World Health Organization raises its pandemic alert level on swine flu

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6:48 p.m.

By E. EDUARDO CASTILLO and PAUL HAVEN
Associated Press Writers

MEXICO CITY (AP) - The World Health Organization raised its global alert level on the spreading swine flu virus Monday, but stopped short of declaring a global emergency - even as the U.S. said it was acting as if the outbreak would grow into a full pandemic.
The United States advised Americans against most travel to Mexico and ordered stepped up border checks in neighboring states. The European Union health commissioner advised Europeans to avoid nonessential travel both to Mexico and parts of the United States.
The suspected number of deaths rose to 149 in Mexico, the epicenter of the outbreak with nearly 2,000 people believed to be infected.
The number of U.S. cases doubled to 40, the result of further testing at a New York City school, although none was fatal. Other U.S. cases have been reported in Ohio, Kansas, Texas and California. Worldwide there were 73 cases, including six in Canada, one in Spain and two in Scotland.
While the total cases were still measured in hundreds, not thousands, Mexican Health Secretary Jose Angel Cordova said the epidemic was entering an extremely dangerous phase, with the number of people coming down with the disease mushrooming even as authorities desperately ramped up defenses.
"We are in the most critical moment of the epidemic. The number of cases will keep rising, so we have to reinforce preventative measures," Cordova said at a news conference.
The WHO raised the alert level to Phase 4, meaning there is sustained human-to-human transmission of the virus causing outbreaks in at least one country.
Its alert system was revised after bird flu in Asia began to spread in 2004, and Monday was the first time it was raised above Phase 3.
"At this time, containment is not a feasible option," as the virus has already spread to several other countries, said WHO Assistant Director-General Keiji Fukuda.
Putting an alert at Phases 4 or 5 signals that the virus is becoming increasingly adept at spreading among humans. That move could lead governments to set trade, travel and other restrictions aimed at limiting the disease's spread.
The WHO's Phase 6 is the pandemic phase, characterized by outbreaks in at least two regions of the world.
Many experts think it may be impossible to contain a flu virus already spreading in several countries.
Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus amid global fears of a pandemic, an epidemic spread over a large area, either a region or worldwide.
President Barack Obama said the outbreak was reason for concern, but not yet "a cause for alarm."
Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said that so far the virus in the United States seems less severe than in Mexico. Only one person has been hospitalized in the U.S.
"I wouldn't be overly reassured by that," Besser told reporters at CDC's headquarters in Atlanta, raising the possibility of more severe cases in the United States.
"We are taking it seriously and acting aggressively," Besser said. "Until the outbreak has progressed, you really don't know what it's going to do."
U.S. customs officials began checking people entering U.S. territory. Millions of doses of flu-fighting medications from a federal stockpile were on their way to states, with priority given to the five already affected and to border states. Federal agencies were conferring with state and international governments.
"We want to make sure that we have equipment where it needs to be, people where they need to be and, most important, information shared at all levels," said Janet Napolitano, head of the Homeland Security Department.
"We are proceeding as if we are preparatory to a full pandemic," Napolitano said.
She said travel warnings for trips to Mexico would remain in place as long as swine flu is detected.
Mexico canceled school at all levels nationwide until May 6, and the Mexico City government said it was considering a complete shutdown, including all public transportation, if the death toll keeps rising. Labor Secretary Javier Lozano Alarcon said employers should isolate anyone showing up for work with fever, cough, sore throat or other signs of the flu.
