SWINE FLU - UPDATES & USEFUL INFORMATION

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Frieden said that if the CDC confirms that the New York students have swine flu, he will likely recommend that the school remain closed Monday "out of an abundance of caution."

One factor, he said, is that the illness appears to be moving efficiently from person to person, affecting as many as 100 to 200 people in a student body of 2,700.

"We're very concerned about what may happen," he said, although he noted that the pattern of illness appeared different from in Mexico, where much larger groups of people have become much sicker. Overall, he said, flu cases have been declining in the city in recent weeks.

The school was being sanitized over the weekend but still was holding a reunion featuring cocktails, dinner and dancing for hundreds of alumni from as far back as 1939. A health department spokeswoman said the sanitization was just a precaution because it's not really the environment that passes the flu.

Alumna Joyce Kal, of the Class of 1979, said she wasn't worried about getting sick.

"I did think about it, but I didn't, you know, worry, because if it's the kids, I don't think it's going to linger," said Kal, a physical therapist from the Bayside neighborhood.


The city health department has asked doctors to be extra vigilant in the coming days and test any patients who have flu-like symptoms and have traveled recently to California, Texas or Mexico.

Investigators also were testing children who fell ill at a day care center in the Bronx, Frieden said. And two families in Manhattan had contacted the city, saying they had recently returned ill from Mexico with flu-like symptoms.

Frieden said New Yorkers having trouble breathing due to an undiagnosed respiratory illness should seek treatment but shouldn't become overly alarmed. Medical facilities in the part of Queens near St. Francis Prep, he said, had already been flooded with people overreacting to the outbreak.

———



Associated Press writer
John Hanna
contributed to this report
from Topeka, Kan.

Copyright 2009
The Associated Press.

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                                              US declares public health emergency for swine flu






           
WASHINGTON

– The U.S. declared a public health emergency Sunday to deal with the emerging new swine flu, much like the government does to prepare for approaching hurricanes.

Officials reported 20 U.S. cases of swine flu in five states so far, with the latest in Ohio and New York. Unlike in Mexico where the same strain appears to be killing dozens of people, cases in the United State have been mild — and U.S. health authorities can't yet explain why.

"As we continue to look for cases, we are going to see a broader spectrum of disease," predicted Dr. Richard Besser, acting chief of the Centers for Disease Control and Prevention. "We're going to see more severe disease in this country."

At a White House news conference, Besser and Homeland Security Secretary Janet Napolitano sought to assure Americans that health officials are taking all appropriate steps to minimize the impact of the outbreak.

Top among those is declaring the public health emergency. As part of that, Napolitano said roughly 12 million doses of the drug Tamiflu will be moved from a federal stockpile to places where states can quickly get their share if they decide they need it. Priority will be given to the five states with known cases so far: California, Texas, New York, Ohio and Kansas.

Napolitano called the emergency declaration standard operating procedure — one was declared recently for the inauguration and for flooding. She urged people to think of it as a "declaration of emergency preparedness."

"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 of seriousness of this outbreak is going to be."

___



On the Net:


CDC: http://www.cdc.gov

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                                                World 'well prepared' for virus 


                                WHO flu expert Dr Keiji Fukuda: 'The picture is evolving'






BBC NEWS
April 26, 2009

The international community is better prepared than ever to deal with the threatened spread of a
new swine flu virus, a top UN health chief has said.

Dr Keiji Fukuda said years of preparing for bird flu had led to improved stocks of anti-virals worldwide.

The World Health Organization (WHO) has warned the outbreak, which it says has killed up to 71
people in Mexico, could become a pandemic.

In the US, about 20 people are infected, but none are seriously ill.

US President Barack Obama was following the situation and has ordered a "very active, aggressive,
and co-ordinated response", White House homeland security advisor John Brennan said.

The latest eight cases to be confirmed were among New York students but "there is no need for Americans to panic," White House spokesman Robert Gibbs said.

The other confirmed US cases are seven in California, two in Texas, two in Kansas and one in Ohio.

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Passengers screened

H1N1 is the same strain that causes seasonal flu outbreaks in humans, but the newly detected
version contains genetic material from versions of flu which usually affect pigs and birds.





