The World Health Organization has raised its pandemic alert for swine flu by one level to phase 4, two steps short of declaring a full-blown pandemic.
WHO says the phase 4 alert means sustained human-to-human transmission is causing outbreaks in at least one country. It signals a significant increase in the risk of a global epidemic, but doesn’t mean a pandemic is inevitable.
Dr. Keiji Fukuda, assistant director for health security and environment, said the WHO committee discussed the level very carefully to consider whether moving to phase 4 or phase 5 was most appropriate, and “it was clearly felt we were seeing human-to-human transmission, and that put us into phase 4.”
He said WHO wants more information about widespread community transmission before suggesting that a pandemic is imminent.
“We don’t really have evidence of community spread,” he said.
The emergency committee was aware that a phase change would have political and economic ramifications that could cause “profound potential implications for everybody,” he said.
On the advice of the agency’s emergency committee meeting, WHO also agreed to continue production of seasonal flu vaccine, instead of switching to immediate manufacture of a targeted vaccine.
The group also agreed to focus on mitigating the effects of the outbreak instead of trying to contain it.
“This virus is too widespread to make containment a feasible operation,” Fukuda said.
Many experts think it may be impossible to contain a flu virus already spreading in several countries.
The WHO did not recommend closing borders or restricting travel because it would have little effect, if any, on stemming the spread of infection.
“At this time, closing of borders would not be effective at doing that,” Fukuda said.
Everyone is at risk for the swine flu, he said.
“At this time, it’s clear that most of the swine H1N1 activity is taking place in North America … but in this age of global travel where people [travel] around in airplanes so quickly, there is no region where this virus could not spread,” Fukuda said.
He urged people who are ill not to travel and to seek medical attention.
Nevertheless, WHO has been working on developing a human vaccine against this virus, especially as the Southern Hemisphere moves into flu season, Fukuda said.
“This is a new influenza virus, so we really don’t know how this one will evolve and how disease related to it will evolve,” he said.
Perhaps some companies could work on producing swine flu vaccine and seasonal vaccine at the same time, Fukuda said.
“At this time, we still do not have to make the decision about whether to stop seasonal vaccine,” he said.
But officials need to move forward with making a swine flu vaccine so that it’s available as soon as possible. In general, it would take four to six months to develop a vaccine and to have the first batches available.
In the past few years, vaccine production capacity has increased considerably based on the work done with avian flu viruses.
WHO has confirmed human cases of swine flu in Mexico, the United States, Canada and Spain. Only Mexico has reported deaths from the new strain. The head of the Homeland Security Department says the United States is preparing as if the swine flu outbreak is a full pandemic.
“Everybody is getting prepared, everybody is leaning forward, everybody’s dusting off their pandemic flu preparation plans in case this is in fact a major pandemic,” Secretary Janet Napolitano told reporters Monday.
The disease started in Mexico and has spread to the United States and beyond, with 42 reported cases in the U.S.
U.S. officials advised Americans against most travel to Mexico on Monday as a swine flu virus spread to the United States and beyond. President Barack Obama said there was reason for concern but not yet “a cause for alarm.”
Dr. Richard Besser, acting director of the Centers of Disease Control and Prevention, said that so far the disease in the United States seems less severe than the outbreak in Mexico, where nearly 2,000 cases have been reported and where the suspected death toll has climbed to 149. No deaths have been reported in the U.S., and only one hospitalization.
“I wouldn’t be overly reassured by that,” Besser told reporters at CDC’s headquarters in Atlanta. He raised the possibility of more severe cases in the United States.
“We are taking it seriously and acting aggressively,” Besser said. “Until the outbreak has progressed, you really don’t know what it’s going to do.”
The U.S. stepped up checks of people entering the country by air, land and sea.
