Mexico plans shutdown as World flu alert raised

MEXICO CITY – Mexico readied a "temporarily closed" sign — taking the drastic step of ordering a suspension of nonessential federal government and private business activity as it tried to squelch a swine flu epidemic. The World Health Organization ratcheted up an alert and warned that "all of humanity" is threatened.

The dire warning showed that world health officials are very worried about the potential for massive numbers of deaths worldwide from the mutated virus, even though the epidemic so far has claimed only a confirmed eight lives in Mexico and one in the United States. Roughly 170 deaths are suspected of having been caused by the virus in Mexico.

The Phase 5 alert, indicating a pandemic could be imminent as the virus spread further in Europe, prompted Mexico to announce the partial May 1-5 shutdown, Mexican Health Secretary Jose Cordova said late Wednesday.

In Washington, President Barack Obama promised "great vigilance" in confronting the outbreak which has sickened nearly 100 people in 11 states and forced schools to close. A Mexican toddler who visited Texas with his family died Monday night in Houston, becoming the first fatality in the U.S., and 39 Marines were confined to their base in California after one came down with the disease.

The virus, a mix of pig, bird and human genes to which people have limited natural immunity, has also spread to Canada, New Zealand, Britain, Germany, Spain, Israel and Austria.

"It really is all of humanity that is under threat during a pandemic," WHO Director General Margaret Chan said in Geneva. "We do not have all the answers right now, but we will get them."

In a televised address, Mexican President Felipe Calderon praised "the heroic work" of doctors and nurses and asked his countrymen to literally stay in their homes between May 1 and May 5, saying "there is no safer place to protect yourself against catching swine flu, than in your house."

"In recent days, Mexico has faced one of the most serious problems in recent years," Calderon said Wednesday night. He brushed aside criticisms that his government's response was slow, stressing several times that authorities had reacted "immediately."

School in Mexico has already been canceled until May 6. During the shutdown, essential services like transport, supermarkets, trash collection and hospitals will remain open.

Calderon said authorities would use the partial shutdown to weigh whether to extend the emergency measures, or "if it is possible to phase out some" restrictions.

The outbreak appeared to already be stabilizing in Mexico, the epicenter. Confirmed swine flu cases doubled Wednesday to 99, but new deaths finally seemed to be leveling off after an aggressive public health campaign was launched when the epidemic was declared April 23. Although 17 new suspected deaths were reported, only one additional confirmed death was announced Wednesday night, for a total of eight countrywide. The virus is believed to have sickened as many as 2,955 people across the country, though hospital records suggest the outbreak may have peaked here last week.

The WHO said the global threat is nevertheless serious enough to ramp up efforts to produce a vaccine against the virus. It declared a Phase 5 outbreak — the second-highest on its threat scale — for the first time ever, indicating a pandemic could be imminent.

In the U.S., eight states closed schools Wednesday, affecting 53,000 students in Texas alone.

Obama said his administration has made sure that needed medical supplies are on hand and he praised the Bush administration for stockpiling 50 million doses of antiviral medications.

"The key now is to just make sure we are maintaining great vigilance, that everybody responds appropriately when cases do come up. And individual families start taking very sensible precautions that can make a huge difference," he said.

Ecuador joined Cuba and Argentina in banning travel to or from Mexico and Peru banned flights from Mexico. The Panama Canal Authority ordered pilots and other employees who board ships passing through the waterway to use surgical masks and gloves. An average of 36 ships per day use the canal, most from the United States, China, Chile and Japan.

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.

Medical detectives have not pinpointed where the outbreak began. 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.

China has gone on a rhetorical offensive to squash any suggestion it's the source of the swine flu after some Mexican officials were quoted in media reports in the past week saying the virus came from Asia and the governor of Mexico's Veracruz state was quoted as saying the virus specifically came from China.

One of the deaths in Mexico directly attributed to swine flu was that of a Bangladeshi immigrant, said Mexico's chief epidemiologist Miguel Angel Lezana.

Lezana said the unnamed Bangladeshi had lived in Mexico for six months and was recently visited by a brother who arrived from Bangladesh or Pakistan and was reportedly ill. The brother has left Mexico and his whereabouts are unknown, Lezana said. He suggested the brother could have brought the virus from Pakistan or Bangladesh.

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.

