Swine flu threat calls for precaution, preparation

— -- How worried should we be?

News of the spread of a novel, possibly life-threatening, swine flu strain escalated over the weekend, not only in Mexico but in the United States as well.

By Sunday evening, there were 20 confirmed cases in five states, school closings in some areas, and the drain of the government's stockpile of antivirals drugs to combat the virus.

On Monday, President Obama sounded a note of calm while addressing the swine flu situation during a speech at the Washington headquarters for the National Academy of Sciences.

The president said the appearance of the flu in a handful of countries is cause for concern but "not a cause of alarm," and he added that he is keeping up to date on the problem. The administration is "closely monitoring" cases of the swine flu — how many people have it and the level of threat. Obama also said the American people can expect to get regular and frequent updates about what Washington is doing.

The tone coming from the government was somewhat more ominous on Sunday, when the government declared a "nationwide public health emergency" to help coordinate a response.

"We have an outbreak of a new infectious disease that we are approaching very aggressively," said Richard Besser, the acting director of the Centers for Disease Control and Prevention at a White House news conference.

Whether a mild wave of swine flu is making the rounds a little off season or the world is teetering on the verge of a deadly pandemic is unclear. Although the U.S. cases are mild, more than 80 deaths linked to the new flu have been reported in Mexico, according to the CDC.

Health officials at home offered comforting words among the scary warnings. Homeland Security Secretary Janet Napolitano said the Department of Health and Human Services issued the declaration of public emergency as a routine step. "It frees up men and resources" to get ready for possible problems, she said, comparing the declaration to an early hurricane watch. The government took similar action during the inauguration and for flooding in North Dakota recently.

International experts were reassuring as well.

"I believe the world is more prepared than we ever have been before for this kind of situation," said Keiji Fukuda, the World Health Organization's assistant director-general ad interim for Health Security and Environment. At a news conference Sunday, he said over the past five years, countries have worked hard to develop new tools and systems in the event of a health crisis. "We have new defenses, better surveillance, stockpiles of antiviral drugs," Fukuda said.

"We are definitely prepared. You could say we have been preparing for this since the SARS outbreak (2003) and the avian influenza outbreak in Asia," said Neil Fishman, director of health care epidemiology and infection control at the University of Pennsylvania Health System.

20 cases in five states

Since last Thursday when two cases of a new strain of swine flu were reported in the San Diego area, the count of confirmed illnesses in the United States has risen to 20 to include Kansas, Ohio, Texas and New York. Six cases were confirmed in Canada on Sunday, as well.

The virus is described as a new subtype of A (H1N1) not previously detected in swine or humans, according to the WHO. Swine flu, uncommon in humans, causes flulike symptoms including respiratory congestion, fever and achy joints, but it mimics many other respiratory infections, said Anne Schuchat, interim deputy director for the CDC's Science and Public Health Program.

Health experts are fairly confident the virus is transmitted from human to human, Schuchat said, which is unusual. A swine flu typically passes between pigs and rarely infects people unless they have contact with pigs.

U.S. and global health officials are shy of labeling the outbreak a flu pandemic. In the news conference Sunday, WHO officials said they will not raise the current alert from a level 3 "pandemic alert," meaning human-to-human transmission of a new virus remains low. They will notify the public Tuesday, if not sooner, if that status changes.

Besser of the CDC said there have been no U.S. deaths and only one hospitalization. He warned that flu viruses can change fast and are unpredictable, so plans to fight it could change quickly, and there is no way to tell how long the threat may last.

"We view this as more of a marathon," Besser said.

Schools closed

Schools in affected areas are taking action to reduce transmission. Eight high school students from the St. Francis Preparatory School in Queens are among those who contracted the virus and some reportedly spent their spring break in Mexico, which is feeling the brunt of the outbreak. The school, where more than 100 students came down with a flulike illness recently, announced it will close temporarily.

Texas' public health department on Sunday closed all 14 schools and canceled all extra-curricular activities in the Schertz-Cibolo-Universal City Independent School District near San Antonio, where two cases of swine flu were confirmed late last week.

"We've found enough illnesses associated with some of the other schools that we believe it's prudent to close all of them before classes resume on Monday," health department Regional Director Sandra Guerra said.

A 9-year-old boy in Lorain County, Ohio, has a mild bout of swine flu, reported the Ohio Department of Health on Sunday, but no school closings have been announced.

A couple in Kansas have come down with the virus as well. It is believed the husband picked it up on a recent trip to Mexico. Both have agreed to isolate themselves to help reduce the chances of infecting others.

The WHO investigation is continuing to clarify the spread and severity of the disease in Mexico and suspect clinical cases have been reported in 19 of the country's 32 states. However, WHO officials are not recommending travel and trade restrictions.

Several airlines are still waiving change fees for passengers flying through Mexico. For a limited time, American Airlines, Continental Airlines, United Airlines, US Airways and Grupo Mexicana will waive fees for changing reservations for anyone traveling to, from or through Mexico.

Two of Mexico's most popular soccer teams, Pumas and America, played home games in stadiums that were completely empty because the Mexican Soccer Federation decided to keep the public out to avoid spreading the virus. Another indication that residents are hunkering down at home: Video rental stores reported a run on DVDs.

No vaccine

Is the U.S. prepared to handle an epidemic of severe, possibly fatal flu if this first wave of the virus evolves into a more virulent strain later this year or next?

There is no vaccine for this strain of flu, but Schuchat said that the agency is already working on the development of a new vaccine if needed. However, vaccine development is a lengthy process and it could take months before one can become available.

Although there are no antiviral drugs that can prevent the illness, the new strain of swine influenza virus is susceptible to the antiviral medications zanamivir (Relenza) and oseltamivir (Tamiflu). It is resistant to the antiviral medications amantadine and rimantadine, though.

The federal government has 50 million treatment courses of Tamiflu and Relenza in the nation's Strategic National Stockpile, Napolitano said. "We are releasing 25% of those courses, making them available to all of the states, but particularly prioritizing the states where we already have confirmed incidents of the flu," she said.

According to the CDC, the infectious period for this strain of swine flu is one day prior to illness onset and up to seven days afterward.

Schuchat said the public can take precautions to slow disease spread by reducing travel, washing hands and staying home when sick. The public should stay in touch with their community and state health departments to stay abreast of outbreaks.

Some hospitals are taking early action. Richard Wenzel, professor and chairman of the department of internal medicine at the Medical College of Virginia in Richmond, said his hospital will isolate patients with suspected cases of swine flu to reduce spread of the virus, and hospital staff will wear protective gowns and goggles. Hand washing is essential, he said.

"We'll go overboard early. I would rather err on the overly cautious side and then drop it back after a couple weeks if we find out there's less transmission," Wenzel said.

Wenzel said he expected the WHO to raise its warning of the outbreak. "My only surprise was that WHO is at a level 3 alert. Looks to me like you got a 4."

Contributing: Chris Hawley in Mexico City, Donna Leinwand and Liz Szabo in McLean Va., and David Jackson in Washington, D.C.; the Associated Press