 SWINE FLU



Swine flu is a respiratory disease found in pigs

Human cases usually occur in those who have contact with pigs

Human-to-human transmission is rare and such cases are closely monitored





Q&A: Swine flu



UK monitoring swine flu outbreak 

The respiratory virus - which infects pigs but only sporadically humans -
is spread mainly through coughs and sneezes.






The WHO has warned the virus has the potential to become a pandemic, and has urged all
governments to step up surveillance.

Several countries in Asia and Latin America have begun screening airport passengers for symptoms.

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Suspected outbreaks



Although all of the deaths so far have been in Mexico, the flu is spreading in the United States
and suspected cases have been detected elsewhere:


 
Susan Watts, BBC Science editor

"The next few days and weeks will be crucial."



One possibly hopeful sign is that of the eight cases in the US there has been only one hospitalisation, and no deaths.


So it may turn out that there is some other kind of infection at work in Mexico, as well as the new flu virus.




Ten New Zealand students who were among a group which travelled to Mexico have tested positive
for influenza A - making it "likely", though not definite, that they are infected with swine flu, said
Health Minister Tony Ryall

In France, a top health official told Le Parisien newspaper there were unconfirmed suspicions that
two individuals who had just returned from Mexico may be carrying the virus

Spain's health ministry says three people who returned from a trip from Mexico with flu symptoms are in isolation and being tested

In Israel, medics are testing a 26-year-old man who has been taken to hospital with flu-like symptoms after returning from a trip to Mexico

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                                     US says not testing travelers from Mexico for flu







 WASHINGTON,
April 26, 2009
(Reuters)

- The United States is not testing airplane travelers from Mexico for the swine flu virus that has heightened fears of a possible pandemic, U.S. Homeland Security Secretary Janet Napolitano said on Sunday.

"Right now we don't think the facts warrant more active testing or screening of passengers coming in from Mexico," she said at a White House briefing.



(Editing by Patricia Zengerle)

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There is a very good possibility that Obama and his entorage were exposed to this in Mexico City last week
and brought it home.

An archeologist he shook hands with last week died with flu like symptoms.

The outbreak coincided with Obama’s trip to Mexico City on April 16.


Obama was received at Mexico’s Anthropology Museum in Mexico City by Felipe Solis,
a distinguished archeologist who died the following day from symptoms similar to flu,
Reforma newspaper reported….

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            British passengers screened for swine flu amid fears that disease has spread worldwide


British passengers returning from Mexico were being screened for signs of swine flu on Sunday night


                               amid fears that the disease has spread across the world.
 





By Caroline Gammell and
Auslan Cramb
26 Apr 2009
The Telegraph.co.uk

 More than 80 people have died in Mexico after contracting a flu-like virus.

Two travellers were admitted to a hospital in Scotland when they complained of flu-like symptoms
after returning from holiday in the country.

Alan Johnson, the Health Secretary, said Britain was on "constant alert" after the previously unknown influenza spread from Mexico to America and cases were reported as far afield as New Zealand, France, Spain, Israel and Canada.

Mexico City becomes 'strange zombie city' as residents hide behind doors He said he had no doubt that there would be more cases of travellers coming into Britain with flu-like symptoms and promised that they will be examined "very, very quickly" by the NHS.

More than 80 people in Mexico are believed to have died from pneumonia and respiratory illness linked to the virus. At least 20 cases have been confirmed as swine flu, also known as H1N1.

President Felipe Calderon called for calm as he said the majority of the 1,300 people who had complained of flu symptoms over the weekend did not have the virus.

In Britain, Mr Johnson advised all returning Britons who felt feverish not to go to their GPs or hospitals, but to stay at home and contact NHS Direct instead.

Last night, the Foreign Office updated its travel advice, warning visitors to Mexico to avoid large crowds, kissing and to maintain a distance of at least 6ft from other people.

As travellers arrived back at London's Heathrow airport yesterday, many were seen wearing face masks before being questioned by officials.

In America, The White House declared a state of public health emergency as they confirmed 20 cases
of swine flu across five states.

In addition, six cases were confirmed in Canada, 10 reported in New Zealand, four reported in France, six reported in Spain, one reported in Israel and two reported in Britain.

Virologists in Britain agreed that in the worst case scenario, an outbreak of the virus could lead to as many as 120 million deaths worldwide.

