Swine Flu - Questions & Answers

Will swine flu end up sweeping the globe in a flu pandemic? The Centers for Disease Control and Prevention announced that it’s taking some aggressive precautions—just in case.The federal agency reported Monday that there were 40 confirmed U.S. cases of swine flu, which were mostly mild infections seen in New York, Ohio, Kansas, Texas, and California. There are 26 confirmed cases in Mexico, but there are thought to be hundreds more not yet confirmed (including reports of 149 deaths). There have also been six cases in Canada and one in Spain.

It sounds scary. But it doesn’t mean it’s time to panic. Experts have long been searching for new flu viruses because they are known to periodically appear and sweep the globe; for example, there were at least three pandemics in the 20th century and as many “pandemic threats.” The last pandemic was the 1968 Hong Kong flu, so researchers say we’re overdue for one and are on high alert for potential candidates.

All this preparation is a good thing. Better surveillance most likely picked up the swine flu cases early. And one reason the government declared a public health emergency is to free up huge stockpiles of antiviral medication. (About 11 million courses of antiviral medication were shipped to affected states). “There’s been tremendous planning that’s been going on around the country over the past number of years,” said Richard Besser, MD, the acting director of the CDC, at a press briefing.

While it’s not time to panic, it is a good time to become more informed about swine flu and to contemplate “what if?” scenarios, including what you plan to do if your child’s school is closed or you can’t go to work, according to the CDC.

“It’s time for businesses to review their plans and think about ‘What would I do if some of my workers couldn’t come to work? How would my business function?’” said Dr. Besser. “Think about that.”

The good news is that there is a wealth of information about swine flu online, and it’s constantly being updated. For example, you can follow current cases on Google maps and get CDC updates via Twitter, as well as find information on the CDC’s and the World Health Organization’s Web sites.

Health.com talked with Brian Currie, MD, vice president and medical director for research at Montefiore Medical Center in the Bronx, N.Y., to get the facts about swine flu. Dr. Currie is an expert in disaster and bioterrorism preparedness. Here are his responses to some frequently asked questions.

Are we in the midst of a global flu pandemic?

I wouldn’t exactly call it a pandemic yet. A pandemic implies a huge spread across the world. Experts have been anticipating something like this would happen and we are somewhat prepared for it, but probably not ideally at the moment. This is a new strain that’s just been discovered, so there’s no vaccine for it—which is usually the most effective way to control dissemination. However, we do have a surveillance system and it looks like it was picked up very early, and we do have stockpiles of antiviral medications that are available if we need them.

Where did the virus come from, and why are experts concerned?

What you have is a swine flu virus that has picked up parts of human flu and mutated to incorporate them so that it can infect humans and it can cause human-to-human transmission as well. It’s made a lot of the changes it would need to become a pandemic. Unlike what’s happening in Mexico, where there’s been a lot of mortality, all of the cases that have occurred in the United States have been relatively mild disease. So it looks like as it spreads, it’s attenuating or become less virulent, so that would the saving grace here.

Isn’t avian flu supposed to be the big risk in terms of a global pandemic?

We knew it was going to be avian flu or swine flu that made the jump into humans and we’ve always been concerned about flu viruses that infect swine, birds, and humans; there are 30 or so in total. Some of the strains that can infect other species cannot typically infect humans. Human strains can infect pigs, so what happens is that pigs get infected with swine flu and human flu at the same time. They recombine the genetic material, so when they produce new viruses it’s got part of the human and part of the pig; you worry that if it gets enough of the human virus, it will be able to bind to human receptors.

Can I get swine flu from eating pork?

Absolutely not. It can’t be transmitted though the food chain. You’re not going to get it from eating pork.

Some of the swine flu cases have included symptoms like diarrhea or vomiting. What symptoms should I look for?

Typically what you are looking for is a sore throat, runny nose, high fever, and aching all over your body—a real good case of flu knocks people right on their backs.

I was sick a week ago—could I have had swine flu?

