WASHINGTON President Barack Obama voiced hope Friday that the swine flu virus will run its course "like ordinary flus" as the government reported more than two dozen new cases and Continental Airlines curtailed flights into more heavily ravaged Mexico.
"I'm optimistic that we're going to be able to manage this effectively," Obama told reporters as got an update from his Cabinet on the federal response to the health emergency. At the same time, he emphasized that the federal establishment is preparing as if the worst is still to come so it won't get caught flat-footed.
Obama's fresh take on the flu scare more intense in neighboring Mexico than in the United States but also present in some measure around the globe came as the Centers for Disease Control and Prevention reported the virus has been confirmed in eight more states.
Confirmed cases have risen from 109 to 141, the CDC said, and it said the flu now is in 19 states, up from 11. Separately a few states reported slightly higher numbers.
Obama said it wasn't clear whether the flu would be more severe than others before it, and he said the swine flu is a cause for special concern because it is new strain and people have not developed an immunity to it.
Government agencies are preparing in case the flu comes back in a more virulent form during the traditional flu season, the president said, talking of an overarching effort to help schools and businesses while also responding to pleas for help from other countries.
Meanwhile, Houston-based Continental became the first U.S. carrier to curtail service. Many travelers have become increasingly concerned about going to Mexico, though authorities there said new cases and the death rate was leveling off. Continental has over 500 flights a week between the United States and Mexico.
Mexico City Mayor Marcelo Ebrard said Friday that no new deaths from swine flu were reported overnight for the first time since the emergency was declared a week ago. Mexico has confirmed 300 swine flu cases but stopped reporting suspected infections when the number approached 2,500. There have been a dozen confirmed deaths there from the flu, although reports have indicated that roughly 120 may have died from it.
Of the curtailment of airline flights, Continental's chairman and chief executive, Larry Kellner, said that "we were already experiencing soft market conditions due to the economy, and now our Mexico routes in particular have extra weakness."
No other U.S. carriers had announced capacity cuts. "We are hearing that there is a softening of demand to and from Mexico," said David Castelveter, a spokesman for the Air Transportation Association, which represents airlines.
Clinics and hospital emergency rooms in New York, California and some other states are seeing a surge in patients with coughs and sneezes that might have been ignored before the outbreak.
The outbreak even touched the White House, which disclosed that an aide to Energy Secretary Steven Chu apparently got sick helping arrange Obama's recent trip to Mexico but that the aide did not fly on Air Force One and never posed a risk to the president.
The aide, Marc Griswold, a former Secret Service agent who was doing advance work for Chu, told The Associated Press when reached at his Department of Energy office Friday that he was feeling better.
He declined to elaborate beyond comments in the Washington Post Friday.
"We're not the Typhoid Mary family, for goodness sake," he told the Post. "We've been told that we're not contagious. We're already past the seven-day mark for that."
So far U.S. cases are mostly fairly mild and, officials said, most so far haven't required a doctor's care.
Still, the U.S. is taking extraordinary precautions including shipping millions of doses of anti-flu drugs to states in case they're needed.
Late Thursday the Department of Health and Human Services announced it was buying 13 million new treatment courses of antiviral drugs to replenish and grow the U.S. strategic stockpile. Eleven million treatment courses have been sent to states 25 percent of each state's allotment and the U.S. also announced plans Thursday to send 400,000 treatment courses to Mexico.
The World Health Organization is warning of an imminent pandemic because scientists cannot predict what a brand-new virus might do. A key concern is whether this spring outbreak will surge again in the fall.
The CDC added the following states Friday to its list of confirmed cases: New Jersey with five cases, Delaware with four, Illinois with three, Colorado and Virginia with two, and Minnesota and Nebraska each with one. The CDC reported one case in Kentucky and none in Georgia, while Georgia officials report one case there that of a sickened Kentucky resident who traveled to Georgia.
CDC previously had confirmed cases in New York, Texas, California, South Carolina, Kansas, Massachusetts, Indiana, Ohio, Arizona, Michigan and Nevada.
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Associated Press Writers Lauran Neergaard, Joan Lowy and Ben Nuckols contributed to this report. Nuckols reported from Baltimore.
