US residents are being urged to take precautions against swine flu at schools, offices and other public places after a weekend of escalating infections triggered global concerns and prompted U.S. officials to declare a public health emergency. No new local infections were reported, and the number of people sickened by the disease in the region remained at four.
But public health officials here and across the nation remained on high alert, predicting that more illnesses will be identified as testing of patients with flu symptoms intensifies. As of last night, officials had confirmed 20 cases in California – including three in Imperial County – Kansas, New York, Ohio and Texas. None of the patients died, and most recovered quickly.
Yesterday, epidemiologists also detected swine flu for the first time in Canada and confirmed more patients in Mexico, the epicenter of the outbreak with more than 1,600 possible infections and 103 deaths potentially linked to the disease.
“We expect the numbers to change. We expect additional states to identify this virus as we go forward,” said Dr. Ann Schuchat, director of respiratory diseases at the federal Centers for Disease Control and Prevention in Atlanta.
She and other researchers still don't know why U.S. cases have been milder than those in Mexico. But Schuchat warned that more serious infections were likely as the spectrum of patients widens.
“I do fear that we will have deaths here,” she said.
The federal government hasn't banned travel to Mexico, but it's asking travelers to follow preventive measures normally recommended for the common flu season. Those include canceling trips and not venturing into public places when sick. Everyone also should wash their hands frequently and avoid people who seem ill.
U.S. epidemiologists are in Mexico to help health officials there set up sophisticated labs capable of testing specimens for swine flu, Schuchat said.
Analyzing a specimen to determine whether it's a common form of influenza is a fairly routine process that can be done at many laboratories around the world. But when an unidentifiable sample turns up, specialized equipment is needed to decode its genetic makeup and match it to the known genetic fingerprint of swine flu.
Health officials in San Diego County are able to identify common strains of flu but must forward unidentifiable samples to the CDC's labs in Atlanta.
Mexico lacks swine-flu-detection facilities. It initially sent samples of unidentifiable flu to Canada's National Microbiology Laboratory in Winnipeg, where the first seven cases from Mexico were identified.
On the domestic front, the White House's emergency declaration yesterday allows federal resources to flow to state and local health agencies investigating swine flu.
President Barack Obama's administration sought to reassure Americans by comparing the emergency declaration with preparing for an approaching hurricane.
“Really, that's what we're doing right now. We're preparing in an environment where we really don't know ultimately what the size or seriousness of this outbreak is going to be,” Homeland Security Secretary Janet Napolitano said during a news conference.
The public health emergency enables authorities to bypass regulations if they interfere with fighting the disease, such as a California law limiting how many patients each hospital nurse can treat, said Dr. Wilma Wooten, public health officer for San Diego County.
In addition, Napolitano said her agency would release 25 percent of the 50 million doses of Tamiflu and Relenza, prescription flu drugs that the federal government has stockpiled. States with confirmed cases of swine flu will receive priority distribution, she said.
An adequate supply is important because the antiviral medications work best when they're administered within 48 hours of symptoms appearing.
Wooten said the county has its own stockpile – enough to treat all first responders and still have 300 doses available for public distribution.
As a precaution, she said, local hospital staff members and public health workers who had direct contact with swine flu patients have received the treatment.
While the makers of Tamiflu and Relenza reported healthy inventories in the United States, supplies of Tamiflu had sold out by yesterday at some pharmacies along Avenida Revolución in Tijuana, where the medicine is sold over the counter.
Store workers said there had been a run on the drug, particularly from U.S. customers. They expected to restock the medication this week.
Worry about swine flu prompted the closure of several schools for today in New York City, San Antonio and suburban Sacramento, where a sick seventh-grader was being tested for the disease.
No such action is being taken in San Diego County, where three youngsters have contracted the illness.
As they did last week, county health officials refused yesterday to identify the local high school, elementary school and day care center where these patients attend classes.
Wooten said there was no need to take broader precautions because all of the youngsters have fully recovered from the flu and no other students at their schools have become ill.
“The principals and administrator at the three facilities are well-aware of the situation,” she said.
It wasn't clear whether parents of other students at the schools were told about the infections.
At the U.S.-Mexico border crossings, U.S. customs agents have stepped up health screenings in hopes of blocking the spread of swine flu. They said the extra efforts shouldn't cause significant delays.
But taking time for medical surveys at the San Ysidro Port of Entry – the world's busiest border crossing – could create a logistical challenge during commuting hours.
Agents are questioning border crossers about their health if they appear to have the flu. Anyone with symptoms could be pulled out of line for further questioning by health officials, and they might not be allowed to enter the United States.
Similar screenings are being done at San Diego's Lindbergh Field, which has three international flights – two from San Jose del Cabo in Mexico and one from Vancouver, Canada – according to its Web site.
Airport officials said they didn't expect the procedure to disrupt operations.
No cases of swine flu have been confirmed in Baja California, the state's health secretary, José Guadalupe Bustamante, said yesterday. But health authorities in that region were reviewing the case of a 7-month-old girl who died of pneumonia Friday in Tecate's Hospital General, he said.
While severe cases of flu can lead to pneumonia, the potentially dangerous lung infection can have other causes.
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