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			Wednesday, April 29, 2009 News Clipping Archives *Maryland / Regional* O'Malley: 6 Probable Cases Of Swine Flu In Md (WBAL Radio Baltimore AM1090) Breaking: County has three 'probable' swine flu cases (Arbutus Times) Six probable cases of swine flu reported in Baltimore, Anne Arundel counties (The Gazette) Probable swine flu case in county, others in state (Annapolis Capital) Not swine flu: Plane's passengers had too much to drink (WTOP News) Plane from Mexico held to check 2 ill passengers (The Associated Press) County health officials watching and waiting (The Gazette) Maryland braces for swine flu's arrival in state (SoMoNews.com online) Maryland Gets First Swine Flu Cases (abc2news.com) 6 Probable Cases Of Swine Flu Reported In Md. (WBALTV.com) Cecil County officials prepare for swine flu (Cecil Whig) County schools brace for swine flu (Cecil Whig) Six Probable Swine Flu Cases In Maryland (WUSA9.com) Swine flu worries prompt record visits to local ERs (Washington Examiner) 4 at U of Delaware have 'minor' flu symptoms (Baltimore Sun) Customers continue to buy pork (Frederick News-Post) '09 pollen count heavier than normal (Annapolis Capital) County, state get poor grades for air pollution (Annapolis Capital) Q&A with Howard’s health officer about Md.’s preparedness (Daily Record) Advocates say report more proof of need for health care reform (Cumberland Times-News) Md. ag secretary to retire (Salisbury Daily Times) Man accused of exposing woman to HIV (Montgomery County Gazette) Hopkins: Suburban expansion to proceed (Frederick News-Post) Six-point county worker health and safety initiative announced (The Gazette) Keyser water treatment lab will remain open (Cumberland Times-News) *National / International* Swine flu continues to spread; Obama asks $1.5 billion to fight it (Tribune Newspapers) U.S. reports first swine flu death (Baltimore Sun) U.S. has first death from swine flu (Reuters) Local Health Agencies, Hurt by Cuts, Brace for Flu (New York Times) Experts Study Differences in Flu's Severity (Washington Post) WHO Raises Swine Flu Alert; Virus Claims First Life in U.S. (Washington Post) Scientists struggle to understand swine flu virus (Washington Post) U.S. Warns Other Nations Not to Ban Pork (Washington Post) Pork Industry Fights Concerns Over Swine Flu (New York Times) World takes drastic steps to contain swine flu (Washington Post) In AIDS Treatment, Sooner Is Better, Study Finds (New York Times) Siblings who kept sister in shed sentenced to jail (Washington Examiner) Judge Allows Asbestos Case to Continue (New York Times) Institute of Medicine Calls for Doctors to Stop Taking Gifts From Drug Makers (New York Times) *Opinion* Why the insurers will win in Obama’s health reform (Washington Examiner Commentary) Swine flu outbreak poses medical, and political, risks (USA Today Editorial) *Maryland / Regional* O'Malley: 6 Probable Cases Of Swine Flu In Md By John Patti and Scott Wykoff WBAL Radio Baltimore AM1090 Wednesday, April 29, 2009 Governor O'Malley says there are 6 probable cases of Swine Flu that have been identified in Maryland. He says those samples are at the CDC and are being tested. The Governor made the announcement from the Maryland Swine Flu Command Center in Baltimore. Maryland Health Secretary John Colmers offered more details about the six probable swine flu cases in Maryland. Three of the probable cases are in Anne Arundel County and three are in Baltimore County. One involves a student at Folger McKinsey Elementary School in Severna Park, which is in Anne Arundel. The other student is a high schooler at Milford Mill Academy in Baltimore County. Governor O'Malley says none of the six have had to be hospitalized and all are recovering. The cases involve people who traveled to Mexico, where there are swine flu cases. Some of the sick people made those trips, while others who have fallen ill are the travelers' relatives. WBAL Radio Baltimore http://wbal.com/ Maryland Swine Flu Command Center with Maryland Emergency Preparedness Workers (Photo by WBAL’s John Patti) Maryland Swine Flu Command Center (Photo by WBAL's John Patti) Copyright 2009 WBAL Radio Baltimore AM 1090. Breaking: County has three 'probable' swine flu cases School system says Milford Mill student is among potential patients By Bryan P. Sears Arbutus Times Wednesday, April 29, 2009 A Milford Mill Academy student is reportedly one of three probable swine flu cases in Baltimore County and among six probable cases in Maryland, according to state health and county school system officials. Samples from all six Maryland patients were tested by the state and confirmed to be influenza cases - but will require additional testing to determine if they are indeed swine flu cases. Those samples have been sent to the Centers for Disease Control in Atlanta for that testing. All six are said to be recovering and required no hospitalization. “This development is what we have expected and prepared for since news of (swine flu) broke last week,” said State Department of Health and Mental Hygiene Secretary John M. Colmers in a statement released this afternoon. Health officials define a probable case as: “An individual with flu-like symptoms who has a recent history of travel to an area affected by swine flu, or contact with another person who has.” Of the three probable cases in Baltimore County, two are members of the same family who recently traveled to an area affected by the swine flu strain, said health officials. The third case involved a person who recently returned from an area that was not considered an area affected by swine flu. Health officials declined to further identify the patients citing confidentiality concerns. Baltimore County Public Schools sent a letter home to parents today notifying them of the probable swine flu case found at Milford Mill Academy. According to county Health Department spokeswoman Monique