But they were also quick to point out that it was far too early to predict the scale of the problem and that the country is well stocked with Tamiflu, the anti-viral drug which has proved effective so far in Mexico.

Britain has stockpiled an estimated £500 million worth of anti-virals Tamiflu and Relenza, enough to treat half the population, according to John Oxford, professor of virology at Barts and The London School of Medicine and Dentistry.

Over the weekend, the World Health Organisation (WHO) warned of a "potential pandemic" as it launched a global emergency system to monitor the virus.

It is currently treating swine flu as a phase three virus, where there are sporadic outbreaks of the virus in humans, but there was growing pressure to raise the risk level to four, where there is evidence of community outbreaks.

Dr Keiji Fukuda, Assistant Director-General of the WHO's Interim for Health Security and Environment, said the threat level would not be increased until further tests were carried out.

"It is clear that we are in a period in which we have to be very careful to collect the best possible information.

"We really need to understand a little more about the epidemiology, we need to understand the behaviour of these viruses. I think it is fair to categorise the situation as serious."

The two tourists taken to hospital in Scotland suffered mild symptoms of flu but were admitted as a precaution and given anti-viral drugs.

The pair had not travelled to any of the areas within Mexico affected by the outbreak but are understood to have undergone a number of tests at Monklands Hospital in Airdrie, Lanarkshire after arriving home on April 21.

Nicola Sturgeon, the Scottish health minister, hinted at three other cases in Britain over the weekend which had all proved negative.

One was that of a British Airways cabin crew member who fell ill on a flight back from Mexico but was found not to have the virus.

Miss Sturgeon insisted there was "no immediate threat to public health" as she sought to calm fears.

But Professor Nigel Dimmock, a virologist and Emeritus professor of Warwick University, said it was unclear how much drug resistance this new strain may have.

"There is reason to be worried," he said. "The virus will travel and if it is, as seems, a new virus and people have no resistance to it, then there's nothing to stop it spreading from person to person and by various means around the world.

"It's poised on a knife edge. It could either burn itself out or it could get very nasty indeed - only time will tell.

"So far it has killed 2 per cent of those infected. In the worst case scenario it could kill 2 per cent of the world's population. "There have been three big pandemics of flu, one in 1918, one in 1957 and one in 1968. Fifty million died in 1918 and from the other pandemics, maybe a million. This flu has the potential to be bigger than Spanish influenza.

"You don't want to panic too much - it may go away. We have to hope for the best and plan for the worst."

Dr John McCauley, virologist at the National Institute for Medical Research, said the figure of 120 million was "not unreasonable".

Mr Johnson said Britain had been planning for potential flu pandemics for several years because of the threat of bird flu. The WHO rated Britain as one of the two countries best prepared for an outbreak, alongside France.

"We've got a whole range of measures in place. If you have flu-like symptoms, don't go to your GP but stay at home and call NHS Direct.

"The whole point about these kinds of epidemics is you don't want to spread them and you spread them by going out and mixing with other people."

The H1N1 swine influenza has combined - or "re assorted" - features of the pig, avian and human viruses.

As a new strain of influenza, it will take several months to create a suitable vaccine, but anti-virals will help control the symptoms, scientists said.

Symptoms include feverish illness accompanied by one or more of a cough, sore throat, headache and muscle aches, according to the Health Protection Agency.

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                                       World govts race to contain swine flu outbreak






Lauran Neergaard,
Ap Medical Writer
18 minutes ago
April 26, 2009
WASHINGTON

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

Mexico, the outbreak's epicenter with up to 86 suspected deaths, canceled some church services and closed markets, restaurants and movie theaters. A televised variety show filled its seats with cardboard cutouts. 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 of people recovering easily, they don't appear to for now.

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 Centers for Disease Control and Prevention.

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.

"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.

In Mexico, soldiers handed out 6 million surgical-style masks to deal with a deadly flu strain that officials say may have sickened 1,400 people since April 13. Special laboratory tests to confirm how many died from it — 22 have been confirmed so far out of 86 suspected deaths — are taking time.

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.

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.

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.

"It was acquired in Mexico, brought home and spread," Nova Scotia's chief public health officer, Dr. Robert Strang, said of Canada's first four confirmed cases, in student travelers.

