MEXICO CITY – On the western edge of Mexico's capital, 10 new luxury apartment towers promise an antiseptically modern lifestyle with spas, private playgrounds and an exclusive shopping center. Blocks away, a world-class private hospital has opened.
But there's no escaping the view from these $1.5 million apartments: Just across a ravine is a slum where maids and construction workers make do in crowded, humid homes of raw concrete and spotty drinking water. For them, getting sick means medicating themselves at a discount pharmacy, or waiting for hours in an overcrowded public hospital.
Wealthy Mexicans aren't alone in trying — and failing — to distance themselves from deprivation and disease. People all over the world want to protect their families from the problems of the less fortunate.
But if there's anything we've learned from the swine flu epidemic, it is this: the virus doesn't discriminate.
"We're all in this together," President Barack Obama said as he urged public health agencies to reach all corners of America. "When one person gets sick, it has the potential of making us all sick."
The outbreak might not have become an epidemic if Mexico's first swine flu victims had been identified and treated quickly. We now know that for most, the virus causes only mild symptoms, and that nearly all of those who become quite sick can recover if they get proper treatment within 48 hours.
We also know that most of Mexico's dead didn't get that treatment in time.
But it feels awfully late to be pointing fingers over initial delays. And by ordering a nationwide shutdown last week of public gathering places where flu can spread, Mexico saved many more lives, experts say.
Now the world must face what Mexicans learned as they stayed home from schools and restaurants, venturing outside fearfully in face masks only to replenish their refrigerators: Rich and poor breathe the same air. The 53 people killed around the world so far range from poor day laborers to the grandson of one of the richest men in Mexico.
It's a moral challenge, as clear now as the view from those luxury living room windows: When vast numbers of poor people lack decent health care, no one is immune from disease.
A rural bricklayer with a bad cough, a kindergartner in a remote mountain village, a maintenance worker in a vast urban slum — these swine flu cases might have seemed a world away from the United States and Europe.
But it takes just four hours by bus for workers to reach the capital from the pig-farming community of La Gloria, where hundreds of villagers were suffering from acute respiratory infections for weeks before one of their kindergartners became Mexico's earliest confirmed swine flu case.
It takes even less time to fly from Mexico City to the U.S., where this strange new strain of swine flu was first identified in a 10-year-old San Diego boy.
No one knows yet where this outbreak began. Despite calls to close the U.S. border, scientists say the deadly chimera — a blend of bird, human and pig flu genes for which humans have limited natural immunity — may have jumped from pigs to humans in North Carolina, about 10 years and 10,000 generations of virus ago.
Millions of dollars have been spent on pandemic preparedness since scientists realized flu could jump between species. Top flu experts even developed a detailed containment plan — with an extremely limited window of opportunity.
World Health Organization experts determined that a virus with pandemic potential would have to be identified, the epicenter quarantined and 80 percent of the initially affected population blanketed with antiviral drugs within three weeks of the first symptoms.
Oh, and the outbreak would have to be limited to a small geographic area — like a remote village of about 1,000 people.
This H1N1 virus was likely spreading all over Mexico and parts of the United States long before anyone got sick enough to be tested. By the time the wheezing, sneezing villagers of La Gloria complained enough for their samples to be taken, dozens had been commuting to Mexico City for weeks.
Before anyone knew this flu's name, cases were popping up all over the megalopolis of 20 million.
A Canadian lab quickly confirmed that swine flu had reached Mexico, and a global alarm was raised. But only hours later, the WHO said it was useless to close borders and ban flights. Travelers had already carried the virus from Mexico to New York and New Zealand. It has since spread to at least 29 countries around the world.
So now Mexico's challenge has become a truly global problem. Experts say even normal seasonal flu infects millions and kills about 500,000 people worldwide every year. With the WHO warning that a possible swine flu pandemic could infect 2 billion people, how on earth can we protect the whole world?
The drug makers say they can "most likely" produce 917 million doses in 10 months, a number considered overly ambitious by some experts.
Even the first vaccines won't be ready for months — too late for the Southern Hemisphere, where flu season is about to start. And if the virus evolves into something more contagious or deadly — possibly by mixing with regular flu or even H5N1 bird flu, which is endemic in parts of Asia and Africa — these vaccines may not provide much protection in the end.
Antiviral drugs will be critical if it comes to that, but they are expensive, and there aren't enough to go around. The largest stockpiles are kept by the wealthiest nations, for their own citizens' protection.
But hoarding antivirals could backfire. A 2007 study modeled what would happen in a flu pandemic if wealthy nations hoard or share these drugs.
They concluded that the hardest-hit populations should be blanketed with antivirals, even if they are too poor to pay for them, and even if it means people with reliable health care in wealthier nations would go untreated.
Doing so would save many millions of lives, they found — including in the wealthy countries that share.
Nobody knows where this current outbreak is headed as the swine flu virus evolves. It may lose its potency.
Or it may become a real killer. And if that happens, there will be some hard decisions to make.
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Minggu, 10 Mei 2009
With swine flu, we're all in this together
US, Costa Rica swine flu deaths reported
SEATTLE – The number of swine flu-related deaths outside Mexico has inched up to five with the U.S. reporting its third fatality and Costa Rica its first, both involving men who also had underlying illnesses.
The number of confirmed cases of the infection in the U.S. has risen to 2,532 in 44 states, the Centers for Disease Control and Prevention reported Sunday.