Amid the warnings, the Mexican government grappled with increasing criticism of its response. At least two weeks after the first swine flu case, the government has yet to say where and how the outbreak began or give details on the victims.
The health department lacked the staff to visit the homes of all those suspected to have died from the disease, Cordova said.
Cordova said 1,995 people have been hospitalized with serious cases of pneumonia since the first case of swine flu was reported April 13. The government does not yet know how many were swine flu. Of those who have died, 20 have been confirmed to be from swine flu and the government was awaiting results on the others.
As if the country did not have enough to deal with, Cordova's comments were briefly interrupted by a 5.6-magnitude earthquake in southern Mexico that rattled already jittery nerves and sent mask-wearing office workers into the streets of the capital.
Aside from the confirmed cases, 13 are suspected in New Zealand, and one is suspected in both France and Israel.
European Union Health Commissioner Androulla Vassiliou advised Europeans to avoid nonessential travel to Mexico and parts of the United States, although Besser said that including the U.S. in the advisory seemed unwarranted at this time.
State Department spokesman Robert A. Wood said Vassiliou's remarks were his "personal opinion," not an official EU position, and therefore the department had no comment.
"We don't want people to panic at this point," Wood said.
The U.S. stepped up checks of people entering the country by air, land and sea.
Besser said a new U.S. travel advisory was being prepared suggesting "nonessential travel to Mexico be avoided."
The best way to keep the disease from spreading, he said, is by taking everyday precautions such as frequent handwashing, covering up coughs and sneezes and staying away from work or school if not feeling well. He said authorities are not recommending that people wear masks at work because evidence that it is effective "is not that strong."
Besser said about 11 million doses of flu-fighting drugs from a federal stockpile have been sent to states in case they are needed. That's roughly one quarter of the doses in the stockpile, he said.
There is no vaccine available to prevent the specific strain now being seen, he said, but some antiflu drugs do work once someone is sick.
If a new vaccine eventually is ordered, the CDC already has taken a key preliminary step - creating what's called seed stock of the virus that manufacturers would use.
Many of the cases outside Mexico have been relatively mild. Symptoms include a fever of more than 100, coughing, joint aches, severe headache and, in some cases, vomiting and diarrhea.
European and U.S. markets bounced back from early losses as pharmaceutical stocks were lifted by expectations that health authorities will increase stockpiles of anti-viral drugs. Stocks of airlines, hotels and other travel-related companies posted sharper losses.
WHO spokesman Peter Cordingley singled out air travel as an easy way the virus could spread, noting that the WHO estimates that up to 500,000 people are on planes at any time.
Governments in Asia - with potent memories of previous flu outbreaks - were especially cautious. Singapore, Thailand, Japan, Indonesia and the Philippines dusted off thermal scanners used in the 2003 SARS crisis and were checking for signs of fever among passengers from North America. South Korea, India and Indonesia also announced screening.
In Malaysia, health workers in face masks took the temperatures of passengers as they arrived on a flight from Los Angeles.
China said anyone experiencing flu-like symptoms within two weeks of arrival had to report to authorities.
China, Russia and Ukraine were among the countries banning imports of pork and pork products from Mexico and three U.S. states that have reported swine flu cases, while other countries, such as Indonesia, banned all pork imports.
The CDC says people cannot get the flu by eating pork or pork products.
Germany's leading vacation tour operators were skipping stops in Mexico City as a precaution. The Hannover-based TUI said trips through May 4 to Mexico City were being suspended, including those operated by TUI itself and also through companies 1-2 Fly, Airtours, Berge & Meer, Grebeco and L'tur.
Japan's largest tour agency, JTB Corp., suspended tours to Mexico through June 30.
Russian travel agencies said about a third of those planning to travel to Mexico in early May had already canceled.

