Flu Cases Increase, but There Is Some Optimism

NYT.COM
By BRIAN KNOWLTON AND DENISE GRADY
WASHINGTON — Swine flu has become widespread in the United States, with cases in 30 states and more expected to turn up in other states in the next few days, federal health officials reported on Sunday.

Around the world, 19 countries have now been affected, including Colombia, which earlier in the day reported the first confirmed case of swine flu in South America. About 800 people have been infected, predominantly in North America. Spain has 44 confirmed cases, more than any other European country, with Britain, Italy and Germany reporting new cases, The Associated Press reported.

Dr. Anne Schuchat, the interim Deputy Director for Science and Public Health at the Centers for Disease Control and Prevention, said at a news conference here that the virus was “circulating all over” the United States.

“The virus has arrived, I would say, in most of the country now,” she added.

By Sunday afternoon, officials reported 226 cases in the United States, an increase of 66 since Saturday, when the presence of the virus had been confirmed in 21 states.

Most cases have been mild, but 30 people have been hospitalized. And the disease, unlike the common types of seasonal flu, appears to strike an unusually high percentage of young people. The median age of people who fall ill is 17.

“Very few confirmed are over 50,” Dr. Schuchat said. “They tend to be younger. Whether it will pan out in the weeks ahead we don’t know, but it is a pattern that looks different from seasonal influenza.”

In Mexico, the hardest-hit country and where the flu was first reported, nine of the 19 confirmed deaths were between the ages of 21 and 39, which is unusually high. But on Sunday its health minister said that the worst had passed in his country.

The course of the disease in Mexico, where many other deaths suspected because of the flu, is now “in its phase of descent,” Health Minister José Ángel Cordova told a news conference, Reuters reported.

The relatively mild nature of the illness in the United States, and the apparent leveling off of cases in Mexico are encouraging, Dr. Schuchat said in Washington, but added, “I don’t think we’re out of the woods yet.”

The worrisome things about this virus, she said, is that it is new, so few people can be expected to have resistance to it, and that it is behaving unusually, flaring up and taking hold at a time when the flu season is normally just about over.

Earlier in the day, Homeland Security Secretary Janet Napolitano predicted that the World Health Organization might “very well” elevate its flu alert from Level 5 to Level 6, the highest, this week. Ms. Napolitano emphasized, however, that even the highest-level W.H.O. warning was not in itself a cause for grave concern. It would indicate that the current flu strain has reached pandemic status, but there can be a pandemic of a mild disease, and this strain is looking milder than first thought.

“Level 6, which they very well could go to this week, all that means is that it is widespread around the world,” Ms. Napolitano said on CBS’s “Face the Nation.”

The W.H.O. said Saturday that there was still no evidence of the flu’s sustained spread outside North America, a requisite condition for raising its alert level.

In Spain, all but four of the cases involved a patient who had recently traveled to Mexico, the Spanish Health Ministry said. Spain is a hub for travel to Mexico, with dozens of flights each day between the two countries.

The ministry, who said all the Spanish patients had responded to treatment, said it would be seeking to tighten controls at airports Monday but did not offer any details about addition measures. Passengers arriving from affected areas this week have been filling questionnaires about possible virus symptoms, and cabin crews have been supplied with gloves and masks in an effort to isolate suspected cases.

In the United States, Ms. Napolitano and other top officials appeared on no fewer than five morning television programs, with a message mixing caution and measured reassurance. They emphasized that since its deadly initial spread in Mexico, the disease had generally shown a milder face.

Dr. Richard Besser, acting head of the C.D.C., pointed to “encouraging signs” that the current strain might end up being no worse than a normal seasonal flu. In New York City, for example, the disease had spread quickly through a private high school in Queens, but the cases were “not that severe, and that’s encouraging,” he said on “Fox News Sunday.”

Kathleen Sebelius, who just last week was confirmed as secretary of health and human services, told Fox that there was cautious optimism in part because “the lethality which initially presented itself as part of the Mexican situation — deaths of an age group you don’t typically see” — was not being seen elsewhere.

But experts were careful to balance their cautious optimism with warnings that the flu might yet get worse.

“These viruses mutate, these viruses change, these viruses can further reassort with other genetic material, with other viruses,” said Dr. Michael Ryan, W.H.O.’s global alert and response director. “So it would be imprudent at this point to take too much reassurance.”

Infectious disease experts say it will be important to watch what this virus does in coming weeks and months, particularly in the Southern hemisphere, which will soon confront its winter flu season. If H1N1 takes hold there, that will be a red flag to scientists.

“This virus could dampen here during the summer per usual, and go to the Southern Hemisphere and pick up steam there and come back to bite us in our winter season next January and February, and it might come back in a more virulent form,” said Dr. William Schaffner, a public health and infectious disease expert at Vanderbilt University.

The U.S. health officials, quite indirectly, took exception with advice from Vice President Joseph R. Biden Jr., who said last week that he would urge his family to avoid travel if it involved “confined spaces,” such as on an airplane or a subway.

Ms. Sebelius said that she would not discourage travel unless the traveler is sick and suggested that that was what Mr. Biden had meant to say.

Exceptionally strong measures by some countries to stop the spread of the flu have led to backlashes. Egypt ordered all pigs killed, provoking violent weekend clashes between police and angry pig farmers. Scientists say the disease is not spread by consuming properly prepared pork. And Mexico complained of the quarantining of dozens of its nationals in China.

The quarantine of dozens of Mexicans in Singapore, Guangzhou and Hong Kong — as well as other guests and workers in a Hong Kong hotel — brought a pointed complaint from the Mexican foreign minister, Patricia Espinosa.

“Mexican citizens showing no signs at all of being ill have been isolated under unacceptable conditions,” Ms. Espinosa said, according to Reuters. “These are discriminatory measures, without foundation.”

Health professionals were studying a new development in Canada, where a swine herd on a family-run farm in Alberta Province apparently contracted the virus from a worker who had visited Mexico. The man-to-pig transmission appeared to be a first for this strain. Both the man and the swine have recovered; the herd remains quarantined.

There has been heated debate about whether the virus, formally known as H1N1, could infect pigs, even though its genetic makeup clearly points to its having originated in swine at some point.