Lyle, the student is one of the two members of the same family identified by the state. The student was not severely ill and was not hospitalized and remained at home “for the entire duration of the student’s illness,” according to a statement on the school’s Web site. Charles Herndon, a Baltimore County Public Schools spokesman, said, “We want to make sure parents stay informed and we’re aware of any other illnesses that occur.” “We’ve been advised that there is no reason not to open school tomorrow,” Herndon said. Health officials are offering several recommendations to protect against exposure from swine flu: • If your children are sick, do not send them to school. Keep them at home. • Teach your children to wash their hands frequently with soap and water for 20 seconds. Set a good example by doing this yourself. • Teach children to cover coughs and sneezes with tissues or by coughing into the inside of the elbow. Set a good example by doing this yourself. • Teach children to stay at least 3 feet away from people who are sick. • People who are sick should stay home and away from other people until they are better. Parents with questions may call the county schools Office of Health services at 410-887-6368, or their doctor. Information is also available on the Baltimore County Health Department Flu Hotline at 410-887-2243 or at www.dhmh.state.md.us. Copyright 2009 Arbutus Times. Six probable cases of swine flu reported in Baltimore, Anne Arundel counties Test results expected Thursday from Centers for Disease Control and Prevention By Megan King The Gazette Wednesday, April 29, 2009 Six probable cases of swine flu have been reported in Anne Arundel and Baltimore counties, and health officials expect to know by Thursday whether the cases are confirmed. David Paulson, a spokesman for the Maryland Department of Health and Mental Hygiene, said three of the cases are in Anne Arundel and three are in Baltimore County. The agency deems "probable" cases as people have tested positive for having the flu — although they aren't sure yet if it is swine flu — and the people have either traveled to one of the areas affected by swine flu, mainly Mexico, or had close contact with someone who had traveled there recently, Paulson said. In the Anne Arundel cases, two of the people were from the same family with no history of foreign travel. However, another family member recently came back from Mexico, health officials said. In Baltimore County, two members of one family — one of whom recently traveled to Mexico — have probable cases of swine flu and the other case is an unrelated individual who recently traveled to the Caribbean, officials said. Paulson said the department expects to receive results from the Centers for Disease Control and Prevention on Thursday as to whether the cases are indeed swine flu. Over the past week, hundreds of human cases of the influenza virus that normally affects pigs have been reported in Mexico, leading to more than 100 deaths there. A 23-month-old boy from Mexico who died Monday in Texas was the only confirmed swine flu death in the U.S. at press time Wednesday. Unlike the regular strains of the disease, the latest outbreak has been shown to spread from person to person. Two of the Maryland cases are school-aged children. One child attends Folger McKinsey Elementary School in Severna Park and the other child attends Milford Mill Academy in Windsor Mill. Paulson said neither of the schools had seen a spike in absenteeism recently. "One of our students at Milford probably has swine flu, although this has not as yet been confirmed. The student, who is now recovering, has not been severely ill or hospitalized. The student has been at home for the entire duration of the student's illness," Milford Mill Academy's Principal Nathaniel Gibson wrote in a letter posted on the school's Web site. Paulson said the department was planning to send letters home to the parents at both schools, advising them of the situation and encouraging them not to send their children to school if they are ill. "If you have flu-like symptoms, call a doctor or health care provider. The CDC recommends you stay home from work or school and limit contact with others to keep from infecting them," Paulson said. The department is also encouraging "common-sense" hygiene precautions, including hand-washing, covering noses and mouths when sneezing, and avoiding close contact with sick people. Staff Writer Marcus Moore contributed to this story. Copyright 2009 The Gazette. Probable swine flu case in county, others in state Associated Press Annapolis Capital Wednesday, April 29, 2009 BALTIMORE (AP) - Maryland officials say the state has its first probable cases of swine flu, including two among public school students. Tests are being performed on samples from six people, with results expected Thursday. Three of the probable cases are in Anne Arundel County and three are in Baltimore County. One involves a student at Folger McKinsey Elementary School in Severna Park, which is in Anne Arundel. The other student is a high schooler at Milford Mill Academy in Baltimore County. Gov. Martin O'Malley says none of the six have had to be hospitalized and all are recovering. The cases involve people who traveled to Mexico, where there are swine flu cases. Some of the sick people made those trips, while others who have fallen ill are the travelers' relatives. See the letter sent to Folger McKinsey parents: www.aacps.org/folgerswineflu.pdf. Copyright 2009 Annapolis Capital. Not swine flu: Plane's passengers had too much to drink WTOP News Wednesday, April 29, 2009 LINTHICUM, Md. - There were some tense moments at Baltimore-Washington International Thurgood Marshall Airport Tuesday night as two passengers had to be evaluated for swine flu. AirTran Airways Flight 85 from Cancun, Mexico radioed ahead to the airport about the two men, said airport spokesman Jonathan Dean. They had fevers and were sick to