Flu May Have Spread Within New York City
By ANEMONA HARTOCOLLIS
The swine flu outbreak in New York may have spread beyond one school in Queens — where victims now are estimated to number in the hundreds — to pockets across the city, including at least two other schools, officials said on Tuesday.
At Public School 177, a school for autistic children in Fresh Meadows, Queens, 12 students had fever or other symptoms that could indicate swine flu. The school, at 56-37 188th Street, which was closed as a precaution, is about half a mile from St. Francis Preparatory School, at 61-00 Francis Lewis Boulevard, where the first cases were detected several days ago. Tests of students there have not been completed.
Continúa: http://www.nytimes.com/2009/04/29/nyregion/29school.html
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The Naming of Swine Flu, a Curious Matter
By KEITH BRADSHER
HONG KONG — What to call the new strain of flu raising alarms around the world has taken on political, economic and diplomatic overtones.
http://www.nytimes.com/2009/04/29/world/asia/29swine.html
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jueves, 30 de abril de 2009
Influenza. 29 de abril de 2009. From Édgar, 5, Coughs Heard Round the World
By MARC LACEY
LA GLORIA, Mexico — Édgar Hernández can rattle off the fierce flu symptoms he suffered a few weeks back, like a boy far beyond his five years: His head was hot. He coughed until his belly and his throat were sore. He did not want to eat, which was strange for him, someone who gobbles up everything he can.
“I was very bad,” he said Tuesday, with his worried parents looking on.
“I feel good now,” he said later, flashing a smile.
LA GLORIA, Mexico — Édgar Hernández can rattle off the fierce flu symptoms he suffered a few weeks back, like a boy far beyond his five years: His head was hot. He coughed until his belly and his throat were sore. He did not want to eat, which was strange for him, someone who gobbles up everything he can.
“I was very bad,” he said Tuesday, with his worried parents looking on.
“I feel good now,” he said later, flashing a smile.
The government has identified Édgar as the first person in Mexico to have become infected with a virulent strain of swine flu, a notoriety that could raise questions about how Mexican officials reacted — or failed to react — to the early stages of what might become a global epidemic.
Édgar was one of hundreds of people in La Gloria who came down with flulike symptoms in an outbreak that federal officials say began March 9.
Local residents accuse public health officials of discounting the outbreak at the time, reassuring them that it was nothing grave.
Federal officials said they did respond quickly, though they acknowledged that they took the matter more seriously after the virus infected people in another part of the country, which was at least a week after Édgar developed symptoms.
Among the many unknowns about the flu that struck Édgar are whether it could have set off more alarms early on, and whether it could have been contained if it had.
La Gloria may not, in the end, be found to be the source of anything. The village has many immigrants in the United States. Mexican epidemiologists say one theory is that someone who had been in the United States brought the virus back to the community.
Before Édgar fell ill, another person in San Diego may have been affected, said Dr. Miguel Ángel Lezana, Mexico’s chief government epidemiologist.
Even now, Édgar’s mother, María del Carmen Hernández, said she received conflicting accounts of the exact illness that kept her son in bed for three days. No one has explained what she should be doing to keep him and the rest of the family healthy, she said, signs that Mexico’s response effort may be spotty, especially in rural areas.
“Some people are saying my boy is to blame for everyone else in the country getting sick,” said Mrs. Hernández, 34, a blank stare on her face as she recounted the family’s ordeal. “I don’t believe that. I don’t know what to think.”
There was a modest increase on Tuesday in new cases of swine flu reported around the world.
In the United States, the number of confirmed cases rose to 64, from Monday’s count of 50, according to a news briefing by Dr. Richard E. Besser, acting director of the Centers for Disease Control and Prevention. The total includes 45 cases in New York State. There have been no deaths from the disease in the United States, but five people have been hospitalized for treatment.
Mexico remains the hardest hit. Late Tuesday, the Health Ministry put the number of suspected cases at 2,498, and the suspected number of deaths at 159.
In La Gloria, a town that has a major pig farming industry, two children died of the flu in March and early April, though the authorities said they had yet to determine whether it was the same strain that infected Édgar and spread widely to other locales. That and other questions have left residents here unnerved and confused.
Each knock on the door brings a surprise to the Hernándezes: fumigators who sprayed her home but did not tell her for what; scientists who asked to take a swab of Édgar’s throat; even the governor of Veracruz, who arrived by helicopter on Monday with an entourage in tow and left Édgar with a soccer ball and a baseball cap.
On Monday, the local physician who treated Mrs. Hernández told her that her son had influenza, but that it was not the swine flu virus, she said. But a few hours before, Gov. Fidel Herrera Beltrán walked right into her home to check on Édgar. He had said publicly over the weekend that Édgar had tested positive for swine flu, and Health Secretary José Ángel Córdova had confirmed on Monday that a boy from La Gloria, whom he refused to identify, had tested positive and then recovered.
“Shouldn’t they tell the mother first?” Mrs. Hernández asked as her younger son, Jonathan, 3, let out a cough of his own.
In fact, it was not Édgar’s case that tipped off heaThe situation changed dramatically,” Dr. Lezana said.
A crisis meeting was called at the office of President Felipe Calderón. By that evening, officials announced the closing of schools in and around the capital, where the bulk of the cases were seen. Now, as the cases continue to come in, all of Mexico’s schools are closed.
“My impression — as an external observer, and that’s what I am now — is that the response has been quite competent,” said Dr. Julio Frenk, a former Mexican health minister who is now dean of Harvard’s School of Public Health. “Not perfect,” he continued, “but quite competent.”
Mexico has acted swiftly since the new flu strain was confirmed.
But officials acknowledge that the country lacks enough health workers to do as much outreach as they would like, and that the country has been unable to even test for the new strain of virus.
It was only this week that two laboratories, one in Mexico City and one in Veracruz, obtained the reagents to do their own checks on the new virus, rather than having to rely solely on epidemiologists in the United States and Canada.
“We never had this kind of epidemic in the world,” Mr. Córdova, the health secretary, responded testily to reporters this week when questioned about the handling of the crisis.
Epidemiologists are likely to have many leads to follow in determining how and where the flu originated.
La Gloria was not alone in experiencing a fierce outbreak in recent weeks. Public health officials in other parts of Mexico said they had noticed an unusual spike in cases in the beginning of April, when the normal flu season would usually be ending.
More than a month before the government confirmed the outbreak of swine flu, Verónica Ramos already knew something was amiss in La Gloria, where she is a teacher at the elementary school.
First, she said, a fourth-grade girl became sick; then more than half of that class had symptoms. The girl’s sister came down with fever, a cough and aches. Soon, one-third of the school’s 300 students were ill.
“Children get sick, I know that,” Ms. Ramos said. “And they infect each other. But it’s not common for so many to get sick so fast.”
Édgar was one of hundreds of people in La Gloria who came down with flulike symptoms in an outbreak that federal officials say began March 9.
Local residents accuse public health officials of discounting the outbreak at the time, reassuring them that it was nothing grave.
Federal officials said they did respond quickly, though they acknowledged that they took the matter more seriously after the virus infected people in another part of the country, which was at least a week after Édgar developed symptoms.
Among the many unknowns about the flu that struck Édgar are whether it could have set off more alarms early on, and whether it could have been contained if it had.
La Gloria may not, in the end, be found to be the source of anything. The village has many immigrants in the United States. Mexican epidemiologists say one theory is that someone who had been in the United States brought the virus back to the community.
Before Édgar fell ill, another person in San Diego may have been affected, said Dr. Miguel Ángel Lezana, Mexico’s chief government epidemiologist.
Even now, Édgar’s mother, María del Carmen Hernández, said she received conflicting accounts of the exact illness that kept her son in bed for three days. No one has explained what she should be doing to keep him and the rest of the family healthy, she said, signs that Mexico’s response effort may be spotty, especially in rural areas.
“Some people are saying my boy is to blame for everyone else in the country getting sick,” said Mrs. Hernández, 34, a blank stare on her face as she recounted the family’s ordeal. “I don’t believe that. I don’t know what to think.”
There was a modest increase on Tuesday in new cases of swine flu reported around the world.
In the United States, the number of confirmed cases rose to 64, from Monday’s count of 50, according to a news briefing by Dr. Richard E. Besser, acting director of the Centers for Disease Control and Prevention. The total includes 45 cases in New York State. There have been no deaths from the disease in the United States, but five people have been hospitalized for treatment.
Mexico remains the hardest hit. Late Tuesday, the Health Ministry put the number of suspected cases at 2,498, and the suspected number of deaths at 159.
In La Gloria, a town that has a major pig farming industry, two children died of the flu in March and early April, though the authorities said they had yet to determine whether it was the same strain that infected Édgar and spread widely to other locales. That and other questions have left residents here unnerved and confused.
Each knock on the door brings a surprise to the Hernándezes: fumigators who sprayed her home but did not tell her for what; scientists who asked to take a swab of Édgar’s throat; even the governor of Veracruz, who arrived by helicopter on Monday with an entourage in tow and left Édgar with a soccer ball and a baseball cap.
On Monday, the local physician who treated Mrs. Hernández told her that her son had influenza, but that it was not the swine flu virus, she said. But a few hours before, Gov. Fidel Herrera Beltrán walked right into her home to check on Édgar. He had said publicly over the weekend that Édgar had tested positive for swine flu, and Health Secretary José Ángel Córdova had confirmed on Monday that a boy from La Gloria, whom he refused to identify, had tested positive and then recovered.
“Shouldn’t they tell the mother first?” Mrs. Hernández asked as her younger son, Jonathan, 3, let out a cough of his own.
In fact, it was not Édgar’s case that tipped off heaThe situation changed dramatically,” Dr. Lezana said.
A crisis meeting was called at the office of President Felipe Calderón. By that evening, officials announced the closing of schools in and around the capital, where the bulk of the cases were seen. Now, as the cases continue to come in, all of Mexico’s schools are closed.
“My impression — as an external observer, and that’s what I am now — is that the response has been quite competent,” said Dr. Julio Frenk, a former Mexican health minister who is now dean of Harvard’s School of Public Health. “Not perfect,” he continued, “but quite competent.”
Mexico has acted swiftly since the new flu strain was confirmed.
But officials acknowledge that the country lacks enough health workers to do as much outreach as they would like, and that the country has been unable to even test for the new strain of virus.
It was only this week that two laboratories, one in Mexico City and one in Veracruz, obtained the reagents to do their own checks on the new virus, rather than having to rely solely on epidemiologists in the United States and Canada.
“We never had this kind of epidemic in the world,” Mr. Córdova, the health secretary, responded testily to reporters this week when questioned about the handling of the crisis.
Epidemiologists are likely to have many leads to follow in determining how and where the flu originated.
La Gloria was not alone in experiencing a fierce outbreak in recent weeks. Public health officials in other parts of Mexico said they had noticed an unusual spike in cases in the beginning of April, when the normal flu season would usually be ending.
More than a month before the government confirmed the outbreak of swine flu, Verónica Ramos already knew something was amiss in La Gloria, where she is a teacher at the elementary school.
First, she said, a fourth-grade girl became sick; then more than half of that class had symptoms. The girl’s sister came down with fever, a cough and aches. Soon, one-third of the school’s 300 students were ill.
“Children get sick, I know that,” Ms. Ramos said. “And they infect each other. But it’s not common for so many to get sick so fast.”
Influenza. Notas publicadas el 29 de abril de 2009 en el portal de The New York Times.