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On the Net:
Health and Human Services Department swine flu site:http://www.pandemicflu.gov
AP: Mexico's epidemiology boss faults WHO
Andrew O. Selsky
Associated Press Writer
MEXICO CITY A top Mexican medical officer accused the World Health Organization of being slow to respond to the country's warning about a health crisis that turned into a global swine flu scare. The WHO disputed the claim.
In the U.S., President Barack Obama said Friday the swine flu might end up running its course "like ordinary flus" but said the government is preparing in case swine flu comes back in a more virulent form.
"I'm optimistic that we're going to be able to manage this effectively," Obama said.
Hong Kong confirmed a case of swine flu, Asia's first, and authorities there ordered a weeklong quarantine of the hotel where the man, a 25-year-old Mexican tourist, stayed. Besides Mexico and the U.S., cases have also been confirmed in six European nations, Canada, New Zealand and Israel.
Mexico's chief epidemiologist, Dr. Miguel Angel Lezana, told The Associated Press late Thursday his center alerted the Pan American Health Organization, a regional arm of WHO, on April 16 about an unusually late rash of flu and pneumonia cases in Mexico.
But he said PAHO took at least 48 hours to notify WHO headquarters when normally that notification occurs immediately. Eight days after Mexico's initial notification, WHO announced it was worried the outbreak could become a pandemic.
"It seems it should have been more immediate," Lezana, director of the National Epidemiology Center, told AP in a telephone interview. He called for an investigation into WHO's handling of the crisis.
WHO officials said Friday the agency learned April 9 of cases of "suspicious influenza" from Mexico and responded quickly on April 24 when U.S. and Canadian laboratories identified the virus as a new strain of flu.
"We moved into operation within a matter of hours," WHO spokesman Thomas Abraham told reporters.
Mexican health authorities came under criticism, particularly from frustrated citizens, for a slow and bumbling early response to the outbreak.
In the United States, the confirmed case count stood at 132. State lab operators say there are more cases than the confirmed number because they are not testing all suspected cases, focusing on finding new outbreak hot spots and limiting the flu's spread.
In Mexico, the outbreak's epicenter, new cases and the death rate were leveling off, the country's top medical officer said. Health authorities there have confirmed 343 swine flu cases and 15 deaths from the virus.
No new deaths from swine flu were reported overnight in the Mexican capital for the first time since the emergency was declared a week ago, said Mexico City Mayor Marcelo Ebrard.
"This isn't to say we are lowering our guard or we think we no longer have problems," Ebrard said. "But we're moving in the right direction."
As recently as Wednesday, Mexico's health secretary said there 168 suspected swine flu deaths in the country and almost 2,500 suspected cases. Mexican officials have stopped updating that number and say those totals may have been inflated.
"The fact that we have a stabilization in the daily numbers, even a drop, makes us optimistic," Mexican Health Secretary Jose Angel Cordova said. "Because what we'd expect is geometric or exponential growth. And that hasn't been the situation."
The only confirmed swine flu death outside Mexico was a Mexican toddler who died in a Texas hospital Monday.
The United States is buying 13 million courses of anti-flu drugs to replenish its stockpile and sending 400,000 courses to Mexico. U.S. health officials say a swine flu vaccine could not be ready until fall at the earliest.
The Red Cross says it is readying an army of 60 million volunteers who could be deployed around the world to help slow the virus' spread.
Cordova said Mexicans with flu symptoms are now seeking medical attention quickly, and suspected swine flu cases are getting treatment even before the virus is confirmed, preventing deaths and limiting the virus' spread.
"If the treatment is given the first day, the patient is practically not contagious," Cordova said.
Cordova said outreach efforts to families of confirmed cases are turning up relatively few other cases.
Mexico shut down all but essential government services and private businesses Friday, the start of a five-day shutdown that includes a holiday weekend. Schools are also closed through Tuesday.
Mexico City's notoriously clogged avenues were clear, crime was down and the smog dropped to levels normally seen only on holidays. Mexico is using the shutdown to determine whether to extend or ease emergency measures.
