WASHINGTON U.S. officials said Monday that it's too early to say the swine-flu threat is receding, even though there are some signs the outbreak may not be as serious as originally feared.
Homeland Security Secretary Janet Napolitano said the outbreak could die down with warmer weather only to roar back during fall flu season. And she said the public shouldn't be alarmed if the World Health Organization declares that the new virus has officially begun a pandemic, meaning it has spread pretty much globally.
That word describes "geography, not severity" and thus wouldn't change U.S. steps to stem infections that have been confirmed in 380 people in more than half the states, she said.
Another top U.S. health official said "there are encouraging signs" of a leveling off in the severity of the threat, but added that it's still too early to declare the problem under control.
"I'm not ready to say that yet," Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said when asked about indications by Mexican health authorities that the disease has peaked there.
"What we're seeing is an illness that looks very much like seasonal flu. But we're not seeing the type of severe disease that we were worrying about," Besser told network television interviewers. He noted that roughly 36,000 people die each year in this country from the winter flu, so it's still a serious matter.
Swine flu had been found in 380 people in 36 states as of late Monday, according to a count by The Associated Press.
"We are by no means out of the woods," Besser said. "In previous pandemics, there have been waves and you don't know what this virus is going to do."
_U.S. confirmed cases from CDC or states: New York, 90; Texas, 40; California, 69; Massachusetts, 34; Delaware, 20; Arizona, 18; Oregon, 17; South Carolina, 15; Illinois, nine; Colorado, Louisiana, and New Jersey, seven; Florida, five; Alabama and Maryland, four; Indiana, New Mexico, Ohio, Virginia and Wisconsin, three; Connecticut, Kansas and Michigan, two; and one each in Nebraska, Iowa, Kentucky, Minnesota, Missouri, Nevada, New Hampshire, North Carolina, Pennsylvania, Rhode Island, Tennessee, Idaho and Utah.
There has been one death in the United States, a toddler who succumbed to the disease after he was brought to this country from Mexico.
Besser said health authorities also are concerned about indications that the flu had so far struck the young more heavily than older people, and that there still may be deaths from it.
He also said he didn't think it was necessarily time to ease off on school closings and other steps that have been taken to contain the spread of the infection.
"We're seeing infections in almost every state," Besser said, "and as that occurs, those who have underlying problems (such as the elderly and people with compromised immune systems) may be affected more. … It may be that this disease is starting first in children, and then moving to the elderly, so there's still much that we do not know."
Besser said that as a parent and a pediatrician, he thinks it's best for kids to be in school, whenever possible, and that adjustments in school shutdowns might be possible "as we learn and see that this virus is not more serious than ordinary flu."
Asked whether the food supply has been compromised, he said, "It may be that pigs have more to fear from people than people have to fear from pigs."
"With each day some of the uncertainty goes away, we learn more, and we're seeing encouraging signs," Besser said. "The encouraging signs have to do with severity." He summed up the situation by saying he was "precautiously optimistic" about trends now surfacing.
But he hastened to add that people still need to take everyday precautions, like vigorous and frequent hand washing, covering their noses and mouths when they sneeze and staying home when they're sick.
Besser said that what now ensues in the Southern Hemisphere, which is just entering flu season, will be "critically important for us to understand as we think about the decisions around vaccination."
The CDC chief was interviewed on CBS's "The Early Show" and NBC's "Today" show.
Mexico gets some bustle back after flu shutdown
Peter Orsi
Associated Press Writer
MEXICO CITY Mexico began a cautious return to normal Tuesday, the government canceling Cinco de Mayo celebrations as traffic picked up in the capital and cafes reopened following a five-day shutdown to contain swine flu.
The canceled events included the largest one a re-enactment of the May 5, 1862, victory over French troops in the central state of Puebla. And health experts warned that Mexico and the rest of the world needed to remain on guard against the virus.
Saying the outbreak is waning in Mexico, the epicenter of an illness that has sickened hundreds around the world, President Felipe Calderon announced it was nearly time to reopen businesses. Universities and high schools will open their doors Thursday, and younger schoolchildren are to report back to school May 11.
"The school schedule will resume with the guarantee that our educational institutions are in adequate hygienic condition," Calderon said. He urged parents to join educators in a "collective" cleansing and inspection of schools nationwide.
"This is about going back to normalcy, but with everyone taking better care," Calderon said.
