Mexico Limits Many Activities as Flu Alerts Are Increased

By DENISE GRADY
NYT.COM
As the swine flu virus spread to new locations as far apart as Peru and Switzerland on Thursday, Mexicans braced for a national shutdown of offices, restaurants, schools, museum and even the stands of soccer stadiums in an attempt to slow the spread of the disease.

In a nationally televised speech Wednesday night, Mexican President Felipe Calderon said that, as of Friday, many public services would be closed through Tuesday, encompassing a long holiday weekend. Most federal offices will be closed, restaurants, schools and museums will remain shuttered, and spectators will be barred from all professional soccer matches.

Churches are expected to be nearly empty on Sunday.

Officials in Asia and Europe also scrambled to confront the sickness, but Hong Kong’s chief executive, Donald Tsang, that “pandemic flu will continue to spread and Hong Kong is very likely to be affected.”

Senior European health officials prepared for emergency talks Thursday in Luxembourg to mold their own response, and governments in Asia stepped up preparations for a potential pandemic.

In Hong Kong, where health checks are being conducted on passengers arriving at the city’s airport, janitors put up fresh sheets of plastic film over elevator buttons so that any sick people pressing the buttons would not share their germs with too many people who pressed the same buttons later.

In China, the official Xinhua news agency reported that Vice Premier Li Keqiang had toured the Chinese Center for Disease Control and Prevention in Beijing on Wednesday and had called for manufacturers to produce more face masks, sterilization chemicals and flu medicines.

Mr. Li said that China still did not have any confirmed cases of swine flu, according to Xinhua.

The measures came after the World Health Organization raised its alert level on swine flu to Phase 5 on Wednesday, based on the flu’s continuing spread in the United States and Mexico. Phase 5, the next-to-highest level in the worldwide warning systemhttp://www.who.int/csr/disease/avian_influenza/phase/en/index.htmlW.H.O. alert system, has never been declared since the system was introduced in 2005 in response to the avian influenza crisis. Phase 6 means a pandemic is under way.

Worldwide, at least 12 countries have confirmed cases of swine flu. Switzerland became the fifth European country to report a case of the disease in a 19-year-old student, while in South America, Peru reported its first case, according to news reports.

“All countries should immediately activate their pandemic preparedness plans,” Dr. Margaret Chan, the W.H.O. director general, said at a late-night news conference in Geneva on Wednesday. While she emphasized the need for calm, at times she spoke as if a pandemic had already begun, saying, for instance, “W.H.O. will be tracking the pandemic.”

Governments around the world sought to balance precaution against panic, offering a raft of wildly differing responses.

In Britain on Thursday, authorities launched an advertising campaign urging people to sneeze into tissues and to wash their hands after doing so. The campaign was called “Catch it, bin it, kill it.”

But in Mexico, the epicenter of the disease, Mr. Calderón urged much broader precautions. People should stay inside their homes during the holiday hiatus, he said, and the shutdown and restrictions could possibly be extended further into next week.

The Mexican minister of health, Jose Cordova, said all nonessential federal services will shut down, and Mexico City extended the federal ban to include health clubs, gyms, museums and movie theaters.

Police stations, airports, bus stations and the capital’s subway system were to remain open under the federal plan, along with banks, food stores, pharmacies and gasoline stations.

Some 2,500 Mexicans have been sickened since the swine flu outbreak began last week in the town of La Gloria, 110 miles east of Mexico City. Mexico has reported just 99 confirmed cases of swine flu to the W.H.O., along with eight deaths, although as many as 168 people are suspected to have died from the disease there.

The only death from swine flu outside Mexico was reported Wednesday in the United States — a 23-month-old child from Mexico who was being treated in Houston.

The Centers for Disease Control and Prevention reported 91 confirmed cases from 10 states, up from 64 cases in 5 states on Tuesday. The number of confirmed cases was almost certain to grow as laboratories completed further tests on cases now termed “likely” or “probable.”

The first infection in Switzerland was confirmed Thursday morning as health ministers from the European Union gathered in Luxembourg to coordinate efforts in how to manage the flu outbreak on the continent. Cases of swine flu have already been confirmed in Germany, Spain, Britain and Austria, and some of the ministers expected the flu to spread in the coming days.

