Flu overhyped? Some say officials 'cried swine'

CHICAGO – Did government health officials "cry swine" when they sounded the alarm on what looked like a threatening new flu?

The so-far mild swine flu outbreak has many people saying all the talk about a devastating global epidemic was just fear-mongering hype. But that's not how public health officials see it, calling complacency the thing that keeps them up at night.

The World Health Organization added a scary-sounding warning Thursday, predicting up to 2 billion people could catch the new flu if the outbreak turns into a global epidemic.

Many blame such alarms and the breathless media coverage for creating an overreaction that disrupted many people's lives.

Schools shut down, idling even healthy kids and forcing parents to stay home from work; colleges scaled back or even canceled graduation ceremonies; a big Cinco de Mayo celebration in Chicago was canned; face masks and hand sanitizers sold out — all because of an outbreak that seems no worse than a mild flu season.

"I don't know anyone who has it. I haven't met anyone who knows anyone who contracted it," said Carl Shepherd, a suburban Chicago video producer and father of two. "It's really frightening more people than it should have. It's like crying wolf."

Two weeks after news broke about the new flu strain, there have been 46 deaths — 44 in Mexico and two in the United States. More than 2,300 are sick in 26 countries, including about 900 U.S. cases. Those are much lower numbers than were feared at the start based on early reports of an aggressive and deadly flu in Mexico.

Miranda Smith, whose graduation ceremony at Cisco Junior College in central Texas was canceled to avoid spreading the flu, blames the media.

"It's been totally overblown," she said Thursday.

"Everyone seems to know it's not going to kill you and it's not as deadly as they think," she said. "Everybody needs to just calm down and chill out."

Craig Heyl of Decatur, Ga., said the government overreacted.

"Swine flu is just another strain of flu. People get the flu. I guess you have to call it a pandemic when it's a widespread virus, but I don't think the severity of it is all that concerning," said Heyl, 43.

Public health authorities acknowledge their worst fears about the new virus have not materialized. But no one's officially saying it's time to relax. And experts worry that people will become too complacent and tune out the warnings if the virus returns in a more dangerous form in the fall.

"People are taking a sigh of relief too soon," said Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention.

In an interview Wednesday with The Associated Press, Besser said the outbreak in the United States appears to be less severe than was first feared. But the virus is still spreading and its future potential as a killer is not clearly understood.

"The measures we've been talking about — the importance of handwashing, the importance of covering coughs, the real responsibility for staying home when you're sick and keeping your children home when you're sick — I'm afraid that people are going to say, 'Ah, we've dodged a bullet. We don't need to do that,'" Besser said.

"The thing that's keeping me up right now is that feeling of dodging the bullet," he added.

Peter Sandman, a risk communication specialist, says on his Web site that reminding people the risk is still real and warning them in the future if a pandemic looks imminent "will be extremely difficult."

"Swine flu looks to be an extremely mild pandemic if it goes pandemic at all, despite WHO warnings that it may 'come back with a vengeance' in the fall. People are going to be very, very skeptical," Sandman wrote.

That concern is shared by infectious disease specialists. But elsewhere, especially online, talk of hype is rampant.

"If I hear 1+ person freaking out because of the "Swine Flu" they won't have 2 worry about dying from it. I will kill them w/ my handbag!" read a comment Wednesday on Twitter.

"Adults are acting like a bunch of crybabies in a B-rated science fiction germ-outbreak movie, wringing their hands, whining about what to do next," Dallas Morning News reader Mark Thompson wrote in a letter to the editor posted online Wednesday.

Kari Carsey Valente of Lake Oswego, Ore., had similar thoughts in a letter on the Oregonian newspaper's Web site.

"Is the daily front page body count really necessary? In reading the entire content of the collected articles one learns that the H1N1 strain is not likely to be more lethal than its predecessors. Give it a rest — and lots of liquid!," Valente wrote.

Colt Ables, 22, an economics major at the University of Texas in Arlington, said he thinks the Obama administration overreacted and unfairly tried to make it seem as if Republicans have been soft on preparedness.

"This shouldn't be about politics or about hyping up a virus to send the American people into a panic. Do yourself a favor, wash your hands and turn off the TV," he wrote in a campus newspaper column.

Whether the media overhyped or accurately reported the dangers is a toss-up, according to a USA Today/Gallup poll published Thursday on Americans' views of the media's flu coverage.

