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

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 Hong Kong 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
fly 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. 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.

On Sunday, the government of Hong Kong announced some of the toughest
measures yet of any jurisdiction in response to the swine flu outbreak.
Officials there 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.

The new policy, shaped by Hong Kong’s lasting scars as an epicenter of a
SARS outbreak six years ago, has the potential to dampen air travel across
the Pacific. Hong Kong has Asia’s busiest airport hub for international
air travel, with Boeing 747s arriving around the clock from cities all
over the United States and Canada, but not Mexico.

Ever since the 2003 outbreak of severe acute respiratory syndrome, Hong
Kong has used infrared scanners to measure the facial temperature of all
arrivals at its airport and border crossings with mainland China. Visitors
are required to remove any hats to ensure accurate measurement, and
children are checked with ear thermometers because the scanners are less
reliable in measuring their faces.

Dr. Thomas Tsang, the controller of the Hong Kong government’s Center for
Health Protection, said at a press conference on Sunday afternoon that any
traveler who has passed through a city with laboratory-confirmed cases and
who arrives in Hong Kong with a fever and respiratory symptoms will be
intercepted by officials and sent to a hospital to await testing.

“Until that test is negative, we won’t allow him out,” he said.

An aide later said that the cut-off for having a fever would be 38 degrees
Celsius, or 100.4 degrees Fahrenheit, and that it would take two or three
days to obtain test results.

Dr. York Chow, Hong Kong’s secretary for health and food, asked residents
to watch the news for reports of which states in the United States have
outbreaks and discouraged travel to these states, but reserved his
strongest warning for travel to Mexico.

“Do not travel to Mexico unless it is absolutely necessary,” he said.

The Hong Kong government will also amend its health regulations in the
next couple days to make it mandatory for any health professional to alert
the government of any suspected cases of swine flu, he said.

Hong Kong should “prepare for the worst” if the swine flu virus develops a
clear ability to pass from person to person, Dr. Chow said, while adding
that the risk from the virus was low if this did not happen.

One legacy of SARS is that Hong Kong may now be better prepared for a flu
pandemic than practically anywhere else on the world. Fearing that SARS
might recur each winter, the city embarked on a building program to
enlarge its capacity to isolate and treat those infected with communicable
respiratory diseases.

Hong Kong now has 1,400 beds for this purpose each equipped with
mechanical ventilators for treating those with severe pneumonia or other
respiratory difficulties. But only 80 to 100 of these beds are needed on
any given day, so they have been used until now for patients with other
medical problems, Dr. Chow said.

The city has also expanded its flu research labs, already among the best
in the world and leaders in tracking the H5N1 avian flu influenza virus.
The so-called bird flu virus, which kills an unusually high share of its
victims, has periodically triggered fears over the past decade about a
possible pandemic but is different from the H1N1 swine flu influenza virus
now causing illnesses in Mexico and the United States.

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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