Unless you had contact with pigs or people from Mexico, it’s probably unlikely, although anything is possible.

Should I wear a mask in public? What’s the best way to avoid swine flu?

At the moment [wearing a mask in public] is a bit much. Basically you should practice good hand hygiene, and try to avoid contact with people coming from areas where there are known cases.
Read CDC recommendations regarding the use of respirators and face masks and the best ways to avoid the flu.

Should I keep my children home from school?

There’s only one school [in the New York area] where they have found cases and it’s limited to that school so far, so there is really no reason not to send your children to school at this point.

Should I cancel travel plans?

[The United States is] one of the sites people are worried about coming to now; Europe is telling people no unnecessary travel to Mexico and United States, so we’re being targeted rather than targeting other people. The caution would be, if you really don’t have to go, then put [trips] off and wait until we have more information.
Read the travel advisory issued by the CDC, which recommends delaying any non-essential travel to Mexico.

Should I get a flu shot?

No. In fact, it’s pretty unlikely that a flu shot will protect you against this strain.

I think I’m getting sick. Should I take an antiviral drug?

Currently what they are suggesting is if you are young and healthy, just go home and wait it out. That way we can keep the Tamiflu for people who have other chronic illnesses that put them at high risk, for example, those who are pregnant or the elderly. Those are people we are likely to test; then if they are positive, we’ll treat them.

Read CDC recommendations on what to do if you get sick.

I have to fly. Should I take any special precautions when traveling in a plane?

No, just stay away from people who look overtly ill. (And airports are generally screening people for symptoms.)

Should I go to the grocery store and stockpile food in the case of a quarantine?

No, just stay calm. The story is unfolding very rapidly and we’ll have more information shortly. But signs are encouraging so far, at least for what’s here in New York. If what’s happening in Mexico occurs someplace else, it could be another issue. Every U.S. case has been mild, so that’s in our favor. At the same token, there have been almost 200 [reported] deaths in Mexico.

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Swine Flu

The number of confirmed cases of swine flu in the United States has doubled to 40, with all the new cases coming from a New York City high school that had previously reported eight cases of the infectious disease, U.S. health officials said Monday.

The officials also said they were tightening their travel advisory to Mexico — believed to be the source of the outbreak that continues to reach around the world — recommending that all nonessential travel to that country be avoided.

“This situation is evolving very quickly, it is changing quickly,” Dr. Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention, said during an afternoon teleconference. “We are officially reporting 40 confirmed cases in the United States. The only change from yesterday is 20 confirmed cases in New York City. These are associated with the same school outbreak and really represent additional testing in that group and not an ongoing spread.”

All 40 U.S. patients — 28 in New York, seven in California, two in Texas, two in Kansas and one in Ohio — have either recovered or had mild infections, Besser said.
“Later today, we will be releasing a new travel advisory for Mexico,” he added. “This is out of an abundance of caution, and we will be recommending that nonessential travel to Mexico be avoided.”

Mexico is reporting as many as 1,900 possible swine flu infections and as many as 149 deaths.
Earlier Monday, President Barack Obama said the threat posed by the swine flu outbreak was a cause for concern but “not a cause for alarm.”

“The Department of Health and Human Services has declared a public health emergency as a precautionary tool to ensure that we have the resources we need at our disposal to respond quickly and effectively,” Obama told a gathering of scientists at the National Academy of Sciences, amid increasing worries worldwide about a possible pandemic, the Associated Press reported.

Besser said that he “expects that we will see [swine flu] cases in other parts of the country, and I would fully expect that we will see a broader range in terms of the severity of infection. Thankfully, so far we have not seen severe disease in this country as has been reported in Mexico.

Besser said the United States will step up checks of people entering the country by air, land and sea, looking for signs of infection, and the CDC will begin distributing “yellow cards at ports of entry.”

“These will provide information on swine flu, so that people coming into the United States will have information about this outbreak — what to do if they become sick, what things they can do to prevent the likelihood that they will become sick,” he said.