Already more vehicles prowled the streets of the capital Monday than over the weekend, and fewer people wore surgical masks. Some cafes even reopened ahead of time.
Health Secretary Jose Cordova said infections were trending downward after Mexico's 27 deaths, including a Mexican toddler who died in Texas. He said those infected appeared to pass the virus on to an average of 1.4 other people, near the normal flu rate of around 1.3.
Cordova said soccer stadiums and concert halls could reopen but only if fans were kept 2 meters, about 6 1/2 feet, apart.
However, world health officials stressed that the global spread of swine flu was still in its early stages and a pandemic could be declared in the days to come. Experts inside Mexico's swine flu crisis center warned that the virus remained active throughout Mexico and could bounce back once millions return to work and school.
"It's clear that it's just about everywhere in Mexico," Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention, told The Associated Press.
The World Health Organization said it was starting to ship 2.4 million treatments of antiflu drugs to the 72 countries "most in need" on Tuesday.
The agency declined to name the countries, but said they included Mexico, which has been hardest hit by the outbreak. Other countries included those that have been unable to afford building stockpiles of the drugs.
Scientists said the virus is spreading in the U.S. and that chances of severe cases could rise there as well, even as a New York City school reopened after the swine flu hit following a spring break trip by some students to Mexico.
"We are by no means out of the woods," said Dr. Richard Besser, acting director of the CDC.
As of Monday, Mexico had 802 confirmed cases, and U.S. cases grew to at least 380 in 36 states. Globally, the virus had infected more than 1,447 people in 20 countries, according to the World Health Organization and other health bodies. South Korea, Italy and Germany all reported new cases Tuesday. Experts said the known cases were almost certainly only a fraction of the real total.
The latest figures from Mexico suggest the virus may be less lethal and infectious than originally feared. Only 38 percent of suspected cases have turned out to be swine flu, and no new deaths have been reported since April 29. But Cordova acknowledged that about 100 early deaths in which swine flu was suspected may never be confirmed because mucous or tissue samples were not collected.
WHO was studying whether to raise the pandemic alert to 6, its highest level, which would mean a global outbreak had begun. WHO uses the term pandemic to refer only to geographic spread and not to the severity of an illness. The two most recent pandemics in 1957 and 1968 were relatively mild.
"We do not know how long we will have until we move to Phase 6," WHO Director-General Margaret Chan said. "We are not there yet. The criteria will be met when we see in another region outside North America, showing very clear evidence of community-level transmission."
The Southern Hemisphere is particularly at risk. While Africa still hasn't reported any swine flu infections and New Zealand is the only country south of the equator with confirmed cases, winter is only weeks away. Experts worry that typical winter flus could combine with swine flu, creating a new strain that is more contagious or dangerous.
"You have this risk of an additional virus that could essentially cause two outbreaks at once," Dr. Jon Andrus said at the Pan American Health Organization's headquarters in Washington.
Still, the U.N. health agency urged governments to avoid unproven actions to contain the disease, including group quarantines of travelers from Mexico and bans on pork imports.
China, Argentina and Cuba are among the nations banning regular flights to and from Mexico, marooning passengers at both ends. Mexico and China both sent chartered flights to each other's countries to collect their citizens, with the chartered Mexican plane hopscotching China Tuesday to retrieve stranded residents. Argentina also chartered a flight to bring Argentines home.
In a televised message to the country late Monday, Calderon had harsh words for countries that he said are treating Mexicans unfairly. "Stop taking actions that only hurt Mexico and don't contribute to avoid the transmission of the disease."
Chinese authorities quarantined Mexicans and other passengers who came in close contact with them, even those who didn't show symptoms.
China changed its visa rules for U.S. citizens. The Web site for the Chinese embassy and its consulates in the U.S said all visa applications would now require six business days to process, with express and rush services for visa applications suspended until further notice.
The new regulation, which became effective Monday, appears to apply to all Chinese visas, including tourist and business categories.
The American Embassy in Beijing said Tuesday that four U.S. citizens were quarantined in China. Embassy spokeswoman Susan Stevenson said two of the Americans were in Beijing and the other pair were in the southern province of Guangdong. She said two of them were released.
In Tokyo, 37 passengers and two flight attendants on a flight from Los Angeles were detained in a hotel after Japanese officials suspected one traveler of having swine flu. They were released about 10 hours later when the passenger, a Japanese woman coming back from Las Vegas, tested negative for swine flu, American Airlines spokesman Tim Smith said.