Cordova, the Mexican health secretary, said getting proper treatment within 48 hours of falling ill "is fundamental for getting the best results" and 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."

Gonzalez finally took her husband to Mexico City's main respiratory hospital, "dying in the taxi." Doctors diagnosed pneumonia, but it may be 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.

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AP writers Frank Jordans in Geneva, Tom Raum and Lauran Neergaard in Washington, Olga Rodriguez in Oaxaca, Mexico, Paul Haven and E. Eduardo Castillo in Mexico City, and Mike Stobbe in Atlanta contributed to this report.

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World takes drastic steps to contain swine flu

From Egypt's order that all 300,000 pigs in the country be slaughtered to travel bans and putting the kibosh on kissing, the world is taking drastic — and some say debatable — measures to combat swine flu.

Egypt ordered the pig slaughter even though there hasn't been a single case of swine flu there and no evidence that pigs have spread the disease. 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.

All this and more, even though world health experts say many of these measures may not stop the disease from spreading. On Wednesday, the World Health Organization raised its pandemic alert to the second-highest level, meaning it believes a global outbreak of the disease is imminent.

"Scientifically speaking, the main thing is that every virus behaves differently," said Joerg Hacker, president of the Robert Koch Institute, Germany's top public health authority. "At the moment, the main issue is to get to know this virus, how it works."

In Germany, where officials confirmed three cases, Lufthansa announced that starting Thursday it will put a doctor aboard all flights to Mexico, the epicenter of the outbreak.

Experts said that makes sense: The doctors will be able to field questions from uneasy passengers and tend to anyone who might fall ill.

The World Health Organization said total bans on travel to Mexico — such as one imposed by Argentina, which hasn't had any confirmed cases — were questionable because the virus is already fairly widespread.

Roselyne Bachelot, France's health minister, said she would ask the European Union to suspend all flights to Mexico at a meeting Thursday in Luxembourg.

Travel bans were effective during the 2003 outbreak of SARS in Asia, because that illness can be transmitted only by people who already show symptoms. With flu, by contrast, the incubation period ranges from 24 hours to four days, meaning people often are infectious before they have symptoms.

Health officials don't know enough about swine flu right now to say what the precise incubation period is, but if it's similar to other flu, people are likely able to spread it before they're sick.

"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."

Nor will killing pigs, as Egypt began doing Wednesday, infuriating pig farmers who blocked streets and stoned Health Ministry workers' vehicles in protest. While pigs are banned entirely in some Muslim countries because of religious dietary restrictions, they are raised in Egypt for consumption by the country's Christian minority.

Unlike bird flu, where the H5N1 strain that spread to humans was widespread in bird populations and officials worried about people's exposure to infected birds, WHO says there is no similar concern about pigs — and no evidence that people have contracted swine flu by eating pork or handling pigs.

"There is no association that we've found between pigs and the disease in humans," WHO spokesman Dick Thompson said.

But that hasn't stopped governments from banning pig products. Macedonia ordered a halt to all live pig imports and on Tuesday, Mexico City closed down all its popular streetside taco stands for at least a week.

Dr. Nikki Shindo, a WHO flu expert, said the agency will consider requests to stop calling the disease swine flu, since the virus is not food-borne and has nothing to do with eating pork.

U.S. Agriculture Secretary Tom Vilsack and others have suggested a new name, arguing that swine flu implies a problem with pork products. China, Russia and Ukraine are among countries that have banned pork imports from Mexico and parts of the United States affected by swine flu.

But some anti-flu measures have merit, such as Obama's admonition Wednesday that more American schools might have to be closed temporarily if swine flu cases spread. Already tens of thousands of students in Texas, New York, California, Chicago and elsewhere are out of school.

The WHO said closing schools and public places, along with banning or restricting mass gatherings, can be a way to contain the spread of disease. Epidemiologists call it "social distancing," and the idea is simple: If you keep people who have the virus away from others, you can stop the chain of transmission.

"That's a technique we would be recommending in a pandemic," said WHO's Thompson. "We would recommend it to nations as a useful technique to be applied given the special circumstances of each nation."

Officials in Hong Kong, which has no confirmed cases, said workers were scrubbing public toilets every two hours in an effort to improve hygiene.

