Zeno Swijtink
04-29-2009, 02:20 PM
washingtonpost.com (https://www.washingtonpost.com/wp-dyn/content/article/2009/04/29/AR2009042900956.html)
Swine Flu Infections Spread
Swine flu infections spread to more locations across the United States and around the world, while the World Health Organization considered raising its pandemic threat alert level.
By Rob Stein, Spencer S. Hsu and William Branigin
Washington Post Staff Writers
Wednesday, April 29, 2009; 4:36 PM
The World Health Organization today raised its pandemic threat alert level for swine flu, as the infection spread to more locations across the country and around the world and U.S. health officials reported the first confirmed death in the United States from swine flu -- a toddler from Mexico who died in Texas.
The WHO raised the alert level to "phase 5," its second-highest level, which means that human-to-human spread of the virus has been found in at least two countries in one WHO region. While most countries will not be affected at this stage, according to WHO, the declaration of phase 5 represents "a strong signal that a pandemic is imminent and that the time to finalize the organization, communication and implementation of the planned mitigation measures is short."
In making the announcement, WHO Director-General Margaret Chan urged countries to activate their pandemic flu response plans.
"This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions now should be undertaken with increased urgency and at an accelerated pace," she said.
U.S. officials said they are already treating the swine flu outbreak as a "phase 6" event -- the highest alert level -- in the United States in terms of preparations and informing the public.
In a news conference, Richard E. Besser, acting director of the Centers for Disease Control and Prevention in Atlanta, said there are now 91 confirmed swine flu cases in 10 states -- up from 64 cases in five states in the CDC's report yesterday. He said New York has 51 confirmed cases; Texas 16; California 14; Massachusetts, Michigan and Kansas two each; and Arizona, Nevada, Indiana and Ohio one each. But he cautioned that "these numbers are almost out of date by the time I say them."
The 91 cases cited by CDC do not include the child who died or a U.S. Marine who was confirmed this afternoon to have swine flu.
Testifying on Capitol Hill, senior U.S. homeland security and health officials rejected the idea of closing the border with Mexico, saying such a response would be ineffective in stemming the spread of the disease.
In Geneva, meanwhile, a senior official at the World Health Organization, Keiji Fukuda, said the agency is "moving closer" to raising the pandemic threat alert another notch, to the "phase 5" level. He said new cases suggest the virus is spreading more easily among people, including those who have not been to Mexico, the epicenter of the deadly influenza strain.
"It is clear that the virus is spreading, and we don't see evidence of it slowing down at this point," said Fukuda, the WHO's acting assistant director-general for health security and environment. However, he said the agency has not yet made a decision on raising the alert level. "I don't think we're there yet," he said. Such a move would be a "significant milestone," and the agency was waiting until there was clear evidence of "sustained transmission" of the virus in "at least two or more countries" before taking that step, he said.
"Investigations continue full-bore in many different countries," he said. "At this point, there is very intense analysis of all the information available going on."
As the U.S. caseload climbed again, officials reported four probable cases at the University of Delaware, the closest so far to the Washington area. Cases were reported in Germany for the first time, and researchers searched for clues as to how readily the virus causes the pneumonia that has killed scores of patients in Mexico, the epicenter of the outbreak.
Houston health officials said today that a nearly 2-year-old toddler died Monday night in a hospital in the city after developing a fever and other flu symptoms. The child, who was not immediately identified, had traveled by plane with his family from Mexico City to a town near the U.S. border April 4. He then crossed into the United States to visit relatives in the border town of Brownsville and developed flu symptoms April 8.
Several days later, with his condition worsening, the boy was admitted to a Brownsville hospital. He was transported to Houston for additional treatment the next day. It is not known whether the child contracted the virus in Mexico or on the U.S. side of the porous border.
Officials said the child had underlying health problems. His relatives are healthy and have not been infected, officials said.
President Obama today offered his "thoughts and prayers and deepest condolences" to the toddler's family and to other victims and their loved ones.
He said U.S. authorities were monitoring the spread of the virus carefully, and he urged local authorities to report all suspected cases and close schools where infections are reported to minimize spread of the disease. Private citizens, Obama said, should take care to wash their hands frequently, stay home from work or school if they are sick and cover their mouths when coughing.
"We need your assistance," Obama said.
Obama and other U.S. officials took care today to refer to the flu strain as the H1N1 virus, instead of swine flu, which officials said is a misnomer that unfairly gives pork a bad name. Agriculture Secretary Tom Vilsack and other officials stressed that no swine herds in the United States or Mexico are known to be infected with the virus. In any case, they said, the illness is not food-borne and cannot be contracted by eating pork or pork products.