Washington state health officials said the victim there was a man in his 30s who had underlying heart conditions and viral pneumonia when he died Thursday from what appeared to be complications from swine flu. The state Department of Health said in a statement Saturday that swine flu was considered a factor in his death.
"We're working with local and federal partners to track this outbreak," said Washington State Secretary of Health Mary Selecky.
The man was not further identified. He began showing symptoms on April 30, and was treated with anti-viral medication. Dr. Gary Goldbaum, Snohomish Health District medical director, said medical officials hadn't been able to isolate any "risk factors" for the man to identify where he might have been exposed.
The death of a 53-year-old man in Costa Rica on Saturday was the first involving swine flu outside North America. He also suffered from diabetes and chronic lung disease, the Health Ministry said.
Most of the victims in Mexico, the center of the outbreak where 48 people with swine flu have died, have been adults aged 20 to 49, and many had no reported complicating factors.
Previously, U.S. authorities reported swine flu deaths of a toddler with a heart defect and a woman with rheumatoid arthritis, and Canadian officials said the woman who died there also had other health problems but gave no details.
Mexico, which raised its count of confirmed cases to 1,626 based on tests of earlier patients, has been gradually lifting a nationwide shutdown of schools, businesses, churches and soccer stadiums.
But an upswing in suspected — though not confirmed — cases in parts of Mexico prompted authorities in at least six of the country's 31 states to delay plans to let primary school students return to class Monday after a two-week break.
"It has been very stable ... except for those states," Health Department spokesman Carlos Olmos said, referring to states in central and southern Mexico.
Mexican health authorities released a breakdown of the first 45 of the country's 48 flu deaths that showed that 84 percent of the victims were between the ages of 20 and 54. Only 2.2 percent were immune-depressed, and none had a history of respiratory disease.
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Marshall reported from Seattle; Jimenez reported from San Jose, Costa Rica.
news source www.news.yahoo.com
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Health overhaul draws groups' competing demands
WASHINGTON – Patients and doctors. Small businesses and multinationals. Retirees, workers and insurance companies.
Some have more money and clout. All have something in common when it comes to overhauling health care: a huge stake in the outcome.
Their competing demands will help determine what happens as Congress writes legislation to reshape the nation's $2.5 trillion health care system to bring down costs and cover 50 million uninsured people. If the whole undertaking starts to fall apart, look to opposition from one or more of these groups as the reason why.
All say their goal is for everyone to have access to quality and affordable care. Beyond that, consensus breaks down.
A look at 10 groups with the most influence, or most at stake, in the health debate, and what they want and are trying to avoid:
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Workers:
Some 60 percent of people under age 65 get health care through an employer. But employers don't have to offer health insurance, and as the economy frays, some are dropping it. Labor unions want to require employers to help pay for coverage for their employees.
Unions also believe the path to affordable care runs through a new public insurance plan that would compete with private plans. Middle-class workers, for the first time, would have the option of government insurance. Proponents of this approach, already embraced by President Barack Obama and many Democrats, believe it would drive down costs for all.
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People with health conditions:
A common complaint about insurers is that they won't cover people with existing health conditions or that they charge them too much. Patients' advocacy groups want to require insurers to cover all comers, not just the healthy, and limit what they can charge the sick. They contend that would spread risk and costs throughout the population.
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Older people:
Among the top goals for AARP is ensuring health coverage for people age 50-64 (at 65 they can get Medicare). That could be done by allowing middle-aged people to buy into Medicare. AARP also is eager for Congress to fix the coverage gap in the Medicare drug benefit that patients fall into once their prescription expenses exceed about $2,700.
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Uninsured people:
The estimated 50 million uninsured people in the U.S. don't have lobbyists, but various advocacy groups aim to speak on their behalf. The liberal group Health Care for America Now says any health overhaul should mean coverage for everyone by including a public plan, basing out-of-pocket costs on ability to pay and providing a standard benefit with preventive care and treatment for serious and chronic diseases.
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Insurance companies:
For private insurers, the bogeyman is competition from the government. They contend a public plan would drive them out of business. To stave that off, the industry is offering to curb its practice of charging higher premiums to people with a history of medical problems, as long as Congress requires all Americans to get insurance.
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Small businesses:
Opposition from small business helped kill a health care overhaul during the Clinton years. Their top goal remains the same: to avoid any kind of requirement for employers to provide health care. The National Federation of Independent Business says that is unacceptable and favors subsidies to help people buy insurance. Small businesses want to make the same tax breaks for health insurance available to all, not just those who get coverage through an employer.
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Big businesses:
Even though most big businesses offer health care to their employees, they strongly oppose an employer mandate, fearing the government would start dictating what kind of policies they could offer. Businesses want to avoid taxes on the health insurance benefits.
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Hospitals:
Hospitals worry that a new government insurance plan would reduce the fees they can collect. They support requirements for individuals and employers to purchase insurance so "everyone plays a role in making sure that there's coverage," says Tom Nickels, a senior vice president at the American Hospital Association.
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Doctors: Doctors have similar concerns as hospitals about a public plan. They also want to prevent insurers from raising rates on patients with health problems. They would cap or eliminate tax breaks for employer-provided benefits, using the revenue to subsidize care for low-income people. Doctors want curbs on medical malpractice awards so they don't face the threat of huge jury awards. They contend that leads to "defensive medicine" — performing unnecessary procedures to avoid getting sued.