their stomachs. "The airport's fire and rescue department responded," Dean tells WTOP. "They evaluated the passengers and determined that there was no public health threat. They were actually ill before boarding." According to David Paulson, spokesman for the Maryland Department of Health and Mental Hygiene, the men had to be isolated and examined to make sure it wasn't swine flu. The men did not have respiratory distress that accompanies the flu, Paulson says. Federal Aviation Administration spokesman Jim Peters says the men just had too much to drink. The men refused treatment after being evaluated. The rest of the passengers had to stay on the plane for a little under an hour. Swine flu is suspected in 159 deaths and 2,498 illnesses in Mexico. The U.S. reported its first death Wednesday morning. (Copyright 2009 by WTOP and The Associated Press. All Rights Reserved.) LINTHICUM, Md. - There were some tense moments at Baltimore-Washington International Thurgood Marshall Airport Tuesday night as two passengers had to be evaluated for swine flu. AirTran Airways Flight 85 from Cancun, Mexico radioed ahead to the airport about the two men, said airport spokesman Jonathan Dean. They had fevers and were sick to their stomachs. "The airport's fire and rescue department responded," Dean tells WTOP. "They evaluated the passengers and determined that there was no public health threat. They were actually ill before boarding." According to David Paulson, spokesman for the Maryland Department of Health and Mental Hygiene, the men had to be isolated and examined to make sure it wasn't swine flu. The men did not have respiratory distress that accompanies the flu, Paulson says. Federal Aviation Administration spokesman Jim Peters says the men just had too much to drink. The men refused treatment after being evaluated. The rest of the passengers had to stay on the plane for a little under an hour. Swine flu is suspected in 159 deaths and 2,498 illnesses in Mexico. The U.S. reported its first death Wednesday morning. Copyright 2009 WTOP News. Plane from Mexico held to check 2 ill passengers Associated Press By The Associated Press Wednesday, April 29, 2009 LINTHICUM, Md. (AP) — Two men who had too much to drink caused 117 passengers on a flight from Mexico to Maryland to wait on board after landing while health authorities checked the two for symptoms of swine flu, officials said Tuesday. The commotion began when AirTran Flight 85 from Cancun, Mexico, radioed ahead to Baltimore-Washington International Thurgood Marshall Airport that two passengers were had nausea and fever, said airport spokesman Jonathan Dean. When it landed, the airport's fire and rescue department met it. The two men were isolated and examined, said David Paulson, director of communications for the Maryland Department of Health and Mental Hygiene. Federal Aviation Administration spokesman Jim Peters said they simply had too much to drink. They did not have respiratory distress that is a symptom of swine flu, Paulson said. They refused treatment, and they and the other passengers were allowed to leave the plane after being detained less than an hour. Swine flu was said to have been a factor in more than 150 deaths and over 1,600 illnesses in Mexico. The number of confirmed cases in the United States climbed to 66 Tuesday, and federal officials warned that deaths were likely. Paulson said contact information was collected from all the passengers, and they were given fact sheets detailing what they should do if they become ill. Copyright © 2009 The Associated Press. All rights reserved. County health officials watching and waiting Swine flu likely to show up, state officials say By Douglas Tallman and Margie Hyslop The Gazette Wednesday, April 29, 2009 Health officials in Montgomery County are in a "watch, wait and see mode" regarding the swine flu, said a spokeswoman for the county Department of Health and Human Services. "We're actively talking and working throughout the area," said spokeswoman Mary Anderson. Toward that end, health officials Tuesday set up a public information hot line for questions about the swine flu at 240-777-4200. Health workers will field calls between 8 a.m. and 5 p.m. weekdays until the line is no longer needed. Although the swine flu hasn't turned up in the county or Maryland, state health officials say it's only a matter of time. "We expect cases here in Maryland. That's what we're preparing for," said Fran Phillips, deputy secretary of public health with the Maryland Department of Health and Mental Hygiene. "This is definitely a situation that's going to evolve in the next 48 to 72 hours." In the meantime, Shady Grove Adventist Hospital has posted signs in English and Spanish asking anyone with flu symptoms to wear a mask. "For most people [swine flu] is a self-resolving viral illness" that takes about a week to run its course, said Gaurov Dayal, a pediatrician and chief medical officer for Shady Grove. People with symptoms should contact their doctor or the hospital before coming in for treatment to avoid exposing more people to the virus, Dayal said. Staff at Shady Grove and other hospitals are asking people with flu symptoms whether they have traveled to areas with swine flu cases. Suburban Hospital in Bethesda reported a record-breaking number of visits to its emergency room over the weekend, but it appears that the cause was the high level of airborne pollen that aggravated allergies. "If you do not have fever, it is very unlikely that you have swine flu or any flu," noted a statement released by Suburban Hospital officials Tuesday. Other hospital emergency rooms also saw lots of patients over the weekend, but officials said they were not sure whether concerns about swine flu were the reason. The state is monitoring hospital emergency rooms and physician's offices to see if people are coming in with swine flu symptoms, which include a fever greater than 100 degrees and a sore