April 28, 2009 -- The swine flu virus outbreak escalated today, with the total number of cases confirmed in the United States jumping to 71 and spreading to two more states, health officials said. Experts expect that figure to keep rising.
"I do expect more cases and expect more states to be affected," Rear Admiral Dr. Anne Schuchat, interim deputy director for the Centers for Disease Control and Prevention's science and public health program, told a Senate hearing today. "I think we need to be prepared that even if it starts to look a little better, it may get a little worse."
To fight the epidemic, the Obama administration is asking Congress for $1.5 billion. White House press secretary Robert Gibbs said the president was requesting the funds "out of an abundance of caution" to "enhance our nation's capability to respond to the potential spread of this outbreak."
The government's request underscores how seriously U.S. officials are treating the threat. Alarmed by the growing number of swine flu cases and the possibility that a California man may have died from the disease, Gov. Arnold Schwarzenegger declared a state of emergency today to help deal with the outbreak.
California has confirmed 15 cases of swine flu, and today it was investigating whether two deaths occurred as a result of the virus. According to Los Angeles County public health official Jonathan Fielding, one of the deaths has been discounted as resulting from swine flu, but the other is still being investigated. If this case is confirmed, it would be the first death in the U.S. attributed to the illness.
Richard Besser, acting director of the CDC, declined to comment on the California investigation, but said, "I fully expect we will see deaths from this infection."
Florida has reported an incidence of swine flu today, and Indiana health officials confirmed this afternoon that a student at Notre Dame has swine flu. These developments bring to seven the number of states where the infections are being investigated.
In Orlando, Fla., the chief medical officer at Florida Hospital Loran Hauck indicated the flu has spread to a tourist who visiting the crowded Disney World.
"A case was diagnosed here in Orlando today on a tourist from Mexico who came to Disney attractions two days ago to visit," Hauck wrote in the email. Florida health officials have not confirmed that the tourist was stricken with swine flu.
Indiana joins Ohio, New York, Texas, Kansas and California as states with confirmed cases.
The outbreak is expected to keep growing because the CDC said today the new count includes "a number of hospitalizations."
The CDC in Atlanta has become the center for the swine flu investigation. It is one of only four laboratories in the world that have the expertise to unravel a novel flu strain.
"What we're trying to do is to identify how bad, how good, the swine flu is currently operating -- is it expanding, is it contracting, is it maintaining a steady state," said Phillip Navin, director of the Division of Emergency Operations at the CDC.
With the uptick in cases, the CDC shipped out more anti-virals and sent additional teams into the field.
"I think at the moment we need to be looking forward and making sure that we're doing everything that we can to keep people from getting sick," said Dr. Steve Reed, director of the CDC's Influeza Coordination Unit.
New York City Has Big Jump in Swine Flu Cases
The biggest increase occurred in New York City where the number of cases leaped from 28 to 45, the CDC said.
Mayor Michael Bloomberg said Monday the cases were confined to a "single cluster," students of St. Francis Preparatory School and their relatives. Several of the students had spent spring break in Cancun, Mexico, which health officials suspect is the origin of the outbreak.
But Bloomberg said today that it appears to have spread to at least one other school, Public School 177, a school for autistic children. Of PS 177's 380 students, 82 called in sick today and at least a dozen have fevers. One of those students has two siblings at St. Francis Prep, Bloomberg said. Both of the those schools are located in the borough of Queens.
The mayor also said there are six possible cases of the flu in a Manattan school, Ascension parochial school.
And New York City Health Commissioner Thomas Frieden said today that "many hundreds" of students and teachers at St. Francis are sick -- though most of those cases appear mild so far.
"It is here and it is spreading," Frieden said. "We do not know whether it will continue to spread."
At one point the Ernst and Young corporation said it had confirmed a case at its Manhattan headquarters, but later retracted the statement.
In addition, there were four more cases in Texas and three additional cases in California.
Leaders in Congress raced each other to hold hearings on the outbreak. Sen. Tom Harkin of Iowa, chairman of the Senate appropriations subcommittee that deals with pandemic preparedness, called an emergency hearing to address funding for states and federal government
Sen. Joe Lieberman, I-Conn., called another hearing for Wednesday and Rep. Henry Waxman, D- Calif., the chairman of the House Energy and Commerce Committee called for a hearing on Thursday.
Concern among travelers was so great that Carnival Cruises today suspended its stops at Mexican ports because of its concerns about swine flu.
Concern about swine flu was spreading globally.
Around the world, New Zealand confirmed 11 cases, and Israel confirmed one today. South Korea, Australia and the Czech Republic announced several suspected cases.
A South Korean Catholic nun traveling in Mexico has tested positive for swine flu, according to reporting by ABC's Joohee Cho. South Korean authorities believe the 51-year-old woman caught the disease from a taxi driver and have requesting the Mexican government look into the matter.
South Korea and Ukraine have temporarily banned all pork imports from North America in response to flu concerns.
Officials Fighting Swine Flu Learned Lessons From SARS
Korean health authorities are examining 315 other passengers that were on the same flight with the nun and have already injected Tamiflu into eight passengers who sat near her.
Spain had one previously confirmed case, the United Kingdom, two and Canada, six. France is still testing some people and some test results in Germany came back negative.
Most of the individuals involved had recently returned from Mexico.
To slow the global spread of the virus, the U.S. State Department and the European Union's health commissioner recommended avoiding nonessential travel to Mexico.
Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus amid global concern about a possible pandemic, which means a prevalent and rapidly spreading disease over a large region.
