Global health authorities warned Wednesday that swine flu was threatening to bloom into a pandemic, and the virus spread farther in Europe even as the outbreak appeared to stabilize at its epicenter. A toddler who succumbed in Texas became the first death outside Mexico.
New cases and deaths finally seemed to be leveling off in Mexico, where 160 people have been killed, after an aggressive public health campaign. But the World Health Organization said the global threat is nevertheless serious enough to ramp up efforts to produce a vaccine against the virus. The group raised its pandemic alert for swine flu to the second highest level Wednesday, meaning that it believes a global outbreak of the disease is imminent. It was the first time the WHO had declared a Phase 5 outbreak.
WHO Director General Margaret Chan declared the phase 5 alert after consulting with flu experts from around the world. The decision could lead the global body to recommend additional measures to combat the outbreak, including for vaccine manufacturers to switch production from seasonal flu vaccines to a pandemic vaccine.
“All countries should immediately now activate their pandemic preparedness plans,” Chan told reporters in Geneva. “It really is all of humanity that is under threat in a pandemic.”
A phase 5 alert means there is sustained transmission among people in at least two countries. Once the virus shows effective transmission in two different regions of the world, a full pandemic outbreak — phase 6 — would be declared, meaning a global epidemic of a new and deadly disease.
“It is important to take this very seriously,” Chan told a news conference watched around the globe on Wednesday. But for the average person, the term “pandemic” doesn’t mean they’re suddenly at greater risk.
Nearly a week after the H1N1 virus, or swine flu, was first identified in California and Texas, about 100 cases have now been confirmed in the U.S. across 11 states. The first U.S. death from the outbreak was a Mexico City toddler who traveled to Texas with family and died Monday night at a Houston hospital. U.S. Health and Human Services Secretary Kathleen Sebelius predicted the child would not be the last U.S. death from swine flu.
In addition to the 160 deaths, the virus is believed to have sickened 2,498 people across Mexico. But only 1,311 suspected swine flu patients remained hospitalized, and a closer look at daily admissions and deaths at Mexico’s public hospitals suggests the outbreak may have peaked during three grim days last week when thousands of people complained of flu symptoms.
The Mexican government has suspended all nonessential services at government offices and private businesses for five days as the country struggled to control an outbreak of swine flu that has killed eight people.
Health Secretary Angel Cordoba Villalobos announced the decision to shut down most of the country’s government and economy shortly after his department reported that confirmed cases of infection with the new strain of influenza had risen to 99, with eight deaths.
Vital services like transportation and airports will remain open, as will crucial economic services like pharmacies and the media, Cordoba said, according to reports from several Mexican newspapers. The Associated Press later confirmed the suspension plans.
Outside of Mexico, almost all cases have had only light symptoms, and only a handful of cases have needed hospitalization.
Officials warned more deaths could be expected as surveillance of the illness increases.
Pharmaceutical companies should ramp up manufacturing, Chan said. Two antiviral drugs — Relenza, made by GlaxoSmithKline and Tamiflu, made by Roche AG — have been shown to work against the H1N1 strain.
Flu viruses are notorious for rapid mutation and unpredictable behavior, she warned. But she also offered words of reassurance.
“The world is better prepared for an influenza pandemic than at any time in history,” Chan said. “For the first time in history we can track the pandemic in real time.”
As fear and uncertainty about the disease ricocheted around the globe, Chan added that WHO did not recommend closing borders or forgoing pork.
No signs of slowing
Peru, Germany and Austria became the latest countries to report swine flu infections Wednesday, with cases already confirmed in Canada, Britain, Israel, New Zealand and Spain, bringing the number of affected countries to 10.
Spain has reported the first case in Europe of swine flu in a person who had not been to Mexico, illustrating the danger of person-to-person transmission.
Nations are taking all sorts of precautions, some more useful than others.
Egypt ordered the pig slaughter even though there hasn’t been a single case of swine flu there. Britain, with only five cases, is trying to buy 32 million masks. And in the United States, President Barack Obama said more of the country’s 132,000 schools may have to be shuttered.
At airports from Japan to South Korea to Greece and Turkey, thermal cameras were trained on airline passengers to see if any were feverish. And Lebanon discouraged traditional Arab peck-on-the-cheek greetings, even though no one has come down with the virus there.
Peru and Ecuador joined Cuba and Argentina on Wednesday in banning travel either to or from Mexico, and other nations considered similar bans. In France, President Nicolas Sarkozy met with cabinet ministers to discuss swine flu, and the health minister said France would ask the European Union to suspend flights to Mexico.
The U.S., the European Union and other countries have discouraged nonessential travel to Mexico. Some countries have urged their citizens to avoid the United States and Canada as well. Health officials said such bans would do little to stop the virus.