New Zealand said 10 students who took a school trip to Mexico probably had swine flu, and on Monday it said three students in a second group just back from Mexico probably have it as well. Spanish authorities had seven suspected cases under observation. In Brazil, a hospital said a patient who arrived from Mexico was hospitalized with some swine flu symptoms. A New York City school where eight cases are confirmed will be closed Monday and Tuesday.

China, Russia, Taiwan and Bolivia 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.

Multiple airlines, including American, United, Continental, US Airways, Mexicana and Air Canada, are waiving their usual penalties for changing reservations for anyone traveling to, from or through Mexico, but have not canceled flights.

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

___

Associated Press writers Mark Stevenson and Olga R. Rodriguez in Mexico City; Frank Jordans in Geneva; Mike Stobbe in Atlanta; and Maria Cheng in London contributed to this report.

___




On the Net:


World Health Organization: http://www.who.int

Centers for Disease Control and Prevention: http://www.cdc.gov

Homeland Security Department: http://www.dhs.gov

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                                                 U.S. Slow to Learn of Mexico Flu



                              Canadian Officials Knew of Rare Strain Before Americans Did





 
By David Brown
Washington Post Staff Writer
Sunday, April 26, 2009

U.S. public health officials did not know about a growing outbreak of swine flu in Mexico until nearly a week after that country started invoking protective measures, and didn't learn that the deaths were caused by a rare strain of the influenza until after Canadian officials did.

The delayed communication occurred as epidemiologists in Southern California were investigating milder cases of the illness that turned out to be caused by the same strain of swine flu as the one in Mexico.

In the wake of the 2001 terrorist attacks, the outbreak of severe acute respiratory syndrome (SARS) in 2003 and the more recent emergence of H5N1 bird flu in Asia, national and local health authorities have done extensive planning for disease outbreaks that could lead to global epidemics, or pandemics. Open and frequent communication between countries and agencies has been a hallmark of that work.

Whether delayed communication among the countries has had a practical consequence is unknown. However, it seems that U.S. public health officials are still largely in the dark about what's happening in Mexico two weeks after the outbreak was recognized.

Asked at a news conference yesterday whether the number of swine flu cases found daily in Mexico is increasing -- a key determinant in understanding whether an epidemic is spreading -- Anne Schuchat, an interim deputy director of the Centers for Disease Control and Prevention, said, "I do not know the answer to those questions."

As of yesterday, U.S. officials had reported 11 domestic cases, none fatal. Last night, Mexican health officials reported more than 1,300 suspected cases and 81 deaths "probably linked to the virus."

The earliest case found in Mexico was a 39-year-old woman who died April 12 of severe viral pneumonia in San Luis Potosi, a city of about 700,000 in central Mexico.


"That attracted the attention of the epidemiologist there," said Mauricio Hernández, deputy minister for disease prevention and health promotion in Mexico's Federal Department of Health.

The national Health Department surveyed 33 hospitals and uncovered about 120 cases, five fatal, of respiratory illnesses that appeared unusual. Initially, the investigators thought they were seeing an unusually severe outbreak of seasonal flu. Authorities urged hospitals to make sure their workers were vaccinated with this year's flu shot and advised physicians to treat flu cases with the antiviral drug oseltamivir.

On April 16 or 17, Mexico notified the Pan American Health Organization of the outbreak, Hernández said. The organization, based in Washington, is the Americas' branch of the World Health Organization. Spokesmen for both groups were not able to say yesterday when the influenza or pandemic planning offices at WHO's Geneva headquarters learned or were informed of the Mexico outbreak.

In recent years, Mexico has done extensive pandemic planning with Canada and developed a close relationship with the National Microbiology Laboratory in Winnipeg. Tests on virus samples from the Mexican patients suggested the strain was different from this year's flu. So on Monday, Mexican officials sent lung and throat swabs to Canada to be characterized.

The CDC, in Atlanta, is one of WHO's four "reference laboratories" for flu. It routinely gets samples from Mexico and many other countries, and processes them with great urgency, Nancy J. Cox, the head of the flu lab, said last night. It, too, eventually received the Mexican samples.

"The only reason the samples went first to Winnipeg is because the paperwork is easier. We were in a rush," Hernández said.