Pentagon Confirms Marine Is Ill With Swine Flu
By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 4:14 p.m. ET
WASHINGTON (AP) -- The Pentagon said Wednesday a Marine based in Southern California has been confirmed to be ill with swine flu and is under quarantine, along with about 30 other Marines.
A Marine spokesman at the Pentagon, Maj. David Nevers, said the sick Marine was doing well and his condition continued to improve. Nevers said approximately 30 other Marines who had been in contact with the sick Marine at the Twentynine Palms base will be held in quarantine for five days as well as to see whether they show symptoms.
Continúa: http://www.nytimes.com/aponline/2009/04/29/health/AP-US-Marines-Swine-Flu.html
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Mexico City Shuts Down Taco Stands Amid Swine Flu
By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 11:49 p.m. ET
MEXICO CITY (AP) -- Tacos filled with pork, sizzling gorditas, juicy carnitas covered with salsa and gobbled down at sidewalk carts while pedestrians brush past -- this is Mexico's version of a fast-food joint, but it is now in peril because of the swine flu epidemic.
With Mexico City authorities urging residents to dine at home to prevent the spread of the deadly virus, vendors at the tens of thousands of taco carts that line the streets of this overcrowded capital have seen business plunge. It hasn't helped that many people mistakenly believe you can contract the flu by eating pork.
Continúa: http://www.nytimes.com/aponline/2009/04/29/world/AP-LT-Swine-Flu-Taco-Terror.html
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World Takes Drastic Steps to Contain Swine Flu
By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 11:54 p.m. ET
From Egypt's order that all 300,000 pigs in the country be slaughtered to travel bans and putting the kibosh on kissing, the world is taking drastic -- and some say debatable -- measures to combat swine flu.
Egypt ordered the pig slaughter even though there hasn't been a single case of swine flu there and no evidence that pigs have spread the disease. Britain, with only five cases, is trying to buy 32 million masks. And in the United States, President Barack Obama said more of the country's 132,000 schools may have to be shuttered.
http://www.nytimes.com/aponline/2009/04/29/world/AP-EU-Swine-Flu-Drastic-Measures.html?pagewanted=1
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WHO Says Swine Flu Pandemic Is Imminent
MEXICO CITY (AP) -- Global health authorities warned Wednesday that swine flu was threatening to bloom into a pandemic, and the virus spread farther in Europe even as the outbreak appeared to stabilize at its epicenter. A toddler who succumbed in Texas became the first death outside Mexico.
Mexico, taking a drastic step as confirmed swine flu cases doubled to 99, including eight dead, announced it would temporarily suspend all nonessential activity of the federal government and private business from May 1-5. Essential services like transport, supermarkets, trash collection and hospitals will remain open.
Continúa: http://www.nytimes.com/aponline/2009/04/29/world/AP-MED-Swine-Flu.html
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Obama Vows Great 'Vigilance' as Swine Flu Spreads
By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 11:21 p.m. ET
WASHINGTON (AP) -- President Barack Obama pledged ''great vigilance'' in confronting the swine flu outbreak Wednesday night as it spread coast to coast across the U.S. The outbreak hit 11 states and closed schools amid confirmation of the first U.S. death -- a Mexican toddler who visited Texas with his family -- and the confinement of dozens of Marines after one came down with the disease in California.
Some 100 schools were closed, and more might need to be shut down temporarily, Obama said, declaring, ''This is obviously a very serious situation.'' The total confirmed cases in the U.S. rose to nearly 100, with many more suspected.
Continúa: http://www.nytimes.com/aponline/2009/04/29/us/politics/AP-MED-Swine-Flu-US.html
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School Nurse’s Response to Flu Wins Applause
By ANEMONA HARTOCOLLIS
Published: April 28, 2009
Too often school nurses are all but forgotten in the education wars over test scores, standardization and vouchers. Across the country, from Atlanta to New York City, amid budget cuts and economic turmoil, advocates say, the jobs of school nurses are increasingly at risk.
Now nurses are crowing over the role of one of their own, Mary Pappas, in uncovering the first swine flu cluster in New York State. Through her quick thinking, she might have lifted the status and perhaps even saved the jobs of thousands of nurses.
Continúa: http://www.nytimes.com/2009/04/29/nyregion/29nurse.html
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By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 4:14 p.m. ET
WASHINGTON (AP) -- The Pentagon said Wednesday a Marine based in Southern California has been confirmed to be ill with swine flu and is under quarantine, along with about 30 other Marines.
A Marine spokesman at the Pentagon, Maj. David Nevers, said the sick Marine was doing well and his condition continued to improve. Nevers said approximately 30 other Marines who had been in contact with the sick Marine at the Twentynine Palms base will be held in quarantine for five days as well as to see whether they show symptoms.
Continúa: http://www.nytimes.com/aponline/2009/04/29/health/AP-US-Marines-Swine-Flu.html
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Mexico City Shuts Down Taco Stands Amid Swine Flu
By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 11:49 p.m. ET
MEXICO CITY (AP) -- Tacos filled with pork, sizzling gorditas, juicy carnitas covered with salsa and gobbled down at sidewalk carts while pedestrians brush past -- this is Mexico's version of a fast-food joint, but it is now in peril because of the swine flu epidemic.
With Mexico City authorities urging residents to dine at home to prevent the spread of the deadly virus, vendors at the tens of thousands of taco carts that line the streets of this overcrowded capital have seen business plunge. It hasn't helped that many people mistakenly believe you can contract the flu by eating pork.
Continúa: http://www.nytimes.com/aponline/2009/04/29/world/AP-LT-Swine-Flu-Taco-Terror.html
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World Takes Drastic Steps to Contain Swine Flu
By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 11:54 p.m. ET
From Egypt's order that all 300,000 pigs in the country be slaughtered to travel bans and putting the kibosh on kissing, the world is taking drastic -- and some say debatable -- measures to combat swine flu.
Egypt ordered the pig slaughter even though there hasn't been a single case of swine flu there and no evidence that pigs have spread the disease. Britain, with only five cases, is trying to buy 32 million masks. And in the United States, President Barack Obama said more of the country's 132,000 schools may have to be shuttered.
http://www.nytimes.com/aponline/2009/04/29/world/AP-EU-Swine-Flu-Drastic-Measures.html?pagewanted=1
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WHO Says Swine Flu Pandemic Is Imminent
MEXICO CITY (AP) -- Global health authorities warned Wednesday that swine flu was threatening to bloom into a pandemic, and the virus spread farther in Europe even as the outbreak appeared to stabilize at its epicenter. A toddler who succumbed in Texas became the first death outside Mexico.
Mexico, taking a drastic step as confirmed swine flu cases doubled to 99, including eight dead, announced it would temporarily suspend all nonessential activity of the federal government and private business from May 1-5. Essential services like transport, supermarkets, trash collection and hospitals will remain open.
Continúa: http://www.nytimes.com/aponline/2009/04/29/world/AP-MED-Swine-Flu.html
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Obama Vows Great 'Vigilance' as Swine Flu Spreads
By THE ASSOCIATED PRESS
Published: April 29, 2009
Filed at 11:21 p.m. ET
WASHINGTON (AP) -- President Barack Obama pledged ''great vigilance'' in confronting the swine flu outbreak Wednesday night as it spread coast to coast across the U.S. The outbreak hit 11 states and closed schools amid confirmation of the first U.S. death -- a Mexican toddler who visited Texas with his family -- and the confinement of dozens of Marines after one came down with the disease in California.
Some 100 schools were closed, and more might need to be shut down temporarily, Obama said, declaring, ''This is obviously a very serious situation.'' The total confirmed cases in the U.S. rose to nearly 100, with many more suspected.
Continúa: http://www.nytimes.com/aponline/2009/04/29/us/politics/AP-MED-Swine-Flu-US.html
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School Nurse’s Response to Flu Wins Applause
By ANEMONA HARTOCOLLIS
Published: April 28, 2009
Too often school nurses are all but forgotten in the education wars over test scores, standardization and vouchers. Across the country, from Atlanta to New York City, amid budget cuts and economic turmoil, advocates say, the jobs of school nurses are increasingly at risk.
Now nurses are crowing over the role of one of their own, Mary Pappas, in uncovering the first swine flu cluster in New York State. Through her quick thinking, she might have lifted the status and perhaps even saved the jobs of thousands of nurses.
Continúa: http://www.nytimes.com/2009/04/29/nyregion/29nurse.html
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Influenza. Notas publicadas el 28 de abril de 2009 en el portal de The New York Times
From Travel Restrictions to Face Masks, Experts Address Readers’ Questions
By PAM BELLUCK
Published: April 27, 2009
By PAM BELLUCK
Published: April 27, 2009
The New York Times asked readers to submit questions about swine flu. Here is a selection of some of the questions, along with answers based on interviews with experts.
Q. Why is the mortality rate so high in Mexico? Is it due to the nature of the virus, the health care system in Mexico, or something else?
Q. Is it possible that the reason United States cases are milder is that Mexico is on a second wave of infection (similar to the 1918 flu, where the initial round was mild and the second round was the killer), while the United States is only in the first round of the infection?
A. Infectious disease experts so far know too little about this swine flu strain to be able to say why it appears to have more seriously affected people in Mexico than in the United States. “As far as I can tell, there is not a good explanation for it yet,” said Dr. Layne. One of the biggest unknowns is how many people in total have been infected in Mexico.
Q. Is it possible that the reason United States cases are milder is that Mexico is on a second wave of infection (similar to the 1918 flu, where the initial round was mild and the second round was the killer), while the United States is only in the first round of the infection?
A. Infectious disease experts so far know too little about this swine flu strain to be able to say why it appears to have more seriously affected people in Mexico than in the United States. “As far as I can tell, there is not a good explanation for it yet,” said Dr. Layne. One of the biggest unknowns is how many people in total have been infected in Mexico.
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W.H.O. Issues Higher Alert on Swine Flu, With Advice
While confirmed cases of swine flu increased only slightly on Monday, the World Health Organization voted to raise its global pandemic flu alert level, but at the same time it recommended that borders not be closed nor travel bans imposed.
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Investors Buy Up Shares of Flu Drug Makers
By DAVID JOLLY
Published: April 27, 2009
PARIS — Shares of GlaxoSmithKline and Roche, makers of prescription flu treatments, rose Monday amid expectations that the swine flu scare would lift demand for their products.
Published: April 27, 2009
PARIS — Shares of GlaxoSmithKline and Roche, makers of prescription flu treatments, rose Monday amid expectations that the swine flu scare would lift demand for their products.
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Teenagers From Queens in Swine Flu Spotlight
By ANNE BARNARD
Published: April 27, 2009
It was the spring break trip they had dreamed of all year: white-sand beaches, a quarter-mile-long swimming pool, young people from all over the world.
Published: April 27, 2009
It was the spring break trip they had dreamed of all year: white-sand beaches, a quarter-mile-long swimming pool, young people from all over the world.
Esti Lamonaca and her friends spent five months planning a trip to Mexico to celebrate their senior year of high school. They chose the Oasis Cancun, better known for college partying than high school vacations (“The center of spring break action,” raves one student travel Web site). Ms. Lamonaca persuaded her parents to let her go if she paid her own way — so she worked every day after school to save up about $1,200.
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Sound the Alarm? A Swine Flu Bind
By LAWRENCE K. ALTMAN, M.D.
Published: April 27, 2009
For all that scientists have learned about influenza since the catastrophic pandemic of 1917-19, one thing has not changed: the predictably unpredictable nature of the viruses that cause it.