Nevertheless, at least 17 countries have imposed partial or total bans on pork imports, threatening a major U.S. export market. U.S. officials have warned that such bans could damage the world's trading system.
The fatality in Texas elevated debate over tightening border controls with Mexico, but top U.S. health and homeland security officials rejected such calls during testimony today at a hearing of the Senate Committee on Homeland Security and Governmental Affairs.
Asked by Sen. John McCain (R-Ariz.) what, if any, conditions would warrant closing the U.S.-Mexican border, Rear Adm. Anne Schuchat, the CDC's interim deputy director for science and public health, said bluntly, "Going forward, there is no circumstance in which closing the border would have value."
Schuchat said that in 2007, the Bush administration modeled the spread of infectious disease and conducted a formal U.S. policy analysis, which concluded that once cases emerged in Canada or Mexico, the ability to stop a virus from spreading into the United States ends "within days."
With the illness confirmed in several states, she said, the probability now is that a person's exposure to the virus in the United States comes from someone who has had no direct contact with Mexico.
"It really is not an effective approach to block things at the border," Schuchat said. "Assets really need to be focused elsewhere, and the border is a real diversion."
Sen. Joseph I. Lieberman (I-Conn.), chairman of the Senate Homeland Security Committee and normally a voice of moderation on such matters, warned Homeland Security Secretary Janet Napolitano that she should at least be open to considering further border checks, such as on temporary workers coming from Mexico, "because I think if you don't, there will be growing pressure to really close the ports of entry."
Napolitano responded that any requirement to screen all individuals crossing the border will create delays, long lines and economic and personal costs.
"We are going to have to be able to explain what is the advantage of that . . . other than symbolism in terms of preventing disease in our country," Napolitano said. "Right now, scientists are telling me beyond symbolism we don't get an advantage" in stopping the spread of the disease.
Napolitano later said that federal border agents at unspecified land ports of entry have so far referred 49 travelers entering through U.S. border checkpoints to federal, state or local health officials because they displayed suspicious flu-like symptoms. She said 41 of the travelers were subsequently cleared and that eight others remain under investigation, with diagnostic tests not yet completed.
"As of today, U.S. Customs and Border Protection has referred a total of 49 suspected cases to CDC or to state and local officials," she said. "All the results have been negative, except the eight that are still under study."
Texas, meanwhile, issued a "disaster declaration" to help respond to the outbreak, allowing the state to implement emergency measures and seek federal funding.
"Texans need to know there is no cause for panic, and Texans can be assured that the state will take every necessary precaution to protect the lives of our citizens," Gov. Rick Perry (R) said. "My office, along with the Department of State Health Services and other state, local and federal partners, have a plan in place to protect Texans should there be a pandemic flu outbreak or other health emergency."
Only a handful of patients in the United States and elsewhere outside Mexico have been hospitalized with the flu so far. Severe complications outside Mexico have been relatively rare, although officials acknowledged yesterday that they see some U.S. fatalities as inevitable.
Houston health department spokeswoman Kathy Barton said the case involving the toddler "posed extremely limited risk to Houston because [he] came in on a medical transport and never left the hospital."
But she urged residents of the city to continue to take precautions, saying other cases were likely to occur as part of the ongoing outbreak.
A Marine at Twentynine Palms in California has swine flu, and as a result more than 30 other Marines who had contact with him have been quarantined, according to the Marine Corps.
"That quarantine will last four or five days," said Marine Corps spokesman Maj. David Nevers.
The ill Marine "is feeling well, his condition continues to improve," Nevers said, and none of the other Marines exposed are displaying any symptoms.
Officials at the base are "aggressively working to contain the potential for the scope to expand" through preventive measures, Nevers said.
According to the WHO and national governments, 10 countries now have confirmed infections. At least 18 other nations have reported suspected swine flu cases.
France, which has two suspected infections, said today it would urge the 27-nation European Union to suspend all flights from member countries to Mexico in an expanded effort to limit exposure to swine flu infections.
French Health Minister Roselyne Bachelot, speaking after a crisis meeting with President Nicolas Sarkozy, said E.U. health ministers will deal with the proposal tomorrow in Luxembourg. She said the bloc's transport ministers also will be asked to back the decision.
Luc Chatel, a French government spokesman, said the suspension would not apply to flights arriving in Europe from Mexico. Canceling these flights would force travelers to take roundabout routes, complicating efforts to track the sources of infection among sick people in Europe, he explained.