Lezana, the chief epidemiologist, said his department was alarmed by flu and pneumonia cases in Mexico earlier in April and notified the local office of PAHO by e-mail, following international protocol.
He said the illnesses raised a red flag because the flu was occurring at least a month after flu season normally ends in Mexico.
Four days later, PAHO still had not responded, so the National Epidemiology Center asked PAHO whether it needed more, Lezana said. He said PAHO responded the alert was being handled.
Lezana said that as far as he knew, the PAHO regional office in Washington and WHO took no action until April 24, when WHO announced an epidemic was under way.
Lezana had learned just the day before, from a testing of a sample that Mexico sent to a lab in Canada, that people were coming down with a new, mutated and lethal swine flu virus. By then, more than 1,000 people had been sickened in Mexico.
Daniel Epstein, a PAHO spokesman in Washington, told The Washington Post the agency received a message from Mexican authorities April 16 about an unusual outbreak. He described a system that sends messages to WHO headquarters in Geneva automatically.
WHO officials in Geneva confirmed Friday that the organization had received reports from Mexico of cases of suspicious influenza and that the organization reacted quickly when the new flu virus was identified on April 24.
WHO chief Dr. Margaret Chan was aboard a flight to the United States at the time but was briefed immediately when she landed, Abraham said. She canceled her appointments, met with U.S. and Mexican authorities and flew back to Geneva on April 25. That evening, WHO told the world it faced a possible flu pandemic.
"I think that is a pretty rapid response," Abraham said.
WHO flu chief Dr. Keiji Fukuda, speaking before the Mexican epidemiologist issued his criticism, told reporters late Thursday there is always some delay when unusual illnesses are detected, particularly during flu season.
"Most diseases do not come out with people walking around with 'new disease' written on their forehead and 'we need to call an international response,'" he said. "And in this case the countries which were affected earlier, they really were communicating in a very appropriate way."
While Mexico waited for WHO to help, Lezana said, Mexican authorities tried to identify the outbreak and stop it. Mexican medical teams interviewed 472 people who may have come into contact with the first known swine flu fatality, a 39-year-old woman.
But only 18 of the 472, all hospital workers, were tested for swine flu. And in other parts of Mexico, health workers only this week started visiting the families of victims to find out whether they contracted it as well.
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Associated Press writers Paul Haven, E. Eduardo Castillo and Istra Pacheco contributed to this report.
Q's without A's: 6 mysteries about swine flu
Eric Carvin
Associated Press Writer
Government officials, public health experts and business leaders have faced a lot of questions about swine flu this week, and three words keep popping up in their answers: "We don't know."
The flu outbreak has spawned many mysteries about origin, scope and impact, just for starters and some of the most fundamental questions remain unanswered, or unanswerable.
Here's some of what we don't know.
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- How many people have had the virus?
A lot of numbers have bubbled up more than 100 lab-confirmed cases in the United States, at least 300 in Mexico, and dozens more in a few other countries. And then there are the suspected cases thousands in Mexico alone.
But the real number of infections around the world is impossible to know, since many people may contract swine flu and simply get better without ever seeing a doctor. Even among the lab-confirmed cases of swine flu, many people have had only mild symptoms, similar to a run-of-the-mill case of seasonal flu. - How big will this get?
This is the million-dollar question, and we probably won't know the answer until scientists figure out how easily the virus spreads and how often it kills. Then, they might be able to project more accurately what damage the outbreak might cause.
An influenza outbreak can spread rapidly and unpredictably, requiring only a cough or sneeze to jump from one person to another. The swine flu has taken hold in densely populated areas like Mexico City, home to 20 million people where it can spread at an alarming rate. And the disease has popped up in many parts of the world, thanks to easy travel between one continent and another.
Even the public health experts most plugged into swine flu don't want to speculate about the ultimate scope of the outbreak.
There have been some clues about the outbreak's future, though: On Thursday, Mexico's top health official said the number of new swine flu cases is stabilizing, at least in that country. Though WHO's flu chief, reacting to similar comments from other Mexican officials, said WHO hadn't seen evidence of leveling off and cautioned that case numbers often go up and down, particularly in the early stages of an outbreak. - When and where did it start?