The samples arrived in Canada on Wednesday. Six hours later, Mexican authorities were told that 16 of 17 had tested positive for swine flu and that it was the same strain just isolated by the CDC from the very different cases in California.

The next day, Mexican health authorities contacted the CDC and the Department of Health and Human Services and said their country's outbreak and the U.S. cases appeared to be two parts of the same event. That same day, the Mexican samples arrived in Atlanta. They were tested in four hours, and Mexico was informed that they pointed to swine flu. 

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                                            Winnipeg, CDC lab find swine flu viruses





By Helen Branswell,
THE CANADIAN PRESS
24th April 2009

Mexican authorities confirmed Friday they have found human infections with swine flu virus, a discovery that suggests the outbreak there may be linked to person-to-person spread of swine flu in the southwestern United States.

Canada’s National Microbiology laboratory found at least 16 positive cases of swine flu out of a shipment of 51 clinical specimens sent from Mexico to Winnipeg for testing, sources say. Those specimens included lung biopsies and nasal swabs, among other types of specimens.

Mexican officials said the U.S. Centers for Disease Control also found positives among samples tested in the CDC labs in Atlanta.

The World Health Organization expressed serious concern, saying it is considering whether it needs to raise the global pandemic alert level and has put the experts who would advise WHO on whether to go that route on alert to be ready to meet. The WHO activated its emergency operations centre on Friday.

The WHO is also deliberating whether it should launch an effort to try to contain the spread of a virus that appears to have possible pandemic potential. Modelling studies have suggested it might be possible to snuff out an emerging pandemic virus and the WHO has made plans over the years to try containment.

“We can’t say for sure that either a phase change or a rapid containment operation will happen. But both have been considered and are being considered,” spokesman Gregory Hartl said from Geneva.

“I still don’t think we have enough information to be able to say that this is a pandemic or not. Because there are questions over transmissibility, let’s say, of the virus. And we need to know more about how easily transmitted the virus is.”

Hartl said there have been no reports of infections in any other countries.

The unusual influenza A H1N1 swine viruses were first reported earlier this week, when the CDC announced it had found two human cases of infection with this never-before-seen virus. Testing shows the virus is vulnerable to Tamiflu and Relenza, the two main drugs used to fight flu.

There has been no public confirmation that the Mexican virus is identical to the U.S. viruses.

Though human H1N1 viruses have been circulating for decades, it is not clear how much protection previous infection with them would confer against a virus made up predominantly of swine flu genes. The virus also has some bird genes and one human gene.

U.S. authorities have confirmed seven cases of swine flu infection in people in Southern California and Texas over the past few days. The seven range in age from nine to 54 years of age. All have recovered from the infection; one needed hospitalization.

But the news coming out of Mexico paints a different story.

In a television interview, Secretary of Health Jose Angel Cordova Villalobos said there have been 45 deaths, but only 16 of those were directly related to the flu in question.

An estimated 943 people are ill, the television report said.

The majority of the cases are occurring in young, previously healthy adults in their mid 20s to mid 40s, reports suggest. Experts aren’t certain if all of those people are sick with this virus or if other flu or respiratory viruses are also circulating and muddling the picture.

Schools were closed Friday in Mexico City, one of three areas of the country where cases have been reported.

Hartl said the WHO is sending staff to Mexico to help authorities there get a better handle on the scope of the problem.

“We’re extremely concerned because we’re looking at five different influenza events which may or may not be connected,” he said, referring to California, Texas and three possibly linked outbreaks in Mexico.

“But they are unusual events, either because of the time of the year that they happened and or because of the people that have been affected. This is a great concern to us and we have activated our strategic health operation centre which is a 24-hour around-the-clock command and control centre.”

Canada and the United States have also launched their emergency control centres, signalling this is an event they want to track around the clock.

The world is currently at level 3 of the WHO’s six-rung pandemic alert ladder, because of ongoing sporadic cases of human infection with the H5N1 avian flu virus. Phase 3 means there are occasional human cases with a novel flu virus.

WHO would need the advice of an expert panel to move up to Phase 4 or beyond. Phase 6 is a pandemic. 

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                                         Spain confirms 1st swine flu case in Europe
           





AP
April 27, 2009
46 mins ago
MADRID

– Spain's Health Ministry confirmed the country's first case of swine flu on Monday and said another 20 people are suspected of having the disease. It was the first confirmed swine flu case in Europe and the first outside of North America.