The May 5 poll also found that concern about the flu peaked a week ago. But even then, only 25 percent of Americans said they worried about getting the virus.

Dr. Robert Daum, a University of Chicago infectious disease expert, says authorities acted properly when news first broke about the new flu strain.

"It's like overcalling a snowstorm in Chicago. You want the plows out even if it's only going to snow a flake," Daum said. If not, and a blizzard hits, "there will be an outcry like you've never seen before."

Still, Daum says authorities have been a bit awkward in "downshifting" now that it appears the U.S. situation isn't dire.

"I think it was right to place everyone on high alert, and now right" to say it's time to calm down, Daum said.

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Medical Writer Lindsey Tanner reported from Chicago and Medical Writer Mike Stobbe reported from Atlanta.

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WHO: Up to 2 billion people might get swine flu

GENEVA – Up to 2 billion people could be infected by swine flu if the current outbreak turns into a pandemic lasting two years, the World Health Organization said Thursday. WHO flu chief Keiji Fukuda said the historical record of flu pandemics indicates one-third of the world's population gets infected in such outbreaks. Independent experts agreed that the estimate was possible but pointed out that many would not show any symptoms.

In Mexico, the hardest hit country so far, high schools and universities opened for the first time in two weeks as the government's top health official insisted the epidemic is on the decline. All students were checked for swine flu symptoms and some were sent home.

"If we do move into a pandemic, then our expectation is that we will see a large number of people infected worldwide," Fukuda said. "If you look at past pandemics, it would be a reasonable estimate to say perhaps a third of the world's population would get infected with this virus."

With the current total population of more than 6 billion, that would mean an infection total of 2 billion, he said, but added that the world has changed since pandemics of earlier generations, and experts are unable to predict if the impact will be greater or smaller.

"We don't really know." said Fukuda. "This is a benchmark from the past. Please do not interpret this as a prediction for the future."

Chris Smith, at flu virologist at Cambridge University in England, said the 2 billion estimate was possible.

"That doesn't sound too outlandish to me for the simple reason that this is a very infectious virus," Smith told The Associated Press. "You're talking about a virus that no one in the population has seen before and therefore everyone is immunologically vulnerable. Therefore it's highly likely that once it starts to spread, people will catch it. And since the majority of the world's population are in contact with one another, you're going to get quite a lot of spread."

John Oxford, professor of virology at St. Bart's and Royal London Hospital, agreed.

"I don't think the 2 billion figure should scare people because it's not as though 2 billion people are going to die. The prediction from WHO is that 2 billion people might catch it. Half of those people won't show any symptoms. Or if they show any symptoms, they will be so mild they will hardly know they've had it."

Fukuda said it also is impossible to say if the current strain of swine flu will become severe or mild, but that even with a mild flu, "from the global perspective there are still very large numbers of people who could develop pneumonia, require respirators, who could die."

A mild outbreak in wealthier countries can be "quite severe in its impact in the developing world," Fukuda said.

People react differently to the flu depending on their general state of health and other factors, he said. Some younger people in the Southern Hemisphere may be more vulnerable because of poor diet, war, HIV infections and other factors.

"We expect this kind of event to unfold over weeks and months," Fukuda said. "Really if you look over a two-year period that is really the period in which you see an increase in the number of illnesses and deaths during a pandemic influenza."

So far the swine flu virus has spread to 26 countries. Brazil and Argentina on Thursday became the second and third countries in South America to announce confirmed cases.

Mexican dance halls, movie theaters and bars were allowed to fully reopen Thursday after a five-day shutdown designed to curb the virus' spread. Businesses must screen for any sick customers, and restaurant employees must wear surgical masks.

Fans can attend professional soccer matches this weekend after all were played in empty stadiums last weekend.

Mexico confirmed two more deaths, for a total of 44, while 1,160 people have been sickened, up 90 from Wednesday. Despite death tolls and confirmed caseloads that rise daily, Health Secretary Jose Angel Cordova insisted the epidemic is waning in Mexico.

WHO raised its global total of laboratory-confirmed cases to 2,099, from 1,893 late Wednesday, and said swine flu also has caused two deaths in the United States.

This swine flu seems to have a long incubation period — five to seven days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. That means the virus can keep being spread by people who won't know to stay home.