Published: April 27, 2009
For all that scientists have learned about influenza since the catastrophic pandemic of 1917-19, one thing has not changed: the predictably unpredictable nature of the viruses that cause it.
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Opinion- Globalism Goes Viral
By DAVID BROOKS
Published: April 27, 2009
In these post-cold war days, we don’t face a single concentrated threat. We face a series of decentralized, transnational threats: jihadi terrorism, a global financial crisis, global warming, energy scarcity, nuclear proliferation and, as we’re reminded today, possible health pandemics like swine flu.
By DAVID BROOKS
Published: April 27, 2009
In these post-cold war days, we don’t face a single concentrated threat. We face a series of decentralized, transnational threats: jihadi terrorism, a global financial crisis, global warming, energy scarcity, nuclear proliferation and, as we’re reminded today, possible health pandemics like swine flu.
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Opinion-Where Will the Swine Flu Go Next?
By JOHN M. BARRY
Published: April 27, 2009
New Orleans
Published: April 27, 2009
New Orleans
AS the swine flu threatens to become the next pandemic, the biggest questions are whether its transmission from human to human will be sustained and, if so, how virulent it might become. But even if this virus were to peter out soon, there is a strong possibility it would only go underground, quietly continuing to infect some people while becoming better adapted to humans, and then explode around the world.
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Flu New Threat to Global Finance
The financial crisis in the United States has reverberated around the world. Now the country faces a new challenge to its economic health — fallout from the swine flu crisis. It’s not yet clear, but the repercussions for the global economy could be severe.
The financial crisis in the United States has reverberated around the world. Now the country faces a new challenge to its economic health — fallout from the swine flu crisis. It’s not yet clear, but the repercussions for the global economy could be severe.
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Stocks Drop Amid Swine Flu Concerns
By JACK HEALY
Published: April 27, 2009
As fears grew about a deadly outbreak of swine flu, investors on Monday performed the financial equivalent of washing their hands and donning surgical masks. They bought heavily into drug stocks, spurned the Mexican peso and shied away from pork producers[...]
Published: April 27, 2009
As fears grew about a deadly outbreak of swine flu, investors on Monday performed the financial equivalent of washing their hands and donning surgical masks. They bought heavily into drug stocks, spurned the Mexican peso and shied away from pork producers[...]
But declines in the United States turned into a rout in Mexico, the center of the outbreak, where 149 people have died and more than 1,300 have probably been infected. The Mexican Bolsa stock index dropped more than 3 percent, the peso fell 4 percent against the dollar, and shares of Mexican food companies, retailers and transportation companies dropped sharply.
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Obama Seeks to Ease Fears on Swine Flu
By ROBERT PEAR and GARDINER HARRIS
Published: April 27, 2009
WASHINGTON — The Obama administration dispatched high-level officials from several agencies Monday to allay concerns about swine flu and to demonstrate that it was fully prepared to confront the outbreak even as the president said there was “not a cause for alarm.”
By ROBERT PEAR and GARDINER HARRIS
Published: April 27, 2009
WASHINGTON — The Obama administration dispatched high-level officials from several agencies Monday to allay concerns about swine flu and to demonstrate that it was fully prepared to confront the outbreak even as the president said there was “not a cause for alarm.”
Janet Napolitano, the secretary of homeland security, and Dr. Richard E. Besser, the acting director of the Centers for Disease Control and Prevention, said the administration was prepared to respond to any further spread of the swine flu virus.
martes, 28 de abril de 2009
Influenza. Notas publicadas el 27 de abril de 2009 en el portal de The New York Times
Early Swine Flu Victim's Widow Not Told of Disease
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 2:24 p.m. ET
Published: April 27, 2009
Filed at 2:24 p.m. ET
XONACATLAN, Mexico (AP) -- The 39-year-old bricklayer fell ill two weeks ago and became one of the first Mexicans to die of swine flu. But no health worker has come to his home outside Mexico City to offer medicine or ask about the neighbors' pigs.
In fact, Gerardo Leyva Lolis' widow says nobody even told her he died of swine flu until The Associated Press informed her the case had been confirmed by the director of the hospital where he was rushed last week.
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Congress to Probe Swine Flu Outbreak
By THE ASSOCIATED PRESS
Published: April 27, 2009
Published: April 27, 2009
WASHINGTON (AP) -- Congress plans to hold emergency hearings this week on swine flu.
Sen. Tom Harkin, D-Iowa, the chairman of an appropriations subcommittee dealing with health issues, called for a hearing Tuesday afternoon to explore the public health response to the outbreak.
Sen. Tom Harkin, D-Iowa, the chairman of an appropriations subcommittee dealing with health issues, called for a hearing Tuesday afternoon to explore the public health response to the outbreak.
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US Reaction to Swine Flu More Muted Than Elsewhere
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 11:57 p.m. ET
Published: April 27, 2009
Filed at 11:57 p.m. ET
EL PASO, Texas (AP) -- U.S. airports and border agents waved people through Monday with little or no additional screening for Mexico's deadly swine flu -- a far more muted reaction than the extreme caution elsewhGere around the world.
The number of confirmed U.S. cases rose to 50, most of them mild and none fatal. The government said it was shipping millions of doses of flu-fighting medicine from a federal stockpile to states along the Mexican border or where the virus has been detected.
But the American reaction to swine flu, which has killed up to 149 people in Mexico and on Monday led the World Health Organization to raise its alert level, was mostly limited to steps that hospitals, schools and mask-wearing individuals took on their own.
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A Timeline of Events in the Swine Flu Outbreak
(Nota completa)
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 8:51 p.m. ET
Published: April 27, 2009
Filed at 8:51 p.m. ET
A timeline of events in the swine flu outbreak:
-- December 2005 to January 2009: The Centers for Disease Control and Prevention receives reports of 12 cases of human infection with swine flu. Five of these 12 cases occurred in patients who had direct exposure to pigs and six reported being near pigs. Exposure in one case is unknown.
-- March 28: Believed to be the date of the earliest onset of the swine flu cases in the U.S., Dr. Nancy Cox of the CDC said in an April 23 press briefing.
-- April 2: A 4-year-old boy contracted the virus before this date in Veracruz state, Mexican Health Secretary Jose Angel Cordova later said citing test results. A community in Veracruz has been protesting pollution from a large pig farm.
-- April 6: Local health officials declare a health alert due to a respiratory disease outbreak in the Mexican town of La Gloria in Veracruz state. Health officials record 400 cases of people who sought medical treatment in the previous week in the town. About 60 percent of the town of 3,000 are affected.
-- April 17: CDC determines that two children in adjacent counties in southern California had illnesses caused by infection with swine flu. Both children became sick in late March.
-- April 22: CDC confirms three additional cases of swine flu in California and two in Texas, near San Antonio.
-- April 22: The Oaxaca Health Department indicates that 16 employees at the Hospital Civil Aurelio Valdivieso have contracted respiratory disease.
-- April 24: Mexico's Minister of Health confirms 20 deaths from swine flu, but 40 other fatalities were being probed and at least 943 nationwide were sick from the suspected flu. Mexico City shuts down schools, museums, libraries, and state-run theaters across the capital.
-- April 26: The number of confirmed cases in the U.S. climbs to 20 in five states. Mexico reports suspect clinical cases have been reported in 19 of the country's 32 states. Canada confirms six cases.
-- April 27: The World Health Organization raises its pandemic alert status to Phase 4, meaning there is sustained human-to-human transmission of the virus causing outbreaks in at least one country.
Cordova said 1,995 people have been hospitalized with serious cases of pneumonia since mid-April and about half of those have been released. The government does not yet know how many were swine flu. The CDC reports the suspected death toll in Mexico has climbed to 149.
The number of confirmed cases in the U.S. climbs to 48 in five states.
Spain reports its first confirmed swine flu case.
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Drugmaker Shares Rise on Swine-Flu Outbreak
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 6:37 p.m. ET
Published: April 27, 2009
Filed at 6:37 p.m. ET
NEW YORK (AP) -- The swine flu outbreak boosted shares of makers of of flu treatments, vaccines and tests Monday.
Though Wall Street remains concerned that swine flu could put a damper on any global economic recovery, several companies could benefit.
Though Wall Street remains concerned that swine flu could put a damper on any global economic recovery, several companies could benefit.
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World Closer to Swine Flu Pandemic
By REUTERS
Published: April 27, 2009
Filed at 11:32 p.m. ET
Published: April 27, 2009
Filed at 11:32 p.m. ET
MEXICO CITY (Reuters) - A new virus has killed up to 149 people in Mexico and world health experts moved closer on Monday to declaring it the first flu pandemic in 40 years as more people were infected in the United States and Europe.
The World Health Organization raised its pandemic alert for the new flu strain to phase 4, indicating a significantly increased risk of a global outbreak of a serious disease.
The World Health Organization raised its pandemic alert for the new flu strain to phase 4, indicating a significantly increased risk of a global outbreak of a serious disease.
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"Wolverine" Mexico Release Delayed By Swine Flu
By REUTERS
Published: April 27, 2009
Filed at 9:28 p.m. ET
Published: April 27, 2009
Filed at 9:28 p.m. ET
LOS ANGELES (Reuters) - A mutant superhero is no match for the swine flu that has killed up to 149 people in Mexico.
Hollywood movie studio 20th Century Fox said on Monday it was scrapping plans to release "X-Men Origins: Wolverine," the first big movie of the summer, in Mexico this weekend.
A spokesman for the News Corp-owned studio said the Hugh Jackman action movie would probably be delayed by a couple of weeks.
Hollywood movie studio 20th Century Fox said on Monday it was scrapping plans to release "X-Men Origins: Wolverine," the first big movie of the summer, in Mexico this weekend.
A spokesman for the News Corp-owned studio said the Hugh Jackman action movie would probably be delayed by a couple of weeks.
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HK Scientists Developing Rapid Test for Swine Flu
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 2:13 p.m. ET
BEIJING (AP) -- Hong Kong said Monday it has assigned a team of scientists to develop a test that will hopefully cut the time it takes to diagnose the new swine flu strain from a few days to a few hours.
Researchers in Hong Kong played a big role in discovering and determining how to treat SARS -- a separate deadly virus that spread rapidly in 2003, killing more than 900 people. The island was the second hardest hit after mainland China.
Published: April 27, 2009
Filed at 2:13 p.m. ET
BEIJING (AP) -- Hong Kong said Monday it has assigned a team of scientists to develop a test that will hopefully cut the time it takes to diagnose the new swine flu strain from a few days to a few hours.
Researchers in Hong Kong played a big role in discovering and determining how to treat SARS -- a separate deadly virus that spread rapidly in 2003, killing more than 900 people. The island was the second hardest hit after mainland China.
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Israeli Official: Swine Flu Name Offensive
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 10:34 a.m. ET
JERUSALEM (AP) -- The outbreak of swine flu should be renamed ''Mexican'' influenza in deference to Muslim and Jewish sensitivities over pork, said an Israeli health official Monday.
Published: April 27, 2009
Filed at 10:34 a.m. ET
JERUSALEM (AP) -- The outbreak of swine flu should be renamed ''Mexican'' influenza in deference to Muslim and Jewish sensitivities over pork, said an Israeli health official Monday.
Deputy Health Minister Yakov Litzman said the reference to pigs is offensive to both religions and ''we should call this Mexican flu and not swine flu,'' he told a news conference at a hospital in central Israel.
Both Judaism and Islam consider pigs unclean and forbid the eating of pork products.