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5:11 p.m.

By PETER ORSI
Associated Press Writer

MEXICO CITY (AP) - Ominous developments Monday in the swine flu epidemic - a jump to 149 deaths and more signs that the virus can jump repeatedly from human to human - prompted the World Health Organization to raise its pandemic alert level, and governments around the world were taking tougher measures.
The virus has already spread to at least a half-dozen countries and half of Mexico. Trying to eliminate crowds, the Mexican government canceled school nationwide and considered closing the capital's subway system. Health Secretary Jose Angel Cordova said 20 deaths have been confirmed to be from swine flu and test results were pending on the others.
"We are the most critical moment of the epidemic. The number of cases will keep rising so we have to reinforce preventive measures," Cordova said at a news conference that was briefly shaken by an earthquake centered in southern Mexico.
WHO said the new phase 4 alert means sustained human-to-human transmission is causing outbreaks in at least one country, signaling a significant increase in the risk of a global epidemic, according to Mexico health department spokesman Carlos Olmos. Phase 4 doesn't mean a pandemic is inevitable, but many experts think it may be impossible to contain a flu virus already spreading in several countries.
Cordova said 1,995 people have been hospitalized with serious cases of pneumonia since mid-April, of whom 1,070 have been released. The government does not yet know how many were swine flu.
Cordova also suggested an earlier timeline for documented swine flu cases inside Mexico. The first death confirmed by the government involved a woman who succumbed from swine flu on April 13 in southern Oaxaca state. But Cordova said tests now show that a 4-year-old boy contracted the disease at least two weeks earlier in neighboring Veracruz state, where a community has been protesting pollution from a large pig farm.
The farm is run by Granjas Carroll de Mexico, a joint venture 50 percent owned by Virginia-based Smithfield Foods, Inc. Spokeswoman Keira Ullrich said the company has found no clinical signs or symptoms of the presence of swine influenza in its swine herd or its employees working at its joint ventures anywhere in Mexico.
But local residents are convinced they were sickened by air and water contamination from pig waste.
There was a widespread outbreak of a particularly powerful respiratory disease in the area early April, and some people reported being sick as early as February. Local health workers intervened in early April, sealing off the town of La Gloria and spraying to kill off flies they said were swarming through their homes.
Cordova said the community was suffering from ordinary influenza - not swine flu. But only one sample was preserved - that of the boy. It was only after U.S. and Canadian epidemiologists discovered the true nature of the virus that Mexico submitted the sample for international testing, and discovered what he suffered from.
The boy has since recovered and Cordova said there have been no new cases detected in the town, but epidemiologists want to take a closer look at pigs in Mexico as a potential source of the outbreak.
Juan Lubroth, an animal health expert at the U.N. Food and Agriculture Organization in Rome, said a team of veterinarians was flying to Mexico. They will examine what surveillance systems are in place to detect swine flu, and review historical data on previous viruses identified in the country. Farmers will be interviewed.
Lubroth said there have been no reports of sick or dying swine in Mexico, but warned that fears surrounding the outbreak could have a devastating effect on the pork industry.
"Although the virus is reported to have a swine origin, it may have been several years ago, and it's only now that it has shown up in humans as a clinical problem that is spreading," he said.
The Mexican government has yet to say where and how the epidemic began or give details on the victims.
Cordova said the health department lacked the staff to visit the homes of all those suspected to have died from the disease. But he assured that the country had enough medicine to treat the ill.
Meanwhile, Mexico suspended all schools nationwide until May 6, extending an order already in place in Mexico City and five of the country's 32 states, and urged people to stay home if they feel sick.
Labor Secretary Javier Lozano Alarcon said employers should isolate anyone showing up for work with fever, cough, sore throat or other symptoms. And the Mexico City government was considering shutting down all public transportation if the death toll keeps rising. Mayor Marcelo Ebrard said surgical masks were being distributed at subway and bus stops across the city.
The disease has hit hardest in the capital, but life was disrupted from Tijuana to Acapulco, a lucrative Pacific resort town where night clubs and bars were ordered closed until further notice. Acapulco Mayor Manuel Anorve Banos said he was worried about tourists from Mexico City spreading the disease.
Some city dwellers headed to the beach, taking advantage of the closed schools. But those who live day-to-day worried about making ends meet if the city completely shuts down.
"We're going to have to stop working," said Raul Alvarez Torres, who relies on the subway to get from his gritty suburb to his shoe shining stand in an upscale Mexico city neighborhood each day. "If people have no transport, getting around is impossible."
Even as Mexican officials urged those with flu symptoms to seek medical help, some complained of being turned away.
In Toluca, a city west of the capital, one family said health authorities refused to treat a relative Sunday who had full-blown flu symptoms and could barely stand. The man, 31-year-old truck driver Elias Camacho, was even ordered out of a government ambulance, his father-in-law told The Associated Press.
Paramedics complained that Camacho - who had a fever, was coughing and had body aches - was contagious, Jorge Martinez Cruz said.
Family members took him by taxi to a public hospital, but a doctor there denied Camacho was sick and told the trio to leave, Martinez said.
"The government told us that if we have these symptoms, we should go to these places, but look how they treat us," Martinez said. Camacho was finally admitted to the hospital - and placed in an area marked "restricted" - after a doctor at a private clinic notified state health authorities, Martinez said.
Jose Isaac Cepeda, who has had fever, diarrhea and joint pains since Friday, said he was turned away from two hospitals - the first because he isn't registered in the public health system, and the second "because they say they're too busy."
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Associated Press writers E. Eduardo Castillo, Niko Price and Olga R. Rodriguez in Mexico and AP Medical Writer Margie Mason contributed to this report.

