WHO Raises Global Threat Level As Reports of Swine Flu Increase

Governments around the world are launching medical and clean up operations to protect citizens against swine flu infections.
By Rob Stein
Washington Post Staff Writer
Tuesday, April 28, 2009

With the number of swine flu cases and deaths continuing to mount, the World Health Organization yesterday raised its pandemic threat level one notch, saying the dangerous new virus was clearly causing sustained community-wide outbreaks.

The decision came amid another day of rapid, sometimes confusing developments from around the world, including a rise in the suspected death toll in Mexico to 149, the confirmation of the first case in Europe and a doubling of the number of confirmed cases in the United States. In the first signs that the outbreak could be taking a toll on the staggering global economy, oil prices, the Mexican peso and airline stocks all plunged.

The WHO decision marks the first time the international body has elevated its official estimation of the threat of an influenza pandemic, using a system that was revised in the wake of the 2003 SARS outbreak. The assessment is two notches below the highest alert level, which marks a full-scale pandemic.

"We are not there yet. We have taken a step in that direction. But a pandemic is not considered inevitable at this time," said Keiji Fukuda, the WHO's assistant director general for health security and environment. "The situation is fluid, and the situation continues to evolve."

The level 4 alert could in some circumstances prompt health authorities to launch massive efforts to contain an outbreak, but Fukuda said the virus had spread too widely to make that realistic.

"This virus has already spread quite far," Fukuda said.

Instead, the move was designed to prompt countries to intensify efforts to minimize the spread of the virus by identifying new cases and clusters quickly and taking other measures.

"Given the current situation, the current focus of efforts should be on mitigation efforts," he said.

Based on the recommendations of a 15-member expert panel it convened for an emergency meeting in Geneva, the WHO also decided against seeking to close any international borders, saying that would be too disruptive. But Fukuda urged people who are sick not to travel and said travelers who become ill should seek medical attention.

The agency also said it would work to develop a swine flu vaccine as quickly as possible, but it rejected proposals to try to deploy a swine flu vaccine instead of the vaccine already in development for the next regular flu season.

The moves came as officials at the epicenter of the outbreak in Mexico outlined a deteriorating situation. Although the number of confirmed deaths remained at 20, the suspected death toll rose to 149, and at least 1,995 people had been hospitalized with pneumonia. The news prompted officials to shut down schools nationwide. The capital, Mexico City, where most of the cases have been reported, had already been brought to a virtual standstill by measures intended to contain the outbreak.

U.S. and state health officials, meanwhile, reported that the number of confirmed cases had more than doubled to 45 and recommended that Americans put off unnecessary travel to Mexico. "This is out of an abundance of caution," said Richard E. Besser, acting director of the Centers for Disease Control and Prevention in Atlanta.

"We want to be aggressive and take bold action to minimize the impact on people's health from this infection," Besser said during a briefing with reporters.

Most of the new U.S. cases were tied to an outbreak at a Catholic high school in New York, where more than 100 students got sick last week after several returned from a spring break trip to Mexico. Eight students were confirmed to have swine flu on Sunday, and at least 20 more were determined Monday to have the virus as well, New York officials said. The new cases are the result of additional testing and not a sign that the infection is still spreading there, Besser said. He added that all the cases were mild, except for one that required hospitalization, and that all the students had recovered.

New Jersey officials reportedly identified five new suspected cases. Eleven have been confirmed in California, including two that required hospitalization, along with three in Texas, two in Kansas and one in Ohio. Confirmed or suspected cases have prompted officials in New York, Texas, California, South Carolina and Ohio to close schools.

President Obama said his administration was monitoring the situation closely. "This is obviously a cause for concern and requires a heightened state of alert," he said at an appearance at the National Academy of Sciences. "But it is not a cause for alarm."

U.S. border officials began screening people entering the country for signs of the disease and handing out cards to everyone arriving from affected areas, advising them to be on the lookout for signs of the illness.

Officials also started shipping millions of doses of antiviral drugs from the federal government's strategic stockpile to California, New York, Texas and other states in case they are needed -- action made possible Sunday when the federal government declared an official "public health emergency."

The Department of Health and Human Services also announced that the Food and Drug Administration is working with the CDC to distribute diagnostic tests to state and local public health laboratories by midweek. And Homeland Security Secretary Janet Napolitano said the government will allow the FDA to permit the distribution of drugs such as Tamiflu to populations, such as very young children, that normally are not encouraged to take them.

In addition to the government measures, Besser urged businesses to begin making contingency plans for workers calling in sick and said individuals should help reduce the chances that the virus will spread by taking common-sense steps, such as staying home from work or school if they are sick, washing hands frequently and covering mouths if they sneeze or cough.

"Hopefully this outbreak would not progress, but leaning forward and thinking about what you would do is one of the most important things individuals and communities can undertake right now," he said.

In Maryland, Virginia and the District, health officials activated plans developed in the aftermath of the 2001 terrorist and anthrax attacks. They are monitoring reports from hospitals and clinics and readying hundreds of thousands of doses of medication. Maryland officials said it was inevitable that the flu would hit the Washington region given how infectious it is and the large number of travelers who pass through the area.

The day started with a warning by the European Union's health commissioner against unnecessary travel from Europe to parts of the United States and Mexico where the disease is circulating.

The warning followed Spain's confirmation of its first case, fueling fears that the virus was spreading to Europe. Cases were later confirmed in Scotland as well. An additional 20 cases were being investigated in Spain, along with 17 potential cases in Britain, 10 in New Zealand, and at least one each in France, Sweden, Germany, Switzerland and Israel.

"Personally, I would try to avoid nonessential travel to the areas that are reported to be in the center of the cluster in order to minimize the personal risk and to reduce the potential risk to spread the infection," said Androulla Vassiliou, the E.U. official.

Vassiliou later said she was simply advising Europeans to avoid "unnecessary travel" to affected areas in North America. Canada also has confirmed six cases of swine flu.

The White House, meanwhile, said Mexican authorities did not notify U.S. officials about the swine flu issue in advance of the president's April 16-17 visit, "but we have no reason to believe they withheld any information they had at the time," and U.S. officials praised the Mexican response. "To date Mexican authorities have been exceptionally cooperative and forthcoming," White House homeland security adviser John Brennan said. "There's been very strong cooperation."

White House press secretary Robert Gibbs told reporters that he is confident that the administration is ready to handle the crisis even though dozens of key public health and emergency response jobs in the administration remain vacant.

"Our response is in no way hindered or hampered by not having a permanent secretary at HHS right now," Gibbs said. "Dr. Besser and thousands of people both at CDC and throughout HHS are responding to this. . . . We feel confident with the team that is there now."

Correspondent Joshua Partlow in Mexico and staff writers Anthony Faiola, Spencer S. Hsu, Michael D. Shear and Ashley Halsey III in Washington contributed to this report.

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