State girds for swine flu

Alert high; N.E. still has no cases

Workers in Texas disinfected a classroom in Cibolo, where all schools and parks were closed for a week after two cases of swine flu were confirmed in the area. Workers in Texas disinfected a classroom in Cibolo, where all schools and parks were closed for a week after two cases of swine flu were confirmed in the area. (Eric Gay/ Associated Press)
By Kay Lazar and John C. Drake
Globe Staff / April 28, 2009
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Massachusetts public health officials yesterday mobilized against a possible swine flu outbreak as the World Health Organization raised its alert level to Phase 4 - signaling significant risk of a global epidemic - and the number of confirmed cases in the United States more than doubled, to at least 50.

State Public Health Commissioner John Auerbach said the state is on high alert, sending information to thousands of physicians, hospitals, day-care providers, and other healthcare centers about vigilantly watching for signs and symptoms of the disease.

Officials have already ruled out the illness in many of two dozen suspected cases in Massachusetts, although other samples have been sent to the Centers for Disease Control and Prevention in Atlanta for further testing.

As of last night, no cases had been confirmed in New England.

Some 200,000 doses of antiviral medications, requested by state officials, will be shipped from the national stockpile and are expected to arrive here by week's end. Massachusetts already has "tens of thousands" of antiviral medication at the ready, Auerbach stressed.

"We encourage people . . . to stay calm," he said. "We want to ensure the public that everything is being done within state government . . . to protect the public health and to do everything we can to minimize illness."

That was also the message yesterday from President Obama, saying there was reason for concern but not yet "a cause for alarm."

The federal government is advising Americans to avoid nonessential travel to Mexico, where the death toll yesterday was 149 and rising. Also yesterday, the European Union's health commissioner advised Europeans to avoid nonessential travel to Mexico and to parts of the United States.

Top disease trackers said they aren't sure why the disease so far in the United States seems less severe than the outbreak in Mexico, where more than 1,600 cases have been reported. Although cases have been confirmed in New York, Ohio, Kansas, Texas, and California, no deaths have been reported, and only one hospitalization.

"I wouldn't be overly reassured by that," Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, told reporters at CDC's headquarters in Atlanta. He raised the possibility of more severe cases, and deaths, in the United States.

Last night five probable cases were reported in New Jersey.

Specialists say that what they don't know about the disease is what makes them uneasy. The A/H1N1 swine flu confirmed in the Mexican, US, and Canadian cases is a previously unknown combination of pig, human, and avian flu viruses.

"Swine flu is a novel strain of influenza virus," said Dr. Alfred DeMaria, chief epidemiologist for Massachusetts. "The concern is about transmission of a virus that we don't have a natural immunity to."

Right now, he said, Massachusetts health officials have the ability to do only first-line screening of suspected swine flu cases; those that seem probable must be sent to the CDC for a definitive ruling. However, state officials hope by week's end to have their own testing ability in place.

A state Department of Public Health spokeswoman, Jennifer Manley, declined last night to elaborate on the samples sent to the CDC. She also would not say whether they included those from two siblings in Lowell who were tested for the respiratory illness after they got sick during a vacation to Mexico.

Frank Singleton, director of the Health Department in Lowell, says there is no concern that the children may have spread the illness in school because they fell ill when they came home from vacation and never returned to classes.

In Boston, the city's top health specialist said her office is working with the superintendent of schools to monitor potential illnesses.

"We'll be reviewing on a case-by-case situation where children may be infected," said Barbara Ferrer, executive director of the Boston Public Health Commission. "It's all a matter of where those children have been, were they even in school at the time they were potentially infectious, and who else they came in contact with."

The city has activated its medical incident command center, which coordinates surveillance and communication across all city agencies and health facilities. It provides a 24-hour, seven-day a week feed from all the emergency rooms in the city, to detect any rise in flulike illnesses.

One of the state's largest medical practices, Harvard Vanguard Medical Associates, said it is ramping up its electronic system of 400,000 patient medical records across 15 sites, from Chelmsford to Braintree, to scan for any increases in influenza-like illness. That information can be fed directly to state public health officials.

And at Partners HealthCare, which includes Brigham and Women's Hospital and Massachusetts General Hospital, patients displaying any symptoms of respiratory illnesses are being given masks and a reminder to cover their coughs.

Worldwide jitters prompted by a deadly Asian outbreak of avian flu four years ago helped disease specialists build a strong pandemic surveillance system, said Dr. Richard Zane, medical director for emergency preparedness and biodefense at Partners.

"Pandemic planning for avian flu is completely applicable to swine flu," Zane said. "Emergency preparedness is generic; most of it is applicable to most circumstances."

World health officials, in raising the official pandemic alert level to Phase 4, verified that swine flu is spread by human-to-human contact. Phase 6 is a full-fledged pandemic, an epidemic that has spread to a wide geographic area.

Yesterday, federal customs officials began checking people entering US territory.

At Logan Airport, three families returning to Boston from vacationing in Cancun, Mexico, said they faced little questioning by customs officials. Traveling with her husband and 12-year-old son, Dorian Brown, 47, of Georgetown, said the screening process at Logan on their return flight was unremarkable - although officials did ask her family how they were feeling.

Airport staff handed all passengers returning from Mexico information sheets from the CDC on the symptoms of the swine flu. Some security officials at Logan were wearing masks, said Cory Brown, in an interview at the international arrival gate.

One passenger - Darcey Klein, 52, of Brookline, N.H. - said she cut her stay in Cancun short after hearing about the outbreak. "We bought masks on our own to wear at the airport," she said.

There were no reports of schools closing in Massachusetts but in Texas a school district was closed and residents of Guadalupe County were asked to avoid public gatherings and stay home if they are ill.

Globe correspondent Jenna Nierstedt contributed to this story. Material from the Associated Press was also used. Kay Lazar can be reached at