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4:42 p.m.

By E. EDUARDO CASTILLO
Associated Press Writer

MEXICO CITY (AP) - The World Health Organization raised its global alert level Monday, signaling the swine flu virus was spreading from human to human in community outbreaks, but it stopped short of declaring a full-blown pandemic.
The WHO announcement in Geneva followed a decision by the top EU health official urging Europeans to postpone nonessential travel to parts of the United States and Mexico because of the virus.
Mexico health department spokesman Carlos Olmos confirmed the move by the WHO to raise the alert level from Phase 3 to Phase 4.
Putting an alert at Phases 4 or 5 signals that the swine flu virus is becoming increasingly adept at spreading among humans. That move could lead governments to set trade, travel and other restrictions aimed at limiting the disease's spread.
The WHO's Phase 6 is the pandemic phase, characterized by outbreaks in at least two regions of the world.
U.S. Homeland Security Secretary Janet Napolitano said the United States is preparing as if the swine flu outbreak already is a full pandemic.
The virus was suspected in up to 149 deaths in Mexico, the epicenter of the outbreak with more than 1,600 cases suspected, while 40 cases - none fatal - were confirmed in the United States and six in Canada, the WHO said, adding that the number of confirmed cases worldwide was 73.
A young man in Spain and two people in Scotland have come down with swine flu following trips to Mexico, health officials said, in what were the first cases reported outside North America. The World Health Organization said it was still awaiting official reports from the U.K. about the Scottish cases.
Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus amid global concern about a possible pandemic.
European and U.S. markets bounced back from early losses as pharmaceutical stocks were lifted by expectations that health authorities will increase stockpiles of anti-viral drugs. The stocks of airlines, hotels and other travel-related companies posted sharper losses.
"Today we've seen increased number of confirmed cases in several countries," WHO spokesman Paul Garwood told The Associated Press. "WHO is very concerned about the number of cases that are appearing, and the fact that more and more cases are appearing in different countries."
President Barack Obama said the threat of spreading infections is cause for concern but "not a cause for alarm."
In Luxembourg, European Union Health Commissioner Androulla Vassiliou urged Europeans to postpone nonessential travel to parts of the United States and Mexico affected by swine flu, toning down earlier comments referring to all of North America.
"I meant a travel advisory, not a travel ban, for travel to Mexico City and those states in the United States where we have outbreaks" of swine flu, he said.
The EU health commissioner only makes recommendations to the 27 member countries; they must make a final decision to set travel advisories through their foreign ministries.
Dr. Richard Besser, acting head of the Centers for Disease Control and Prevention in Atlanta, said the EU recommendation was not warranted. "At this point I would not put a travel restriction or recommendation against coming to the United States."
Spain's first swine flu case - confirmed by the WHO - was a young man in the town of Almansa who recently returned from Mexico for university studies and is responding well to treatment, said Health Minister Trinidad Jimenez. Neither the young man nor any of the 20 other people under observation for the virus were in serious condition.
Scottish Health Secretary Nicola Sturgeon said tests "conclusively" confirmed swine flu in two people also recently returned from Mexico. A government spokeswoman said the two were recovering in Monklands Hospital in the Scottish town of Airdrie with flu-like symptoms. The virus matched the strain of flu that has affected Mexico, said the woman, who spoke on condition of anonymity in line with Scottish government policy.
She said tests were conducted at a Glasgow laboratory before being sent to the Health Protection Agency's Colindale Center for Infections in London, which confirmed the outbreak.
