By David Brown
Washington Post Staff Writer
Monday, April 27, 2009
The United States declared a "public health emergency" yesterday as countries from New Zealand to Scotland investigated suspected cases of illness that they feared might be a strain of swine flu that has been identified in Mexico, the United States and Canada.
As of yesterday, however, no confirmed cases of the newly emerged flu strain had been found outside those three countries. Many of the people under observation around the world reported recent travel to Mexico.
With the U.S. announcement, civilian and military stockpiles of antiviral drugs were being readied for rapid distribution in the event that transmission of swine flu virus accelerates. The declaration also called for greater vigilance at border crossings and in airports for travelers who are coughing or appear ill.
Those steps fell far short of those that could be invoked in a confirmed pandemic, which could include restricting travel, actively screening travelers for fever or illness, quarantining the sick, closing schools and banning public gatherings.
In Mexico, where the infection is suspected of causing as many as 103 deaths and more than 1,600 illnesses, Masses were canceled and a high-profile soccer game was played before an empty stadium as officials urged the public to take precautions.
In Geneva, the World Health Organization urged increased surveillance for influenza worldwide.
The U.N. agency's public health emergency committee planned to meet again tomorrow to decide whether the outbreak warrants elevation of the pandemic threat level, which in turn could trigger international travel restrictions and other measures.
"The committee unanimously agreed that we are in a situation that really warrants the utmost attention," said Keiji Fukuda, WHO's head of health security. "So on the basis of that . . . we have requested countries to help clarify this situation and to provide as much information as possible."
Suspected cases were being reported in Brazil, Spain, New Zealand, France, Israel and Scotland, and some nations issued travel warnings for Mexico and the United States, wire services reported.
As of last night, there had been 20 confirmed cases of swine flu in the United States, 22 in Mexico and six in Canada. The U.S. cases are in California, Texas, Kansas, New York and Ohio. Mexico reported suspected cases in 19 of its 32 states. In Canada, four cases were reported in the Atlantic province of Nova Scotia and two on the Pacific Coast in British Columbia. The American and Canadian cases appeared to generally be milder than the Mexican cases, and none had been fatal.
The A/H1N1 swine flu confirmed in the Mexican, U.S. and Canadian cases is a previously unknown combination of pig, human and avian flu viruses. Pigs, which are easily infected with all three types of flu, can function as "mixing vessels" in which flu viruses exchange genetic material and emerge in new forms.
At a White House briefing today, Homeland Security Secretary Janet Napolitano said the emergency declaration was in large part a procedural step.
"That sounds more severe than really it is," she said. "This is standard operating procedure and allows us to free up federal, state and local agencies and their resources." She noted that the government had made the same declaration for recent flooding in North Dakota and Minnesota and for the inauguration of President Obama.
Among the steps being taken: readying drug supplies sufficient to treat 3 million people for flu from the Department of Health and Human Services' "strategic stockpile," which can treat up to 50 million. The Defense Department was readying supplies sufficient for another 7 million people for use by military personnel.
The declaration also allows use of certain medications and diagnostic tests in children and releases money to purchase more drugs if necessary.
The World Bank yesterday said it would give Mexico an immediate loan of $25 million for medicine and equipment, along with longer-term loans of $180 million.
Major airlines, including American, United and Continental, began revising their policies so that travelers flying to Mexican cities could change their plans without fees or penalties. About 5.9 million U.S. citizens flew to Mexico in 2008.
The 20 confirmed U.S. cases of A/H1N1 swine flu yesterday were an increase from the 11 reported Saturday.
Overnight, lab tests confirmed eight cases among students at St. Francis Preparatory School in the New York City borough of Queens, where more than 100 students last week came down with flu symptoms. The school canceled classes for today. Ohio reported a case in a 9-year-old boy from Lorain County, near Cleveland, who was recuperating at home.
Fewer details are available about the outbreak in Mexico. Health officials there have said they are investigating more than 1,600 cases of suspicious, severe flulike infections, with 103 people reportedly dead. Just 22 cases of swine flu have been confirmed there, however.
Why the same virus appears to be acting so differently in Mexico and the United States, where there have been no deaths and all reported cases have been relatively mild, is one of the unanswered questions about the outbreak. The other is whether the virus is still spreading in Mexico.
Napolitano said that people crossing from Mexico into the United States "from a location of human infection of swine flu" will be asked whether they are ill. Those who are will be isolated and given masks. Airlines will also be told to be on the lookout for people who look sick and are about to board planes.
"Right now we don't think the facts warrant a more active testing or screening of passengers coming in from Mexico," she said.
Richard E. Besser, acting director of the Centers for Disease Control and Prevention in Atlanta, said that as physicians aggressively look for flu and test patients, more cases of the new swine flu strain will almost certainly be found, and some are likely to be severe. He also predicted that swine flu will reappear in the fall, when the traditional flu season begins.
"In terms of detection . . . we're going to find cases in many different parts" of the country, he said.
The officials said people should be thinking about what they might do if the virus spreads, schools are closed and travel is restricted. In the meantime, they should wash their hands, keep their fingers out of their mouths, and stay home if they are sick.
"Clearly we all have individual responsibility for dealing with this situation," said deputy national security adviser John O. Brennan.
Scientists are preparing a "seed strain" of the new virus that could be used to make a vaccine. Drug companies are in the early stages of making next season's flu shot, a mixture of three flu strains currently circulating the globe.
If companies stopped that work to make a swine flu vaccine, the first shots would not be available for at least two months. Another possibility being pondered is whether to add a fourth, swine flu component to the current recipe.
Epidemiologists from Mexico, Canada, the United States and WHO are investigating cases in Mexico. Experts say that until more is known about what is happening there, it will be hard to evaluate the pandemic potential of the new strain.
Only a few throat swabs from Mexico that have been tested in the United States and Canada have shown swine flu, which suggests that a sizeable number of Mexican illnesses may have another cause.
"How different is this from seasonal influenza? Does this virus have a different potential to cause severe illness? That is what is so critical to find out about Mexico," a high-placed HHS scientist said yesterday, speaking on the condition of anonymity because he was not authorized to discuss the situation publicly.
"If you didn't know about Mexico, what is happening here would just be a few strange cases of flu happening late in the season," he said.
Staff writers Sholnn Freeman in Washington and Robin Shulman in New York and special correspondent Samuel Sockol in Israel contributed to this report.