throat, difficulty breathing, confusion, an inability to eat or drink, and a bluish tinge to the skin, Phillips said. In those cases, people should contact their doctor or visit an emergency room, she said. The Maryland Department of Health and Mental Hygiene has opened a command center at its Baltimore offices to handle questions and to coordinate response if a swine flu case is reported in Maryland, spokesman David Paulson said. A handful of specimens statewide have been taken and tested in Baltimore. All have been negative, Phillips said. The state is also using "nontraditional" ways of conducting medical surveillance. For example, a couple of hundred pharmacies have their inventories plugged into a network of computers. State health officials can get a daily report on sales of over-the-counter medications, which might show an increase in respiratory illness, she said. "We're not seeing evidence of any significant increase in retail sales," she said. The swine flu cases that have appeared in the United States have been relatively mild compared with the severity of the cases in Mexico, Phillips said. Maryland has a stockpile of 276,000 doses of Tamiflu, one of four known anti-viral medications that is effective against swine flu, Paulson said. The federal government also plans to release its stockpile of Tamiflu, should it be necessary, he said, and that would mean 200,000 additional doses. To prevent the spread of swine flu, the following tips are offered by the Centers for Disease Control and Prevention: -Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick, too. -Stay home when you are sick. If possible, stay home from work, school and errands when you are sick. You will help prevent others from catching your illness. -Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. -Clean your hands. Washing your hands often will help protect you from germs. -Avoid touching your eyes, nose or mouth. Germs are often spread when people touch something that is contaminated with germs and then touch their eyes, nose, or mouth. -Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food. Source: Centers for Disease Control and Prevention Copyright 2009 The Gazette. Maryland braces for swine flu's arrival in state Health officials expect cases to show up here By Douglas Tallman and Jason Babcock SoMoNews.com online Wednesday, April 29, 2009 Although the swine flu hadn't turned up in Maryland by Tuesday afternoon, state health officials say it's only a matter of time. "We expect cases here in Maryland. That's what we're preparing for," said Fran Phillips, deputy secretary of public health with the Maryland Department of Health and Mental Hygiene. "This is definitely a situation that's going to evolve." Governor Martin O'Malley announced Tuesday the opening of a swine flu operation center in Baltimore. A handful of specimens statewide have been taken and tested. All have been negative, Phillips said Monday. There have been about 40 cases reported nationally and all are recovering, Nancy Lugenbill, director of health services for the St. Mary's County Health Department, said Tuesday. The state is monitoring hospital emergency rooms and physician's offices to see if people are coming in with any swine flu symptoms, which include a fever greater than 100 degrees and a sore throat, difficulty breathing, confusion, an inability to eat or drink and a bluish tinge to the skin, Phillips said. In those cases, people should contact their doctor or visit an emergency room, she said. The state is also using "nontraditional" ways of conducting medical surveillance. For example, a couple of hundred pharmacies have their inventories plugged into a network of computers. State health officials can get a daily report on sales of over-the-counter medications, which might show an increase in respiratory illness, Phillips said. "We're not seeing evidence of any significant increase in retail sales," she said. Emergency rooms have seen a slight increase in the number of people arriving with flu-like symptoms, Phillips said, but that could be the result of seasonal flu, greater sensitivity because of media reports and a tremendous increase in the pollen count, which could have people confusing allergic reactions to the flu. Maryland has extended the existing influenza surveillance period beyond its original end date of May 20 until further notice, the state health department said. Any health care provider with a suspected case of flu is requested to contact their local health department and submit samples to the State Public Health Laboratory for testing on all cases of flu-like illness that fit the appropriate characteristics. Phillips said the swine flu cases that have appeared in the United States have been relatively mild compared with the severity of the cases in Mexico. That could mean people have had swine flu and recovered, never knowing they had it. On the one hand, that's fortunate because people are not as ill, she said. "But on other hand, that means right now the spread of this virus is under way in proportions that we don't know," she said. Maryland has a stockpile of 276,000 doses of Tamiflu, one of four known anti-viral medications that is effective against swine flu, said David Paulson, a spokesman for the state's Department of Health and Mental Hygiene. The federal government also plans to release its stockpile of Tamiflu, should it be necessary, he said, and that would mean 200,000 additional doses. Lugenbill said the state would send Tamiflu to affected jurisdictions in the state upon confirmation of a case of swine flu. The Centers for Disease Control will determine where the distributions would be made if needed, she said. "We have an outbreak - it's rather contained at this point in time," she said. "Fortunately this flu does seem sensitive to the anti-virals that are available. I think the concern is it's not a virus we have seen in a while." "Just as we've planned