WHO spokesman Peter Cordingley singled out air travel as an easy way the virus could spread, noting that the WHO estimates that up to 500,000 people are on planes at any time.
New Zealand was testing 13 students, their parents and teachers who were showing flu-like symptoms after returning from Mexico, said Health Minister Tony Ryall. Israel, France, Brazil and Switzerland were also conducting tests.
At Germany's bustling Frankfurt Airport, people suspected of having the disease were examined before getting off planes, said the health minister for Hesse state, Juergen Banzer. The policy was in effect since Saturday at continental Europe's second-busiest airport, after Charles de Gaulle in Paris.
Governments in Asia - with potent memories of SARS and avian flu outbreaks - heeded the warning amid global fears of a pandemic.
Singapore, Thailand, Japan, Indonesia, and the Philippines dusted off thermal scanners used in the 2003 SARS crisis and were checking for signs of fever among passengers from North America. South Korea and Indonesia introduced similar screening.
In Malaysia, health workers in face masks took the temperatures of passengers as they arrived on a flight from Los Angeles.
Russia, Hong Kong and Taiwan said visitors returning from flu-affected areas with fevers would be quarantined.
Australian Health Minister Nicola Roxon said pilots on international flights would be required to file a report noting any flu-like symptoms among passengers before being allowed to land in Australia.
China said anyone experiencing flu-like symptoms within two weeks of arrival had to report to authorities.
India will start screening people arriving from Mexico, the United States, Canada, New Zealand, Spain, Britain and France for flu-like symptoms, said Vineet Chawdhry, a top Health Ministry official. It also will contact people who have arrived from Mexico and other affected countries in the past 10 days to check for the symptoms, he said.
Some officials cautioned that the checks might not be enough.
The virus could move between people before any symptoms show up, said John Simon, a scientific adviser to Hong Kong's Center for Health Protection.
China, Russia and Ukraine banned imports of pork and pork products from Mexico and three U.S. states that have reported cases of swine flu, and other governments were increasing their screening of pork imports. Azerbaijan banned all livestock products from all of North America.
Indonesia, which was hit hardest by bird flu, said it was banning all pork imports. Lebanon said all pork products, except for some canned varieties, were banned.
The CDC says people cannot get the flu by eating pork or pork products.
Germany's leading vacation tour operators were skipping stops in Mexico City as a precaution. The Hannover-based TUI said trips through May 4 to Mexico City were being suspended, including those operated by TUI itself and also through companies 1-2 Fly, Airtours, Berge & Meer, Grebeco and L'tur.
TUI said other holiday trips to Mexico would continue to operate but would not make stops in Mexico City "for the next few weeks." Japan's largest tour agency, JTB Corp., suspended tours to Mexico at least through June 30.
Russian travel agencies said 30 percent of those planning to travel to Mexico in early May had already canceled.
At Madrid's Barajas International Airport, passengers arriving from Mexico were asked to declare where they had been and whether they had felt any cold symptoms. They were told to leave a contact address and phone number.
"Where we were, there was no real alarm but we followed what was happening on the news and we're a little bit worried," said Spaniard Filomeno Ruiz, back from vacation in Cancun.
Passengers were also urged to contact health authorities if they notice any symptoms in the 10 days following arrival.
In the airport's baggage claim area, ground crews and police wore surgical face masks. Some travelers took precautions even though they had not been in Mexico.
"Nobody has recommended it, but I've put the mask on out of precaution," said Roger Holmes of Britain, who was traveling to Tunisia from Madrid. "I'm not afraid, but it costs nothing to be careful."
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On the Net:
WHO swine flu page: http://www.who.int/csr/disease/swineflu/en/index.html
CDC: www.cdc.gov