed over the past five years to prepare for the next super-flu. The WHO on Saturday asked all countries to step up detection of this strain of A/H1N1 swine flu and will reconsider on Tuesday whether to raise the pandemic threat level, in turn triggering additional actions.

Swine flu outbreak
Closing border ‘not something we’re looking at’
April 26: Homeland Security Secretary Janet Napolitano joins NBC’s Lester Holt to discuss the United States’ response to the spread of swine flu.

A potential pandemic virus is defined, among other things, as a novel strain that’s not easily treated. This new strain can be treated with Tamiflu and Relenza, but not two older flu drugs. Also, the WHO wants to know if it’s easily spread from one person to a second who then spreads it again — something U.S. officials suspect and are investigating.

“Right now we have cases occurring in a couple of different countries and in multiple locations, but we also know that in the modern world that cases can simply move around from single locations and not really become established,” cautioned WHO flu chief Dr. Keiji Fukuda.

There is no vaccine against swine flu, but the CDC has taken the initial step necessary for producing one — creating a seed stock of the virus — should authorities decide that’s necessary. Last winter’s flu shot offers no cross-protection to the new virus, although it’s possible that older people exposed to various Type A flu strains in the past may have some immunity, CDC officials said Sunday.

Worldwide, attention focused sharply on travelers.

In announcing the first known case in Europe, Spanish Health Minister Trinidad Jimenez said the infected young man had recently been in Mexico. Seventeen other cases are suspected in Spain, Jimenez said.

Nova Scotia’s chief public health officer, Dr. Robert Strang, said Canada’s first four confirmed cases were found in student travelers.

New Zealand said 13 students who took a school trip to Mexico “likely” had swine flu. A New York City school where eight cases are confirmed will be closed Monday and Tuesday.

China, Russia and Taiwan began planning to quarantine travelers arriving from flu-affected areas if they have symptoms. Italy, Poland and Venezuela advised citizens to postpone travel to affected parts of Mexico and the U.S.

The U.S. hasn’t advised against travel to Mexico but does urge precautions such as frequent hand-washing while there, and began questioning arriving travelers about flu symptoms.

U.S. to screen travelers at borders
The U.S. will begin screening travelers at the nation’s borders and isolating people who are actively ill with suspected influenza, Napolitano said. No travel restrictions are issued currently, but that could change, she said.

CDC officials said Sunday they would begin handing out “yellow cards” at airports with information about signs, symptoms and ways to reduce the chance of acquiring the virus.

Health officials said the facts of the outbreak don’t yet warrant testing or quarantine of travelers from Mexico, but that that could change if the situation gets worse.

Anne Schuchat reiterated that the outbreak can’t be contained.

“We cannot stop this at the border,” she said, adding: “But we think there’s a lot we can do to limit the impact on health and to slow transmission.”

“We think that slowing transmission can have an impact on health,” she said.

Past flu pandemics


The Spanish flu pandemic that started in 1918 was possibly the deadliest outbreak of all time. It was first identified in the U.S., but became known as the Spanish flu because it received more media attention in Spain than in other countries, which were censoring the press during World War I. The 1918 flu was an H1N1 strain — different from the one currently affecting Mexico and the U.S. — and struck mostly healthy young adults. Experts estimate it killed about 40 to 50 million people worldwide.


The 1957 pandemic was known as the Asian flu. It was sparked by an H2N2 strain and was first identified in China. There were two waves of illness during this pandemic; the first wave mostly hit children while the second mostly affected the elderly. It caused about 2 million deaths globally.


The most recent pandemic, known as the Hong Kong flu, was the mildest of the three pandemics this century. It was first spotted in Hong Kong in 1968 and it spread globally over the next two years. The people most susceptible to the virus were the elderly. About 1 million people are estimated to have been killed by this pandemic, an H3N2 flu strain.
Source: The Associated Press• Print this

MSNBC staff writers, NBC News, the Associated Press and Reuters contributed to this report.