and practiced for years, we are taking the necessary precautions to be ready if and when swine flu comes to Maryland," said John M. Colmers, state health department secretary. "We want to emphasize that the greatest tool for combating this serious health threat is the common sense approach anyone can take, such as washing your hands frequently and covering your mouth when you cough," he said. "If you're ill, stay home," Lugenbill said. dtallman@gazette.net jbabcock@somdnews.com To learn more For more information on swine flu, Marylanders can go to www.dhmh.state.md.us/. Copyright ©, 2009 Southern Maryland Newspapers - ALL RIGHTS RESERVED. Maryland Gets First Swine Flu Cases abc2news.com Wednesday, April 29, 2009 Governor Martin O'Malley says there are 6 suspected swine flu cases in Maryland, two of them are children. One of the kids with the flu goes to Milford Mill Academy in Baltimore County. The other goes to Folger McKinsey Elementary School in Severna Park, Anne Arundel County. According to the State Health Department, the students have not been in school since last week. The incubation period for the swine flu is 3-7 days. The Health Department also says some of the victims are related. Copyright 2009 The E.W. Scripps Co. All rights reserved. 6 Probable Cases Of Swine Flu Reported In Md. 3 Reported Each In Anne Arundel, Baltimore Counties WBALTV.com Wednesday, April 29, 2009 BALTIMORE -- State officials have announced that there are six probable cases of swine flu -- two in school-aged children -- in two Maryland counties in the Baltimore area. Officials said three of the cases are in one household in Anne Arundel County and the other three are in two different households in Baltimore County. Maryland Health Secretary John Colmers said two of the cases are in school-aged children -- one from Folger McKinsey Elementary in Severna Park and one from Milford Mill Academy in Baltimore County. Gov. Martin O'Malley said the cases have been sent to the Centers for Disease Control and Prevention for testing and confirmation. He said none of the six had to be hospitalized and that all are recovering. O'Malley said parents and teachers at those schools were notified regarding the cases and that the information was online, but at this time, he said it is not necessary to order closures of those schools. O'Malley said both infected children had had contact with people who had recently traveled out of Mexico and that no other cases had been identified in those schools. Milford Mill families were told in a letter that the student possibly infected has been at home for the entire duration of his illness. The school's administration said it is keeping a close watch on any students who are absent and working closely with the county Health Department regarding those absentees. Colmers said it takes three to seven days for swine flu symptoms to appear. He said they are expecting to get confirmation tests back by Thursday. Across the nation, swine flu cases have surged to 91. Officials said Tuesday that they expect the swine flu virus to continue to spread, and hospitals are preparing for it. St. Joseph Medical Center Dr. Rich Boehler said the hospital is taking every precaution. "We're watching to get guidance from the CDC and others. We've always been prepared for epidemics, and we're dusting off our plans, reviewing protocols and policies with staff," he said. Maryland health officials also opened a command center on Monday to help experts respond quickly to any suspected cases of swine flu. Swine flu is a combination of swine, human and bird flu, infection specialist nurse Leigh Chapman said. She said people should be worried not only about their own travels, but about any close contact with people who have been to Mexico or any of the other states that have been affected. Meanwhile, Boehler said quarantine protocols are in place at St. Joe's. "We anticipate the usual port of entry will be the emergency room. We've begun working with the ER staff on how to isolate appropriately the testing protocol for rapid flu testing, who we may or may not treat and how the staff can protect themselves. So, that's all being rehearsed," Boehler said. State officials said Maryland has plenty of anti-flu drugs. As a precaution, the federal government has sent 200,000 doses to Maryland, which already had 276,000. State officials are urging common sense steps to avoid swine flu. State Health Secretary John Colmers said if people feel sick, they should stay home. Previous Stories: * April 29, 2009: 2 Drunk Passengers Cause Forced Plane Landing * April 28, 2009: Md. Hospitals Prep For Swine Flu * April 28, 2009: Maryland Opens Swine Flu Command Center Copyright 2009 by wbaltv.com. All rights reserved. Cecil County officials prepare for swine flu WHO raises pandemic caution level to 5 out of 6 By Jane Bellmyer Cecil Whig Wednesday, April 29, 2009 The mantra is similar to that of the annual winter influenza, but Cecil County health officials are saying it louder with the impending arrival of swine flu. “We are urging people who are sick to stay home and call a doctor,” said Cecil County Health Officer Stephanie Garrity. “We don’t want people just going to the (emergency room) or the doctor’s office. Don’t spread it.” Copyright 2009 Cecil Whig. County schools brace for swine flu Reported cases at Univ. of Del. heightens concerns By Sonia Dasgupta Cecil Whig Wednesday, April 29, 2009 University of Delaware officials have opened a clinic to treat students showing signs of swine flu after 10 were identified with likely symptoms this week. Dr. Paul Silverman, an associate deputy director for health information and science at the Delaware Division of Public Health, said his agency is submitting samples from the four cases to the Centers for Disease Control and Prevention to determine if they are swine flu. Copyright 2009 Cecil Whig. Six Probable Swine Flu Cases In Maryland Maryland state officials have