Swine Flu Update: WHO Raises Global Alert Level

Today, we learn that the US has seen the first fatality from the swine flu. It was apparently a 23-month-old Mexican girl who came to the US with her family on a trip. To keep this in perspective, the garden-variety flu that everyone seems to ignore kills 36,000 annually while sickening anywhere from 5 to 20% of the US population.

Swine flu has yet to approach those figures yet, but it bears watching. Caution is the name of the game. Thus far, nearly 2,500 cases were reported in Mexico, with 159 fatalities.

Confirmed U.S. cases, by state: 45 in New York, 11 in California, six in Texas, two in Kansas and one each in Indiana and Ohio, according to CDC and states.

U.S. Food and Drug Administration issues emergency guidance allowing certain antiviral drugs to be used in broader range of population if needed. Public health emergency declared and roughly 12 million doses of Tamiflu from federal stockpile to be delivered to states.

Cuba bans flights to and from Mexico; Argentina suspends flights from Mexico; U.S., European Union, other countries discourage nonessential travel there. Arriving travelers questioned at Mexico's U.S. border and world airports. Cruise lines avoid Mexico ports.

Mexico suspends all schools until May 6. In U.S., some schools closed in New York City, Texas, California, South Carolina, Connecticut and Ohio.

Egypt ordering the slaughtering of entire herds of pigs isn't likely to stop the spread of the disease, especially given that the disease is now being transmitted between people. It was only the initial incidences that included transmission between pigs and people.

France is hoping to get the EU to cancel all flights to Mexico. I think the time for such measures has passed as we're seeing cases pop up all over the world, including in Germany.

Meanwhile, President Obama is basically reinforcing what has already happened in the NYC metro area. He's said that schools where outbreaks have been reported should be shuttered. That's already happened with St. Francis Prep, and it may happen with a nearby school that has seen several cases.

The CDC and health departments across the country have protocols for dealing with communicable disease outbreaks like flu, and they should be followed. There's no reason to panic unnecessarily. While the Obama Administration will take the credit for the response to the outbreak (which still suffered problems from delays in obtaining information from Mexico over the growing epidemic there), once the CDC and other health organizations received that information, they were able to plan and prepare because of the groundwork laid by the Bush Administration, who spent billions preparing for this eventuality.

However, timely and accurate information should be passed on to the public.

What is thus far a most curious situation is that virtually all of the fatalities are in Mexico. That's a question epidemiologists will have to sort out. Is it a comparatively less comprehensive health care system? Access to health care? Or is the particular strain in Mexico more deadly than the version seen elsewhere? It could be a combination of factors.

UPDATE:
Two more schools have closed in Brooklyn:

Two more New York City schools will be shuttered after students came down with confirmed cases of swine flu, an official said Wednesday.

St. Brigid's School and Good Shepherd School, both in Brooklyn, each had at least one child sickened by the virus and will be closed for the rest of the week, a diocese official told the Daily News.

That brings the number of schools in the city closed as a swine flu precaution to four, putting already anxious parents further on edge.

I expect more closures in the NYC metro area as clusters break out in different parts of the city. It would be interesting to see the connections between the various schools and whether there's some common thread. That's likely to come much later. For now, health experts are trying to limit the spread, and the closures reduce the chances that the cases will spread beyond the immediate families of those already sickened.

UPDATE:
A WHO official says that only seven deaths can be attributed to swine flu, not the widely circulated 152. All the fatalities are in Mexico. They also say that there's been only 79 confirmed cases worldwide. Well, don't that beat all when you've got various agencies not talking to each other and getting information from different sources and using different measures to describe the situation.

Compare that with the US CDC, which notes that there are 94 confirmed cases in the United States.

UPDATE:
The WHO has raised the global alert level to 5 out of a possible 6.

WHO Director-General Margaret Chan declared the phase 5 alert after consulting with flu experts from around the world. The decision could lead the global body to recommend additional measures to combat the outbreak, including for vaccine manufacturers to switch production from seasonal flu vaccines to a pandemic vaccine.

"All countries should immediately now activate their pandemic preparedness plans," Chan told reporters in Geneva. "It really is all of humanity that is under threat in a pandemic."

A phase 5 alert means there is sustained transmission among people in at least two countries. Once the virus shows effective transmission in two different regions of the world a full pandemic outbreak would be declared.

WHO has confirmed human cases of swine flu in Mexico, the United States, Canada, Britain, Israel, New Zealand and Spain. Mexico and the U.S. have reported deaths.