Sarkozy's administration, in one of a number of such precautions urged by individual European governments, has been advising French nationals since yesterday to avoid travel to Mexico except for imperative reasons.
The French National Health Watch Institute said about 30 people in France are being investigated for possible infections, most of them after trips to Mexico. Of those, it said, a man and a woman hospitalized in the Paris region after returning from Mexico are considered likely to test positive for swine flu. The institute's director, Françoise Weber, told reporters that test results for the couple were likely by the end of the week. In the meantime, she said, they are doing well and showing symptoms of an ordinary flu.
Among the most severe U.S. cases until now has been an adult in California's Imperial County who ended up on a ventilator, said county health officer Stephen W. Munday. No swine flu has been confirmed in the Washington area, but the University of Delaware said last night that it was awaiting final test results for four students who had been treated for influenza on campus and, according to preliminary tests, were "probable" swine flu cases.
In addition to the U.S. and Mexican cases, at least six have been confirmed in Israel, at least two in Spain, five in Britain and two in New Zealand, according to WHO. Israeli officials said they had confirmed two more cases, both in men who recently returned from Mexico.
On Wednesday, German health officials said three citizens who recently returned from Mexico had tested positive for swine flu. The patients were all expected to make a full recovery, officials said, though they warned that the virus was likely to spread and that they were monitoring other suspected cases in Germany.
British Prime Minister Gordon Brown said today that all of those known to be infected in his country had been in Mexico recently and were responding well to treatment. "All of them have mild symptoms. All of them are receiving and are responding well to the treatment that has been effective so far, the use of Tamiflu," Brown said.
Brown said Britain had heightened airport checks of travelers who might have the flu and significantly expanded its stock of anti-viral medicines. The government had also ordered millions of extra face masks and planned to deliver information leaflets to every household in the country on the swine flu. In Devon, in western England, authorities closed a school after one of its students was confirmed to be infected.
Correspondents Jill Drew in Beijing, Craig Whitlock in Berlin, Mary Jordan in London, Edward Cody in Paris, Howard Schneider in Jerusalem and Emily Wax in Mumbai and staff writers Keith B. Richburg in New York, Ceci Connolly in Atlanta, Ann Scott Tyson, Michael D. Shear and Debbi Wilgoren in Washington and Ashley Surdin and Karl Vick in Los Angeles contributed to this report.
Swine Flu Infections Spread
Swine flu infections spread to more locations across the United States and around the world, while the World Health Organization considered raising its pandemic threat alert level.
By Rob Stein, Spencer S. Hsu and William Branigin
Washington Post Staff Writers
Wednesday, April 29, 2009; 4:36 PM
The World Health Organization today raised its pandemic threat alert level for swine flu, as the infection spread to more locations across the country and around the world and U.S. health officials reported the first confirmed death in the United States from swine flu -- a toddler from Mexico who died in Texas.
The WHO raised the alert level to "phase 5," its second-highest level, which means that human-to-human spread of the virus has been found in at least two countries in one WHO region. While most countries will not be affected at this stage, according to WHO, the declaration of phase 5 represents "a strong signal that a pandemic is imminent and that the time to finalize the organization, communication and implementation of the planned mitigation measures is short."
In making the announcement, WHO Director-General Margaret Chan urged countries to activate their pandemic flu response plans.
"This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions now should be undertaken with increased urgency and at an accelerated pace," she said.
U.S. officials said they are already treating the swine flu outbreak as a "phase 6" event -- the highest alert level -- in the United States in terms of preparations and informing the public.
In a news conference, Richard E. Besser, acting director of the Centers for Disease Control and Prevention in Atlanta, said there are now 91 confirmed swine flu cases in 10 states -- up from 64 cases in five states in the CDC's report yesterday. He said New York has 51 confirmed cases; Texas 16; California 14; Massachusetts, Michigan and Kansas two each; and Arizona, Nevada, Indiana and Ohio one each. But he cautioned that "these numbers are almost out of date by the time I say them."
The 91 cases cited by CDC do not include the child who died or a U.S. Marine who was confirmed this afternoon to have swine flu.
Testifying on Capitol Hill, senior U.S. homeland security and health officials rejected the idea of closing the border with Mexico, saying such a response would be ineffective in stemming the spread of the disease.
In Geneva, meanwhile, a senior official at the World Health Organization, Keiji Fukuda, said the agency is "moving closer" to raising the pandemic threat alert another notch, to the "phase 5" level. He said new cases suggest the virus is spreading more easily among people, including those who have not been to Mexico, the epicenter of the deadly influenza strain.