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Drug companies:
The drug lobby opposes a government insurance plan and has joined the advocacy group Families USA in proposing to cover more of the uninsured by expanding Medicaid, the federal-state insurance program for the poor. Pharmaceutical companies support federal subsidies to help middle-class people unable to afford insurance. Drug companies oppose efforts to squeeze bigger discounts from them under Medicaid.
"We don't want bureaucrats making the decisions about what medicines can be used by the patients of our country and that's the end result of a pure public plan," says Billy Tauzin, head of the Pharmaceutical Research and Manufacturers of America.
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On the Net:
Pharmaceutical Research and Manufacturers of America: http://www.phrma.org/
American Hospital Association: http://www.aha.org/
National Federation of Independent Business: http://www.nfib.com/
AFL-CIO: http://www.aflcio.org/
AARP: http://www.aarp.org/
America's Health Insurance Plans: http://www.ahip.org
American Medical Association: http://www.ama-assn.org/
Families USA: http://www.familiesusa.org/
Health Care for America Now: http://www.healthcareforamericanow.org/
news source www.news.yahoo.com
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Flu exposes flaws in Mexico's health care system
MEXICO CITY – Mexicans will do almost anything to avoid a public hospital emergency room, where ailing patients may languish for hours slumped on cracked linoleum floors that smell of sweat, sickness and pine-scented disinfectant.
Many don't see doctors at all, heading instead to the clerk at the corner pharmacy for advice on coping with a cold or a flu.
So it's no surprise that when a dangerous new swine flu virus began to sweep across Mexico, many waited too long to seek medical help — more than a week on average, according to federal Health Secretary Jose Angel Cordova.
These initial delays complicated treatment, possibly explaining why 48 of the world's 52 confirmed swine flu-linked deaths occurred in Mexico.
It also made it more difficult for Mexico to recognize the outbreak for what it was. By the time Cordova announced a swine flu epidemic on April 23, the virus had already spread across the country and beyond.
Mexico's big cities have fancy private hospitals stocked with modern equipment and staffed with U.S. board-certified specialists. Americans increasingly come to Mexico for good care at low prices. The best of the public system is world-class too, with top doctors at elite centers for specialized diseases.
But Mexico's everyday public hospital system is in crisis.
Some patients suspected of having swine flu told The Associated Press that public hospitals turned them away or forced them to wait for hours for treatment even after the government declared a national emergency.
Those who sought help before the alert — often arriving with headaches, high fevers and difficulty breathing — encountered baffled doctors who had not been warned to watch for a new virus.
Mexicans navigate a patchwork of public and private hospital systems. There are hospitals for government employees and hospitals for workers enrolled in government health plans through private employers. Most patients have to go to a hospital tied to a specific agency.
"If someone is sick, he can't simply say, 'I'm going to the doctor' or 'I'm going to the hospital,' because it depends on whether he has Social Security or if he has to go to another institution," said Dr. Malaquias Lopez Cervantes, a leading epidemiologist at Mexico's National Autonomous University.
"And if he comes (to the wrong hospital), somebody is going to tell him that he doesn't have the right to be treated."
While access to health care is a right enshrined in the Mexican constitution, millions of Mexicans have no health insurance at all.
Mexico spends only 6.6 percent of its gross domestic product on health care — less than half the U.S. figure. No country in the 30-nation Organization for Economic Cooperation and Development puts a smaller share of public money into its health care system.
That means the hospitals serving most of Mexico's 44 million poor are often crowded, ill-equipped and staffed with harried, underpaid staff working for a dizzying array of bureaucracies.
It's so crowded, confusing and bureaucratic that the poor are more likely to head for a pharmacy, hoping to find a cheap remedy for "gripe" (pronounced GREE-pay) — a word that can cover anything from a mild cold to a deadly flu.
Most pharmacies dole out antibiotics and a host of other powerful drugs without a prescription. That encourages Mexicans to self-medicate, relying on a counter clerk's suggestion, dosing themselves with whatever worked the last time they had a fever and waiting a day or two to see what happens.
Some pharmacies even drum up business by tacking a doctor's office onto the side — offering basic checkups for as little as 25 pesos ($2) — still roughly half a day's pay for a minimum-wage worker.
In Mexico City's working-class Padierna neighborhood, Dr. Oscar Aguilera sees patients in a small office at the back of a discount pharmacy, with an open-air waiting room behind a row of graffiti-tagged taco stands.
Even in normal times, most of his patients come in with a cold or a flu. Most now show no signs of swine flu, he said, but "20 percent show some symptoms and we send them to the hospital."
Following the public alert on April 23, fear has driven patients to his office even at the slightest symptom.
Mexicans with flu symptoms might have sought better care far earlier if the public health care system had done the same kind of flu surveillance common in the U.S. and other developed nations.
Mexico keeps close watch on dangerous tropical diseases such as dengue, but epidemiologists pay less attention to flu, just one class of viruses contributing to Mexico's 23 million annual cases of respiratory illness.
Mexican doctors "really were not trained thinking of the existence of influenza" as a specific threat, Lopez Cervantes said.
In all of 2008, Mexico's official epidemiological bulletin reported only 151 confirmed cases of flu. By comparison, U.S. officials ran tests that confirmed nearly 40,000 flu cases last season. Mexico has about a third the population of the United States.
Research suggests children can recover from autism
CHICAGO – Leo Lytel was diagnosed with autism as a toddler. But by age 9 he had overcome the disorder.