Scientists are unsure where the new swine flu virus originally emerged, though it was identifed first in the United States. They say there is nothing about the virus that makes it ''Mexican'' and worry such a label would be stigmatizing.
Both Judaism and Islam consider pigs unclean and forbid the eating of pork products.
Scientists are unsure where the new swine flu virus originally emerged, though it was identifed first in the United States. They say there is nothing about the virus that makes it ''Mexican'' and worry such a label would be stigmatizing.
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House Panel to Probe Swine Flu Outbreak
By THE ASSOCIATED PRESS
Published: April 27, 2009
By THE ASSOCIATED PRESS
Published: April 27, 2009
WASHINGTON (AP) -- A House committee will hold an emergency hearing this week on increasing cases of swine flu in the United States and other countries.
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White House: Obama Never Endangered by Swine Flu
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 2:59 p.m. ET
Published: April 27, 2009
Filed at 2:59 p.m. ET
WASHINGTON (AP) -- The White House says President Barack Obama has shown no symptoms of swine flu and that his health was never in danger when he visited Mexico earlier this month.
http://www.nytimes.com/aponline/2009/04/27/us/politics/AP-US-Swine-Flu-Obama-Health.html
http://www.nytimes.com/aponline/2009/04/27/us/politics/AP-US-Swine-Flu-Obama-Health.html
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WHO Raises Its Pandemic Alert Level on Swine Flu
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 11:46 p.m. ET
MEXICO CITY (AP) -- The World Health Organization raised its global alert level Monday, signaling the swine flu virus was spreading from human to human in community outbreaks, but it stopped short of declaring a full-blown pandemic.
The WHO announcement in Geneva followed a decision by the top EU health official urging Europeans to postpone nonessential travel to parts of the United States and Mexico because of the virus.
Published: April 27, 2009
Filed at 11:46 p.m. ET
MEXICO CITY (AP) -- The World Health Organization raised its global alert level Monday, signaling the swine flu virus was spreading from human to human in community outbreaks, but it stopped short of declaring a full-blown pandemic.
The WHO announcement in Geneva followed a decision by the top EU health official urging Europeans to postpone nonessential travel to parts of the United States and Mexico because of the virus.
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Swine Flu Epidemic Enters Dangerous New Phase
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 9:44 p.m. ET
MEXICO CITY (AP) -- The swine flu epidemic entered a dangerous new phase Monday as the death toll climbed in Mexico and the number of suspected cases there and in the United States nearly doubled. The World Health Organization raised its alert level but stopped short of declaring a global emergency.
Published: April 27, 2009
Filed at 9:44 p.m. ET
MEXICO CITY (AP) -- The swine flu epidemic entered a dangerous new phase Monday as the death toll climbed in Mexico and the number of suspected cases there and in the United States nearly doubled. The World Health Organization raised its alert level but stopped short of declaring a global emergency.
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Swine Flu Fears Grip World Markets
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 8:38 a.m. ET
LONDON (AP) -- Airlines and travel companies led world stock markets lower Monday as investors worried that a deadly outbreak of swine flu in Mexico could go global and derail any global economic recovery, though pharmaceutical companies rallied on expectations that demand for anti-viral drugs may surge to deal with any pandemic.
Investors are fretting that a flu outbreak could set back already-enfeebled global trade and travel, just at a time when policy-makers around the world have begun sounding more optimistic about the global economy's prospects.
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 8:38 a.m. ET
LONDON (AP) -- Airlines and travel companies led world stock markets lower Monday as investors worried that a deadly outbreak of swine flu in Mexico could go global and derail any global economic recovery, though pharmaceutical companies rallied on expectations that demand for anti-viral drugs may surge to deal with any pandemic.
Investors are fretting that a flu outbreak could set back already-enfeebled global trade and travel, just at a time when policy-makers around the world have begun sounding more optimistic about the global economy's prospects.
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Swine Flu Could Mean New Threat to US Economy
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 7:31 p.m. ET
WASHINGTON (AP) -- The U.S. economy, which was showing tentative early signs of a recovery, faces a potentially grave new threat: swine flu. A widespread outbreak could batter the tourism, food and transportation industries in particular, deepening the recession in the U.S. and possibly worldwide.
With the U.S. and the global economy already fragile, another severe blow could reverse any progress made in easing the recession.
Published: April 27, 2009
Filed at 7:31 p.m. ET
WASHINGTON (AP) -- The U.S. economy, which was showing tentative early signs of a recovery, faces a potentially grave new threat: swine flu. A widespread outbreak could batter the tourism, food and transportation industries in particular, deepening the recession in the U.S. and possibly worldwide.
With the U.S. and the global economy already fragile, another severe blow could reverse any progress made in easing the recession.
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Seeing Warning Signs of Outbreak, School Nurse Set Response in Motion
By ANEMONA HARTOCOLLIS
Published: April 26, 2009
It was a routine call last Thursday from a diligent high school nurse that put health detectives in New York City on the trail of a swine flu outbreak. Over the next few days, things unfolded much like a criminal investigation, with alert epidemiologists cast in the role of the police officer who remembers information on a wanted poster.
Published: April 26, 2009
It was a routine call last Thursday from a diligent high school nurse that put health detectives in New York City on the trail of a swine flu outbreak. Over the next few days, things unfolded much like a criminal investigation, with alert epidemiologists cast in the role of the police officer who remembers information on a wanted poster.
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Hong Kong, Minding SARS, Announces Tough Measures in Response to Swine Flu
By KEITH BRADSHER
Published: April 26, 2009
HONG KONG — Hong Kong, the epicenter of a SARS outbreak six years ago, announced some of the toughest measures anywhere on Sunday in response to a swine flu outbreak in Mexico and the United States.
By KEITH BRADSHER
Published: April 26, 2009
HONG KONG — Hong Kong, the epicenter of a SARS outbreak six years ago, announced some of the toughest measures anywhere on Sunday in response to a swine flu outbreak in Mexico and the United States.
Officials urged residents not to travel to Mexico, and they ordered the immediate detention at a hospital of anyone who arrived with a fever and symptoms of a respiratory illness after traveling in the previous seven days through a city with a laboratory-confirmed outbreak.
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Mexico Faces Criticism Over Swine Flu Response
By THE ASSOCIATED PRESS
Published: April 27, 2009
Filed at 9:33 p.m. ET
MEXICO CITY (AP) -- Two weeks after the first known swine flu death, Mexico still hasn't given medicine to the families of the dead. It hasn't determined where the outbreak began or how it spread. And while the government urges anyone who feels sick to go to hospitals, feverish people complain ambulance workers are scared to pick them up.
Published: April 27, 2009
Filed at 9:33 p.m. ET
MEXICO CITY (AP) -- Two weeks after the first known swine flu death, Mexico still hasn't given medicine to the families of the dead. It hasn't determined where the outbreak began or how it spread. And while the government urges anyone who feels sick to go to hospitals, feverish people complain ambulance workers are scared to pick them up.
27 de abril: Swine Flu
Times Topic
Swine Flu
April 27, 2009
The New York Times
OVERVIEW
An outbreak of swine flu in Mexico has raised concerns worldwide that the disease could be emerging as a global pandemic. On April 26, 2009, American officials declared a public health emergency after 20 cases of swine flu were confirmed in the United States; by the next day, the number had doubled.
The virus in the American cases looked identical to the A (H1N1) swine flu in Mexico that is believed to have killed 149 people and sickened about 1,600. Health officials in the United States and at the World Health Organization urged the public not to panic, noting that the cases confirmed outside of Mexico had been mild, and that the virulence of the virus remained unknown.
Still, they urged Americans to forego nonessential travel to Mexico, where many schools and public venues had been shut. On April 27, the European Union's health commissioner urged Europeans to avoid nonessential travel to the United States or Mexico. The acting director of the Centers for Disease Control and Prevention, Dr. Richard Besser, responded that the advisory was unwarranted.
Officials said that 28 of the 50 confirmed cases in the United States were diagnosed in New York City, all among students at St. Francis Preparatory School in Fresh Meadows, Queens. Officials said they had also confirmed cases in California, Kansas, Texas and Ohio. Diagnoses have also been made in Canada, Spain, Scotland and New Zealand.
Mexican officials said they had traced the origins of the outbreak to a rural area known as La Gloria in the southeastern state of Veracruz, the site of several major pig farms.
SWINE FLU QUESTIONS
The new swine flu cases are caused by an influenza strain called H1N1, which appears to be easily passed from person to person. Doctors have little information yet on the mortality rate, as there is no reliable data on the total number of people infected.
The central question every flu expert in the world would like answered, Dr. Martin Cetron, director of global migration and quarantine for the Centers for Disease Control, said in an interview, is how many mild cases Mexico has had.
The ages of the victims in Mexico concern health officials. Unlike typical flu seasons, when infants and the aged are usually the most vulnerable, none of the initial deaths in Mexico were in people older than 60 or younger than 3 years old, a spokeswoman with the World Health Organization said. Pandemic flus - like the 1918 flu and outbreaks in 1957 and 1968 - often strike young, healthy people the hardest.
Reports from the United States suggest that some cases may be mild and therefore may go undetected - allowing the disease to spread further. Flu experts are trying to determine if this year's flu shots, which contain H1N1 strain, offer any protection.
In contrast, the lethal avian flu that has kept world health authorities anxious for years is caused by H5N1 influenza virus. It has killed 257 of the 421 people who have contracted it, or 61 percent. But it has shown very little ability to pass from person to person, mainly infecting poultry, and some experts have suggested that there may be something about the H5N1 virus that makes it inherently less transmissible among people.
As a benchmark, the deadliest influenza pandemic in the past century, the Spanish influenza of 1918 to 1919, had an estimated mortality rate of around 2.5 percent but killed tens of millions of people because it spread so widely. Many of those lives would have been saved if anti-flu drugs, antibiotics and mechanical ventilators had existed.
The virus that caused widespread panic in Asia in 2003, SARS - severe acute respiratory syndrome - is both easily spread and virulent. In the 2003 outbreak in Hong Kong, it killed 299 of the 1,755 people it infected there, or 17 percent.
RESPONSE FROM PUBLIC HEALTH OFFICIALS
Homeland Security Secretary Janet Napolitano called the United States' emergency declaration "standard operating procedure," and said she would rather call it a "declaration of emergency preparedness."
The emergency declaration in the United States lets the government free more money for antiviral drugs and give some previously unapproved tests and drugs to children. One-quarter of the national stockpile of 50 million courses of antiflu drugs will be released.
Border patrols and airport security officers are to begin asking travelers if they have had the flu or a fever; those who appear ill will be stopped, taken aside and given masks while they arrange for medical care.
The speed and the scope of the world's response showed the value of preparations made because of the avian flu and SARS scares, public health experts said.
There were no immediate signs of shortages of flu drugs. Roche, the Swiss maker of Tamiflu, said Monday that the World Health Organization has enough stockpiled to treat up to 5 million people, on top of millions more doses held by governments. Tamiflu has been stockpiled for years by governments, companies and health authorities.
Shares of GlaxoSmithKline and Roche, makers of prescription flu treatments, rose Monday amid expectations that the swine flu scare would lift demand for their products.
The lessons learned from SARS did not go to waste in Hong Kong. While Mexico struggles to confirm cases of swine flu and sends samples to the United States, Hong Kong is already performing swift genetic tests on patient samples and will have laboratories doing so at six local hospitals by Thursday. Tens of thousands of doctors and nurses, including retirees and those with medical training who have moved to other occupations, are tracked on databases and ready to be mobilized.