Laughing and joking, high school students gathered at the entrance of the National School of Graphic Arts in Mexico City, waiting to fill out forms that asked about their health.

Of 280 students entering the school in the first 20 minutes, two showed symptoms of swine flu, including coughing and nasal congestion, said assistant principal Ana Maria Calvo Vega. Their parents were notified and they won't be readmitted without a statement from a doctor saying they don't have the virus, she said.

Students at a Mexico City vocational high school were welcomed with a hand sanitizer and a surgical mask. Joyful to see each other again, students embraced and kissed — some through masks.

But some worried that the virus could surge back once young people gather in groups again.

"My 17-year-old daughter is afraid. She knows she must go back but doesn't want to," said Silvia Mendez as she walked with her 4-year-old son, Enrique, in San Miguel Topilejo, a town perched in forested mountains near the capital.

Working parents have struggled to provide child care during the shutdown. It forced many to stay home from work, bring their youngsters to their jobs, or leave them at home.

Each school, Mexican officials said, had to be cleaned and inspected this week. Complicating the task: Many schools are primitive buildings with dirt floors and lack proper bathrooms. It was unclear how students attending those schools could adhere to the government's strict sanitary conditions.

The government promised detergent, chlorine, trash bags, anti-bacterial soap or antiseptic gel and face masks to state governments for delivery to public schools. But some local districts apparently didn't get the word.

U.S. health officials are no longer recommending that schools close because of suspected swine flu cases since the virus has turned out to be milder than initially feared. But many U.S. schools have done so anyway, including the school of a Texas teacher who died.

In Asia, top health officials said the region must remain vigilant over the threat of swine flu, stepping up cooperation to produce vaccines and bolstering meager anti-viral stockpiles.

The virus has so far largely spared Asia. Only South Korea and Hong Kong have confirmed cases. On Thursday, China and Hong Kong released dozens of people quarantined over suspected contact with one of the region's few swine flu carriers.

Experience has been the spur to WHO to make sure the world is as prepared as possible for a pandemic, which would be indicated by a rise to phase 6 from the current phase 5 in the agency's alert scale. That would mean general spread of the disease in another region beyond North America, where the outbreak so far has been heaviest.

"I'm not quite sure we know if we're going to phase six or not or when we would do so," Fukuda said. "It's really impossible for anybody to predict right now."

Officials said the agency was likely to shorten its annual meeting of its 193 member states later this month from 10 days to five because of the outbreak, which it was scheduled to discuss.

"That is under consideration," Fukuda said. "Sure it is possible."

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Contributions from AP Medical Writer Maria Cheng in London and Associated Press writers Andrew O. Selsky in Mexico City and Michael Casey in Bangkok.

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US swine flu victims had chronic health problems

ATLANTA – America's two swine flu deaths — a toddler and a pregnant woman — each suffered from several other illnesses when they were infected with the virus, according to a study released Thursday.

The report by the Centers for Disease Control and Prevention presented a clearer picture of the complicated medical situations faced by those who have gotten swine flu and had the most serious cases so far.

The Mexican toddler had a chronic muscle weakness called myasthenia gravis, a heart defect, a swallowing problem and lack of oxygen. Little Miguel Tejada Vazquez fell ill and died during a family visit to Texas.

The pregnant woman, Judy Trunnell, 33, was hospitalized for two weeks until she died Tuesday. The teacher was in a coma, and her baby girl was delivered by cesarean section. According to the report, she had asthma, rheumatoid arthritis, a skin condition called psoriasis and was 35 weeks pregnant.

People with chronic illnesses are at greatest risk for severe illness from the flu, along with the elderly and young children. So far, most of those with the swine flu in the U.S. and Mexico have been young adults.

"We're still learning about what patients are most at risk" from the new virus, said Dr. Fatima Dawood, a CDC epidemiologist.

The CDC report released by the New England Journal of Medicine also provided more detailed information on 22 people hospitalized with swine flu. Nine had chronic medical conditions, including the two who died and a 25-year-old man with Down syndrome and a congenital heart disease. Five of the patients had asthma alone.

Separately, the CDC also described the symptoms experienced by Americans with swine flu. About 90 percent reported fever, 84 percent reported cough and 61 percent reported a sore throat — all similar to what's seen with seasonal flu.