The virus may have mutated into its current form months or even a year ago, and it happened, well, somewhere in the world.
The first symptoms started to show up in early March in the Mexican state of Veracruz, an area with a number of pig farms. The earliest confirmed case was a 5-year-old boy, one of hundreds of people in the town of La Gloria whose flu symptoms left them struggling to breathe.
People from La Gloria kept going to jobs in Mexico City despite their illnesses, and could have infected people there.
Still, there's no guarantee the virus came into existence in Veracruz. It spreads so easily, it could have made its way to Mexico from just about anywhere.
Some Mexican officials have offered some other suggestions of places where the virus may have begun, such as China, Pakistan or Bangladesh. But the fact is that the flu's origin remains a mystery.
Fortunately, it also doesn't really matter the outbreak has made its way around the world, and nothing can be done now at the point of origin to slow it down. - Why have so many people died in Mexico, but virtually nobody anywhere else?
OK, this is the REAL million-dollar question, and a swarm of public health experts including several from the U.S. Centers for Disease Control and Prevention have descended upon Mexico in search of an answer. This is especially a head-scratcher because experts have found no difference in samples of the virus collected in Mexico and the United States.
One theory is that many more people have had the virus in Mexico than health officials realize, and the number of cases there could well eclipse the number anywhere else in the world. If so, that country's death toll at least a dozen confirmed deaths and many more suspected ones would make sense.
Other theories have been floated and ruled out for the number of deaths in Mexico:- Lab tests of Mexican patients found no sign of complications from a second infection.
- CDC investigators have not seen any obvious problem with low-quality health care.
- The CDC found no evidence of an over-the-counter medicine or folk remedy compounding the problem.
- Complications from Mexico City's altitude or air pollution are unlikely because severe cases have been reported in parts of Mexico at low altitude and with cleaner air.
- Who are the victims in Mexico?
The Mexican government has revealed little about the victims, citing privacy reasons. The government has even been a bit haphazard about providing information that would not violate privacy rules, such as ages and hometowns.
After prodding by journalists, Health Secretary Jose Angel Cordova revealed Thursday that 5 of the 12 confirmed dead were between the ages of 20 and 40 and that they had an overactive immune system possibly explaining why they did not survive.
On Wednesday, when there were 99 confirmed cases, he said 83 of them were from Mexico City. But when the number jumped Thursday, no information about hometowns was offered.
Also, Mexico's chief epidemiologist, Miguel Angel Lezana, told reporters Wednesday that one of those confirmed dead was a Bangladeshi who had been in Mexico for six months, and whose brother also apparently sick had recently visited from Bangladesh or Pakistan.
And on Thursday, Mexico City government officials announced that preliminary investigations showed most of the people suspected to have died of swine flu in the capital lived in poor neighborhoods. - Will changes in the WHO alert level help stem the outbreak?
That's the idea, but it's unclear what concrete actions are actually taken by WHO and countries with a change in the alert level which was bumped up on Wednesday to phase 5, one step away from the highest level, which indicates a global outbreak.
The alert levels mainly signify WHO's assessment of the pandemic situation, but they do come with actions and responsibilities. At the higher alert levels, WHO is essentially warning countries to prepare for a pandemic.
WHO monitors the outbreak situation at every level, but surveillance increases at higher levels for unusual outbreaks, the disease's spread, and the virus' possible drug resistance. WHO may also issue guidance about travel advisories, border closures, closings of schools and offices, and suspension of mass gatherings such as sporting events.
The alert system, however, is largely untested. Monday was the first time it had ever been raised above phase 3, which signifies only occasional cases or small clusters of a new flu virus.
Also, it's ultimately up to individual governments to activate pandemic response plans and to take such steps as closing schools or workplaces where a disease might spread. WHO cannot force countries to comply with recommendations.
At phases 5 and 6, WHO will also consider asking vaccine producers to switch from making seasonal flu vaccine to pandemic vaccine. It will also oversee distribution of its emergency stockpile of 5 million antiviral treatments to countries in need and help negotiate with vaccine makers for a proportion of the vaccine to go to developing countries.
