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."
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Swine flu fears close schools in NY, Texas, Calif.
by Karen Matthews
Associated Press Writer
NEW YORK Cleaning crews spent the day scrubbing down every desk, chair and classroom at a New York City high school. Infected students wore surgical masks as they recovered in their beds. Anxious parents woke their children at night to check their temperature.
The same strain of swine flu that was suspected in the deaths of 86 people in Mexico has infected at least eight students at a large Roman Catholic high school in Queens, and possibly more than 100.
About a dozen students from St. Francis Preparatory school apparently brought back the virus after spending a week in Cancun for spring break. All of the cases were mild.
Swine flu has been confirmed in at least 20 people in the U.S., also in Kansas, California, Texas and Ohio. Many of the victims had recently visited Mexico. The federal government declared a public health emergency Sunday to respond to the outbreak.
Homeland Security Secretary Janet 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. Several governors requested medication and masks.
Meanwhile, health officials nationwide were monitoring the outbreak, with many saying it was a not a question of whether their state would be affected but when cases would surface.
Health 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.
In San Diego, signs posted at border crossings, airports and other transportation hubs advised people to "cover your cough."
At Los Angeles International Airport, Alba Velez, 43, and her husband Enrique, 46, were wearing blue face masks Sunday when they emerged from the arrival gate after a trip to Mexico.
The Los Angeles couple hadn't seen anyone sick while in Guadalajara but were nervous because of the stream of information about new cases.
"Most of the cases were in Mexico City," Enrique Velez said, adding that the couple were wearing the masks because they're "just cautious."
It was a different story for edgy passengers heading south of the border.
"I'm worried," said Sergio Ruiz, 42, who checked in for a flight home to Mexico City after a business trip to Los Angeles.
The technology manager said he planned to stay home when he gets back. "I'm going to stay there and not do anything," he said.
Ruiz said his daughter told him by phone that her classes were canceled until at least May 6.
Officials said numerous U.S. schools, including St. Francis, would be closed for days. In California, St. Mel's Catholic School in Fair Oaks, near Sacramento, was closed until at least Thursday while health officials determine if a seventh-grader has a flu linked to the outbreak. Near San Antonio, all 14 schools in the Schertz-Cibolo-Universal City Independent School District were closed for at least the next week after two students at a Cibolo high school caught the virus.
Mayor Michael Bloomberg said Sunday that many New York victims are recovering, but that some family members of students also had flu symptoms, "suggesting it is spreading person to person."
Gov. David Paterson said 1,500 treatment courses of the antiviral Tamiflu had been sent to New York City; it wasn't immediately clear if hospitals were using the doses. Infectious-disease specialists, epidemiologists and disaster preparedness workers have been dispatched to New York to monitor and respond to possible flu cases.
St. Francis is the largest private Catholic high school in the nation, with 2,700 students. The school canceled classes on Monday and Tuesday in response to the outbreak.
Brother Leonard Conway, principal of St. Francis, said cleaning crews sanitized the school during the weekend, using heavy-duty disinfectant to cleanse desks, chairs, labs, offices and classrooms.
School officials 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.
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 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.
At St. Francis, parent Jackie Casola said Sunday that her son Robert Arifo, a sophomore, told her Thursday that a number of children had been sent home because of illness. On Friday, he said hardly anyone was in school.
Robert hasn't shown any symptoms, but some of his friends have, his mother said, and she has been extra vigilant about his health.
"I must have drove him crazy, I kept taking his temperature in the middle of the night," Casola said.
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Associated Press writers Josh Hoffner, Jennifer Peltz and Deepti Hajela in New York, Michael R. Blood in Los Angeles, Michelle Roberts in San Antonio and Meghan Barr in Columbus, Ohio, contributed to this report.