Health Minister Trinidad Jimenez said the patient is a young man who had recently returned from Mexico where he had been as part of his university studies.

Jimenez told a press conference the man is responding well to treatment and that neither he nor any of the people under observation are in serious condition.

"The situation is under control," Jimenez said.

Jimenez said this is Europe's first confirmed case of the swine flu outbreak that started in Mexico and is blamed for at least 22 deaths there.

The man with the confirmed case is from the town of Almansa in the Castilla-La Mancha region, according to regional health authorities.

He checked in to a clinic Saturday complaining of fever and respiratory problems and was eventually hospitalized, the regional health department's Web site says.

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                                     World gov'ts race to contain swine flu outbreak
           





Lauran Neergaard,
Ap Medical Writer –
2 hrs 21 mins ago
April 27, 2009
WASHINGTON

– Governments are racing to find and contain pockets of swine flu around the globe, seeking to stem both the threat of a pandemic and public panic.

"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," U.S. Homeland Security Secretary Janet Napolitano said Sunday.

In Mexico, the outbreak's epicenter, soldiers handed out 6 million face masks to help stop the spread of the novel virus that is suspected in up to 103 deaths. Most other countries are reporting only mild cases so far, with most of the sick already recovering. Cases have been confirmed in Canada — six — and the U.S. — 20 — and other countries from Spain to New Zealand were investigating whether other people with flulike symptoms really have this new swine flu or something else.

There is not a global pandemic yet, but waiting until scientists know if the new virus is going to spread rapidly and easily would be too late.

The U.S. declared the health emergency amid confusion about whether new numbers really mean ongoing infections — or just that health officials had missed something simmering for weeks or months. But the move allows the government to ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually need them.

A spokesman for the World Health Organization, Peter Cordingley, said the virus was spreading quickly in Mexico and the southern U.S. and has the potential to become a pandemic and a global threat.

President Barack Obama is set to address the health crisis Monday in remarks to a meeting of the nation's top scientists. His administration sought on Sunday to strike a balance, informing Americans without panicking them.

"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 Centers for Disease Control and Prevention.

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, plus advice on how other nations have dealt with similar crises. Mexico officials say the flu strain may have sickened 1,614 people since April 13 but laboratory testing to confirm that and how many truly died from it — at least 22 so far out of the 103 suspected deaths — is taking time.

Worldwide, attention focused sharply on travelers.

"It was acquired in Mexico, brought home and spread," Nova Scotia's chief public health officer, Dr. Robert Strang, said of Canada's first confirmed cases.

A New York City school where eight cases were confirmed will be closed Monday and Tuesday, and 14 schools in Texas, including a high school where two cases were confirmed, will be closed for at least the next week.

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.

Singapore, Thailand, Japan, Indonesia, South Korea and the Philippines were checking for signs of fever among passengers arriving at airports from North America. In Malaysia, health workers in face masks took the temperatures of passengers as they arrived from a flight from Los Angeles.

Travelers with flu-like symptoms would be given detailed health checks.

Multiple airlines, including American, United, Continental, US Airways, Mexicana and Air Canada, are waiving their usual penalties for changing reservations for anyone traveling to, from, or through Mexico, but have not canceled flights.

Officials along the U.S.-Mexico border were asking health care providers to take respiratory samples from patients who appear to have the flu. Travelers were being asked if they visited flu-stricken areas.

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.

___

Associated Press writers Mark Stevenson and Olga R. Rodriguez in Mexico City; Frank Jordans in Geneva; Mike Stobbe in Atlanta; and Maria Cheng in London contributed to this report.

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                                        In Mexico, young adults appear most at risk



                                    Capital grinds to a halt as country death toll rises






 
By Joshua Partlow
The Washington Post
April 26, 2009
MEXICO CITY

- Six days a week, Luis Enrique Herrera rode his bicycle to work, a round-trip journey of nearly 20 miles. He worked with his hands as an auto mechanic and seemed to his relatives a healthy 35-year-old man, which is why they did not feel overly worried when he had to go to the hospital. "We thought he had a common cold, something normal," said his younger brother, Gabriel Herrera.