OVERVIEW
An outbreak of swine flu in Mexico has raised concerns worldwide that the disease could be emerging as a global pandemic. On April 26, 2009, American officials declared a public health emergency after 20 cases of swine flu were confirmed in the United States; by the next day, the number had doubled.
The virus in the American cases looked identical to the A (H1N1) swine flu in Mexico that is believed to have killed 149 people and sickened about 1,600. Health officials in the United States and at the World Health Organization urged the public not to panic, noting that the cases confirmed outside of Mexico had been mild, and that the virulence of the virus remained unknown.
Still, they urged Americans to forego nonessential travel to Mexico, where many schools and public venues had been shut. On April 27, the European Union's health commissioner urged Europeans to avoid nonessential travel to the United States or Mexico. The acting director of the Centers for Disease Control and Prevention, Dr. Richard Besser, responded that the advisory was unwarranted.
Officials said that 28 of the 50 confirmed cases in the United States were diagnosed in New York City, all among students at St. Francis Preparatory School in Fresh Meadows, Queens. Officials said they had also confirmed cases in California, Kansas, Texas and Ohio. Diagnoses have also been made in Canada, Spain, Scotland and New Zealand.
Mexican officials said they had traced the origins of the outbreak to a rural area known as La Gloria in the southeastern state of Veracruz, the site of several major pig farms.
SWINE FLU QUESTIONS
The new swine flu cases are caused by an influenza strain called H1N1, which appears to be easily passed from person to person. Doctors have little information yet on the mortality rate, as there is no reliable data on the total number of people infected.
The central question every flu expert in the world would like answered, Dr. Martin Cetron, director of global migration and quarantine for the Centers for Disease Control, said in an interview, is how many mild cases Mexico has had.
The ages of the victims in Mexico concern health officials. Unlike typical flu seasons, when infants and the aged are usually the most vulnerable, none of the initial deaths in Mexico were in people older than 60 or younger than 3 years old, a spokeswoman with the World Health Organization said. Pandemic flus - like the 1918 flu and outbreaks in 1957 and 1968 - often strike young, healthy people the hardest.
Reports from the United States suggest that some cases may be mild and therefore may go undetected - allowing the disease to spread further. Flu experts are trying to determine if this year's flu shots, which contain H1N1 strain, offer any protection.
In contrast, the lethal avian flu that has kept world health authorities anxious for years is caused by H5N1 influenza virus. It has killed 257 of the 421 people who have contracted it, or 61 percent. But it has shown very little ability to pass from person to person, mainly infecting poultry, and some experts have suggested that there may be something about the H5N1 virus that makes it inherently less transmissible among people.
As a benchmark, the deadliest influenza pandemic in the past century, the Spanish influenza of 1918 to 1919, had an estimated mortality rate of around 2.5 percent but killed tens of millions of people because it spread so widely. Many of those lives would have been saved if anti-flu drugs, antibiotics and mechanical ventilators had existed.
The virus that caused widespread panic in Asia in 2003, SARS - severe acute respiratory syndrome - is both easily spread and virulent. In the 2003 outbreak in Hong Kong, it killed 299 of the 1,755 people it infected there, or 17 percent.
RESPONSE FROM PUBLIC HEALTH OFFICIALS
Homeland Security Secretary Janet Napolitano called the United States' emergency declaration "standard operating procedure," and said she would rather call it a "declaration of emergency preparedness."
The emergency declaration in the United States lets the government free more money for antiviral drugs and give some previously unapproved tests and drugs to children. One-quarter of the national stockpile of 50 million courses of antiflu drugs will be released.
Border patrols and airport security officers are to begin asking travelers if they have had the flu or a fever; those who appear ill will be stopped, taken aside and given masks while they arrange for medical care.
The speed and the scope of the world's response showed the value of preparations made because of the avian flu and SARS scares, public health experts said.
There were no immediate signs of shortages of flu drugs. Roche, the Swiss maker of Tamiflu, said Monday that the World Health Organization has enough stockpiled to treat up to 5 million people, on top of millions more doses held by governments. Tamiflu has been stockpiled for years by governments, companies and health authorities.
Shares of GlaxoSmithKline and Roche, makers of prescription flu treatments, rose Monday amid expectations that the swine flu scare would lift demand for their products.
The lessons learned from SARS did not go to waste in Hong Kong. While Mexico struggles to confirm cases of swine flu and sends samples to the United States, Hong Kong is already performing swift genetic tests on patient samples and will have laboratories doing so at six local hospitals by Thursday. Tens of thousands of doctors and nurses, including retirees and those with medical training who have moved to other occupations, are tracked on databases and ready to be mobilized.
27 de abril: Swine Flu: A Cause for Panic?
April 27, 2009, 8:19 pm — Updated: 8:48 pm -->
Swine Flu: A Cause for Panic?
By The Editors
The World Health Organization raised its global alert level for the swine flu on Monday, as Mexican officials reported that the death toll from the outbreak had reached 149. In the United States, the number of people sickened by the virus reached 40 (with 28 in one New York City school), though officials said that none of the cases were serious. Amid travel advisories and health warnings, how worried should Americans be that the disease might turn into a far more serious epidemic?
David Ozonoff, epidemiologist
James Jay Carafano, Heritage Foundation
Ruth A. Karron and Ruth R. Faden, Johns Hopkins
Alfred W. Crosby Jr., historian
Fewer Resources Now
David Ozonoff, a doctor and chronic-disease epidemiologist, is a professor of environmental health at the Boston University School of Public Health:
Although we’ve been told for a long time to expect another flu pandemic, now that one may be just around the corner many people seem surprised. Pandemics happen, and there have been two in my lifetime — the Asian flu in 1957 and the Hong Kong flu in 1968.
Whether 2009’s swine flu will become another we don’t know. Flu pandemics are caused by variants of the influenza virus which are new and novel to our immune systems, and the current swine flu virus is just such an example. There is no natural immunity to it (that we know of at this moment), it causes human disease (most of the 144 different flu subtypes just infect other animals, like birds), and it appears to be fairly transmissible. If its transmission becomes sustained as more cases are reported (at least four countries have confirmed cases), we may well face a pandemic, the contemporaneous infection of many people in many parts of the world.
So far, the swine flu virus looks clinically like the usual seasonal flu virus. That may reassure some people, but from the public health standpoint, even a serious outbreak of seasonal flu is a major concern.
It’s estimated that seasonal flu kills close to 40,000 people in the U.S. each year. A virus killing at that rate and causing a similar level of hospitalization and absenteeism would put enormous strain on an already teetering medical care, public health and social services system. Most public health services exist at the state and local level, exactly where the economic crisis has hurt government the most. Just when we need them, we are laying off substantial numbers of public health and social service workers.
Hospitals are at the bare minimum of staffed beds and can easily be overwhelmed by even a bad flu season, much less a pandemic. In 1957 and 1968, when there were more staffed hospital beds per capita than now, gurneys where lined up head to toe along university health services and hospital corridors.
It would be worse today. Given this highly plausible, though still uncertain, scenario, there’s clearly reason for worry. So concern is appropriate even as the world health authorities work to gather more facts.
Not Close to a Pandemic
James Jay Carafano is a senior research fellow in defense and homeland security at the Douglas and Sarah Allison Center for foreign policy studies at the Heritage Foundation.
There are some basic facts that Americans ought to know. The first is that the news coverage is driven more by the unusual nature of the disease than how serious it might be. The swine flu appeared at what is normally considered the “end” of the flu season. A flood of cases now is not common.
Second, it is a flu from a strain that normally affects pigs. Popular attention had been fixated in recent years on the threat of mutating bird flu. Americans hadn’t heard much about swine flu in decades. In 1975, a U.S. soldier died of swine flu, fueling fears of an outbreak. A vaccine was rushed out. No pandemic occurred but the vaccine had some bad side effects. The debacle helped sink the re-election chances of President Ford, who had pushed for the vaccination campaign. Since then politicians didn’t like talking about swine flu.
Third, there have been an unexpected number of deaths reported in otherwise “healthy” adults in Mexico. Usually, flu kills only the very old and young or folks with depressed immune systems, like AIDS sufferers.
All these rare facts grab headlines. In addition, news stories play fast and loose with terms like “outbreak,” “epidemic,” and “pandemic.” They are not interchangeable. Each describes an increasing degree of the number of infected and the geographical scope of the infection. We are not close to having a pandemic yet. And if we do it may not be anything like a catastrophe. The disease looks to respond to existing medication.
Finally, the swine flu makes news because we can pin it to a location. But it might be premature to call this the “Mexican” flu, just as it turned out it was wrong to call the 1918 pandemic the “Spanish” flu (which scientists think actually first appeared in Kansas).
The bottom line is we do not have near all the facts yet, and the ones we do have so far say: don’t panic, don’t rush to judgment.
For now we should all just wash our hands and go to the doctor if we have flu symptoms.
Don’t Panic, Prepare
Ruth A. Karron is the director of the Center for Immunization Research and Johns Hopkins Vaccine Initiative at the Johns Hopkins Bloomberg School of Public Health. Ruth R. Faden is the executive director of the Johns Hopkins Berman Institute of Bioethics.
As the numbers of reported swine flu cases increase, anxiety over the possibility of a pandemic is a natural response.
But now is not the time to panic. Panicking never helps; moreover, it distracts from things we all should be doing to reduce the impact of swine flu on ourselves and on others.
To that end, stay informed and follow evolving guidance from local and national public health authorities. While it’s always important to follow basic hygiene practices, you should also contact a health professional if you or someone in your family develops flu-like symptoms (fever with a cough or sore throat).
Don’t go to school or work while you are ill, and be prepared for the possibility that public health authorities may ask you to stay at home for a period of time to slow the pace by which flu is spread.
Making sure that you have enough food and water at home is good for your family, and may help public authorities provide for those who are unable to do so for themselves.
Details about the severity and numbers of people infected are still coming in, but this is general information that should help with any potential pandemic and will keep us all from panicking.
Infection and Its Aftermath
Alfred W. Crosby Jr. is the author of “America’s Forgotten Pandemic: The Influenza of 1918.”
Let me offer a few rules and regulations about epidemic influenza:
A truly new flu infection often travels faster than we can devise a pertinent vaccination, mass-produce it, and get it into arms. We have to be ready to deal with the clutter and rubble of our failure.
If the Mexican flu of 2009 is truly bad, we will require cots, blankets, food, shelter, transportation, medical personnel, coffins, etc, now - or even yesterday, if we can manage that. In most pandemics most people die of official ineptitude than of infection.
Swine Flu: A Cause for Panic?
By The Editors
The World Health Organization raised its global alert level for the swine flu on Monday, as Mexican officials reported that the death toll from the outbreak had reached 149. In the United States, the number of people sickened by the virus reached 40 (with 28 in one New York City school), though officials said that none of the cases were serious. Amid travel advisories and health warnings, how worried should Americans be that the disease might turn into a far more serious epidemic?
David Ozonoff, epidemiologist
James Jay Carafano, Heritage Foundation
Ruth A. Karron and Ruth R. Faden, Johns Hopkins
Alfred W. Crosby Jr., historian
Fewer Resources Now
David Ozonoff, a doctor and chronic-disease epidemiologist, is a professor of environmental health at the Boston University School of Public Health:
Although we’ve been told for a long time to expect another flu pandemic, now that one may be just around the corner many people seem surprised. Pandemics happen, and there have been two in my lifetime — the Asian flu in 1957 and the Hong Kong flu in 1968.