40 swine flu cases in US; agents checking borders
by Lauran Neergaard
AP Medical Writer
WASHINGTON President Barack Obama declared Monday that spreading swine flu infections were a concern but "not a cause for alarm," while customs agents began checking people coming into the United States by land and air. The World Health Organization said there were 40 confirmed cases in the U.S. but no deaths.
Countries across the globe increased their vigilance amid increasing worries about a worldwide pandemic. Obama told a gathering of scientists that his administration's Department of Health and Human Services "has declared a public health emergency as a precautionary tool to ensure that we have the resources we need at our disposal to respond quickly and effectively."
The acting head of the Centers for Disease Control and Prevention, Dr. Richard Besser, said that Americans should be prepared for the problem to become more severe, and that it could involve "possibly deaths."
The quickening pace of developments in the United States in response to some 1,600 swine flu infections in neighboring Mexico and reports that Mexico's suspected swine flu death toll had climbed to 149 was accompanied by a host of varying responses around the world. Mexico suspended schools nationwide. The European Union advised against nonessential travel to the U.S. and Mexico, while China, Taiwan and Russia considered quarantines and several Asian countries scrutinized visitors arriving at their airports.
U.S. customs officials began checking people entering U.S. territory. Officers at airports, seaports and border crossings were watching for signs of illness, said Customs and Border Protection spokesman Lloyd Easterling.
The borders are open," Easterling added. He said officials were "just taking a second look at folks who may be displaying a symptom of illness."
If a traveler says something about not feeling well, the person will be questioned about symptoms and, if necessary, referred to a CDC official for additional screening, Easterling said. The customs officials were wearing personal protective gear, such as gloves and masks, he said.
The CDC can send someone to the hospital if they suspect a case, but no one is being refused entry. Also, the CDC is readying "yellow cards" with disease information for travelers, in case they later experience symptoms.The border monitoring resembles that done during the SARS epidemic earlier in the decade.
Multiple airlines, including American, United, Continental, US Airways, Mexicana and Air Canada, said they were waiving usual penalties for changing reservations for anyone traveling to, from, or through Mexico, but had not canceled flights.
The CDC's Besser said that while the U.S. hasn't advised against travel to Mexico, it has urged people to take precautions, such as frequent hand-washing while there.
He also said he did not believe that the EU's inclusion of the U.S. in its travel warnings was warranted "at this point."
A private school in South Carolina was closed Monday because of fears that young people who recently returned from Mexico might have been infected.
"We are closely monitoring the emerging cases of swine flu in the United States," Obama said. "I'm getting regular updates on the situation from the responsible agencies, and the Department of Health and Human Services as well as the Centers for Disease Control will be offering regular updates to the American people so that they know what steps are being taken and what steps they may need to take."
"This is obviously a cause for concern and requires a heightened state of alert, but it's not a cause for alarm," he said.
World stock markets fell as investors worried that the outbreak could derail economic recovery. Wall Street, too, dipped in morning trading but stocks regained their footing and posted modest gains by midday.
The U.S. declared a national health emergency in the midst of uncertainty about whether the mounting sick count meant new infections were increasing or health officials had simply missed something that had been simmering for weeks or months. The declaration allowed Washington to ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they are needed.
Besser said he was not reassured by the fact that so far in the U.S., no one had died from the disease.
"From what we understand in Mexico, I think people need to be ready for the idea that we could see more severe cases in this country and possibly deaths," he said. "That's something people have to be ready for and we're looking for that. So far, thankfully, we haven't seen that. But we're very concerned and that's why we're taking very aggressive measures."
Meanwhile, officials of Newberry Academy in South Carolina said Monday that seniors from the school were in Mexico earlier this month and some had flu-like symptoms when they returned.
State Department of Health and Environmental Control spokesman Jim Beasley said test results on the students could come back as early as Monday afternoon. The agency has stepped up efforts to investigate all flu cases in South Carolina. There have been no confirmed swine flu cases in the state.