Preventing infection
The 40 confirmed cases in the U.S. announced on Monday were double the 20 initially reported by the CDC. Besser said this was due to further testing — not further spreading of the virus — in New York at a school in Queens, bringing the state’s total to 28. Besser said other cases have been reported in Ohio, Kansas, Texas and California.
The best way to keep the disease from spreading, he said, is by taking everyday precautions such as frequent hand washing, covering up coughs and sneezes, and staying away from work or school if not feeling well. He also recommended people not give “that little kiss of greeting that they’re used to right now.”
While the cases reported so far in the United States seem relatively mild, Besser said, far more will be known about the disease’s transmission traits and severity in a week or two. He said the particular virus at issue had not been seen before, either in the United States nor Mexico.
He said authorities are not currently recommending that people across the country put on masks in the workplace to protect against infection. The evidence “is not that strong” that the wearing of protective masks effectively limits the outbreak of such diseases, he said.
Besser said about 11 million doses of flu-fighting medications from a federal stockpile have been sent to states in case they are needed. That’s roughly one quarter of the doses in the stockpile, he said.
There is no vaccine available to prevent the specific strain now being seen, he said. However, there are antiflu drugs that do work once someone is sick.
If a new vaccine eventually is ordered, the CDC already has taken a key preliminary step — creating what’s called seed stock of the virus that manufacturers would use.
The quickening pace of developments in the United States in response to swine flu infections in neighboring Mexico was accompanied by a host of varying responses around the world. The European Union advised against nonessential travel to the U.S. and Mexico, while China, Taiwan and Russia considered quarantines and several Asian countries scrutinized visitors arriving at their airports.
Screening at U.S. borders
U.S. customs officials began checking people entering U.S. territory. Officers at airports, seaports and border crossings were watching for signs of illness, said Customs and Border Protection spokesman Lloyd Easterling.
If a traveler says something about not feeling well, the person will be questioned about symptoms and, if necessary, referred to a CDC official for additional screening, Easterling said. The customs officials were wearing personal protective gear, such as gloves and masks, he said.
Besser described the new U.S. border initiative as “passive screening.” He said authorities were “asking people about fever and illness, looking for people who are ill.”
Multiple airlines, including American, United, Continental, US Airways, Mexicana and Air Canada, said they were waiving usual penalties for changing reservations for anyone traveling to, from or through Mexico, but had not canceled flights.
National health emergency
The U.S. declared a national health emergency in the midst of uncertainty about whether the mounting sick count meant new infections were increasing or health officials had simply missed something that had been simmering for weeks or months.
A private school in South Carolina was closed Monday because of fears that young people who recently returned from Mexico might have been infected.
Officials of Newberry Academy in South Carolina said Monday that seniors from the school were in Mexico earlier this month and some had flu-like symptoms when they returned.
State Department of Health and Environmental Control spokesman Jim Beasley said test results on the students could come back as early as Monday afternoon. The agency has stepped up efforts to investigate all flu cases in South Carolina. There have been no confirmed swine flu cases in the state.
A New York City school where 28 cases were confirmed was closed Monday and is expected to remain closed Tuesday. In addition, 14 schools in Texas, including a high school where two cases were confirmed, will be closed for at least the next week. Some schools in California and Ohio also were closing after students were found or suspected to have the flu.
In Mexico, the outbreak’s center, soldiers handed out 6 million face masks to help stop the spread of the virus. Most other countries are reporting only mild cases so far, with most of the sick already recovering.
Spain reported its first confirmed swine flu case on Monday and said another 17 people were suspected of having the disease. Also, three New Zealanders who recently returned from Mexico are suspected of having it.
Scotland’s health secretary Nicola Sturgeon confirmed Britain’s first two cases of swine flu Monday, and said that seven other people were showing signs of the virus. All the cases appeared to be mild.
Worldwide, attention focused on travelers.
“It was acquired in Mexico, brought home and spread,” Nova Scotia’s chief public health officer, Dr. Robert Strang, said of Canada’s first confirmed cases.