Whether 2009’s swine flu will become another we don’t know. Flu pandemics are caused by variants of the influenza virus which are new and novel to our immune systems, and the current swine flu virus is just such an example. There is no natural immunity to it (that we know of at this moment), it causes human disease (most of the 144 different flu subtypes just infect other animals, like birds), and it appears to be fairly transmissible. If its transmission becomes sustained as more cases are reported (at least four countries have confirmed cases), we may well face a pandemic, the contemporaneous infection of many people in many parts of the world.
So far, the swine flu virus looks clinically like the usual seasonal flu virus. That may reassure some people, but from the public health standpoint, even a serious outbreak of seasonal flu is a major concern.
It’s estimated that seasonal flu kills close to 40,000 people in the U.S. each year. A virus killing at that rate and causing a similar level of hospitalization and absenteeism would put enormous strain on an already teetering medical care, public health and social services system. Most public health services exist at the state and local level, exactly where the economic crisis has hurt government the most. Just when we need them, we are laying off substantial numbers of public health and social service workers.
Hospitals are at the bare minimum of staffed beds and can easily be overwhelmed by even a bad flu season, much less a pandemic. In 1957 and 1968, when there were more staffed hospital beds per capita than now, gurneys where lined up head to toe along university health services and hospital corridors.
It would be worse today. Given this highly plausible, though still uncertain, scenario, there’s clearly reason for worry. So concern is appropriate even as the world health authorities work to gather more facts.
Not Close to a Pandemic
James Jay Carafano is a senior research fellow in defense and homeland security at the Douglas and Sarah Allison Center for foreign policy studies at the Heritage Foundation.
There are some basic facts that Americans ought to know. The first is that the news coverage is driven more by the unusual nature of the disease than how serious it might be. The swine flu appeared at what is normally considered the “end” of the flu season. A flood of cases now is not common.
Second, it is a flu from a strain that normally affects pigs. Popular attention had been fixated in recent years on the threat of mutating bird flu. Americans hadn’t heard much about swine flu in decades. In 1975, a U.S. soldier died of swine flu, fueling fears of an outbreak. A vaccine was rushed out. No pandemic occurred but the vaccine had some bad side effects. The debacle helped sink the re-election chances of President Ford, who had pushed for the vaccination campaign. Since then politicians didn’t like talking about swine flu.
Third, there have been an unexpected number of deaths reported in otherwise “healthy” adults in Mexico. Usually, flu kills only the very old and young or folks with depressed immune systems, like AIDS sufferers.
All these rare facts grab headlines. In addition, news stories play fast and loose with terms like “outbreak,” “epidemic,” and “pandemic.” They are not interchangeable. Each describes an increasing degree of the number of infected and the geographical scope of the infection. We are not close to having a pandemic yet. And if we do it may not be anything like a catastrophe. The disease looks to respond to existing medication.
Finally, the swine flu makes news because we can pin it to a location. But it might be premature to call this the “Mexican” flu, just as it turned out it was wrong to call the 1918 pandemic the “Spanish” flu (which scientists think actually first appeared in Kansas).
The bottom line is we do not have near all the facts yet, and the ones we do have so far say: don’t panic, don’t rush to judgment.
For now we should all just wash our hands and go to the doctor if we have flu symptoms.
Don’t Panic, Prepare
Ruth A. Karron is the director of the Center for Immunization Research and Johns Hopkins Vaccine Initiative at the Johns Hopkins Bloomberg School of Public Health. Ruth R. Faden is the executive director of the Johns Hopkins Berman Institute of Bioethics.
As the numbers of reported swine flu cases increase, anxiety over the possibility of a pandemic is a natural response.
But now is not the time to panic. Panicking never helps; moreover, it distracts from things we all should be doing to reduce the impact of swine flu on ourselves and on others.
To that end, stay informed and follow evolving guidance from local and national public health authorities. While it’s always important to follow basic hygiene practices, you should also contact a health professional if you or someone in your family develops flu-like symptoms (fever with a cough or sore throat).
Don’t go to school or work while you are ill, and be prepared for the possibility that public health authorities may ask you to stay at home for a period of time to slow the pace by which flu is spread.
Making sure that you have enough food and water at home is good for your family, and may help public authorities provide for those who are unable to do so for themselves.
Details about the severity and numbers of people infected are still coming in, but this is general information that should help with any potential pandemic and will keep us all from panicking.
Infection and Its Aftermath
Alfred W. Crosby Jr. is the author of “America’s Forgotten Pandemic: The Influenza of 1918.”
Let me offer a few rules and regulations about epidemic influenza:
A truly new flu infection often travels faster than we can devise a pertinent vaccination, mass-produce it, and get it into arms. We have to be ready to deal with the clutter and rubble of our failure.
If the Mexican flu of 2009 is truly bad, we will require cots, blankets, food, shelter, transportation, medical personnel, coffins, etc, now - or even yesterday, if we can manage that. In most pandemics most people die of official ineptitude than of infection.
lunes, 27 de abril de 2009
26 de abril: Mexican Tourism, Already Hurt by Violence, Bears Blow of a Health Scare
By MARC LACEY
Published: April 26, 2009
The New York Times
MEXICO CITY — Mexico’s tourism industry was in crisis even before the government announced the presence of a deadly influenza virus a few days ago and began handing out surgical masks by the millions and shuttering virtually all public gathering spots in the capital.
The industry has been grappling in recent months with fears that Mexico’s drug war has made the country too risky to visit. Now comes a mysterious virus that runs the risk of turning the country into a no-go zone in the minds of many travelers.
Rafael García González, president of the Mexico City Hotel Association, reported a 20 percent drop in national tourism to the capital over the weekend and said the effects of the crisis on international visitors were still being assessed. Daniel Loaeza, vice president of the National Restaurant Association, said the closing of restaurants for even a few days could mean significant damage to the industry.
Alejandro Rojas, Mexico City’s secretary of tourism, met with Rodolfo Elizondo, the national tourism director, and others in the industry on Sunday to assess how the health crisis could affect tourism and to mount an aggressive response.
“We are going to come to an agreement to distribute to the world the real situation in Mexico,” Mr. Rojas told the newspaper Reforma.
Still, the news from health officials only seems to get worse, with the number of deaths believed tied to the flu virus rising to 103, according to government officials, and the number of people suspected to have been sickened across the country about 1,600 since April 13.
Mexican officials took pains to note that no government had issued an official ban on travel to Mexico. But there were worrisome indications on the horizon, with Hong Kong issuing a strong warning against travel here.
For those who had already arrived, many of the recommended tourist destinations, including historical sites, museums and top restaurants, have been shut down on the order of health officials. And Mayor Marcelo Ebrard told reporters on Sunday that if the epidemic grew worse he might order additional measures, including the closing of the public transportation system.
Double-decker tour buses continued to traverse Mexico’s capital over the weekend, rolling past the majestic National Palace, areas in the expansive Chapultepec Park, including the zoo, and the Frida Kahlo Museum. But the tourists aboard, who took in the sights wearing face masks, were unable to go inside the popular attractions because of the emergency measures.
“It’s such a shame,” said Elena Rogova, who was visiting from Moscow with a friend. “We wanted to go to the Anthropology Museum and the Frida Kahlo Museum and so many other museums. All we can do is walk.”
Another visitor, Paula Sezenna, walking along the Paseo de la Reforma, found a silver lining to the crisis. Ms. Sezenna, who was on a business trip from Italy, said the normal crowds at the pyramids of Teotihuacan outside the capital on weekends had thinned considerably.
Warned at a youth hostel that they should not go downtown, a group of women from Australia and New Zealand decided to go anyway, equipped with hand sanitizer and accepting masks from a soldier once they got to the Zócalo, the city’s central square. “We put them on for photos,” said Stephanie Gawne, 24, who professed not to be alarmed.
But Jessamyn Cull, 23, said she had been recovering from the flu when she arrived. “I am a tad worried,” she said, indicating that the group might leave Mexico soon and head for their next stop in Guatemala.
There was no apparent rush to leave the country at Mexico City’s airport, although a few foreign tourists said in interviews there that they had changed their flights to return home early.
“I was afraid they would stop people from flying back to the United States,” said Tom Dillon, 43, who was returning to New York.
A soccer team from the German School of White Plains considered its trip a bust. The boys had arrived to play in a tournament on Friday and Saturday, only to find that all their matches had been canceled.
The United States Embassy in Mexico City, which has warned Americans about the effects of drug violence in a travel alert, said there were no constraints on travel between the United States and Mexico. But after Mexico decided to limit public gatherings, the embassy said it would suspend the processing of thousands of tourist visas this week.
Elisabeth Malkin and Antonio Betancourt contributed reporting.
A version of this article appeared in print on April 27, 2009, on page A10 of the New York edition.
Published: April 26, 2009
The New York Times
MEXICO CITY — Mexico’s tourism industry was in crisis even before the government announced the presence of a deadly influenza virus a few days ago and began handing out surgical masks by the millions and shuttering virtually all public gathering spots in the capital.
The industry has been grappling in recent months with fears that Mexico’s drug war has made the country too risky to visit. Now comes a mysterious virus that runs the risk of turning the country into a no-go zone in the minds of many travelers.
Rafael García González, president of the Mexico City Hotel Association, reported a 20 percent drop in national tourism to the capital over the weekend and said the effects of the crisis on international visitors were still being assessed. Daniel Loaeza, vice president of the National Restaurant Association, said the closing of restaurants for even a few days could mean significant damage to the industry.
Alejandro Rojas, Mexico City’s secretary of tourism, met with Rodolfo Elizondo, the national tourism director, and others in the industry on Sunday to assess how the health crisis could affect tourism and to mount an aggressive response.
“We are going to come to an agreement to distribute to the world the real situation in Mexico,” Mr. Rojas told the newspaper Reforma.
Still, the news from health officials only seems to get worse, with the number of deaths believed tied to the flu virus rising to 103, according to government officials, and the number of people suspected to have been sickened across the country about 1,600 since April 13.
Mexican officials took pains to note that no government had issued an official ban on travel to Mexico. But there were worrisome indications on the horizon, with Hong Kong issuing a strong warning against travel here.
For those who had already arrived, many of the recommended tourist destinations, including historical sites, museums and top restaurants, have been shut down on the order of health officials. And Mayor Marcelo Ebrard told reporters on Sunday that if the epidemic grew worse he might order additional measures, including the closing of the public transportation system.
Double-decker tour buses continued to traverse Mexico’s capital over the weekend, rolling past the majestic National Palace, areas in the expansive Chapultepec Park, including the zoo, and the Frida Kahlo Museum. But the tourists aboard, who took in the sights wearing face masks, were unable to go inside the popular attractions because of the emergency measures.
“It’s such a shame,” said Elena Rogova, who was visiting from Moscow with a friend. “We wanted to go to the Anthropology Museum and the Frida Kahlo Museum and so many other museums. All we can do is walk.”
Another visitor, Paula Sezenna, walking along the Paseo de la Reforma, found a silver lining to the crisis. Ms. Sezenna, who was on a business trip from Italy, said the normal crowds at the pyramids of Teotihuacan outside the capital on weekends had thinned considerably.
Warned at a youth hostel that they should not go downtown, a group of women from Australia and New Zealand decided to go anyway, equipped with hand sanitizer and accepting masks from a soldier once they got to the Zócalo, the city’s central square. “We put them on for photos,” said Stephanie Gawne, 24, who professed not to be alarmed.