How much does all this help? Until an outbreak has come and gone, the truth is: We don't know.
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Associated Press writers Mike Stobbe in Atlanta and Alexandra Olson, Mark Stevenson and Andrew O. Selsky in Mexico City contributed to this report.
Obama: Swine flu may run course like other flus
WASHINGTON Urging calm but caution, President Barack Obama on Friday said that it is not clear the swine flu outbreak in the United States and other nations is any worse than "ordinary flus." But he said agencies across the government are preparing for the worst.
Even if the new flu "is relatively mild on the front end, it could come back in a more virulent form during the actual flu season," Obama said at the close of a Cabinet meeting devoted to the topic.
The president described a two-pronged U.S. response to the swine flu, a mix of pig, bird and human genes to which people have limited natural immunity.
He said the immediate effort remains to identify people who have the flu, get medical help to the right places and provide clear guidance to both state and local officials and the public. Obama said his government is also doing longer-range work producing a vaccine, developing clear guidelines for school closings, trying to ensure that businesses cooperate with workers who run out of sick leave, and preparing for requests for aid from other countries.
"I'm optimistic that we're going to be able to manage this effectively," Obama said.
In the United States, the confirmed case count stood at more than 130. State lab operators say there have been more cases than are counted, because officials are not testing all suspected cases, focusing instead on finding new outbreak hot spots and limiting the flu's spread. The flu has reached several countries.
In Mexico, the outbreak's epicenter, new cases and the death rate were leveling off, the country's top medical officer said.
Obama referred to the flu by its scientific name, H1N1. The World Health Organization has stopped using the term "swine flu" to avoid suggesting there's a danger posed by pigs.
"We don't know for certain that this will end up being more severe than other seasonal flus that we have," Obama said. "And it's been noted, I think, before that you have over 36,000 people die on average every year from seasonal flus. You have 200,000 hospitalizations. It may turn out that H1N1 runs its course like ordinary flus, in which case we will have prepared and we won't need all these preparations."
Still, he said, Americans and people around the world have not built up immunity to this new flu strain, "So that's why we're taking it seriously."
Swine flu could put damper on immigration rallies
Sophia Tareen
Associated Press Writer
CHICAGO The timing is not the best. Immigration-rights rallies are set for Friday as health officials try to clamp down on a swine flu epidemic with roots in the same country as many of the expected demonstrators: Mexico.
Public health officials on Thursday had not advised canceling large-scale events unless they were specifically tied to an institution or location with a laboratory-confirmed case of the illness. They urged people to stay home if they are sick.
Organizers of the May Day rallies, which have drawn thousands and even hundreds of thousands of people in recent years, said they would look to recommendations from public health officials about whether to cancel or modify the events.
"We're monitoring the situation to make sure that anything that is going to be conducive to the health and safety of communities is observed," said Clarissa Martinez, a director for the National Council of La Raza.
Crowds on Friday were expected to be around the same as last year. In Chicago, which has had the nation's largest marches in the country, about 15,000 participated in 2008. That's a dramatic drop from 2006, when more than 400,000 took to the streets.
Thousands also were expected at events Friday in Houston, Los Angeles, Miami, New York, Seattle and other cities. Health officials urged participants to use common sense.
"The message ought to be clear that if people are sick no matter whether it's Cinco de Mayo, a school, a church, a synagogue or any place of worship or anywhere else a movie theater they should stay home," Chicago Department of Public Health Commissioner Terry Mason said Wednesday.
Some schools have closed because of the swine flu outbreak, and U.S. and Mexican officials have been urging migrant workers to take health precautions and get medical care if they feel sick.
The rallies come as illegal immigrants are being blamed on some conservative blogs and talk shows for spreading swine flu in the U.S. The outbreak is believed to have originated in Mexico, where there are 168 suspected deaths from the disease, before spreading to at least 10 other countries, including the U.S.
The only confirmed U.S. swine-flu death was of a Mexican toddler who family was visiting relatives in Texas; many reported cases were among U.S. citizens who vacationed in Mexico.