Dr. Chan, in her remarks, emphasized that flu epidemics tended to take much higher death tolls in poor countries than in rich ones, and said her organization and others would need to make special efforts to help poorer nations.

She called for global solidarity, saying, “After all, it really is all of humanity that is under threat during a pandemic.”

President Obama, terming the outbreak “cause for deep concern but not panic,” took the unusual step Wednesday of using a prime-time televised news conference, convened to mark his 100th day in office, to deliver a public health message to the American people.

“Wash your hands when you shake hands, cover your mouth when you cough,” he said from the East Room of the White House. “It sounds trivial, but it makes a huge difference. If you are sick, stay home. If your child is sick, take them out of school. If you are feeling certain flu symptoms, don’t get on an airplane.”

With public health officials recommending that schools close if there are more confirmed or suspected cases, Mr. Obama urged parents and businesses to “think about contingency plans” in case of such closings. Government preparedness plans may include steps like ensuring that laboratories can test for the disease and that health systems can identify and treat cases, track an outbreak and prevent the virus from spreading in hospitals and clinics. Governments should also decide on measures similar to those already taken in Mexico, such as closing schools and discouraging or banning public gatherings.

“The more recent illnesses and the reported death suggest that a pattern of more severe illness associated with this virus may be emerging in the U.S.,” the C.D.C. said on its Web site. More hospitalizations and deaths are expected, the site said, because the virus is new and most people have no immunity to it.

The outbreak has caused such concern because officials have never seen this particular strain of the flu passing among humans before, said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

“There is no background immunity in the population, and it is spreading from human to human — all of which has the potential for a pandemic,” Dr. Fauci said.

The disease centers’ count of 91 confirmed cases in the United States did not include some later reports by states that confirmed cases after the C.D.C. tally was posted. In addition, there were suspected cases in Louisiana and Delaware. Kits being provided to the states and other countries will allow them to test for the virus on their own and obtain results within a few hours.

New York City added five new confirmed cases, bringing its total to 49. All have links to Mexico or St. Francis Preparatory School in Queens, where the virus first surfaced in New York, health officials said. The city identified five more probable cases.

The total in Canada rose to 19, from 16. In Mexico, more than 150 people are suspected to have died from the flu, and almost 2,500 are thought to have been infected.

Kathleen Sebelius focused on the outbreak on Wednesday during her first news conference as the secretary of health and human services.

“We’re determined to fight this outbreak and do everything we can to protect the health of every American,” Ms. Sebelius said.

She noted that the Centers for Disease Control and Prevention had recommended that schools close only if a student is found to be infected. More aggressive steps are under discussion, Ms. Sebelius said, but officials realize that school closings can cause problems for families.

“What happens to parents? Where do children go?” she asked.

Dr. Besser, who joined the news conference via a video feed, said the most recent cases included patients of a broad range of ages, with two-thirds of all cases occurring in people under 18.

“There have been five hospitalizations so far, including the child who died. But we have a number of suspect cases that have been hospitalized and we expect that number to go up,” Dr. Besser said.

Dr. Besser said that a quarter of the nation’s stockpile of 50 million treatments of antiviral medicines would be distributed to states by Sunday.

The United States has no plans to close international borders because, Dr. Besser said, such closings are not effective in slowing pandemics. When Hong Kong was hit with severe acute respiratory syndrome, or SARS, “increased border screening on entry and exit was not an effective way of identifying cases or preventing transmission,” he said.

Nonetheless, Customs and Border Protection agents have stepped up efforts to spot sick travelers and are passing out travel health advisories.

Some elected officials have begun to question the decision to leave the borders open. Homeland Security Secretary Janet Napolitano was grilled by senators on Wednesday who asked whether her agency was doing enough to stop the virus from spreading from Mexico. The senators, including John McCain of Arizona and Joseph I. Lieberman of Connecticut, asked several times why the administration had decided against closing the border and banning travel to Mexico.

Senator Susan Collins of Maine urged that customs officials inspect more thoroughly and that the agency consider using heat sensors that allow agents to detect fevers among travelers entering the country.