His progress is part of a growing body of research that suggests at least 10 percent of children with autism can "recover" from it — most of them after undergoing years of intensive behavioral therapy.
Skeptics question the phenomenon, but University of Connecticut psychology professor Deborah Fein is among those convinced it's real.
She presented research this week at an autism conference in Chicago that included 20 children who, according to rigorous analysis, got a correct diagnosis but years later were no longer considered autistic.
Among them was Leo, a boy in Washington, D.C., who once made no eye contact, who echoed words said to him and often spun around in circles — all classic autism symptoms. Now he is an articulate, social third-grader. His mother, Jayne Lytel, says his teachers call Leo a leader.
The study, funded by the National Institute of Mental Health, involves children ages 9 to 18.
Autism researcher Geraldine Dawson, chief science officer of the advocacy group Autism Speaks, called Fein's research a breakthrough.
"Even though a number of us out in the clinical field have seen kids who appear to recover," it has never been documented as thoroughly as Fein's work, Dawson said.
"We're at a very early stage in terms of understanding" the phenomenon, Dawson said.
Previous studies have suggested between 3 percent and 25 percent of autistic kids recover. Fein says her studies have shown the range is 10 percent to 20 percent.
But even after lots of therapy — often carefully designed educational and social activities with rewards — most autistic children remain autistic.
Recovery is "not a realistic expectation for the majority of kids," but parents should know it can happen, Fein said.
Doubters say "either they really weren't autistic to begin with ... or they're still socially odd and obsessive, but they don't exactly meet criteria" for autism, she said.
Fein said the children in her study "really were" autistic and now they're "really not."
University of Michigan autism expert Catherine Lord said she also has seen autistic patients who recover. Most had parents who spent long hours working with them on behavior improvement.
But, Lord added, "I don't think we can predict who this will happen for." And she does not think it's possible to make it happen.
The children in Fein's study, which is still ongoing, were diagnosed by an autism specialist before age 5 but no longer meet diagnostic criteria for autism. The initial diagnoses were verified through early medical records.
Because the phenomenon is so rare, Fein is still seeking children to help bolster evidence on what traits formerly autistic kids may have in common. Her team is also comparing these children with autistic and non-autistic kids.
So far, the "recovered" kids "are turning out very normal" on neuropsychological exams and verbal and nonverbal tests, she said.
The researchers are also doing imaging tests to see if the recovered kids' brains look more like those of autistic or nonautistic children. Autistic children's brains tend to be slightly larger than normal.
Imaging scans also are being done to examine brain function in formerly autistic kids. Researchers want to know if their "normal" behavior is a result of "normal" brain activity, or if their brains process information in a non-typical way to compensate for any deficits.
Results from those tests are still being analyzed.
Most of the formerly autistic kids got long-term behavior treatment soon after diagnosis, in some cases for 30 or 40 hours weekly.
Many also have above-average IQs and had been diagnosed with relatively mild cases of autism. At age 2, many were within the normal range for motor development, able to walk, climb and hold a pencil.
Significant improvement suggesting recovery was evident by around age 7 in most cases, Fein said.
None of the children has shown any sign of relapse. But nearly three-fourths of the formerly autistic kids have had other disorders, including attention-deficit problems, tics and phobias; eight still are affected.
Jayne Lytel says Leo sometimes still gets upset easily but is much more flexible than before.
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On the Net
National Institute of Mental Health: http://www.nimh.nih.gov
Autism Speaks: http://www.autismspeaks.org/
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Kamis, 07 Mei 2009
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
news source www.news.yahoo.com
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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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Rabu, 06 Mei 2009
Plenty of flu caution as Mexico returns to work
MEXICO CITY – In gleaming office towers and gritty markets, Mexicans returned to work Wednesday after a five-day swine flu shutdown, and dozens returned to a heroes' welcome from "humiliating" quarantines in China. But Mexico's death toll rose, feeding fears of more infections now that crowds are gathering again.
The World Health Organization urged countries not to quarantine visitors or impose trade restrictions without scientific reasons. But China defiantly justified its quarantines as protection for its densely populated cities. And even impoverished Haiti turned away a Mexican ship carrying desperately needed food aid because of flu fears.
In Mexico City, friends and co-workers greeted each other with back slaps, firm handshakes — and dollops of hand sanitizer. Some high-rises stationed doctors in their lobbies who questioned returning employees and required visitors to fill out forms stating they had no flu symptoms. Maitre d's in surgical masks stood at attention amid rows of sidewalk tables that were pulled out and washed down for the first time in days.
"We're returning to normal," said Eugenio Velis, 57, a graphic artist sipping coffee with friends in the trendy Condesa neighborhood.
But Ernesto Viloria, 40, worried about his children using public transit and returning to school.
"Nothing can be the same," insisted Viloria, who works in finance. "The virus continues, even though it's declining, and we have to pay attention."
Mexico's government said the shutdown reduced the spread of the virus at its epicenter. Deaths have slowed as the country mobilized an aggressive public health response to the epidemic that has sickened thousands in 24 countries.
Sweden and Poland were the latest countries to confirm swine flu cases, both in women who had recently visited the U.S.
In Mexico, the confirmed death toll reached 42 Wednesday — mostly as backlogged cases got tested, but also two new deaths on Tuesday. It also confirmed more than 1,100 nonfatal cases. Eighty percent of Mexico's swine flu infections have been in and around the capital, and a majority of the dead were between 20 and 39 years old.