"It is clear that the virus is spreading, and we don't see evidence of it slowing down at this point," said Fukuda, the WHO's acting assistant director-general for health security and environment. However, he said the agency has not yet made a decision on raising the alert level. "I don't think we're there yet," he said. Such a move would be a "significant milestone," and the agency was waiting until there was clear evidence of "sustained transmission" of the virus in "at least two or more countries" before taking that step, he said.
"Investigations continue full-bore in many different countries," he said. "At this point, there is very intense analysis of all the information available going on."
As the U.S. caseload climbed again, officials reported four probable cases at the University of Delaware, the closest so far to the Washington area. Cases were reported in Germany for the first time, and researchers searched for clues as to how readily the virus causes the pneumonia that has killed scores of patients in Mexico, the epicenter of the outbreak.
Houston health officials said today that a nearly 2-year-old toddler died Monday night in a hospital in the city after developing a fever and other flu symptoms. The child, who was not immediately identified, had traveled by plane with his family from Mexico City to a town near the U.S. border April 4. He then crossed into the United States to visit relatives in the border town of Brownsville and developed flu symptoms April 8.
Several days later, with his condition worsening, the boy was admitted to a Brownsville hospital. He was transported to Houston for additional treatment the next day. It is not known whether the child contracted the virus in Mexico or on the U.S. side of the porous border.
Officials said the child had underlying health problems. His relatives are healthy and have not been infected, officials said.
President Obama today offered his "thoughts and prayers and deepest condolences" to the toddler's family and to other victims and their loved ones.
He said U.S. authorities were monitoring the spread of the virus carefully, and he urged local authorities to report all suspected cases and close schools where infections are reported to minimize spread of the disease. Private citizens, Obama said, should take care to wash their hands frequently, stay home from work or school if they are sick and cover their mouths when coughing.
"We need your assistance," Obama said.
Obama and other U.S. officials took care today to refer to the flu strain as the H1N1 virus, instead of swine flu, which officials said is a misnomer that unfairly gives pork a bad name. Agriculture Secretary Tom Vilsack and other officials stressed that no swine herds in the United States or Mexico are known to be infected with the virus. In any case, they said, the illness is not food-borne and cannot be contracted by eating pork or pork products.
Nevertheless, at least 17 countries have imposed partial or total bans on pork imports, threatening a major U.S. export market. U.S. officials have warned that such bans could damage the world's trading system.
The fatality in Texas elevated debate over tightening border controls with Mexico, but top U.S. health and homeland security officials rejected such calls during testimony today at a hearing of the Senate Committee on Homeland Security and Governmental Affairs.
Asked by Sen. John McCain (R-Ariz.) what, if any, conditions would warrant closing the U.S.-Mexican border, Rear Adm. Anne Schuchat, the CDC's interim deputy director for science and public health, said bluntly, "Going forward, there is no circumstance in which closing the border would have value."
Schuchat said that in 2007, the Bush administration modeled the spread of infectious disease and conducted a formal U.S. policy analysis, which concluded that once cases emerged in Canada or Mexico, the ability to stop a virus from spreading into the United States ends "within days."
With the illness confirmed in several states, she said, the probability now is that a person's exposure to the virus in the United States comes from someone who has had no direct contact with Mexico.
"It really is not an effective approach to block things at the border," Schuchat said. "Assets really need to be focused elsewhere, and the border is a real diversion."
Sen. Joseph I. Lieberman (I-Conn.), chairman of the Senate Homeland Security Committee and normally a voice of moderation on such matters, warned Homeland Security Secretary Janet Napolitano that she should at least be open to considering further border checks, such as on temporary workers coming from Mexico, "because I think if you don't, there will be growing pressure to really close the ports of entry."
Napolitano responded that any requirement to screen all individuals crossing the border will create delays, long lines and economic and personal costs.
"We are going to have to be able to explain what is the advantage of that . . . other than symbolism in terms of preventing disease in our country," Napolitano said. "Right now, scientists are telling me beyond symbolism we don't get an advantage" in stopping the spread of the disease.
Napolitano later said that federal border agents at unspecified land ports of entry have so far referred 49 travelers entering through U.S. border checkpoints to federal, state or local health officials because they displayed suspicious flu-like symptoms. She said 41 of the travelers were subsequently cleared and that eight others remain under investigation, with diagnostic tests not yet completed.
"As of today, U.S. Customs and Border Protection has referred a total of 49 suspected cases to CDC or to state and local officials," she said. "All the results have been negative, except the eight that are still under study."