It was 12 days ago that Luis Herrera walked into this city's National Institute for Respiratory Illnesses with a fever of more than 102 degrees, aching bones and breathing problems. Now he is isolated, uncommunicative, bedridden and breathing through a tube. His doctors have not confirmed which strain of flu he has contracted, but his family fears it is the deadly new swine virus that has virtually shut down this city of 20 million people.

"He just kept getting worse and worse and worse," Gabriel Herrera said. "His condition now is really very grave."

The anxiety over the virus has vastly altered the rhythm of Mexico City, with millions of people staying home and many of those who venture out doing so wearing masks. On Sunday, Catholic Masses across the city were canceled. One of the most popular Mexican professional soccer teams played a game in front of an empty stadium, which can seat more than 100,000 people. Mayor Marcelo Ebrard said he might have to shut down all public transportation if the crisis worsens.

The question of who contracts and ultimately dies from this virus has become a matter of central concern in Mexico. And the answers that are beginning to emerge as the death toll rises have been ominous. Relatively young adults, presumably among the population's most healthy, have been the first to succumb. All 86 people suspected to have died of swine flu in Mexico were ages 25 to 50, said an official at the Health Ministry, speaking on the condition of anonymity.

All the 15 people in Mexico City who died from the virus were 25 to 37 years old, Ebrard said in a radio interview Sunday.

The high proportion of young adults among the fatalities is one of several mysteries about this virus. The same pattern emerged during the 1918-1919 Spanish influenza epidemic, which killed at least 50 million people, and it remains unexplained in that case as well.

One theory is that the virus triggers an excessively aggressive immune response that destroys the throat and lung tissue. Young adults, with the most robust immune systems, may be especially at risk.

The greatest concentration of cases and deaths have been in Mexico City, the surrounding state of Mexico, and the state of San Luis Potosi to the north. Health Secretary José Ángel Córdova said 30 suspected swine flu cases are spread out among 17 other states.

Most of the fatal cases involved extensive lung damage, requiring doctors to prescribe mechanical breathing assistance. Exactly what caused the lung damage is not known.

Justino Regalado Pineda, an epidemiologist with the Health Ministry, said adults would be more likely to contract the flu simply because they tend to congregate more in public places, such as at their workplaces.

He speculated that one reason people have died in Mexico as opposed to the United States is that the life span of the virus could have been longer in Mexico.

[Bianca]

After flu infections, people can develop an additional bacterial "superinfection" that could be lethal,
said Brian Currie, an infectious-diseases doctor and vice president and director of clinical research
at Montefiore Medical Center in New York City. Currie said it remained a mystery why people in
Mexico were dying while the cases reported in the United States have been relatively benign.

"You've got to remember, this is a strain of flu nobody has seen before," Currie said.

Even though there is no known vaccine for humans for this strain of swine flu -- which combines
genetic material from more common types of pig, bird and human flus -- Mexican officials have
stressed that it is curable. President Felipe Calderón said Sunday that of the 1,324 patients with
flulike symptoms as of Saturday, 929 have been treated and released from the hospital.

Mexican officials said there is no shortage of antiviral medication. The difference between who lives
and dies seems largely linked to how quickly patients receive treatment, officials said.

"With a sickness like this, if you don't take it seriously, if you don't go to the doctor right away, it
can have very grave consequences," Calderón said in a televised address Sunday.

Calderón gave a national lesson on public health, instructing people to wash their hands regularly,
wear surgical masks, cover their mouths when they cough and avoid sharing food.

Officials in Mexico City have handed out 6 million masks.

"Everyone, absolutely every Mexican, needs to make a special effort to avoid contacting other
people who could potentially be infected with the virus," the president said.

Jorge Francisco Guzmán Suárez, a 24-year-old who died Saturday at the National Institute for Respiratory Illnesses, was initially treated by a private doctor for a stomachache, rather than the
flu, his aunt, Herminia Guzmán, told the Reforma newspaper.

"We are devastated," the aunt told the paper. "The miracle did not arrive."

An outdoor market in the colonial neighborhood of Coyoacan on Sunday was a shadow of its usual
self. Candelaria Villanueva, 72, a vendor of jewelry and blouses, said sales have plummeted. She
was worried, she said, because her 20-year-old granddaughter recently got sick and was told by
a doctor that it was "just the flu."