There was some concern that Mexico was relaxing too quickly, especially with high schools and universities reopening Thursday, and primary schools reopening next week. While "filter teams" prepared to screen out sick students and teachers, epidemiologists warn that the virus has spread throughout Mexico, and could bounce back.
"We have seen a tendency (of the outbreak) to diminish but not disappear," Health Secretary Jose Angel Cordova acknowledged.
Indeed, this swine flu seems to have a long incubation period — 5-7 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. And that means the virus can keep being spread by people who won't know to stay home.
While restaurants opened, Mexico City's government indefinitely closed bars, discos, gymnasiums, movie theaters and dance halls. Sports halls and arenas were allowed to reopen only at half capacity. Archaeological sites began reopening Wednesday, with museums to follow.
From gritty taco stands to the Cartier store on Mexico City's version of Rodeo Drive, people were glad to be back at work.
Jesus Cortez, 43, manned El Taquito Veloz, "The Speedy Little Taco," in the rough Tepito neighborhood, offering roasted pork on a spit as its specialty — tacos al pastor. Nearby, workers sliced chunks of meat from a boiled steer's skull, flanked by cilantro branches.
"People are just starting to come back out, but they're still afraid," Cortez said. "We're going to have to open on Sundays now, and we're going to have to work really hard. If not, we're not going to make enough money."
Cartier manager Paula Guerra, 34, waited out the furlough in Valle de Bravo, a lakeside retreat for Mexico City's well-to-do, and returned Wednesday blowing air kisses to her employees through her surgical mask. But she, too, was hoping to make up for lost sales — in Mother's Day merchandise.
Rafael Ramirez, 65, rushed to the just-reopened Metropolitan Cathedral to pray to a Christ statue known as the Lord of Health, which the church brought out from storage for the first time in 300 years.
"I gave thanks that the city is returning to normal, and prayed so countries stop looking down their noses at us," Ramirez said.
Mexico has protested Chinese quarantines and China's cancellation of direct flights between the countries as discriminatory.
First lady Margarita Zavala was up before dawn to greet 136 Mexicans who were flown home from China on a government charter. None had flu symptoms, Mexican diplomats said.
While Zavala pointedly removed her face mask and smiled broadly as she welcomed the Mexicans home, the scene in Shanghai was far different: 119 returning Chinese gamely waved their country's flags as health workers in full body suits escorted them into a weeklong quarantine.
Several Mexican passengers said they were treated well in China. Others begged to differ.
"It was discrimination and humiliation in my case," said Myrna Berlanga, who said she was taken off a flight from the United States and put in a mobile laboratory for five hours without food, water or a bathroom. "They took me out because of my passport."
Haitian officials said they would not accept a Mexican navy ship carrying 77 tons of rice, fertilizer and emergency food kits, said Mexico's ambassador, Zadalinda Gonzalez y Reynero. She said Haiti asked for the ship to come "on another occasion."
Haitian officials had no immediate comment.
In San Diego, Calif., the U.S. Navy canceled the deployment of the USS Dubuque, an amphibious transport ship, after a crew member was confirmed to have swine flu. About 50 others were suspected cases, and all crew members were being treated with anti-viral drugs.
The ship was to leave June 1 on a humanitarian mission to the South Pacific, Navy spokesman Lt. Sean Robertson said.
And the Philippines urged boxing idol Manny Pacquiao to postpone a triumphant return home after beating Ricky Hatton in Las Vegas, saying a motorcade in Manila could risk spreading the virus through adoring crowds. There are no confirmed cases in the Philippines.
In Washington, officials with the U.S. Centers for Disease Control and Prevention said they identified genetic characteristics of the virus and were in position to produce a vaccine if one is needed.
Dr. Dennis Carroll, a special adviser on pandemics with the U.S. Agency for International Development, said investments to stave off an avian flu epidemic aided the quick swine flu response.
Canada, meanwhile, said researchers at the National Microbiology Laboratory in Winnipeg, Manitoba, genetically sequenced three samples of the virus from Mexico and Canada, a breakthrough they hope will answer questions about how it spreads and mutates.
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Associated Press writers Margie Mason, Mark Stevenson, Lisa J. Adams and Juan Carlos Llorca in Mexico City and Jonathan M. Katz in Port-au-Prince contributed to this report.
Selasa, 05 Mei 2009
Nation's first face transplant patient shows face
CLEVELAND – Five years ago, a shotgun blast left a ghastly hole where the middle of her face had been. Five months ago, she received a new face from a dead woman. Connie Culp stepped forward Tuesday to show off the results of the nation's first face transplant, and her new look was a far cry from the puckered, noseless sight that made children run away in horror.
Culp's expressions are still a bit wooden, but she can talk, smile, smell and taste her food again. Her speech is at times a little tough to understand. Her face is bloated and squarish, and her skin droops in big folds that doctors plan to pare away as her circulation improves and her nerves grow, animating her new muscles.
But Culp had nothing but praise for those who made her new face possible.
"I guess I'm the one you came to see today," the 46-year-old Ohio woman said at a news conference at the Cleveland Clinic, where the groundbreaking operation was performed. But "I think it's more important that you focus on the donor family that made it so I could have this person's face."
Up until Tuesday, Culp's identity and how she came to be disfigured were a secret.