About 200 passengers who flew from the United Kingdom to Brunei were under quarantine in a Brunei hospital over swine flu fears Tuesday after three of them showed fever symptoms, an official said Tuesday.
Developments on swine flu worldwide
- Key developments on swine flu outbreaks, according to Centers for Disease Control and Prevention, World Health Organization, and government officials:
- Deaths: 26 confirmed in Mexico and one confirmed in U.S., a toddler from Mexico who died in Texas.
- Confirmed sickened worldwide, 1,276: 727 in Mexico; 300 in U.S.; 140 in Canada; 44 in Spain; 27 in Britain; eight in Germany; six in New Zealand; four in Israel, Italy and France; two in El Salvador; one each in Austria, Costa Rica, Colombia, Denmark, Hong Kong, Ireland, the Netherlands, Portugal, South Korea and Switzerland.
- U.S. confirmed cases from CDC or states: New York, 90; Texas, 43; California, 29; Delaware, 20; Arizona, 18; South Carolina, 15; Illinois, nine; Colorado, Louisiana, Massachusetts and New Jersey, seven; Florida, five; Alabama and Maryland, four; Indiana, Ohio, Oregon, Virginia and Wisconsin, three; Connecticut, Kansas and Michigan, two; and one each in Nebraska, Iowa, Kentucky, Minnesota, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Pennsylvania, Rhode Island, Tennessee, Idaho and Utah.
- More U.S. school closings announced, including all 24 schools in a district west of Detroit after a high school student came down with an apparent case of the illness. New York City high school that had 45 students with confirmed swine flu cases reopens.
- Centers for Disease Control and Prevention says about a third of confirmed U.S. cases are people who had been to Mexico and likely picked up the infection there.
- Hong Kong, where severe acute respiratory syndrome killed 299 in 2003, ordered weeklong quarantine of downtown hotel where a Mexican tourist was confirmed to have the illness, trapping 274 guests and employees inside.
- Mexico to allow most businesses to reopen Wednesday. Mexico City cafes, museums and libraries to reopen this week; schools to reopen after inspections are completed.
- Mexican government charters a plane to bring its citizens home from China after 70 Mexican nationals traveling in China were quarantined there. China sends its own plane to retrieve Chinese nationals stranded in Mexico. Mexico also criticizes Argentina, Peru and Cuba for banning flights.
- World Health Organization says slaughtering pigs unnecessary because virus is being spread through humans; says swine herd in Canada likely infected by farmworker who returned from Mexico.
- U.S. Meat Export Federation, which represents pork and beef interests abroad, estimates that U.S. pork exports have dropped about 10 percent since the swine flu scare started.
- Visitation at all California prisons is suspended after an ill inmate at Centinela State Prison in Imperial County is tested for swine flu.
On the Net:
CDC:http://www.cdc.gov/swineflu
WHO: Swine flu epidemic still spreading
Eliane Engeler
Associated Press Writer
GENEVA The World Health Organization began to ship 2.4 million treatments of anti-flu drugs to 72 needy countries Tuesday, and its flu chief said the swine flu epidemic was still spreading.
WHO flu chief Keiji Fukuda said new infections were among the 405 confirmed swine-flu cases reported to WHO in the last 24 hours.
"We are seeing testing of specimens that were collected from previous infections and then the laboratory work is catching up to it," Fukuda said. "But we're also seeing new infections occurring."
"So, there's both of these things going on simultaneously," he told reporters.
The countries getting Tamiflu included Mexico, Afghanistan, Angola, Bhutan, Bolivia, Eritrea, Haiti, Moldova, Pakistan, Sri Lanka, Uganda and Zimbabwe, among others.
The drugs are from a stock of 5 million treatments of Tamiflu that manufacturer Roche Holding AG donated in 2005 and 2006, WHO spokeswoman Fadela Chaib said. They were being shipped from Geneva and Basel in Switzerland, Maryland in the U.S. and Dubai in the United Arab Emirates.