A New York City school where eight cases were confirmed will be closed Monday and Tuesday. Of the 40 reported cases in the U.S., 28 are in New York. Also, 14 schools in Texas, including a high school where two cases were confirmed, will be closed for at least the next week. Some schools in California and Ohio also were closing after students were found or suspected to have the flu.
In Mexico, the outbreak's center, soldiers handed out 6 million face masks to help stop the spread of the 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.
Spain reported its first confirmed swine flu case on Monday and said another 17 people were suspected of having the disease. The European Union health commissioner advised Europeans to avoid nonessential travel to Mexico and the United States. Also, three New Zealanders recently returned from Mexico are suspected of having it.
"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.
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Associated Press writers Mark Stevenson and Olga R. Rodriguez in Mexico City; Frank Jordans in Geneva; Mike Stobbe in Atlanta; Maria Cheng in London and Eileen Sullivan in Washington contributed to this report.
World govts race to contain swine flu outbreak
by Lauran Neergard
AP Medical Writer
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.
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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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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
Developments on swine flu worldwide
Key developments Sunday on swine flu outbreaks:
- Deaths: 86, all in Mexico.
- Confirmed cases: About 1,400 in Mexico; 20 in U.S.; 4 in Canada.
- Suspected cases: 10 in New Zealand; 4 in France; 3 in Spain; 1 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 in U.S: Roughly 12 million doses of Tamiflu being moved from federal stockpile to be delivered 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.
- 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 Mexican City and three provinces. Italy, Poland and Venezuela advised citizens to postpone travel to affected areas of Mexico and the United States.
Mexico fights swine flu with 'pandemic potential'
by Mark Stevenson
Associated Press Writer
MEXICO CITY Mexican soldiers and health workers patrolled airports and bus stations, looking for people who may be infected with a deadly new swine flu strain. Tourist markets and restaurants were nearly empty. And throngs of Mexicans some with just a fever rushed to hospitals.
With each passing day, this metropolis of 20 million people becomes increasingly fearful of an outbreak that has killed as many as 81 people and prompted world health officials to warn Saturday that it could become a global epidemic.
"The people are scared," said a tired Dr. Roberto Ortiz, 59, as he leaned against an ambulance and sipped coffee outside Hospital Obregon. "A person gets some flu symptoms or a child gets a fever and they think it is this swine flu and rush to the hospital."
Ortiz said none of the cases so far at the hospital had turned out to be swine flu.
As concerns grew among Mexicans that the government botched the response to the deadly strain, President Felipe Calderon on Saturday assumed new powers to isolate infected people and to inspect homes and traveler's baggage.
Meanwhile, new cases of swine flu were confirmed in Kansas and California and suspected in New York City; officials have confirmed previous U.S. cases were caused by the same virus responsible for the Mexican deaths and likely sickened more than 1,324 in Mexico since April 13.
The World Health Organization on Saturday asked countries to step up reporting and surveillance of the strain a combination of swine, bird and human influenza that people may have no natural immunity to and implement a coordinated response to contain it.
Two dozen new suspected cases were reported in Mexico City alone, where authorities suspended schools and all public events until further notice. More than 500 concerts, sporting events and other gatherings were canceled in the metropolis.
In the nearly empty Insurgentes tourist market, Rafael Lopez, 48, read a newspaper as he sat beside his stall selling Mexican handicrafts. He had made no sales all day. "Tourists started staying away because of the insecurity, now there is the swine flu," Lopez said.
"If they start telling people not to visit Mexico it could get even worse," he said.
The Mexican officials said the decree granting Calderon the new powers gives clear legal authority to the government's health workers who might otherwise face reprisals.
At Mexico City's international airport, health workers passed out written questionnaires seeking to identify passengers with flu symptoms. Surgical masks and brochures were handed out at bus and subway stations.
The U.S. embassy posted a message advising U.S. citizens to avoid large crowds, shaking hands, greeting people with a kiss or using the subway.
