World Health Organization Raises Swine Flu Alert Level

By DENISE GRADY
NYT.COM
The global spread of swine flu, a pandemic, is highly likely, the World Health Organization said on Wednesday and raised its alert level to Phase 5, the next-to-highest level in the worldwide warning system.

Phase 5 has never been declared before. Phase 6 means a pandemic is under way. The health organization’s said its decision was based on the continuing spread of swine flu in the United States and Mexico, particularly the increasing numbers of unexplained cases among people not exposed to travelers or to institutions like schools or hospitals where many people have close contact with one another and high rates of transmission might be expected.

“All countries should immediately activate their pandemic preparedness plans,” Dr. Margaret Chan, director-general of the organization, said at a news conference in Geneva. “Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.”

The first death from swine flu in this country — of a 22-month-old child from Mexico who was being treated in Houston — was reported on Wednesday, along with more infections and hospitalizations. The Centers for Disease Control and Prevention reported 91 confirmed cases from 10 states, up from 64 cases in 5 states on Tuesday.

Dr. Chan emphasized the need for calm, but at times spoke as if a pandemic had already begun, saying, for instance, “W.H.O. will be tracking the pandemic.” She also 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 planned to use his opening remarks at a prime time news conference on Wednesday to discuss the worsening outbreak. “This is obviously a very serious situation,” Mr. Obama said, according to excerpts of his prepared text released by the White House, “and every American should know that their entire government is taking the utmost precautions and preparations.”

Preparedness plans referred to by Dr. Chan include things like making sure 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 whether to take measures like closing schools and discouraging or banning public gatherings to prevent disease transmission. Mexico, for instance, has prohibited people from eating in restaurants and is allowing restaurants to provide only take-out food.

“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.

Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said that officials had no way of predicting whether the outbreak would become more serious.

“You don’t know if this is a virus that will fizzle in a couple of weeks or one that will become more or less virulent or severe in the diseases it causes,” Dr. Besser said.

He said officials must follow government plans for a pandemic because of that unpredictability, just in case.

“If we could see into the future, it would be wonderful so that we could tailor all our responses specifically to what is occurring,” Dr. Besser said.

The disease centers’ count of 91 confirmed cases in the United States did not include later reports by Maine and Nevada of confirmed cases there, which were announced after the C.D.C. tally had been posted. In addition, Louisiana and Delaware had suspected cases. 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 illness, and almost 2,500 are thought to have been infected.

The outbreak was the focus of Kathleen Sebelius’ first news conference as health secretary on Wednesday, and she promised a vigorous fight against the disease.

“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 with the swine flu virus. More aggressive steps are under discussion, Ms. Sebelius said, but officials realize that school closings can cause problems from 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 from a broad range of ages, with two-thirds of all cases occurring in people under the age of 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.

He added: “It’s a serious outbreak, and we’re taking aggressive measures.”

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 closures 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,” Dr. Besser said.

Nonetheless, Customs and Border Protection agents have stepped up efforts to spot sick travelers and are passing out travel health advisories telling people whether to see a doctor if they become sick.

“Individuals who are identified as sick are referred to public health professionals for evaluation,” Dr. Besser said.

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 acting aggressively enough to stop the virus from spreading from Mexico into the United States. The senators, including John McCain of Arizona, and Joseph Lieberman of Connecticut asked several times why the Obama Administration had decided against closing the border, and banning travel to Mexico.

Sen. Susan Collins of Maine took issue with Ms. Napolitano’s decision to use only “passive inspection techniques,” to monitor people entering the United States. She urged that the customs officials conduct more aggressive inspections and that the agency consider using heat-sensors that would allow agents to detect people who are entering the country with fevers.