Texas, meanwhile, issued a "disaster declaration" to help respond to the outbreak, allowing the state to implement emergency measures and seek federal funding.
"Texans need to know there is no cause for panic, and Texans can be assured that the state will take every necessary precaution to protect the lives of our citizens," Gov. Rick Perry (R) said. "My office, along with the Department of State Health Services and other state, local and federal partners, have a plan in place to protect Texans should there be a pandemic flu outbreak or other health emergency."
Only a handful of patients in the United States and elsewhere outside Mexico have been hospitalized with the flu so far. Severe complications outside Mexico have been relatively rare, although officials acknowledged yesterday that they see some U.S. fatalities as inevitable.
Houston health department spokeswoman Kathy Barton said the case involving the toddler "posed extremely limited risk to Houston because [he] came in on a medical transport and never left the hospital."
But she urged residents of the city to continue to take precautions, saying other cases were likely to occur as part of the ongoing outbreak.
A Marine at Twentynine Palms in California has swine flu, and as a result more than 30 other Marines who had contact with him have been quarantined, according to the Marine Corps.
"That quarantine will last four or five days," said Marine Corps spokesman Maj. David Nevers.
The ill Marine "is feeling well, his condition continues to improve," Nevers said, and none of the other Marines exposed are displaying any symptoms.
Officials at the base are "aggressively working to contain the potential for the scope to expand" through preventive measures, Nevers said.
According to the WHO and national governments, 10 countries now have confirmed infections. At least 18 other nations have reported suspected swine flu cases.
France, which has two suspected infections, said today it would urge the 27-nation European Union to suspend all flights from member countries to Mexico in an expanded effort to limit exposure to swine flu infections.
French Health Minister Roselyne Bachelot, speaking after a crisis meeting with President Nicolas Sarkozy, said E.U. health ministers will deal with the proposal tomorrow in Luxembourg. She said the bloc's transport ministers also will be asked to back the decision.
Luc Chatel, a French government spokesman, said the suspension would not apply to flights arriving in Europe from Mexico. Canceling these flights would force travelers to take roundabout routes, complicating efforts to track the sources of infection among sick people in Europe, he explained.
Sarkozy's administration, in one of a number of such precautions urged by individual European governments, has been advising French nationals since yesterday to avoid travel to Mexico except for imperative reasons.
The French National Health Watch Institute said about 30 people in France are being investigated for possible infections, most of them after trips to Mexico. Of those, it said, a man and a woman hospitalized in the Paris region after returning from Mexico are considered likely to test positive for swine flu. The institute's director, Françoise Weber, told reporters that test results for the couple were likely by the end of the week. In the meantime, she said, they are doing well and showing symptoms of an ordinary flu.
Among the most severe U.S. cases until now has been an adult in California's Imperial County who ended up on a ventilator, said county health officer Stephen W. Munday. No swine flu has been confirmed in the Washington area, but the University of Delaware said last night that it was awaiting final test results for four students who had been treated for influenza on campus and, according to preliminary tests, were "probable" swine flu cases.
In addition to the U.S. and Mexican cases, at least six have been confirmed in Israel, at least two in Spain, five in Britain and two in New Zealand, according to WHO. Israeli officials said they had confirmed two more cases, both in men who recently returned from Mexico.
On Wednesday, German health officials said three citizens who recently returned from Mexico had tested positive for swine flu. The patients were all expected to make a full recovery, officials said, though they warned that the virus was likely to spread and that they were monitoring other suspected cases in Germany.
British Prime Minister Gordon Brown said today that all of those known to be infected in his country had been in Mexico recently and were responding well to treatment. "All of them have mild symptoms. All of them are receiving and are responding well to the treatment that has been effective so far, the use of Tamiflu," Brown said.
Brown said Britain had heightened airport checks of travelers who might have the flu and significantly expanded its stock of anti-viral medicines. The government had also ordered millions of extra face masks and planned to deliver information leaflets to every household in the country on the swine flu. In Devon, in western England, authorities closed a school after one of its students was confirmed to be infected.
Correspondents Jill Drew in Beijing, Craig Whitlock in Berlin, Mary Jordan in London, Edward Cody in Paris, Howard Schneider in Jerusalem and Emily Wax in Mumbai and staff writers Keith B. Richburg in New York, Ceci Connolly in Atlanta, Ann Scott Tyson, Michael D. Shear and Debbi Wilgoren in Washington and Ashley Surdin and Karl Vick in Los Angeles contributed to this report.