By Tom Randall
April 28 (Bloomberg) -- The number of confirmed cases of swine flu in the U.S. jumped to 64, as global health officials monitored New York City as a second possible epicenter for the international outbreak.
The virus has taken its biggest hold in four states in Mexico, the only country in which deaths have been recorded. The U.K., Israel, Canada, New Zealand and Spain have also confirmed cases. The World Health Organization said it’s watching New York to see whether the virus has become rooted in another country, a finding that would boost the agency’s pandemic alert system.
At least five states have confirmed outbreaks, including New York with 45, California with 10, Texas 6, Kansas 2, and Ohio 1, the U.S. Centers for Disease Control and Prevention reported on its Web site today. The U.S. can expect to see hospitalizations and deaths, and businesses and schools should plan for a pandemic, said Richard Besser, the acting head of the Atlanta-based agency. Yesterday, the agency reported there were 40 cases in the U.S.
“We’re in a pre-pandemic phase and it’s going to be hard to know until we’re much further along what this is going to progress to,” Besser said in an interview today. “Given the case in Mexico, where we’re seeing much more severe disease, I would expect we’re going to find hospitalized individuals and, unfortunately, I expect we will see deaths in this country.”
New York Cases Tracked
The WHO raised its global pandemic alert yesterday, saying the disease is no longer containable and it’s time to prepare for outbreaks. It’s the first time the level has been raised to a 4 since the measure was adopted in 2005. It’s been at level 3 since 2007, when it was elevated for an outbreak of avian flu.
The biggest concern is whether the virus is spreading efficiently outside Mexico, said Keiji Fukuda, the WHO’s assistant director-general for health security and environment on a conference call with reporters today. The confirmed New York cases have been limited to a private school in Queens.
The WHO is working with U.S. and state health officials in tracking the speed and ferocity of the New York-based transmissions as a way to determine how the flu may spread in the future, he said.
“There is definitely the possibility that this virus can establish that kind of community-wide outbreak capacity in multiple countries,” Fukuda said. “It’s a very serious possibility, but it’s still too early to say that it’s inevitable.”
California Cases
California health officials said today on the state’s Web site that it had confirmed an 11th case, though the added instance was not reflected in the CDC data.
As many as 152 people have died in Mexico with suspected swine flu, and the number of worldwide cases confirmed by laboratory tests reached 79, officials said. Japan said today it will suspend visa-free entry for Mexican nationals, while Asian countries, including Singapore and South Korea, are screening air passengers. The Geneva-based WHO isn’t recommending travel restrictions.
The threat level, increased to 4 from 3, “signifies that we have taken a step closer” to a pandemic, Fukuda said yesterday. “It is also possible that as the situation evolves over the next few days we could move into Stage 5.”
Defining a Pandemic
Scientists are trying to determine why swine flu, a respiratory disease that’s caused by a type-A influenza virus, has been more severe in Mexico. In the U.S., where the number of confirmed cases today reached 64, only one person has required hospitalization, Besser said.
“In terms of defining a pandemic, there is no requirement that it cause severe disease,” said Arnold Monte, a scientist from the University of Michigan in Ann Arbor. “It doesn’t have to be killing millions. The virus may be bad in terms of the likelihood of getting infected, but not necessarily in terms of severity.”
A pandemic, rated 6 on the WHO’s alert system, is an unexpected outbreak of a new contagious disease that spreads from person-to-person across borders. In such cases, almost no one has natural immunity.
The World Bank, in a worst-case scenario published in October, said a flu pandemic that’s similar in scope to the 1918 outbreak known as the Spanish flu could kill 71 million people worldwide and push the economy into a “major global recession” costing more than $3 trillion.
The raised level indicates health officials need to prepare for a pandemic, though it isn’t inevitable, WHO’s Fukuda said.
Dynamic Situation
“The situation is very fluid, very dynamic, and it is rapidly evolving,” said Tim Uyeki, an epidemiologist in the CDC’s flu division. “The cases in the U.S. don’t have any links to contact with pigs. This appears to be ongoing human-to-human transmission.”
Production of influenza vaccine for seasonal outbreaks, which U.S. health officials have said is ineffective against the new flu, should continue, Fukuda said. The WHO is working with companies to prepare for a swine-flu vaccine, and would help produce it if the outbreak becomes a pandemic, he said.