Open-air markets and restaurants common to Mexico seemed the hardest hit. "People aren't going out so they won't get infected. The market is empty," said Maria Tobar, who sells chile rellenos and other prepared Mexican specialties for people to heat at home.
With confirmed swine flu cases in at least six states and possibly as many as 16 the government's efforts seemed unlikely to stop the spread.
WHO Director-General Margaret Chan said the outbreak of the never-before-seen virus has "pandemic potential." But she said it is still too early to tell if it would become a pandemic.
"The situation is evolving quickly," Chan said in Geneva. "A new disease is by definition poorly understood."
WHO lays out three criteria necessary for a global epidemic to occur: The virus is able to infect people, can readily spread person-to-person and the global population has no immunity to it.
Out of the many cases in Mexico reported, relatively few samples have been tested.
Early detection and treatment are key to stopping any outbreak. WHO guidance calls for isolating the sick and blanketing everyone around them with anti-viral drugs such as Tamiflu.
With patients showing up all across Mexico and its teeming capital, Mexico appears to have lost valuable days or weeks in detecting the new virus.
Health authorities started noticing a threefold spike in flu cases in late March and early April, but they thought it was a late rebound in the December-February flu season.
Testing at domestic labs did not alert doctors here to the new strain, and Health Secretary Jose Cordova acknowledged labs here lacked the necessary profiling data to detect the previously unknown strain.
The first death occurred in southern Oaxaca state on April 13, but Mexico didn't send the first of 14 mucous samples to the Centers for Disease Control until April 18, around the same time it dispatched health teams to hospitals looking for patients with severe flu or pnuemonia-like symptoms.
Those teams noticed something strange: The flu was killing people aged 20 to 40. Flu victims are usually either infants or the elderly. The Spanish flu pandemic, which killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults.
Even though U.S. labs detected the swine flu in California and Texas before last weekend, Mexican authorities as recently as Wednesday were referring to it as a late-season flu.
But mid-afternoon Thursday, Mexico City Health Secretary Dr. Armando Ahued said, officials got a call "from the United States and Canada, the most important laboratories in the field, telling us this was a new virus."
"That was what led us to realize it wasn't a seasonal virus … and take more serious preventative measures," Cordova said.
Some Mexicans suspected the government had been less than forthcoming. "They always make a big deal about good things that happen, but they really try to hide anything bad," Mexico City paralegal Gilberto Martinez said.
Hospitals dealt with crowds of people seeking help. A hot line fielded 2,366 calls in its first hours from frightened city residents who suspected they might have the disease. At least one pharmacy reported brisk sales of surgical masks and flu medications.
Doctors reported that anti-viral medications and even steroids were working well against the disease.
Airports around the world were screening travelers from Mexico for flu symptoms. But containing the disease may not be an option.
"Anything that would be about containing it right now would purely be a political move," said Michael Osterholm, a University of Minnesota pandemic expert.
Scientists have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals.
This swine flu and regular flu can have similar symptoms mostly fever, cough and sore throat, though some of the U.S. victims who recovered also experienced vomiting and diarrhea. But unlike with regular flu, humans don't have natural immunity to a virus that includes animal genes and new vaccines can take months to bring into use.
The same virus also sickened at least 11 people in the United States, though there have been no deaths north of the border.
The Kansas Department of Health and Environment on Saturday confirmed two cases of swine flu in two adults in the same household. One of the patients had recently traveled to Mexico. Another eight students at a New York City high school probably have human swine influenza, but health officials said they don't know for sure whether it is the same strain.
A "seed stock" genetically matched to the new swine flu virus has been created by the CDC, said Dr. Richard Besser, the agency's acting director. If the government decides vaccine production is necessary, manufacturers would need that stock to get started.
Mexican authorities did lay to rest one persistent doubt, after Mexican museum director Felipe Solis died this week, just days after accompanying U.S. President Barack Obama on a tour of the National Museum of Anthropology on April 16.
Cordova said Solis had a pre-existing illness and died of pneumo