"Not only will we be stepping up our usual efforts, but also we will make special efforts to make sure that our back alleys, public housing estates, recreation and transportation facilities are thoroughly cleansed and disinfected," said Gabriel Leung, undersecretary for the Food and Health Bureau.

Experts, however, said it's debatable how much good disinfecting public places will do. It probably helps cut down on bacteria and kill viruses lurking on surfaces, but it's unclear whether it would stop person-to-person transmission.

Ditto the advice to stop kissing on the cheek, which was among the earliest measures — along with refraining from handshakes — to be recommended by authorities in Mexico.

WHO's Thompson was noncommittal on the "don't kiss" advice, saying only: "There are different national circumstances that health officials are going to know far better than we will. It's up to them to make that call."

But at a news conference announcing the elevated pandemic level, WHO chief Margaret Chan went further, suggesting it was time to rethink the traditional three kisses on the cheek popular in Switzerland and elsewhere in Europe. "Perhaps instead of having the traditional three hugs to say hello and welcome your friends, maybe you don't do that anymore," she said. "Don't hold each other and hug their face three times."

The flu virus is airborne and spread through tiny particles — mostly through sneezing and coughing. That helps explain why governments worldwide have been distributing millions of face masks, even though the U.S. Centers for Disease Control and other agencies have questioned their effectiveness.

Some doctors warn masks might even be harmful, causing people to take risks — like venturing into crowds or neglecting to wash hands — in the mistaken belief the mask protects them. More expensive high filtration masks like those used by health professionals can filter out fine particles carried in the air, but even these must be used properly to give real protection.

Other measures, such as installing thermal cameras at airports to screen passengers from infected countries, are simply inconclusive. Scanners were set up across Asia during the SARS outbreak, but officials aren't sure they caught any cases. WHO says the usefulness of such devices is debatable.

Amid the flurry of measures being taken, fear mingled with a sense of fatalism.

"You can't protect yourself — not in the way that people are traveling nowadays," said Karin Henriksson, 56, of Stockholm.

"Then you would have to put the entire population in quarantine. And you can't do that, can you?"

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Kole reported from Vienna; Cheng, an AP Medical Writer, from London.

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Scientists struggle to understand swine flu virus

ATLANTA – Mexico's health secretary may have thought he was allaying fears about swine flu when he suggested that the nation's swine flu death rate was 6 or 7 percent. In reality, that would mean a monstrous killer virus — and no experts are close to saying that. The secretary's comment reflects how much remains unknown about the new flu virus — most notably how lethal it is and why it seems so much deadlier in Mexico than anywhere else.

American health officials believe they are getting closer to answering those questions, or, at least, to ruling out wrong-headed theories.

"We've begun to knock off hypotheses," said Dr. Scott F. Dowell, director of global disease detection with the U.S. Centers for Disease Control and Prevention.

Among the factors disease detectives have discounted are Mexico's air pollution, secondary infections and poor health care. But they still do not know why so many Mexicans have died, although it could be because many more people actually have had the virus than health officials realize.

In Mexico, the virus is suspected of killing more than 150 people and sickening more than 2,400. Recent information suggests swine flu-related hospital admissions and deaths may have peaked and are declining, but no other country has shown any numbers close to those seen in Mexico.

The only other country to report a swine flu death is the United States, and that involved a toddler from Mexico who was visiting Texas with his family.

The leading theory remains that the virus itself is not significantly different in Mexico, but that the outbreak has for some reason just hit harder there, infecting more people overall. The more people who are infected, the more likely there will be severe cases and even deaths.

When the Mexican health secretary spoke this week about a 6 or 7 percent death rate, his figures were based on the number of deaths divided by the number of suspected infections. But authorities cannot be certain how many people have been infected, especially those who suffered only mild symptoms.

Mexican authorities have not tried to count mild cases, focusing instead on the severely ill and the dead. So the death rate may be much lower than 6 or 7 percent — and probably is, according to some experts.

A 6 to 7 percent death rate would make the Mexican swine flu nearly three times deadlier than the worst flu pandemic in the last 100 years — the 1918 Spanish flu, which killed an estimated 20 million to 50 million people worldwide.

That seems unbelievably high for this new virus, said Richard Webby, a flu researcher at St. Jude Children's Research Hospital in Memphis.

Webby and others do not believe the swine flu in Mexico is different from what's been seen in U.S. patients. The virus samples in both countries match.