"For people who like to blame Mexicans, they are going to blame us for everything no matter what," said Jorge Mujica, a labor union activist and organizer for Chicago's immigrant rights march. "We are not going to pay attention to that."
For most rally organizers, swine flu was secondary to promoting immigration reform, including pathways to citizenship for an estimated 12 million illegal immigrants hopes buoyed with Barack Obama in the White House and a Democratic-controlled Congress.
More than 1 million people marched in cities across the country in 2006, when some in Congress were pushing for tougher laws against illegal immigrants. Although turnout at the marches has dropped steeply since then, organizers say their mission remains the same.
"It's important for us to continue the fight," said Margarita Klein with Workers United in Chicago, adding that union workers had been preparing for two months for Friday's event.
Union leaders said they have set aside differences to promote a unified immigration overhaul plan they hope will get through Congress this year.
"I think we're in a different position now in April 2009 than in April 2007," said Angela Kelley, vice president for immigration policy at the Center for American Progress. "I think it's become more diverse and mainstream, sort of at the same time."
Some say immigration reform will help the economy.
"Immigrants are workers that are central to our economic success, and immigration reform is essential for stabilizing our work force," said Joshua Hoyt, executive director of Illinois Coalition for Immigrant and Refugee Rights.
Others say having a new president whose father was from another country Kenya has also buoyed hopes.
"You can feel it in the streets, people are waiting for some kind of solution," said Mujica, the organizer in Chicago. "We have been waiting."
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Associated Press Writers Don Babwin in Chicago, Amy Taxin in Los Angeles and Deepti Hajela in New York contributed to this report.
Swine flu outbreak prompts sports cancellations
John Zenor
AP Sports Writer
MONTGOMERY, Ala. .The swine flu outbreak has forced the cancellation or postponement of sporting events across the country, affecting everything from prep contests in Texas and Alabama to a college baseball road trip in Delaware.
The Alabama High School Athletic Association is pushing back its championship events until at least next week amid dozens of school shutdowns in the Huntsville area, where two probable cases of swine flu were reported. The state track and field championships were scheduled for this weekend in Gulf Shores and Troy.
Special Olympics Texas, meanwhile, canceled its spring games a day after all public high school athletic competitions in the state were put off until May 11.
Mexico has been at the center of the flu outbreak and its sports have been badly disrupted. Mexican pro soccer matches this weekend 176 in all will be played in empty stadiums and a pair of Copa Libertadores matches were moved to Colombia next week. The Copa Libertadores is Latin America's most prestigious club championship.
Back in the United States, the flu's impact hasn't yet hit major league sports.
Texas Rangers spokesman John Blake said team physician David Hunter is keeping in contact with local health organizations. The Rangers also have distributed an information sheet about the flu provided by Major League Baseball to all ballpark personnel.
"It is a concern, because we do travel a lot," New York Yankees manager Joe Girardi said. "We're in places where there are big crowds all the time. I feel very good about the medicine in our country and the way our country handles situations.
"So you try to take as many precautions as you can, but you can't stop living."
Milwaukee Brewers pitcher Yovani Gallardo, who was born in Michoacan, Mexico, and went to high school in Fort Worth, Texas, was concerned about relatives in the area.
"Everybody's pretty worried about it," he said. "But no, I haven't heard anything as far as my family to this point and hopefully it stays that way."
At the college level, the NCAA said it was monitoring the situation but as of now doesn't plan changes to its various spring championship sites.
The University of Delaware canceled a baseball series at North Carolina-Wilmington after 10 probable cases of the virus were identified among Delaware students, including one team member. The player's name was not released.
Delaware and Hofstra also scratched a three-game softball series at Hofstra this weekend.
A rural school district in central New York is closing for two days after preliminary testing indicated a female student who had traveled to Mexico recently had contracted swine flu.
Fabius-Pompey Superintendent Tim Ryan says all sports and other activities also have been canceled through Friday. The rural district 10 miles south of Syracuse has 860 students.
North Kingstown High School in Rhode Island closed for the week and canceled all home and away games starting Wednesday afternoon. Health of