The World Health Organization said total bans on travel to Mexico were questionable because the virus is already fairly widespread.
“WHO does not recommend closing of borders and does not recommend restrictions of travel,” said Dr. Keiji Fukuda, the Geneva-based organization’s flu chief. “From an international perspective, closing borders or restricting travel would have very little effect, if any effect at all, at stopping the movement of this virus.”
Scientists believe that somewhere in the world, months or even a year ago, a pig virus jumped to a human and mutated, and has been spreading between humans ever since. Unlike with bird flu, doctors have no evidence suggesting a direct pig-to-human infection from this strain, which is why they haven’t recommended killing pigs.
Medical detectives have not zeroed in on where the outbreak began. Mexico’s chief epidemiologist suggested Wednesday that someone could have carried it in from Pakistan or Bangladesh — or just about anywhere else in the world.
By March 9, the first symptoms were showing up in the Mexican state of Veracruz, where pig farming is a key industry in mountain hamlets and where small clinics provide the only health care.
The earliest confirmed case was there: a 5-year-old boy who was one of hundreds of people in the town of La Gloria whose flu symptoms left them struggling to breathe.
Days later, a door-to-door tax inspector was hospitalized with acute respiratory problems in the neighboring state of Oaxaca, infecting 16 hospital workers before she became Mexico’s first confirmed death.
Neighbors of the inspector, Maria Adela Gutierrez, said Wednesday that she fell ill after pairing up with a temporary worker from Veracruz who seemed to have a very bad cold. Other people from La Gloria kept going to jobs in Mexico City despite their illnesses, and could have infected people in the capital.
The deaths were already leveling off by the time Mexico announced the epidemic April 23. At hospitals Wednesday, lines of anxious citizens seeking care for flu symptoms dwindled markedly.
The Mexican health secretary, Jose Angel Cordova, said getting proper treatment within 48 hours of falling ill “is fundamental for getting the best results” and said the country’s supply of medicine was sufficient.
Cordova has suggested the virus can be beaten if caught quickly and treated properly. But it was neither caught quickly nor treated properly in the early days in Mexico, which lacked the capacity to identify the virus, and whose health care system has become the target of widespread anger and distrust.
In case after case, patients have complained of being misdiagnosed, turned away by doctors and denied access to drugs. Monica Gonzalez said her husband, Alejandro, already had a bad cough when he returned to Mexico City from Veracruz two weeks ago and soon developed a fever and swollen tonsils.
As the 32-year-old truck driver’s symptoms worsened, she took him to a series of doctors and finally a large hospital. By then, he had a temperature of 102 and could barely stand.
“They sent him away because they said it was just tonsillitis,” she said. “That hospital is garbage.”
That was April 22, a day before Mexico’s health secretary announced the swine flu outbreak. But the medical community was already aware of a disturbing trend in respiratory infections, and Veracruz had been identified as a place of concern.
Gonzalez finally took her husband to Mexico City’s main respiratory hospital, “dying in the taxi.” Doctors diagnosed pneumonia, but it may have been too late: He has suffered a collapsed lung and is unconscious. Doctors doubt he will survive.
Swine flu has symptoms nearly identical to regular flu — fever, cough and sore throat — and spreads like regular flu, through tiny particles in the air, when people cough or sneeze. People with flu symptoms are advised to stay at home, wash their hands and cover their sneezes.
H1N1 swine flu is seen as the biggest risk since H5N1 avian flu re-emerged in 2003, killing 257 people of 421 infected in 15 countries. In 1968 a “Hong Kong” flu pandemic killed about 1 million people globally, and a 1957 pandemic killed about 2 million.
Seasonal flu kills 250,000 to 500,000 people in a normal year, including healthy children in rich countries.
While epidemiologists stress it is humans, not pigs, who are spreading the disease, sales have plunged for pork producers around the world. Egypt began slaughtering its roughly 300,000 pigs on Wednesday, even though no cases have been reported there. WHO says eating pork is safe, but Mexicans have even cut back on their beloved greasy pork tacos.
Pork producers are trying to get people to stop calling the disease swine flu, and Obama notably referred to it Wednesday only by its scientific name, H1N1. U.N. animal health expert Juan Lubroth noted some scientists say “Mexican flu” would be more accurate, a suggestion already inflaming passions in Mexico.
Authorities have sought to keep the crisis in context. In the U.S. alone, health officials say about 36,000 people die every year from flu-related causes.
Mexico’s government said it remains too early to ease restrictions that have shut down public life in the overcrowded capital and much of the country. Pyramids, museums and restaurants were closed to keep crowds from spreading contagion.
“None of these measures are popular. We’re not looking for that — we’re looking for effectiveness,” Mexico City Mayor Marcelo Ebrard said. “The most important thing to protect is human life.”