announced that there are six probable cases of swine flu in two Maryland counties. By Carl Gottlieb WUSA9.com Wednesday, April 29, 2009 BALTIMORE, Md. (WUSA) - Maryland state officials have announced that there are six probable cases of swine flu in two Maryland counties. Maryland's Health Secretary, John Colmers says at least two of the cases are in school children. One of the children attends classes at Folger McKinsey Elementary School in Anne Arundel County and the other at Milford Mill Academy in Baltimore County. Both infected children had contact with people who had recently visited Mexico. Parents and teachers where the children went to school have been notified says Maryland Governor Martin O'Malley. Governor O'Malley says the flu samples have been sent to the Center for Disease Control in Atlanta for testing. The Governor says test results should be back from the CDC within the next 24 to 48 hours. In a live interview with 9NEWS NOW, Governor O'Malley says, "What we have now are 6 probable cases and from the advice of the public health doctors and the epidemiologists, looking at this, they believe the liklihood is they will come back as confirmed case." O'Malley went on to say there are no plans at this time to close the schools where the children attend. O'Malley says all 6 of the people with suspected swine flu are recovering at this time, and Maryland has adequate medical supplies to deal with a potential outbreak. Copyright 2009 WUSA9.com. Swine flu worries prompt record visits to local ERs By: Examiner Staff Writer Washington Examiner Wednesday, April 29, 2009 A record number of patients have flooded some Washington-area hospitals fearing they have contracted the swine flu, but there had been no confirmed cases of the disease as of Tuesday afternoon. Takoma Park’s Washington Adventist Hospital has been averaging 20 extra emergency room patients a day since Friday, including a record-breaking 171 visitors Monday, according to a spokeswoman. Many patients who were concerned they might have the swine flu complained of allergy symptoms, spokeswoman Lydia Parris said. “There’s a lot of pollen in the air right now,” Parris said. It was a similar scene at Suburban Hospital in Bethesda, which had a record-breaking day Sunday, largely because of allergy suffers who thought they might have the swine flu, according to a spokeswoman. Symptoms of swine flu include runny nose or nasal congestion, cough, sore throat and a fever higher than 100 degrees. Two hospitals in suburban Virginia also saw an increase in ER visitors concerned about swine flu, according to a spokesman. The virus has killed dozens in Mexico, infected more than 60 in five different states in the U.S. and has spread to several corners of the globe. Hospital officials said that patients who are exhibiting flulike symptoms should try to consult with their personal physician before going to the emergency room. Local governments have stepped up efforts to try to combat any potential outbreak of the disease, including establishing hot lines and starting public education campaigns to encourage people to wash their hands more often. Metro officials said they were continuing a flu-season program of wiping down surfaces throughout the transit system with “hospital-grade disinfectant” because of the swine flu outbreak. Metro trains and station equipment are disinfected daily, officials said, with buses disinfected at least every 14 days. Copyright 2009 Washington Examiner. 4 at U of Delaware have 'minor' flu symptoms Associated Press By Brian Witte Baltimore Sun Wednesday, April 29, 2009 NEWARK, Del. - Delaware Gov. Jack Markell and state health officials sought to assure residents Wednesday they need not be anxious about four flu cases at the University of Delaware that met probable definitions of swine flu. Markell underscored that the four students have "minor symptoms," and he said state health officials are closely monitoring hospitals, schools and large businesses for any signs of an outbreak. Health officials emphasized that it's common for people to experience flu symptoms this time of year. "At this point, I would just say that there is no reason to get particularly anxious about this," said Dr. James Newman, chief medical officer at Christiana Care Health System, who noted it would take between 24 and 36 hours to identify whether the students have swine flu. The four students sought treatment Monday evening. Preliminary tests were taken and forwarded to the Centers for Disease Control. Markell said 31 nurses and more than 50 other health professionals have been sent to the university in Newark, Del., to help monitor the situation and screen students. University of Delaware President Patrick Harker said at the news conference in Wilmington that fewer than 100 students had come to two centers to be checked out. He said the school sees about 170 students on a typical day for a variety of medical conditions. "While we expect that the numbers will of course be higher, we don't expect they will be higher by order of magnitude," Harker said. The university did not cancel classes, and the campus appeared calm Wednesday morning. Maciej Klosowski, a freshman from Wilmington, said he received a text message from the university Tuesday night at about 9:15 p.m. notifying him of the four illnesses. "It's not confirmed yet, so I'm not terribly too scared yet, but later on, maybe," he said. Harker said the university is keeping a close eye on developments and may reschedule large gatherings or events at the school, but he said there are no current plans to close the campus. "Keeping the university open right now actually makes it easier for us to test and treat students," Harker said. Two of the students lived in dormitories and two lived in off-campus housing. School officials have reached out to people who lived with them. Dr. Paul Silverman, associate deputy director of the Delaware Division of Public