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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