But Jessamyn Cull, 23, said she had been recovering from the flu when she arrived. “I am a tad worried,” she said, indicating that the group might leave Mexico soon and head for their next stop in Guatemala.
There was no apparent rush to leave the country at Mexico City’s airport, although a few foreign tourists said in interviews there that they had changed their flights to return home early.
“I was afraid they would stop people from flying back to the United States,” said Tom Dillon, 43, who was returning to New York.
A soccer team from the German School of White Plains considered its trip a bust. The boys had arrived to play in a tournament on Friday and Saturday, only to find that all their matches had been canceled.
The United States Embassy in Mexico City, which has warned Americans about the effects of drug violence in a travel alert, said there were no constraints on travel between the United States and Mexico. But after Mexico decided to limit public gatherings, the embassy said it would suspend the processing of thousands of tourist visas this week.
Elisabeth Malkin and Antonio Betancourt contributed reporting.
A version of this article appeared in print on April 27, 2009, on page A10 of the New York edition.
26 de abril: U.S. Declares Public Health Emergency Over Swine Flu
By DONALD G. McNEIL Jr.
Published: April 26, 2009
The New York Times
Responding to what some health officials feared could be the leading edge of a global pandemic emerging from Mexico, American health officials declared a public health emergency on Sunday as 20 cases of swine flu were confirmed in this country, including eight in New York City.
Other nations imposed travel bans or made plans to quarantine air travelers as confirmed cases also appeared in Mexico and Canada and suspect cases emerged elsewhere.
Top global flu experts struggled to predict how dangerous the new A (H1N1) swine flu strain would be as it became clear that they had too little information about Mexico’s outbreak — in particular how many cases had occurred in what is thought to be a month before the outbreak was detected, and whether the virus was mutating to be more lethal, or less.
“We’re in a period in which the picture is evolving,” said Dr. Keiji Fukuda, deputy director general of the World Health Organization. “We need to know the extent to which it causes mild and serious infections.”
Without that knowledge — which is unlikely to emerge soon because only two laboratories, in Atlanta and Winnipeg, Canada, can confirm a case — his agency’s panel of experts was unwilling to raise the global pandemic alert level, even though it officially saw the outbreak as a public health emergency and opened its emergency response center.
As a news conference in Washington, Homeland Security Secretary Janet Napolitano called the emergency declaration “standard operating procedure,” and said she would rather call it a “declaration of emergency preparedness.”
“It’s like declaring one for a hurricane,” she said. “It means we can release funds and take other measures. The hurricane may not actually hit.”
American investigators said they expected more cases here, but noted that virtually all so far had been mild and urged Americans not to panic.
The speed and the scope of the world’s response showed the value of preparations made because of the avian flu and SARS scares, public health experts said.
The emergency declaration in the United States lets the government free more money for antiviral drugs and give some previously unapproved tests and drugs to children. One-quarter of the national stockpile of 50 million courses of antiflu drugs will be released.
Border patrols and airport security officers are to begin asking travelers if they have had the flu or a fever; those who appear ill will be stopped, taken aside and given masks while they arrange for medical care.
“This is moving fast and we expect to see more cases,” Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said at the news conference with Ms. Napolitano. “But we view this as a marathon.”
He advised Americans to wash their hands frequently, to cover coughs and sneezes and to stay home if they felt ill; but he stopped short of advice now given in Mexico to wear masks and not kiss or touch anyone. He praised decisions to close individual schools in New York and Texas but did not call for more widespread closings.
Besides the eight New York cases, officials said they had confirmed seven in California, two in Kansas, two in Texas and one in Ohio. The virus looked identical to the one in Mexico believed to have killed 103 people — including 22 people whose deaths were confirmed to be from swine flu — and sickened about 1,600. As of Sunday night, there were no swine flu deaths in the United States, and one hospitalization.
Other governments tried to contain the infection amid reports of potential new cases including in New Zealand and Spain.
Dr. Fukuda of the W.H.O. said his agency would decide Tuesday whether to raise the pandemic alert level to 4. Such a move would prompt more travel bans, and the agency has been reluctant historically to take actions that hurt member nations.
Canada confirmed six cases, at opposite ends of the country: four in Nova Scotia and two in British Columbia. Canadian health officials said the victims had only mild symptoms and had either recently traveled to Mexico or been in contact with someone who had.
Other governments issued advisories urging citizens not to visit Mexico. China, Japan, Hong Kong and others set up quarantines for anyone possibly infected. Russia and other countries banned pork imports from Mexico, though people cannot get the flu from eating pork.
In the United States, the C.D.C. confirmed that eight students at St. Francis Preparatory School in Fresh Meadows, Queens, had been infected with the new swine flu. At a news conference on Sunday, Mayor Michael R. Bloomberg said that all those cases had been mild and that city hospitals had not seen a surge in severe lung infections.
On the streets of New York, people seemed relatively unconcerned, in sharp contrast to Mexico City, where soldiers handed out masks.
Hong Kong, shaped by lasting scars as an epicenter of the SARS outbreak, announced very tough measures. Officials there urged travelers to avoid Mexico and ordered the immediate detention of anyone arriving with a fever higher than 100.4 degrees Fahrenheit after traveling through any city with a confirmed case, which would include New York.
Everyone stopped will be sent to a hospital for a flu test and held until it is negative. Since Hong Kong has Asia’s busiest airport hub, the policy could severely disrupt international travel.
The central question is how many mild cases Mexico has had, Dr. Martin S. Cetron, director of global migration and quarantine for the Centers for Disease Control, said in an interview.
“We may just be looking at the tip of the iceberg, which would give you a skewed initial estimate of the case fatality rate,” he said, meaning that there might have been tens of thousands of mild infections around the 1,300 cases of serious disease and 80 or more deaths. If that is true, as the flu spreads, it would not be surprising if most cases were mild.
Even in 1918, according to the C.D.C., the virus infected at least 500 million of
the world’s 1.5 billion people to kill 50 million. Many would have been saved if antiflu drugs, antibiotics and mechanical ventilators had existed.
Another hypothesis, Dr. Cetron said, is that some other factor in Mexico increased lethality, like co-infection with another microbe or an unwittingly dangerous treatment.
Flu experts would also like to know whether current flu shots give any protection because it will be months before a new vaccine can be made.
There is an H1N1 human strain in this year’s shot, and all H1N1 flus are descendants of the 1918 pandemic strain.
But flus pick up many mutations, and there will be no proof of protection until the C.D.C. can test stored blood serum containing flu shot antibodies against the new virus. Those tests are under way, said an expert who sent the C.D.C. his blood samples.
Reporting was contributed by Sheryl Gay Stolberg from Washington, Jack Healy from New York, Keith Bradsher from Hong Kong and Ian Austen from Ottawa.
Published: April 26, 2009
The New York Times
Responding to what some health officials feared could be the leading edge of a global pandemic emerging from Mexico, American health officials declared a public health emergency on Sunday as 20 cases of swine flu were confirmed in this country, including eight in New York City.
Other nations imposed travel bans or made plans to quarantine air travelers as confirmed cases also appeared in Mexico and Canada and suspect cases emerged elsewhere.
Top global flu experts struggled to predict how dangerous the new A (H1N1) swine flu strain would be as it became clear that they had too little information about Mexico’s outbreak — in particular how many cases had occurred in what is thought to be a month before the outbreak was detected, and whether the virus was mutating to be more lethal, or less.
“We’re in a period in which the picture is evolving,” said Dr. Keiji Fukuda, deputy director general of the World Health Organization. “We need to know the extent to which it causes mild and serious infections.”
Without that knowledge — which is unlikely to emerge soon because only two laboratories, in Atlanta and Winnipeg, Canada, can confirm a case — his agency’s panel of experts was unwilling to raise the global pandemic alert level, even though it officially saw the outbreak as a public health emergency and opened its emergency response center.
As a news conference in Washington, Homeland Security Secretary Janet Napolitano called the emergency declaration “standard operating procedure,” and said she would rather call it a “declaration of emergency preparedness.”
“It’s like declaring one for a hurricane,” she said. “It means we can release funds and take other measures. The hurricane may not actually hit.”
American investigators said they expected more cases here, but noted that virtually all so far had been mild and urged Americans not to panic.
The speed and the scope of the world’s response showed the value of preparations made because of the avian flu and SARS scares, public health experts said.
The emergency declaration in the United States lets the government free more money for antiviral drugs and give some previously unapproved tests and drugs to children. One-quarter of the national stockpile of 50 million courses of antiflu drugs will be released.
Border patrols and airport security officers are to begin asking travelers if they have had the flu or a fever; those who appear ill will be stopped, taken aside and given masks while they arrange for medical care.
“This is moving fast and we expect to see more cases,” Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said at the news conference with Ms. Napolitano. “But we view this as a marathon.”
He advised Americans to wash their hands frequently, to cover coughs and sneezes and to stay home if they felt ill; but he stopped short of advice now given in Mexico to wear masks and not kiss or touch anyone. He praised decisions to close individual schools in New York and Texas but did not call for more widespread closings.
Besides the eight New York cases, officials said they had confirmed seven in California, two in Kansas, two in Texas and one in Ohio. The virus looked identical to the one in Mexico believed to have killed 103 people — including 22 people whose deaths were confirmed to be from swine flu — and sickened about 1,600. As of Sunday night, there were no swine flu deaths in the United States, and one hospitalization.
Other governments tried to contain the infection amid reports of potential new cases including in New Zealand and Spain.
Dr. Fukuda of the W.H.O. said his agency would decide Tuesday whether to raise the pandemic alert level to 4. Such a move would prompt more travel bans, and the agency has been reluctant historically to take actions that hurt member nations.
Canada confirmed six cases, at opposite ends of the country: four in Nova Scotia and two in British Columbia. Canadian health officials said the victims had only mild symptoms and had either recently traveled to Mexico or been in contact with someone who had.
Other governments issued advisories urging citizens not to visit Mexico. China, Japan, Hong Kong and others set up quarantines for anyone possibly infected. Russia and other countries banned pork imports from Mexico, though people cannot get the flu from eating pork.
In the United States, the C.D.C. confirmed that eight students at St. Francis Preparatory School in Fresh Meadows, Queens, had been infected with the new swine flu. At a news conference on Sunday, Mayor Michael R. Bloomberg said that all those cases had been mild and that city hospitals had not seen a surge in severe lung infections.
On the streets of New York, people seemed relatively unconcerned, in sharp contrast to Mexico City, where soldiers handed out masks.
Hong Kong, shaped by lasting scars as an epicenter of the SARS outbreak, announced very tough measures. Officials there urged travelers to avoid Mexico and ordered the immediate detention of anyone arriving with a fever higher than 100.4 degrees Fahrenheit after traveling through any city with a confirmed case, which would include New York.
Everyone stopped will be sent to a hospital for a flu test and held until it is negative. Since Hong Kong has Asia’s busiest airport hub, the policy could severely disrupt international travel.
The central question is how many mild cases Mexico has had, Dr. Martin S. Cetron, director of global migration and quarantine for the Centers for Disease Control, said in an interview.
“We may just be looking at the tip of the iceberg, which would give you a skewed initial estimate of the case fatality rate,” he said, meaning that there might have been tens of thousands of mild infections around the 1,300 cases of serious disease and 80 or more deaths. If that is true, as the flu spreads, it would not be surprising if most cases were mild.
Even in 1918, according to the C.D.C., the virus infected at least 500 million of
the world’s 1.5 billion people to kill 50 million. Many would have been saved if antiflu drugs, antibiotics and mechanical ventilators had existed.