But Gregory Hartl, a World Health Organization spokesman, told reporters that it did not recommend border closure or travel restrictions as a countermeasure.
He noted that infected people may not show symptoms at the airport or when they reach a border crossing. "Certainly, if you feel that you are ill, you should not travel, in any case, to anywhere," Hartl said.
Lessons learned from the SARS (a viral respiratory disease) outbreak in Asia in 2003 showed that border closure was economically disruptive and not particularly effective. "In public health terms, it didn't work, so we don't want to repeat something that didn't work" Hartl said.
But governments in Asia were not taking any chances. Singapore, Thailand, Japan, Indonesia and the Philippines dusted off thermal scanners used in the SARS crisis as they checked for signs of fever among passengers from North America.
South Korea and Indonesia introduced similar screening. In Malaysia, health workers in face masks took the temperatures of passengers as they arrived on a flight from Los Angeles.
China said anyone experiencing flulike symptoms within two weeks of arrival had to report to authorities.
India will start screening people arriving from Mexico, the United States, Canada, New Zealand, Spain, Britain and France for flulike symptoms, said Vineet Chawdhry, a top health ministry official. It also will contact people who have arrived from Mexico and other affected countries in the past 10 days to check for the symptoms, he said.
These measures came after the World Health Organization announced that it had raised its pandemic alert level to Phase 4 from Phase 3, the first time the alert level has been raised above 3 since the system was adopted in 2005.
The Phase 4 designation signifies that the new swine flu virus can cause sustained outbreaks and is adapting itself to spread among humans, significant steps toward a pandemic. But the ranking does not necessarily mean that a pandemic is a foregone conclusion.
"If the virus is an efficient virus, if it spreads easily from human to human, it will probably continue to spread," Hartl said.
All transmission of the disease so far appears to have been human to human and not from animal or other contact, according to the WHO. "There is no danger from eating pork," Hartl said. "If you cook pork well, if you cook all meat well, it kills all virus."
Swine Flu Ground Zero
Outside Mexico, where 159 people have died, the United States has been the country worse hit by the swine flu outbreak. Many of the cases appear to be students who recently visited Mexico.
Addressing the National Academy of Sciences Monday, President Obama acknowledged the efforts to keep pace with the spread of the disease within the United States.
"We are closely monitoring the emerging cases of swine flu in the United States," he said. "And this is obviously a cause for concern and requires a heightened state of alert. But it is not a cause for alarm."
There is no vaccination for the swine flu strain, which has elements of pig, bird and human strains. But officials said they have ramped up medical surveillance around the country and, as part of the emergency declaration, freed up state and federal resources for prevention. Officials also emphasized the importance of individual care and good hygienic practices.
"Even if this outbreak is a small one, we can't anticipate we won't have follow-up outbreaks," U.S. Homeland Security Secretary Janet Napolitano said.
A different scenario is unfolding across the border in Mexico. While authorities hunt for the source of the swine flu outbreak, the country is under lock down. Schools, museums, parks and even churches in Mexico City have been shut down by the government. A leading business group estimates that canceled events and closure of establishments to prevent the spread of swine flu is costing Mexico City at least $57 million a day.
"I haven't been out for days," said one woman, who only left to bring her baby to the doctor for a routine vaccination.
More than a thousand people countrywide have been infected. The government has advised people to stay home and indicated that those infected by the virus could be isolated. In the country's deserted capital, public events were cancelled for the next week or so. Sales of masks have soared as people try to prevent themselves from the potentially deadly disease.
Mexican officials are hoping the 10-day shut-down will be enough to cover the two-day incubation period and the seven-day recovery of anyone who has the virus.
Mexico's first suspected case of the swine flu was detected in the remote farming village of La Gloria, where 5-year-old Edgar Hernandez contracted the disease nearly one month ago, authorities say.
"The most likely way that this young boy got the infection was from another person who had been in contact with the pigs," said Dr. Kathryn Edwards of Vanderbilt Medical Center.
More than 800 people in the town of 2,000 were infected, authorities say, but no deaths were reported. It took seven days for Mexico to confirm its first cases of swine flu, according to World Health Organization estimates.
Officials say it's still too early to determine how the disease spread from La Gloria into a global health emergency.
"It's a new virus, new virus combination, it does transmit from person to person and we already know it causes fatalities so we already have all the makings of a possible pandemic," Irwin Redlener of Columbia University's Mailman School of Public Health said.
But Dr. Nancy Cox of the CDC has said she believes the earliest onset of swine flu in the United States in this current outbreak happened March 28.
A quarter of the 50 million doses of Tamiflu stockpiled by the U.S. government has been released and the Obama administration has declared a public health emergency to free up the medicine and federal help to the states who need it.
But pharmacies in several states have been flooded with phone calls from concerned customers.
"Our first phone calls were doctors asking if we had Tamiflu," New York City pharmacist Yvonne Zampitella said. "They were prescribing it for their patients and family members."
Symptoms of the swine flu are similar to the regular flu, health officials say, including aching muscles, fever and fatigue. The virus appears to be responsive to medication.
"These drugs do not kill the virus, they help prevent its replication and therefore help reduce the symptoms, but they have to be taken within 48 hours so people have to recognize they have a serious illness, get to a doctor and start treatment," ABC News' Dr. Tim Johnson said on "World News" Monday.
"But we should not be telling people to go out and buy these drugs for use as preventive measure. We need to reserve drug for actual cases and outbreak."
The Associated Press contributed to the reporting of this story.