He also said U.S. officials were questioning border visitors about their health, looking for signs of possible infection.

The fast-unfolding events in the United States — where all 40 cases have been relatively mild and there have been no deaths — came in response to some 1,900 swine flu infections and as many as 149 deaths in neighboring Mexico.

Officials in other nations around the globe responded to the threat of a possible pandemic. China, Taiwan and Russia considered quarantines, and several Asian countries scrutinized visitors arriving at their airports, the AP reported.

The European Union on Monday advised against nonessential travel to the United States and Mexico. Early Monday, Spain confirmed that a man hospitalized in the eastern part of the country had tested positive for swine flu, in what’s believed to be Europe’s first case of the disease. Health authorities were also testing 17 other possible cases in Spain, a major travel link between Mexico and Europe, The New York Times reported.

Responding Monday to the EU’s travel advisory, the CDC’s Besser said, “Based on the situation in the United States right now, I think it is premature to put travel restrictions on people coming to the United States. As the situation changes, that needs to be evaluated by different countries.”

On Sunday, U.S. health officials declared a public health emergency in response to the swine flu outbreak.

Homeland Security Secretary Janet Napolitano said the declaration was a precautionary measure and did not mean that the threat posed by the outbreak was worsening. But, the move allows federal and state governments easier access to flu tests and medications, she said.

Napolitano said the federal government had 50 million doses of the antiviral flu medication Tamiflu, and a quarter of those doses were being released to states, if needed, “particularly prioritizing the states where we already have confirmed incidence of the flu.”

Napolitano also said Sunday that the Department of Homeland Security had started “passive surveillance protocols to screen people coming into the country.”

“All persons entering the United States from a location of human infection of swine flu will be processed by appropriate CDC protocols,” she said. “Right now, these are passive. They are looking for people and asking about: ‘Are you sick? Have you been sick?’ and the like. And if so, they can be referred over for further examination. Travelers who do present with symptoms will be isolated.”

Speaking at a Sunday press conference, Dr. Anne Schuchat, the CDC’s Interim Deputy Director for Science and Public Health Program, said that U.S. health officials had numerous tools to fight the illness’ spread and protect the health of Americans. The swine flu viruses found in the United States are resistant to two antiviral medications — amantadine and rimantadine — but are susceptible to the antivirals oseltamivir (Tamiflu) and zanamivir (Relenza), Schuchat said.

Schuchat said steps were already being taken to devise a vaccine against this strain of swine flu, although the process takes time. “We are taking the initial steps in terms of preparing the seed virus to hand off to the industry partners, to produce large quantities. But you know it takes months to produce a vaccine,” she said.

Besser said there are steps people can take to help prevent catching and spreading the flu, including frequent hand-washing. “If you are sick, it is very important that people stay at home. If your children are sick, have a fever and flu-like illness, they shouldn’t go to school. And if you are ill, you shouldn’t get on an airplane or another public transport. Those things are part of personal responsibility in trying to reduce the impact,” he said.

Meanwhile, in Mexico, authorities continued to take dramatic steps — including suspending school and public gatherings — to try to contain the outbreak that officials say has killed as many as 149 people, and sickened more than 1,900 others in that country.

Some of the U.S. cases involved people who had recently returned from trips to Mexico, Schuchat said Sunday. The two cases reported in Kansas involved a husband and wife who had recently been to that country, she said. And The New York Times reported that some of the students at St. Francis Preparatory School, in Queens, had recently come back from Mexico as well.

Also on Sunday, Canadian officials confirmed four “very mild” cases of swine flu at a school in Nova Scotia, and two other cases in British Columbia. According to the AP, a provincial health official said that the infection that sickened the students in Nova Scotia “was acquired in Mexico, brought home and spread.”

Swine flu is a respiratory disease of pigs caused by type A influenza. Swine flu does not normally infect humans. However, human infections do occur, usually after exposure to pigs. Symptoms resemble those of the regular flu, including sore throat, coughing and fever.