The CDC sent four epidemiologists and one lab scientist to Mexico over the weekend to investigate the disease there, and the agency expects to send a half-dozen more people this week, said Dowell, of the CDC.

Among the hypotheses being ruled out as explanations for Mexico's higher death rate:

• A second infection complicating the flu cases. A common danger in flu is that the patient is co-infected with pneumonia or other bacteria, which can lead to death. But lab tests of 33 Mexican patients, including seven who died, did not find that problem.

• Low-quality health care. CDC investigators have not seen any obvious problem. They have found capable doctors and well-equipped, high-quality hospitals, Dowell said.

• A medicine is compounding the problem. Investigators have looked into whether patients who got sick had taken some over-the-counter medicine or folk remedy that actually made things worse.

Such a problem has sometimes occurs in children recovering from flu who are given aspirin — a severe illness called Reye's syndrome, which causes vomiting, lethargy and even seizures. But there's no evidence of something like that in Mexico, Dowell said.

• Altitude or air pollution: Mexico City's altitude and its infamous air pollution have raised speculation that those factors may have made people more susceptible to the virus. But severe cases are being reported over much of Mexico, including coastal communities and places with cleaner air, making that theory unlikely.

The CDC has also been investigating when the swine flu first hit Mexico.

Some have wondered whether it's possible people have been getting sick with the virus for months, but the illness went undetected because special swine flu tests were not used to diagnose patients.

But CDC officials say no, the flu probably did not hit Mexico until March at the earliest. An analysis of hundreds of samples from Mexico that were collected from January to March never turned up the swine flu virus, Dowell said.

There's also the question of where it started — a standard inquiry of public health investigations since at least the mid-19th century.

One of the heroes of public health history is John Snow, a London physician who helped end an 1854 cholera outbreak by determining that cases were clustered around a water pump and that the disease was spread through water. The pump handle was removed, and the cholera deaths subsided.

But flu is different because it's spread by human-to-human contact. Scientists know it's more difficult to pin down the origin of a novel strain of influenza to a specific country, let alone a village or pig farm.

Knowledge of the origin is also less useful than in a cholera outbreak.

"Flu, unlike cholera, spreads around the world in a matter of weeks. You can't remove the pump handle" to stop the epidemic, said Dr. Andrew Pavia, a University of Utah pediatrics professor who leads the Infectious Diseases Society of America's pandemic flu task force.

A current theory is that the outbreak started in the town of La Gloria on the eastern coast of Mexico, because a 5-year-old boy was the first known case. He first suffered flu-like symptoms in late March. However, Mexican health officials have downplayed claims the outbreak started in La Gloria, because mucous samples of other patients from there found nothing.

Dowell said the place of origin is a secondary concern at the moment.

"That probably will be useful in the long term. But for the present, our team in the field is focused on things that will make the most difference for mitigation" of the outbreak, he said.

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Associated Press Writer Olga R. Rodriguez in Mexico contributed to this report.

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Little boy, far from home, 1st US swine flu death

HOUSTON – He was not yet 2, far from home and dying. The first victim of swine flu in the U.S. was a Mexican toddler who struggled to survive for weeks in Texas hospitals — long before it was known doctors were dealing with an international outbreak.

Now the hunt is on to find anyone who came into contact with the little boy while he visited relatives in the border city of Brownsville from his home in Mexico City.

The state's health director, Dr. David Lakey, at an Austin news conference, called it "highly likely" that the boy contracted the disease in Mexico before his trip to the U.S.

Officials in Brownsville are trying to trace his family's trip to find out how long they were in the area, who they visited and how many people were in the group, said Cameron County Judge Carlos Cascos.

The boy, who was 23 months old, had "underlying health issues" before he flew to Matamoros, Mexico, on April 4 and crossed into Brownsville to visit relatives, state health officials said.

He developed flu symptoms four days later and was taken to a Brownsville hospital April 13 and transferred the following day to Texas Children's Hospital in Houston, where he died Monday night.

The U.S. Centers for Disease Control and Prevention on Wednesday confirmed that he had been infected with the swine flu virus. The cause of the death was pneumonia caused by the virus, Cascos said.

Health officials insisted the boy posed no contagion threat to Houston. He had no contact with other patients at Texas Children's Hospital and none of the staff was exposed, said Dr. Jeffrey Starke, the hospital's director of infectious disease.