The global body says there are now 1,490 cases and 30 confirmed deaths from the swine flu epidemic. Of those, 822 cases and 29 deaths were in Mexico; the United States had 403 cases and 1 death; Canada had 140 cases, Spain 57, Britain 27, Germany nine, New Zealand six and Italy five. Israel and France had four cases each, Korea and El Salvador had two each, and Austria, Hong Kong, Costa Rica, Colombia, Denmark, Ireland, the Netherlands, Portugal and Switzerland had one case each.
Most of the people infected with the so-called A/H1N1 virus were young people in their mid-20s, Fukuda said, and most had been traveling to Mexico, the hardest-hit country.
Travel could also explain why mostly younger people appear to be affected, as they tend to be the ones traveling, Fukuda said.
"With influenza, oftentimes we see the infections go to younger people first and then go to older people later," Fukuda told reporters.
Another reason could be that older people already have some kind of protection against the virus from previous infections, he added.
Fukuda said patients who recover from the new swine flu virus would likely gain some immunity to future outbreaks, if only for a few years.
"With influenza viruses, when you are infected it provides some protection against future influenza viruses similar to the one which infected you," he said.
The protection lasts "a couple of years and then the viruses themselves change enough so that it's kind of a new virus for your body so that you are susceptible again."
The disease is affecting females and males equally, Fukuda said, and the incubation period has ranged from around one day to a week, the same as seasonal flu.
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Associated Press writers Alexander G. Higgins and Frank Jordans contributed to the report.
How will the uninsured fare in swine flu outbreak?
Ricardo Alonso Zaldivar
Associated Press Writer
WASHINGTON Swine flu could shine a glaring light on the best and worst about American-style health care.
At top labs, scientists are optimistic they can make a vaccine that's effective against the new virus. But in a country where one in seven people lack medical insurance, doctors worry that some individuals won't get needed protection because of cost.
It could leave the rest of society more vulnerable.
In a flu epidemic, the uninsured face the worst options: flooding the emergency rooms or self-medicating with cold preparations and hoping for the best. Many might not be aware they can also go to a federally-funded community health center and see a doctor or nurse for little or no cost.
Helping the estimated 50 million uninsured will mean more than just paying for their health care. For example, if they're here as illegal immigrants, should taxpayers still cover the costs?
Public health experts say obstacles to getting medical attention are counterproductive if you're trying to stop an infectious disease in a highly mobile society like the United States.
"The person I'm most worried about is the one who decides to delay getting care, and does it in such a way that they infect others or put themselves at greater risk," said Dr. Georges Benjamin, executive director of the American Public Health Association. "To have an epidemic with millions of people who may not go to the doctor because they can't afford to pay remains one of the unique challenges of our system."
Lawmakers are already proposing fixes. The big health care overhaul Congress is working on probably won't be ready if a bad flu strikes later this year.
Sen. Dick Durbin, D-Ill., and Rep. Lois Capps, D-Calif., have introduced legislation to pay for temporary medical treatment for uninsured people during a public health emergency. It could be a natural disaster such as an earthquake or hurricane, a bioterror attack, or a medical emergency such as a flu pandemic.
"We can't afford to have barriers that keep people from getting care when an epidemic is sweeping the community," Capps said.
Separately, Sen. Tom Harkin, D-Iowa, has proposed to offer all individuals a free flu shot each year.
The Obama administration has not taken a position on either bill. But it has started shipping anti-flu medicines to community health centers, which provide basic medical care to the uninsured.
Trust for America's Health, a public health group that has focused on pandemic flu preparedness, is supporting the Durbin-Capps bill.
"During a public health emergency, the federal government would step in and take care of the needs of the people who are affected by that emergency," said Jeff Levi, executive director of the group. "Health care providers would not be left holding the bag for people who are uninsured. It will be a 'win' for individuals because they'll be able to get the care they need."
Many details of the legislation are still being worked out. Government coverage would be limited to treatment for problems that are related to the public emergency.
Dealing with immigrants could be one of the most difficult issues.
The uninsured are mostly native born. But immigrants are more than twice as likely to be uninsured as people born here.
When Congress was under Republican control it sharply restricted safety net benefits for immigrants, even legal ones. The Democratic-controlled Congress reversed that trend for legal immigrants when it expanded health insurance earlier this year for children in low-income families.
It would be another issue to cover illegal immigrants, even if only for a short time. But since Mexico is the epicenter of the outbreak, some experts say that may be prudent.
"We don't want to have a policy that drives people underground," Benjamin said. "It's better to have them present for care so that they don't put anybody else at risk."