Health, said none of the students had been in Mexico. One student has gone home, and the other three students remained in their school homes. Newman said there has not been a noticeable increase in respiratory illnesses at Christiana. At the Student Health Center at Laurel Hall on campus, staff wore masks as they tended to students. Outside the center, signs were posted on doors directing students who were concerned they might have symptoms to a separate entrance. Tiffany Brooks, a 20-year-old student from Dewey Beach, Del., said a group meeting for a school project she is working on was called off after two students expressed concern about the flu. "When I was at the dining hall, it seemed like everybody was talking about it," Brooks said. Michelle DeBonis, a 20-year-old student from Sayville, N.Y., said she was slightly concerned, because illnesses tend to spread quickly on college campuses. "I just don't like it when something gets out on campus, because it spreads like wildfire," DeBonis said. The university alerted 43,547 people Tuesday night by text messages, phone calls and e-mails, said Andrea Boyle, a university spokeswoman. The university has about 20,000 students and 4,000 faculty and staff. Parents of students also were notified. Swine flu is suspected of killing more than 150 people and sickening more than 2,400 in Mexico. U.S. health officials have confirmed 91 cases in 10 states. Copyright 2009 Baltimore Sun. Customers continue to buy pork By Ike Wilson Frederick News-Post Wednesday, April 29, 2009 Melissa Bowman holds a freshly cut rack of pork ribs in her family's store, Shuff's Meat in Thurmont. Pork sales are where they should be at Shuff's Meat in Thurmont , and Hillside Turkey Farm owners have fielded no consumer worried about the pork they sell despite the international swine flu outbreak. "As of right now, we're not getting any concerns" from shoppers, said Jim Boone, a meat cutter at Shuff's. USDA inspector Robin Brown was on the job Tuesday at Shuff's Meat. "As of this time, there's no statement from the USDA saying anything is wrong with pork in this country," Brown said. "There's absolutely nothing wrong with eating pork. We just killed hogs this morning." Local meat shops may not have fielded any consumer concerns about swine flu and the pork they sell, but the American Farm Bureau has, the bureau said in a statement. The Centers for Disease Control and Prevention has said swine flu cannot be caught from eating pork or pork products. All U.S. cases were spread by human-to-human contact. "Eating properly handled and cooked pork products is safe," the bureau said. Today, there are no reports of influenza virus circulating in the U.S. swine herd, the farm bureau said. Not since 1976 has there been a swine flu outbreak in the U.S., Boone said. The World Organization for Animal Health said Tuesday "North American" flu is the virus that has been identified in those infected. The flu virus spreading around the world should not be called "swine flu" because it also contains avian and human components and no pig has been infected with it. Questions to national grocery chains were directed to corporate headquarters, which did not respond by press time. The public should take some responsibility for food-borne diseases, said Brian Bowman, manager of Shuff's Meats. "A lot of diseases like E. coli and salmonella is the result of people not cooking their food well enough," Bowman said. "It's fresh when I put it on my scale, but for convenience, they drive it around in their cars for three or four hours. The public needs to learn about these things." The swine flu outbreak triggered Bowman's disdain for government regulations costly to small businesses like Shuff's. For eight years, Shuff's Meat has been taking samples to a Hagerstown lab that has determined their meat is safe, Bowman said. With that kind of record, the federal government should give a small business like Shuff's a break by cutting back on costly inspections for at least one year, Bowman said. "We go through so many tests that are not required in other countries. I see a lot of New Zealand beef coming into this country. How can you inspect boxed products?" Bowman asked. Assigning only two inspectors to a large industrial meat plant doesn't assure adequate inspection, Bowman said. A small business like Shuff's Meats that hires 10 people gets the same level of inspection as a large industrial meat plant, which is unfair, Bowman said. Copyright 2009 Frederick News-Post. '09 pollen count heavier than normal By Shantee Woodards Annapolis Capital Wednesday, April 29, 2009 The recent influx of pollen is a double-edged sword for Wayne Shepherd. As an allergy sufferer, he's tired of coughing whenever he goes outside. But, as owner of Shepherd's Car Wash, he enjoys seeing cars lining up at his Spa Road business. He has seen a few that look like his black truck, which has been sitting around for two weeks and now appears bright green because of the heavy pollen mist that has settled on it. "Business has been phenomenal," Shepherd said. "I appreciate the business, but my allergies are really suffering. I'm getting the good and the bad, and waiting for the ugly." The state's prime pollination season has begun, and a mix of oak, birch and beech pollen grains is filling the air. The season typically starts in the second to fourth week of April, immediately preceded by the pollination of cedar, maple and elm trees. Once this cycle is complete, experts say, it will be time for the grass pollen to enter its peak season. Yesterday's pollen counts from Annapolis Allergy and Asthma show the pollen levels have topped 5,000 grains per cubic meter, higher than levels typically reached during this season. And in the past 24 hours, the count reached 7,120 grains per cubic meter, a level that Dr. Duane Gels said he can't recall ever having seen before. Fortunately, there is a respite on the horizon: rain in