Another hypothesis, Dr. Cetron said, is that some other factor in Mexico increased lethality, like co-infection with another microbe or an unwittingly dangerous treatment.
Flu experts would also like to know whether current flu shots give any protection because it will be months before a new vaccine can be made.
There is an H1N1 human strain in this year’s shot, and all H1N1 flus are descendants of the 1918 pandemic strain.
But flus pick up many mutations, and there will be no proof of protection until the C.D.C. can test stored blood serum containing flu shot antibodies against the new virus. Those tests are under way, said an expert who sent the C.D.C. his blood samples.
Reporting was contributed by Sheryl Gay Stolberg from Washington, Jack Healy from New York, Keith Bradsher from Hong Kong and Ian Austen from Ottawa.
25 de abril: Mexico Takes Powers to Isolate Cases of Swine Flu
The New York Times
MEXICO CITY — This sprawling capital was on edge Saturday as jittery residents ventured out wearing surgical masks and President Felipe Calderón published an order that would give his government emergency powers to address a deadly flu outbreak, including isolating those who have contracted the virus, inspecting the homes of affected people and ordering the cancellation of public events.
White-coated health care workers fanned out across the international airport here to look for ailing passengers, and thousands of callers fearful they might have contracted the rare swine flu flooded government health hot lines. Health officials also began notifying restaurants, bars and nightclubs throughout the city that they should close.
Of those Mexicans who did go out in public, many took the advice of the authorities and donned the masks, which are known here as tapabocas, or cover-your-mouths, and were being handed out by soldiers and health workers at subway stops and on street corners.
“My government will not delay one minute to take all the necessary measures to deal with this epidemic,” Mr. Calderón said in Oaxaca State during the opening of a new hospital, which he said would set aside an area for anyone who might be affected by the new swine flu strain that has already killed as many as 81 people in Mexico and sickened more than 1,300 others.
Mr. Calderón pointed out that he and the other officials who attended the ceremony intentionally did not greet each other with handshakes or kisses on the cheek, which health officials have urged Mexicans to avoid.
At a news conference Saturday night to address the crisis, Mexico’s health minister, José Ángel Córdova, said 20 of the 81 reported deaths were confirmed to have been caused by swine flu, while the rest are being studied. Most of the cases of illness were reported in the center of the country, but there were other cases in pockets to the north and south.
The government also announced at the news conference that schools in and around the capital that serve millions of students would remain closed until May 6.
With 20 million people packed together tight, Mexico City typically bursts forth on the weekends into parks, playgrounds, cultural centers and sidewalk cafes. But things were quieter than usual on Saturday.
The government encouraged people to stay home by canceling concerts, closing museums and banning spectators from two big soccer matches on Sunday that will be played in front of television cameras, but no live crowd.
At street corners on Saturday, even many of the jugglers, dancers and musicians who eke out a living collecting spare change when the traffic lights turn red were wearing bright blue surgical masks.
The newspaper Reforma reported that President Obama, who recently visited Mexico, was escorted around Mexico City’s national anthropology museum on April 16 by Felipe Solis, an archaeologist who died the next day from flu-like symptoms. But Dr. Córdova said that it does not appear that Mr. Solis died of influenza.
White House officials said Saturday that they were aware of the news reports in Mexico but that there was no reason to be concerned about Mr. Obama’s health, that he had no symptoms and that his medical staff had recommended he not be tested.
The Centers for Disease Control and Prevention in Atlanta said Saturday that it had sent a team of experts to Mexico to assist with the investigation of the outbreak, which has already been reported in Texas and California and possibly in New York, raising fears that it could spread into a global pandemic.
The possible New York cases were reported at a Queens high school, where eight students tested positive for a type of influenza that health officials suspect could be the new swine flu. Some of the school’s students had traveled to Mexico recently.
Still, the World Health Organization, which held a meeting on Saturday to discuss the outbreak, chose not to raise the level of global pandemic flu alert, which has been at a Level 3 because of the avian flu.
Epidemiologists want to know exactly when the first cases occurred in Mexico. Mexican health officials said they first noticed a huge spike in flu cases in late March. In mid-April, they began noticing that otherwise healthy people were dying from the virus. But it was only on Thursday night that officials first sounded an alarm to the population by closing schools, after United States health officials announced a possible swine flu outbreak.
By issuing the emergency decree Saturday, Mr. Calderón may have been trying to head off criticism that his government had been too slow to act. He had earlier called in the army to distribute four million masks throughout the capital and its suburbs.
Lt. Raymundo Morales Merla, who stood outside a military transport truck parked outside a downtown subway station on Saturday, led a group of 27 soldiers who had arrived at 7 a.m. to hand out as many masks as they could.
The scene at the airport was alarming, with doctors stationed at the entrances to answer questions and to keep an eye out for obviously sick people. Regular public address announcements in English and Spanish warned travelers that anyone exhibiting any symptoms should cancel their flight and immediately seek medical attention.
Even Sunday Mass will probably be affected. The Roman Catholic Church gave worshipers the option to listen to Masses on the radio and told priests who decided to hold services to be brief and put Communion wafers in worshipers’ hands instead of their mouths.
Axel de la Macorra, 46, a physics professor at National Autonomous University of Mexico, said he became worried when he learned recently that a 31-year-man who played at a tennis club he once belonged to had suddenly died. “He got sick at the beginning of April and two weeks later, he was dead,” said Mr. de la Macorra, who was weighing whether to attend a First Communion with 200 guests on Saturday.
“My mother told me to wear it so I did,” said Noel Ledezma, 29, who had his mask pulled down so he could sip a coffee and eat a muffin as he walked to work. “Who knows who will be next.”
Sarahe Gomez, who was selling jewelry at a mall in the upscale Polanco neighborhood, spoke through a mask to the few customers who visited her kiosk. “I’m in the middle of all these people and one of them could have it,” she said. “The virus could be anywhere. It could be right here.”
She then took a half step back.
“This is no joke,” said Servando Peneda, 42, a lawyer who ventured out to pay a bill, but left his two sons home. “There’s 20 million of us in this city and I’d say half of us have these masks on today. I know all of us will die one day, but I want to last out the week.”
Antonio Betancourt contributed reporting from Mexico City, and Sheryl Gay Stolberg from Washington.
Student Falls Ill and Swine Flu is likely the cause
By DONALD G. McNEIL Jr.
Published: April 25, 2009
The New York Times
Tests show that eight students at a Queens high school are likely to have contracted the human swine flu virus that has struck Mexico and a small number of other people in the United States, health officials in New York City said yesterday.
The students were among about 100 at St. Francis Preparatory School in Fresh Meadows who became sick in the last few days, said Dr. Thomas R. Frieden, New York City’s health commissioner.“All the cases were mild, no child was hospitalized, no child was seriously ill,” Dr. Frieden said.
Health officials reached their preliminary conclusion after conducting viral tests on nose or throat swabs from the eight students, which allowed them to eliminate other strains of flu. Officials were also suspicious since some St. Francis students recently had been to Mexico, where the outbreak is believed to have started.
The president in Mexico assumed emergency powers to deal with the crisis, which has killed at least 81 people and infected about 1,300 others. All public gatherings have been banned, including more than 500 concerts and sporting events and the popular bicycle rides on closed boulevards.Dr. Margaret Chan, the director-general of the World Health Organization, said the events in Mexico “constitute a public health emergency of international concern.”
The W.H.O. convened an emergency meeting of experts on Saturday, but the panel adjourned without raising the global pandemic alert level, saying it wanted more information. Some experts expressed surprise that no action was taken since the Mexico outbreak seems to meet the definition of a Level 4 alert — sustained human-to-human transmission of a new virus.
The alert has been at Level 3 for years because of small clusters of human cases of avian flu.In the United States, so far, at least 11 swine flu cases have been confirmed. Seven were confirmed in San Diego and Imperial Counties in California and two in Kansas.
In Texas, two 16-year-old students at Byron Steele High School in Cibolo, near San Antonio, were confirmed to have swine flu, and one of their classmates was suspected to have the virus. There have been no deaths, and officials said most of the 11 seemed to be recovering.Officials said they expect to find many more cases as they begin testing for them.
In New York, the samples from the Queens students have been sent to the Centers for Disease Control and Prevention in Atlanta, the only lab in the country that can positively confirm the new swine flu strain — which has been identified as H1N1. Results were expected on Sunday, officials said.Fearing a panic that might tax local health facilities, Dr. Frieden urged New Yorkers not to go to a hospital if they had typical mild cold or flu symptoms.
If they are seriously ill, especially with lung problems, they should seek medical attention promptly, he said, because antiflu drugs work best if taken in the first 48 hours.Because of fears of the H5N1 avian flu, both New York City and the United States have had detailed pandemic emergency plans in place since 2005, as well as stockpiles of emergency supplies and flu drugs (the plan can be read at http://www.pandemicflu.gov/).
Dr. Frieden said that for such an emergency, the city had extra hospital ventilators, huge reserves of masks and gloves and “millions of doses of Tamiflu,” an antiflu drug that thus far appears to work against the new swine strain.
The eight Queens students were positive for an A-strain flu virus but negative for all previously known A-strains. That result, called “A-untypeable,” led officials to suspect it was the new swine flu.Dr. Frieden said the city was also testing samples from students from a day care center in the Bronx. Health officials would not identify it.Thomas Skinner, a spokesman for the C.D.C., said the agency would send a team to New York, as it has to California, Texas and Mexico, if requested.
New York has one of the most sophisticated health departments in the world, but the C.D.C. can assist by releasing supplies from the National Strategic Stockpile. Tamiflu, masks, gloves, purifying gel, ventilators and other goods useful in a flu crisis are kept in warehouses around the country and can be moved out in a matter of hours, Mr. Skinner said.
In Texas, Byron Steele High School was closed and all its extracurricular activities were canceled “to reduce the risk to students, staff and the community,” said Dr. Sandra Guerra, a regional director for the state health department. She urged students not to hang out together anyway as “that would defeat the purpose.”Gov. Rick Perry of Texas asked the C.D.C. to send 37,430 doses of Tamiflu.
According to one expert involved in telephone discussions about flu preparedness on Saturday, there was debate among officials about whether to move some of the stockpile closer to Texas and California. Presumably, that will be made moot by indications that a mild form of the flu may have already spread elsewhere in the nation.The C.D.C. did not raise the alert level in the United States, which is officially at zero because there have been no human cases of H5N1 avian flu here as there have been in Asia and Egypt. C.D.C. scientists are working on a “seed strain” for a vaccine matched to the new swine flu, but warned that it would take months before enough doses for all Americans are ready.
They are also creating test kits for 140 American labs and dozens of international ones to allow them to test for the new flu.In each year’s flu season, most deaths are in infants and the aged, but none of the first ones in Mexico were in people over 60 or under 3 years old, a W.H.O. spokeswoman said. When a new virus emerges, deaths may occur in healthy adults who mount the strongest immune reactions. Their own defenses — inflammation and leaking fluid in lung cells — can essentially drown them from inside.
The federal pandemic plan includes putting emergency rooms and first-responders on alert, making sure they have seasonal flu shots and putting them first in line for any early batches of a swine flu vaccine.The 1918 “Spanish flu” pandemic came in waves — a summertime one was mild, then a severe one hit the following winter. However, as experts note, in 1918 there was no Tamiflu, no antibiotics to fight pneumonia, and no powered ventilators.
Christine Hauser contributed reporting from New York, James McKinley from Houston and Marc Lacey from Mexico City.
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