Culp's husband, Thomas, shot her in 2004, then turned the gun on himself. He went to prison for seven years. His wife was left clinging to life. The blast shattered her nose, cheeks, the roof of her mouth and an eye. Hundreds of fragments of shotgun pellet and bone splinters were embedded in her face. She needed a tube into her windpipe to breathe. Only her upper eyelids, forehead, lower lip and chin were left.
A plastic surgeon at the Cleveland Clinic, Dr. Risal Djohan, got a look at her injuries two months later. "He told me he didn't think, he wasn't sure, if he could fix me, but he'd try," Culp recalled.
She endured 30 operations to try to fix her face. Doctors took parts of her ribs to make cheekbones and fashioned an upper jaw from one of her leg bones. She had countless skin grafts from her thighs. Still, she was left unable to eat solid food, breathe on her own, or smell.
Then, on Dec. 10, in a 22-hour operation, Dr. Maria Siemionow led a team of doctors who replaced 80 percent of Culp's face with bone, muscles, nerves, skin and blood vessels from another woman who had just died. It was the fourth face transplant in the world, though the others were not as extensive.
"Here I am, five years later. He did what he said — I got me my nose," Culp said of Djohan, laughing.
In January, she was able to eat pizza, chicken and hamburgers for the first time in years. She loves to have cookies with a cup of coffee, Siemionow said.
No information has been released about the donor or how she died, but her family members were moved when they saw before-and-after pictures of Culp, Siemionow said.
Culp said she wants to help foster acceptance of those who have suffered burns and other disfiguring injuries.
"When somebody has a disfigurement and don't look as pretty as you do, don't judge them, because you never know what happened to them," she said. "Don't judge people who don't look the same as you do. Because you never know. One day it might be all taken away."
It's a role she has already practiced, said clinic psychiatrist Dr. Kathy Coffman.
Once while shopping, "she heard a little kid say, `You said there were no real monsters mommy, and there's one right there,'" Coffman said. Culp stopped and said, "I'm not a monster. I'm a person who was shot," and pulled out her driver's license to show the child what she used to look like, the psychiatrist said.
Culp, who is from the small town of Unionport, near the Pennsylvania line, told her doctors she just wants to blend back into society. She has a son and a daughter who live near her, and two preschooler grandsons. Before she was shot, she and her husband ran a painting and contracting business, and she did everything from hanging drywall to a little plumbing, Coffman said.
Culp left the hospital Feb. 5 and has returned for periodic follow-up care. She has suffered only one mild rejection episode that was controlled with a single dose of steroid medicines, her doctors said. She must take immune-suppressing drugs for the rest of her life, but her dosage has been greatly reduced and she needs only a few pills a day.
Also at the Cleveland Clinic is Charla Nash of Stamford, Conn., who was attacked by a friend's chimpanzee in February. She lost her hands, nose, lips and eyelids, and will be blind, doctors said. Clinic officials said it is premature to discuss the possibility of a face transplant for her.
In April, doctors at Harvard-affiliated Brigham and Women's Hospital in Boston performed the nation's second face transplant, on a man disfigured in a freak accident. It was the world's seventh such operation. The first, in 2005, was performed in France on Isabelle Dinoire, a woman who had been mauled by her dog.
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On the Net:
Cleveland Clinic: http://www.clevelandclinic.org/face
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Ga. man stable after 1st US double hand transplant
PITTSBURGH – Teams of surgeons performed the nation's first double hand transplant on a man whose hands and feet were ravaged by a bacterial infection a decade ago and who hoped to once again be able to hold his daughter.
Jeff Kepner, 57, of Augusta, Ga., underwent surgery lasting just under nine hours Monday at the University of Pittsburgh Medical Center, where surgeons worked on each hand simultaneously, a hospital spokeswoman said.
He was in critical but stable condition Tuesday at the hospital's transplant intensive care unit, spokeswoman Amy Dugas Rose said.
Rose did not have information about the donor. The hospital was expected to release more details later this week.
Kepner, a native of Lancaster, Pa., told the Sunday News of Lancaster before his surgery he was looking forward to holding his 13-year-old daughter, who was 3 when he lost his hands and feet.
His surgery was done using a technique developed at UPMC called the Pittsburgh Protocol, which aims to reduce the amount of toxic medication that must be taken to suppress the immune system so the body doesn't reject the new hands. The toxic medication can lead to an increase in the risk for diabetes, infections and other complications.
Under the protocol, Kepner was given antibodies the day of the transplants and will be given bone marrow from the hand donor over the next several days. Instead of a variety of anti-rejection medications, he should have to take just one.
Eight double hand transplants have been performed abroad. Last month, French physicians performed the world's first simultaneous partial face and double hand transplant.
Five U.S. hand transplants have been done at Jewish Hospital Heart and Lung Center of Louisville, Ky.
In March, UPMC performed its first hand transplant, on a Marine who lost his right hand when a quarter-stick of dynamite blew up in it during a training exercise in Quantico, Va.
The first U.S. hand transplant was performed in January 1999, on a New Jersey man who lost his hand in 1985 in an M-80 firecracker blast.
The first hand transplant was done in Ecuador in 1964, but the patient's body rejected the hand after two weeks.
Texan dies of swine flu; Mexico ready for business
MEXICO CITY – Mexico emerged from its swine flu isolation Tuesday as thousands of newspaper vendors, salesmen hawking trinkets and even panhandlers dropped their protective masks and joined the familiar din of traffic horns and blaring music on the streets of the capital.
