U.S. Declares Public Health Emergency Over Swine Flu

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April 27, 2009
U.S. Declares Public Health Emergency Over Swine Flu
By JACK HEALY and SHERYL GAY STOLBERG

http://www.nytimes.com/2009/04/27/world/27flu.html?pagewanted=print

American health officials on Sunday declared a public health emergency over increasing cases of swine flu, saying that they had confirmed 20 cases of the disease in the United States and expected to see more as investigators track down the path of the outbreak.

“We are seeing more cases of swine flu,” Dr. Richard Besser, acting director of the Centers for Disease Control, said in a news conference in Washington. “We expect to see more cases of swine flu. As we continue to look for cases, I expect we’re going to find them.”

“This is moving fast,” Dr. Besser said, “but we want you to understand that we view this more as a marathon.”

Although officials said most of the cases have been mild and urged Americans not to panic, the emergency declaration intensifies the government’s response to the infections, freeing resources to be used toward diagnosing or preventing additional cases and releasing money for more antiviral drugs.

Homeland Security Secretary Janet Napolitano, speaking at the same news conference called the emergency declaration “standard operating procedure,” and said it should be considered a “declaration of emergency preparedness.”

“Really that’s what we’re doing right now,” she said. “We’re preparing in an environment where we really don’t know ultimately what the size of seriousness of this outbreak is going to be.”

Officials said they had confirmed eight cases in New York, seven in California, two in Kansas, two in Texas and one in Ohio. Health officials in New York said on Sunday that the cases there were from the same strain of swine flu that has killed more than 80 people in Mexico and infected 1,300 more, The Associated Press reported.

So far, there have been no deaths from swine flu in the United States, and only one of the people who tested positive for the disease has been hospitalized, officials said.

Still, officials said they expect more severe cases as reports of infection multiply.

“You don’t know how much it’s spread, but you’ve got to at least make the assumption that there’s a lot more virus in this country than is seen at the moment,” Jeffrey Koplan, the C.D.C. director from 1998 to 2002, said in a telephone interview.

Governments around the world stepped up their response to the outbreak, racing to contain the infection amid reports of potential new cases from New Zealand to Spain, raising concerns about the potential for a global pandemic.

Canada also confirmed six cases of the flu on Sunday, all of them linked to people who had traveled to Mexico.

On the eastern coast of Canada, health officials in Nova Scotia said four students who attend the same school had tested positive for swine flu and apparently contracted the disease from classmates who had visited Mexico. All of the cases were mild.

Health officials in the western province of British Columbia reported that two people who went to Mexico recently had also tested positive.

Travelers from Mexico who appear to have flu symptoms will be stopped at the border and isolated, Ms. Napolitano said. (Symptoms of swine flu, which are similar to regular cases of the flu, include fever, tiredness and coughing, and sometimes vomiting and diarrhea.)

But unlike some other countries, the American government is not yet taking the more aggressive step of testing all travelers for the new flu strain. Rather, the screening will be “passive,” Ms. Napolitano said, with customs officials questioning travelers about whether they feel ill or have been sick.

The officials urged Americans to take precautions of their own, by washing their hands frequently and staying home if they are sick. Dr. Besser conceded there is much the authorities still do not know, including why flu victims in Mexico are dying while Americans are recovering.

“That’s a critical question,” he said.

Other governments issued travel advisories urging people not to visit Mexico, the apparent origin of the outbreak. The government of Hong Kong, announcing some of the toughest measures of any jurisdiction, urged residents not to travel to Mexico and ordered the immediate detention at a hospital of anyone who arrives with a fever and symptoms of a respiratory illness after traveling in the previous seven days through a city with a laboratory-confirmed outbreak.

China, Russia and others set up quarantines for anyone possibly infected. Some countries banned pork imports from Mexico, even though there is no link between food products and the flu, and others were screening air travelers for signs of the disease.

The World Health Organization reiterated that it considered the outbreak “a public health emergency of international concern” but said it would put off until Tuesday a decision on whether to raise the pandemic alert level.

Raising it to level 4 “would be a very serious signal that countries ought to be dusting off pandemic plans,” said Dr. Keiji Fukuda, deputy director general of the W.H.O.

The W.H.O. is historically reluctant to declare pandemics in sensitive member countries.

In the United States, the C.D.C. confirmed that eight students of a high school in Queens had been infected with swine flu, the first confirmed cases in New York City, Mayor Michael Bloomberg said at a news conference on Sunday. Mr. Bloomberg said that all of the cases had been mild and hospitals in the city had not seen more patients with severe lung infections.

“So far there does not seem to be any outbreak,” Mr. Bloomberg said. “We don’t know if the spread will be sustained. What’s heartening is the people who tested positive have only mild illnesses.”

About 100 students at St. Francis Preparatory School in Fresh Meadows, Queens, became sick in the last few days, and some family members have also taken ill. Mr. Bloomberg said the school would be closed on Monday, and that officials would then reassess whether to reopen the school.

Other New York City schools will be open as usual on Monday, Mr. Bloomberg said.

Other cases of possible infection in New York turned about to be false alarms. Five of six children at a day-care center in the Tremont section of the Bronx who had shown some flu-like symptoms tested negative for swine flu, said Thomas Frieden, the city’s health commissioner.

Ms. Napolitano, the Homeland Security secretary, said that the government intends to release one quarter of its 50 million-dose stockpile of Tamiflu and Relenza, two antiviral medications to which the new flu strain might be susceptible. Most of the medicine will go to affected states. The Department of Defense has a stockpile of an additional 7 million doses, she said, although those medicines are typically reserved for military personnel.

But whether the drugs will prove effective against the new swine flu virus remains unclear. Dr. Besser said the new strain is not resistant to the medicines, but he did not know whether either drug would shorten the course of the illness, as the medicines do with more commonplace strains of flu.

The outbreak in the United States comes before President Obama has his full health team in place. His nominee for health secretary, Kathleen Sebelius, has not yet been confirmed by the Senate, nor has the woman he selected to Food and Drug Administration, Margaret Hamburg, a former New York City health commissioner. Mr. Obama has not yet named anyone to run the Centers for Disease Control or the National Institutes of Health.

But Robert Gibbs, the White House press secretary, said the administration is prepared.

“I want to be very clear,” Mr. Gibbs said. “There is a team in place, and part of the team is standing behind me.”

Sheryl Gay Stolberg reported from Washington and Jack Healy from New York. Contributing reporting were Keith Bradsher from Hong Kong and Donald G. McNeil Jr. from New York.


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