But about one in four cases have also involved either vomiting or diarrhea, which is not typical for the normal flu bug.

It's possible the virus is spreading not only through coughed and sneezed droplets — as with seasonal flu — but also through feces-contaminated hands, said Dawood.

"This is a new virus and we're still learning how transmission occurs," she said.

There are now nearly 900 confirmed cases in the United States, said the CDC's acting chief, Dr. Richard Besser. That count included 42 hospitalizations as of Thursday.

About 10 percent of the Americans who got swine flu had traveled to Mexico and likely picked up the infection there. That's a change from over the weekend when the CDC said about a third of the U.S. cases at that point were people who had been to Mexico, where the outbreak began.

The ongoing spread within the U.S. borders explains why a shrinking proportion of cases are people who traveled to Mexico, Besser said.

The ages of those in the U.S. who got swine flu now range from 1 month to 87. More than half are under 18.

In the new report, CDC scientists discussed what's known about the swine flu virus. It has a unique combination of genes from flu viruses seen in birds, humans and pigs from not only North America but also Europe and Asia.

"There are no really close relatives, nothing we can say was an immediate precursor," said Michael Shaw, a CDC microbiologist.

It's still not clear how the combination occurred. Pigs from the Americas are imported into Europe and Asia for breeding purposes, but not the other way around, CDC officials said. Yet the virus first surfaced in California and Mexico.

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On the Net:

CDC swine flu web site: http://www.cdc.gov/h1n1flu/

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FDA: Kids at risk from testosterone gel

WASHINGTON – A little testosterone might be good for adults, but it can cause serious harm to children, federal health officials warned Thursday. The Food and Drug Administration said adults using prescription testosterone gel must be extra careful not to get any of it on children to avoid causing serious side effects.

These include enlargement of the genital organs, aggressive behavior, early aging of the bones, premature growth of pubic hair, and increased sexual drive.

Boys and girls are both at risk.

The agency ordered its strongest warning on the products — a so-called black box.

The problems arise if adults don't wash their hands well.

Also, since testosterone gel is usually applied to the upper arms or shoulders, adults must cover up to keep kids from accidentally touching a spot that has the medicine on it.

Testosterone gel is used by men whose bodies no longer make the sex hormone, or who have very low levels of it. Doctors sometimes prescribe it to women to increase sexual drive, although the FDA has not approved that use.

U.S. pharmacies dispensed about 1.8 million prescriptions in 2007 for testosterone gel, with the leading brand, AndroGel, accounting for about three-fourths of the sales.

"These drugs are approved for an important medical need, but can have serious unintended side effects if not used properly," Dr. Janet Woodcock, director of the FDA's drug division, said in a statement. "We must ensure that the adults using them are well-informed about the precautions needed to protect children."

Although current drug warnings recommend that people using the gels wash and cover up, some patients are apparently not heeding the advice.

The FDA said it received reports of eight cases since the beginning of December in which children were accidentally exposed to testosterone gels. The kids ranged in age from nine months to five years. Only a small fraction of cases in which there is a problem with a drug are reported to the FDA, so there could be many more.

Health officials said in most cases the signs and symptoms went away once testosterone gel was identified as the cause of the problem and adults took the proper precautions.

But in some children, enlarged sex organs did not return to their appropriate size, and bone age remained somewhat higher than the child's chronological age. One child underwent surgery because the link to testosterone gel was not recognized right away.

Health officials are recommending that adults who use testosterone gel wash their hands with warm soap and water after each use and cover their skin after the gel has dried. Pregnant women, and those who may become pregnant, should avoid any exposure, since it could lead to birth defects.

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On the Net:

FDA press release: http://tinyurl.com/dnkyeo

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WHO: up to 2 billion people might get swine flu

GENEVA – The World Health Organization says up to 2 billion people could be infected by swine flu, if the current outbreak turns into a pandemic.

WHO flu chief Keiji Fukuda says the number wasn't a prediction, but that past experience with flu pandemics indicated one-third of the world's population gets infected.

Fukuda says that with a world population of 6 billion people, it's "reasonable" to expect that kind of infection tally.

He said WHO is unable to know what the future holds, and it is impossible now to say whether the pandemic would be mild or severe.

WHO has said it believes a global swine flu outbreak is imminent, and last week it raised its alert to five, one step short of a pandemic.
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