There were still signs, however, of the virus that set off world health alarms. A Texas woman who lived near a popular border crossing was confirmed as the 28th person — only the second outside Mexico and the first U.S. resident — to die from the virus.
Across Mexico, people were eagerly anticipating this week's reopening of businesses, restaurants, schools and parks, after a claustrophobic five-day furlough.
"We have a lot of confidence nothing is going to happen," said Irineo Moreno Gonzales, 54, a security guard who Tuesday limited takeout customers to four at a time at a usually crowded downtown Starbucks. "Mexicans have the same spirit we've always had. We're ready to move forward."
The Texas woman, the second to die of swine flu in the U.S., lived not far from the Mexico border and had chronic medical conditions, as did the Mexico City toddler who died of swine flu last week during a visit to Houston, Texas, health officials said.
The 33-year-old woman was pregnant and delivered a healthy baby while hospitalized, said Leonel Lopez, Cameron County epidemiologist. She was a teacher in the Mercedes Independent School District, which announced it would close its schools until May 11.
Mexico's government imposed the shutdown to curb the flu's spread, especially in this metropolis of 20 million where the outbreak sickened the most people. Capital residents overwhelmingly complied, and officials cautiously hailed the drastic experiment as a success.
But by Tuesday, pedestrians — many wearing protective masks, many not — were back to dodging the familiar green-and-white VW taxis cruising for fares and noisy heavy trucks bearing bottled water.
Some officials worried about a sudden rush toward normalcy, though no Mexican swine flu deaths have been confirmed since April 29.
"The scientists are saying that we really need to evaluate more," said Dr. Ethel Palacios, the deputy director of the swine flu monitoring effort here. "In terms of how the virus is going to behave, we are keeping every possibility in mind. ... We can't make a prediction of what's going to happen."
Palacios acknowledged the enormous responsibilities that come with balancing the public's health and economic welfare.
"One of most the important things is that you need to know that these measures do have an impact not only on health but also on other aspect of life and society," Palacios said.
With 840 people sickened in Mexico at last count, public celebrations of Cinco de Mayo were banned, and politicians' homage to the soldiers who fought off the French 147 years ago were subdued.
For the first time in decades, Mexico canceled the popular re-enactment of its May 5, 1862, victory over invading French troops in the central state of Puebla. Another traditionally boisterous Cinco de Mayo party in Mexico City's central plaza, the Zocalo, will wait for another year, as will military ceremonies across the nation.
Cinco de Mayo celebrations generally attract bigger crowds in the U.S., where many Mexican-Americans gather to embrace their heritage. These crowds prompted concerns Tuesday about spreading the virus.
Denver's annual festival, which typically draws 400,000, will be held as planned this weekend, with hand sanitation stations installed at the urging of city health officials. Los Angeles won't skip its weekend celebration on historic Olvera Street. But in Chicago, the Mexican Civic Society of Illinois canceled its annual festivities because of flu concerns.
Swine flu has now sickened more than 1,600 people in 21 countries, including nearly 500 in the United States. The World Health Organization said it was shipping 2.4 million treatments of antiflu drugs to 72 countries "most in need," and France sent 100,000 doses of antiflu drugs worth $1.7 million to Mexico.
Mexican Finance Secretary Agustin Carstens unveiled plans Tuesday to stimulate key industries and fight foreign bans on Mexican pork products. He said persuading tourists to come back will be a top priority.
Carstens said the outbreak cost Mexico's economy at least $2.2 billion, and he announced a $1.3 billion stimulus package, mostly for tourism and small businesses, the sectors hardest hit by the epidemic. Mexico will temporarily reduce taxes for airlines and cruise ships and cut health insurance payments for small businesses.
U.N. Secretary-General Ban Ki-moon said he will ask governments to reverse trade and travel restrictions lacking a clear scientific basis.
About 20 Chinese businessmen and students, each wearing surgical masks, left Tijuana on Tuesday on a Chinese government flight after being stranded when China canceled all direct flights to Mexico.
Mexico, meanwhile, was collecting more than 70 Mexican nationals quarantined in China with its own charter flight.
Four U.S. citizens were quarantined in China, the U.S. Embassy in Beijing said Tuesday, and about 200 passengers who flew from the United Kingdom were under quarantine in a Brunei hospital after three of them arrived with fevers.
Mexico City recovered a bit of its ebullient self Tuesday, one day before the official reopening of stores, restaurants and factories. Only essential services like gas stations and supermarkets have been allowed to operate since April 27, and the weekend's professional soccer games will again be staged in empty stadiums.
High schools and universities were being scrubbed down to reopen Thursday. Younger children return to school on Monday.
Many people shunned their surgical masks Tuesday; a boy selling music CDs on a subway train planted a wet kiss on the unprotected cheek of a girl hawking tiny flashlights. A fruit salad vendor dished up slabs of freshly cut mango and coconut without mask and gloves.
The government is requiring businesses to keep a distance of 2 meters (yards) between customers to prevent the disease from spreading. The rule seemed unlikely to survive in the overcrowded capital.
"It's a little senseless, that people ride into town all jammed together on the subway, and the minute they enter a restaurant, they have to be 2 meters apart," said Nahum Navarette, manager of Yug, a vegetarian restaurant that was still serving only takeout on Tuesday, its dining room deserted.