This case "shouldn't trigger any undue alarm in the community," Starke told a news conference. "The child did not acquire the virus in Houston, Texas."

Dr. Brian Smith, regional director of the Texas Department of State Health Services, said antiviral treatments were given to family members who had close contact with the child and none had contracted swine flu. He said that with the virus' short incubation period, health officials would have begun seeing secondary cases among the child's close contacts by now, but none has appeared.

Although the boy wasn't initially identified as a swine flu case, Starke said concern grew over the last several days as news of the virus intensified.

Officials refused to release any further information about the boy or his family, including his name or any details on his other health issues, citing privacy laws.

Starke said the child was "critically ill the entire time the child was under our care," and that he was transferred to Houston because the hospital in Brownsville, an impoverished border city of 140,000, couldn't provide the kind of care he needed.

Swine flu is suspected of killing more than 150 people and sickening over 2,600 in Mexico, Canada, New Zealand, Britain, Germany, Spain, Israel and Austria.

The virus has spread to 11 U.S. states from coast to coast. Total American cases surged to nearly 100, including a Marine at the Twentynine Palms base in southern California.

According to the CDC, more than 20,000 children younger than age 5 are hospitalized every year because of seasonal flu. In the 2007-08 flu season, the CDC received reports that 86 children nationwide died from flu complications.

Authorities have confirmed at least 93 swine flu cases in the United States. They've identified 16 cases in Texas, 51 in New York, 14 in California, three in Maine; two in Kansas, two in Massachusetts, and one each in Indiana, Ohio, Arizona and Nevada. The CDC also said Michigan had two, but state officials maintained only one was confirmed.

Texas Gov. Rick Perry announced a disaster declaration Wednesday for the entire state. The declaration will allow officials to begin emergency protective measures and seek reimbursement from the federal government.

Texas officials also are postponing all public high school athletic competition until May 11. Schools serving more than 130,000 kids across Texas were closed.

As for future action, Perry said closing the border with Mexico is an option, but he doesn't want to play a "what-if game."

"There's no need to panic," Perry said. "I urge our citizens to act responsibly in the course of this situation. Heed the advice of local and state health officials."

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On the Net:

CDC: http://www.cdc.gov/swineflu

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Attorney in 2007 tuberculosis scare sues CDC

ATLANTA – An Atlanta attorney at the center of an international health scare when he flew to Europe for his wedding even though he was infected with a drug-resistant form of tuberculosis is suing federal health officials, claiming they invaded his privacy.

Andrew Speaker said Wednesday that federal officials knew he was infected with the sometimes deadly lung disease before he left in 2007 and advised him to begin treatment when he returned. Once he was overseas, however, doctors urged him to return because they thought he had a more severe form of the disease. Later tests revealed he had contracted a less dangerous strain.

In the lawsuit, Speaker said Centers for Disease Control and Prevention officials gave him the go-ahead to leave and then pinned the blame on him.

"The whole point of the lawsuit describes how the CDC knew I had TB before I left," he said in a telephone interview. "All the sudden, I get over there and they hold this big press conference."

The lawsuit filed in federal court in Atlanta on Tuesday claims the CDC damaged Speaker's reputation and made him the target of death threats. It also says he and his new bride split up because of the stress and seeks unspecified damages and court fees.

It accuses the CDC of "unlawfully and unnecessarily" revealing Speaker's private medical history and other sensitive information during an extensive media blitz in May 2007.

CDC spokesman Tom Skinner declined to comment.

"We are not in a position to have anything to say about pending litigation," he said.

Speaker, a plaintiff's attorney, was in Europe for his wedding and honeymoon when he learned tests showed he had an extremely drug-resistant strain of tuberculosis known as XDR-TB. He'd been advised not to fly to Europe in the first place, but at that point he'd been diagnosed with a less severe strain.

Despite warnings from health officials not to board another international flight, Speaker flew to Montreal and drove over the American border.

He subsequently became the first American quarantined by the federal government since 1963, and was treated in a Denver hospital. Health officials there learned that Speaker was infected with a less severe strain of the disease.

The lawsuit also seeks records of his test results that he said the CDC has failed to turn over despite repeated requests using the Freedom of Information Act. The complaint, he said, aims to set the record straight.

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