The U.S. Food and Drug Administration signed emergency authorizations yesterday that will permit the CDC to use an unapproved lab test for swine flu and more dosing options than currently recommended for influenza treatments Tamiflu, sold by Swiss drugmaker Roche Holding AG, and Relenza, from London-based GlaxoSmithKline Plc.
Antiviral Stockpiles
There are enough stockpiles of Tamiflu to meet current demand, said Roche spokesman Terence Hurley. Roche has the capacity to manufacture, over one year, enough courses of treatment for 400 million people, Hurley said by telephone.
The WHO has told Roche that it appears Tamiflu would work against this strain of the virus, Hurley said yesterday. Glaxo has increased production of its antiviral Relenza and is in contact with the WHO and CDC, said a Glaxo spokeswoman, Sarah Alspach.
U.S. officials yesterday recommended that nonessential travel to Mexico be avoided and the European Union told travelers to avoid outbreak areas.
Governments in Asia heightened their alert for the spread of the virus. Japan advised its own citizens to defer trips to the Latin American nation.
Yellow Alert
South Korea raised its national disaster level to yellow from blue, the lowest on its scale, after it found one suspected case of swine flu, the health ministry said today.
Cambodia is installing thermal scanners at its two international airports to identify passengers who show symptoms of swine flu, joining Australia, Japan, Malaysia, Singapore and South Korea among nations screening air travelers.
Swine flu results in symptoms similar to those of seasonal influenza, such as fever, lethargy and cough, and may also cause nausea, vomiting and diarrhea, according to the CDC.
Swine-flu viruses aren’t transmitted by food, and eating properly handled and cooked pork and pork products is safe, according to the CDC. There’s no evidence the disease is spread by exposure to “pork or pigs,” WHO’s Fukuda said.
Indonesia said today it will destroy all imported pork and swine products and fumigate agricultural goods bought from Canada, the U.S. and Mexico as a precaution.
Imports Banned
China, the world’s top pork consumer, banned imports of swine products from Mexico and parts of the U.S. The Philippines also barred pork product imports from Canada, the U.S. and Mexico.
U.S. President Barack Obama said the emergence and spread of swine flu in the U.S. merits heightened concern “but it’s not a cause for alarm.”
He declared a public emergency after 40 U.S. cases were confirmed in California, Kansas, New York, Ohio and Texas. New Jersey has identified five probable cases, the state’s Department of Health and Senior Services said. All five cases are awaiting confirmation by the CDC, the department said.
The U.S. Department of Health and Human Services issued an emergency declaration as a “precautionary tool” to free resources to monitor and respond to the spread of the virus, Obama said yesterday.
New York confirmed 28 cases at the St. Francis Preparatory School in Queens, Mayor Michael Bloomberg said yesterday at a news conference. All the cases were mild and as many as 100 may ultimately be found at the school, the mayor said.
‘Gentle Pandemic’
If the world is facing a pandemic, “this is a nice, gentle pandemic,” said John Oxford, a virologist at Queen Mary’s School of Medicine in London. “Virulence seems low.”
Mexico’s Health Minister Jose Cordova said three more flu- related deaths occurred in state-run hospitals yesterday. As many as 149 people may have died in Mexico from the outbreak of swine flu as of April 26, although the cause of the deaths hasn’t been confirmed.
Eight people in Canada contracted swine flu, said WHO Director-General Margaret Chan. New Zealand officials have confirmed three cases, and are monitoring at least 56 people, South Korea has a suspected case, the U.K. confirmed two people contracted the disease, and Spain and Israel each confirmed one case.
Travel restrictions are unnecessary and based on political, not medical considerations, Chan said on a conference call with leaders from health groups around the world.
Closing Countries
“By definition, pandemic influenza will move around the world,” Chan said on the call yesterday. “Does that mean we are going to close every country? Does that mean we are going to bring the world’s economy to a standstill?
“We know from past experience that transmission of influenza or the spread of new influenza disease would not be stopped by closing borders and would not be stopped by restricting movement of people or goods,” Chan said.
The Mexican government requested that bars, movie theaters and churches be closed in Mexico City. It also extended its school closure to May 6 and may shut down more activities, Mexico’s Cordova said.
To contact the reporter on this story: Tom Randall in New York at trandall6@bloomberg.net.
Last Updated: April 28, 2009
Bangkok Post