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Associated Press Writer Katherine Corcoran contributed to this report.
Experts: Mild swine flu could quickly turn deadly
WASHINGTON – A flu virus is a powerhouse of evolution, mutating at the maximum speed nature allows. A mild virus can morph into a killer and vice versa.
One change already made this year's swine flu more of a problem, helping it spread more easily among people. The big question is: What mutations are next? That's why scientists are watching it so closely.
"There are no rules to flu viruses; they are just so mutable," said Dr. Paul Glezen, a flu epidemiologist at the Baylor College of Medicine in Houston. "The fact that it changes all the time really confounds our efforts to control it."
Think of flu's evolution like a family tree: In the current flu's distant ancestry are last century's three pandemics. But its more immediate relatives are swine flu strains that were no big deal to humans.
The good news right now is that this flu has lost some of the most dangerous genetic traits of past pandemics. The bad news is that it's gained something its parents didn't have: the ability to spread from human to human.
Flu reproduces about every eight hours, said Dr. Raul Rabadan, professor of computational biology at Columbia University. That means this morning's flu is a parent by the afternoon, a grandparent by the evening, and a great-grandparent by the next day.
Instead of complex double-helix DNA — nature's basic biological instruction book — flu has a simpler, single strand of genetic code. Normal DNA has a spellcheck-like system that reduces mistakes in replicating the code; the flu virus does not. So mutations come more often. If the mutations are good for the virus, they multiply, and voila, you have a new and sometimes nastier flu.
Scientists are trying to piece together swine flu's ever-changing genome, its genetic ancestors and the random mutations that in this instance turned a simple pig disease into something that scares billions.
They also don't know how the virus is going to mutate next.
In the world's most devastating global flu epidemic in 1918, the first wave of cases in the spring were mild. Then, the virus evolved and came back in the fall as a strain that proved truly deadly, flu experts say. So scientists today are watching to see if that could happen again.
Also troubling is the possibility that this virus could develop resistance to anti-flu drugs, and flu trackers are watching for such changes, Centers for Disease Control and Prevention flu chief Dr. Nancy Cox said.
It's impossible to know where this swine flu strain began exactly, Cox said. But flu trackers do have clues to its closest ancestral genes.
"Its two parents were swine viruses that we know and love," said virologist Dr. Richard Webby, a researcher at St. Jude Children's Research Hospital in Memphis, Tenn.
The mother of the swine flu was a surprising genetic event that went unnoticed except by a few scientists a little over a decade ago. Three influenza strains — some pig, some bird, some human — combined in pigs to form two new strains of swine flu. This new flu was unusual. Virus hunters called it a "triple reassortment."
That 1998-99 flu in pigs first hit a farm in North Carolina, then spread to Iowa, Texas, Oklahoma and eventually to at least 23 states. No more than 4 percent of the swine died. But the disease was in more than one-quarter of tested pigs. A handful of people who were in close contact with the hogs got slightly sick when they caught this flu from pigs, but they didn't die and didn't spread it to others.
In 2005, a 17-year-old Wisconsin boy caught that triple reassortment flu virus from "respiratory secretions" of a pig he had been helping his brother-in-law butcher, according to the CDC. He recovered and didn't pass it on to others.
There have been about 10,000 generations of that virus since. Six of the eight genetic segments of the current swine flu can be traced to that triple combination, Rabadan said.
The rest of the swine flu parentage is more of a mystery. The other two of the eight genetic segments can be traced to pig viruses in Europe and Asia that were seen from time to time in the 1990s, Rabadan said. Scientists don't quite know if those other two segments combined with the triple reassortment at the same time or separately.
How the triple reassortment genes and the European and Asian genes met and mixed is not known, Webby said.
The three global flu epidemics of the past, including the 1918 event, all passed on traits to ancestors of this flu, Rabadan said. But there have been many changes in the thousands of generations since.
A specific gene for virulence that was seen in the 1918, 1957 and 1968 pandemics was notably absent in this swine flu, said Dr. Peter Palese, a prominent flu researcher for Mount Sinai Medical Center in New York. He said when he removed that gene from other viruses of the past, they weren't as dangerous.
Rabadan suggests the way to think of this flu is like a homemade car with parts from different vehicles. The parts have all been in several different vehicles before. Sometimes the combination of parts is a dud and the car doesn't move. And sometimes you get a race car. A pandemic is a race car.
All eight of the new flu's genetic segments have been in different viruses before. But this is the first time this specific combination has been seen. The big question is: Why is this particular swine virus spreading so fast among people when past swine viruses haven't?
One possibility is that it's just this particular combination of the eight parts that makes it spread among people, Webby said. But a more logical explanation is that a small mutation within the individual genetic segments changed things.
These tiny changes are possible because there are about 13,000 individual letters, or bases, in the flu genetic code, Rabadan said. That's tiny compared to more than 3 billion in humans.
One prime suspect is the surface protein hemagglutinin, the "H" in the virus' H1N1 name. It is "probably the most important gene determining virulence and immunological characteristics," according to Palese.
In flu viruses, scientists have so far identified 16 hemagglutinins. Only three — H1, H2 and H3 — commonly infect humans. The other surface protein, neuraminidase, has nine variations. Palese said scientists are seeing more different types of flu strains because of better surveillance and increases in bird, pig and human populations.
"These genetic processes of mutation and genetic reassortment occur all the time," he said, "and every once in a time, it's a lottery winner."
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