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US declares swine flu emergency

Officials seek answers amid lack of data

By David Brown
Washington Post / April 27, 2009
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WASHINGTON - The United States formally declared a public health emergency yesterday as countries from New Zealand to Scotland investigated suspected cases of illness that officials feared might be a strain of swine flu that has been identified in Mexico, the United States, and Canada.

As of yesterday, however, no confirmed cases of the newly emerged flu strain had been found outside those three countries. Many of the people under observation around the world reported recent travel to Mexico.

With the US announcement, civilian and military stockpiles of antiviral drugs were being readied for rapid distribution in the event that transmission of swine flu virus accelerates. The declaration also called for greater vigilance at border crossings and in airports for travelers who are coughing or appear ill.

Those steps fell far short of those that could be invoked in a confirmed pandemic, which could include restricting travel, actively screening travelers for fever or illness, quarantining the sick, closing schools, and banning public gatherings.

In Mexico, where the infection is suspected of causing as many as 103 deaths and more than 1,600 illnesses, Masses were canceled and a high-profile soccer game was played before an empty stadium as officials urged the public to take precautions.

In Geneva, the World Health Organization urged increased surveillance for influenza worldwide.

The United Nations agency's public health emergency committee planned to meet again today to decide whether the outbreak warrants elevation of the pandemic threat level, which in turn could trigger international travel restrictions and other measures.

"The committee unanimously agreed that we are in a situation that really warrants the utmost attention," Keiji Fukuda, WHO's head of health security, said. "So on the basis of that . . . we have requested countries to help clarify this situation and to provide as much information as possible."

Suspected cases were being reported in Brazil, Spain, Colombia, New Zealand, France, and Scotland, and some nations issued travel warnings for Mexico and the United States, wire services reported.

As of last night, there had been 20 confirmed cases of swine flu in the United States, 19 in Mexico, and six in Canada. The US cases are in California, Texas, Kansas, New York and Ohio. Mexico reported suspected cases in 19 of its 32 states. In Canada, four cases were reported in the Atlantic province of Nova Scotia and two on the Pacific Coast in British Columbia. The American and Canadian cases appeared generally to be milder than the Mexican cases, and none had been fatal.

In Massachusetts public health authorities have seen no evidence that swine flu has spread to the state, and there are no reports of the respiratory illness elsewhere in New England. Still, representatives from the state Department of Public Health and Boston Public Health Commission are on heightened alert, and a representative of the state agency said disease trackers are especially mindful that with the end of school vacation week, families may be returning from parts of the United States and Mexico where cases have been identified.

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. Pigs, which are easily infected with all three types of flu, can function as "mixing vessels" in which flu viruses exchange genetic material and emerge in new forms.

At a White House briefing, Janet Napolitano, Homeland Security secretary, said the emergency declaration was in large part a procedural step.

"That sounds more severe than really it is," she said. "This is standard operating procedure and allows us to free up federal, state, and local agencies and their resources."

Among the steps being taken: readying drug supplies sufficient to treat 3 million people for flu from the Department of Health and Human Services' "strategic stockpile," which can treat up to 50 million. The Defense Department was readying supplies sufficient for another 7 million people for use by military personnel.

The declaration also allows use of certain medications and diagnostic tests in children and releases money to purchase more drugs if necessary.

The World Bank yesterday said it would give Mexico an immediate loan of $25 million for medicine and equipment, along with longer-term loans of $180 million.

Major airlines, including American, United, and Continental, began revising their policies so that travelers flying to Mexican cities could change their plans without fees or penalties. About 5.9 million US citizens flew to Mexico in 2008.

The 20 confirmed US cases of A/H1N1 swine flu yesterday were an increase from the 11 reported Saturday.

Lab tests confirmed eight cases among students at St. Francis Preparatory School in Queens, N.Y., where more than 100 students last week came down with flu symptoms. The school canceled classes for today. Ohio reported a case in a 9-year-old boy from Lorain County, near Cleveland, who was recuperating at home.

Why the same virus appears to be acting so differently in Mexico and the United States, where there have been no deaths and all reported cases have been relatively mild, is one of the unanswered questions about the outbreak. The other is whether the virus is still spreading in Mexico.

Napolitano said that people crossing from Mexico into the United States "from a location of human infection of swine flu" will be asked whether they are ill. Those who are will be isolated and given masks.

Airlines will also be told to be on the lookout for people who look sick and are about to board planes.

Scientists are preparing a "seed strain" of the new virus that could be used to make a vaccine. Drug companies are in the early stages of making next season's flu shot, a mixture of three flu strains currently circulating the globe.

If companies stopped that work to make a swine-flu vaccine, the first shots would not be available for at least two months. Another possibility being pondered is whether to add a fourth, swine-flu component to the current recipe.

Stephen Smith of the Globe staff contributed to this report.

WHAT TO DO
  • If you have flu symptoms, stay home from work or school to avoid spreading the disease. Do not return until two days after your symptoms are gone.

  • Cover your nose and mouth when you cough or sneeze, and wash your hands frequently.

  • Go to the hospital if you have severe symptoms such as difficulty breathing, but if your symptoms are mild stay home to avoid spreading the virus to others at the hospital.

  • Masks may be recommended for those who come in close contact with swine flu patients, but there is no need for the public to wear masks.

  • It is safe to eat properly handled pork. Cook it to at least 160 degrees.

    Source: CDC, NY Dept. of Health