this week's forecast. The National Weather Service is calling for showers today with highs in the 60s. Rain is also expected tomorrow and into the weekend. But April showers may only wash away some of the trouble for allergy sufferers. "Over the period of time people are exposed (to pollen), they become more and more sensitized," said Gels, an allergist at the Annapolis office. "In the beginning of the pollen season, it takes more (pollen) to trigger a sneeze than now. Now it takes less pollen." Local pollen counts had only begun to register above 100 when last week's rainfall hit. Over the weekend, the pollen count reached 1,000, and it climbed to 4,300 on Monday. Yesterday the count was above 5,500, a major irritant to allergy sufferers. About 80 percent of the pollen is from oak trees, which are dominant in this area. Allergies are among the most common afflictions in the United States, with about 40 million Americans suffering from indoor and outdoor allergies, according to the Asthma and Allergy Foundation of America. Some common triggers for indoor allergies are mold spores and cat or dog dander, while tree, grass and weed pollen are among the most common outdoor causes. At this point, allergy sufferers should stay inside with the air conditioning on to avoid the pollen, Gels said. Over-the-counter medications are beneficial, as is rinsing the nose with saline. Serious allergy sufferers also should have started their annual round of treatment, which will help them build up a resistance to allergens. "It's easier to treat early on than to let it wait," Gels said. "Then you have more and more mucus pile up." Copyright 2009 Annapolis Capital. County, state get poor grades for air pollution Some progress made statewide By Pamela Wood Annapolis Capital Wednesday, April 29, 2009 Anne Arundel County continues to have unhealthy levels of air pollution, posing health risks to sensitive residents, according to a report issued today. Advertisement The American Lung Association gave the county a grade of F for smog and D for soot pollution in its annual "State of the Air" report. Anne Arundel also squeaked out a "pass" on a pass/fail measurement of year-round soot pollution. Overall, the Baltimore-Washington metro area ranks 14th-worst nationally both for daily smog pollution and daily soot pollution. The lung association report measures two types of pollution: smog, also known as ground-level ozone; and soot, also called particulate matter. The report issued today covered the years 2005 to 2007 and is based on government data. Ozone occurs when hot air, sunshine and airborne pollutants combine. Ozone contributes to decreased lung function, respiratory infections, lung inflammation and worsening of lung problems. Particulate matter, tiny bits of solid and liquid pollution in the air, also causes health warnings and health problems, including increased hospital visits for asthma and heart patients, according to the lung association. "Air pollution is serious," said Dr. Norman H. Edelman, chief medical officer for the lung association. Air pollution is caused by emissions from gasoline and diesel vehicles, coal-burning power plants and other sources. Despite the poor grades, state environment officials said Maryland's air pollution is decreasing. "We've made some progress, but we still have a ways to go," said Tad Aburn, the top air-quality official at the state Department of the Environment. "The reality is, the air Marylanders breathe is a whole bunch cleaner than 10 years ago." Aburn, who was attending a multistate meeting about power-plant pollution yesterday, said Maryland needs to continue to cut down on pollution from local sources as well as work with neighboring states. On some days, 50 percent to 70 percent of Maryland's air pollution blows in from the Ohio Valley. Maryland lawmakers have taken steps to combat air pollution. The Healthy Air Act, passed in 2006, requires pollution controls at power plants, some of which already have been installed. And the Clean Cars Act of 2007 will eventually require more low-emissions cars to be sold here. Those laws and other programs should result in better pollution scores in the future, Aburn said. Charles D. Conner, CEO of the lung association, said the report underscores the importance of fighting air pollution, even as the nation wrestles with other urgent, related issues such as global warming and energy independence. "We still must recognize the problems we have with old-fashioned air pollution," he said. The report mainly looks at how often air quality alerts such as "code orange" and "code red" are issued to warn sensitive people to stay inside because of high levels of soot or smog. Those alerts are issued mostly in the summer, when hot air and sunlight make the effects of pollution worse. The lung association offered ideas for improving air quality: require pollution controls at coal-burning power plants, clean up the nation's diesel trucks and buses, clean up dirty oceangoing ships, and tighten pollution regulations. Individuals can take action by driving less and using less electricity, not burning wood or trash, lobbying for cleaner buses, and getting involved in pollution policy, officials said. This is the 10th year for the "State of the Air" report, which initially gave grades only for smog. Soot was added later. If you're looking for a place with air that's easier to breathe, the lung association says Fargo, N.D., has the cleanest air in the nation. --- HOW WE RANK The American Lung Association annually ranks cities, counties and regions on air quality. The rankings are based on data collected by the U.S. Environmental Protection Agency. The 2009 report is based on data from 2005 to 2007. Here's how Anne Arundel County scored: • SMOG Ozone - Grade: F 48 code orange days, 2 code red days, 1 code purple day. Weighted score: 17.7, fifth-worst in Maryland. • SOOT Short-term particle pollution - Grade: D 7 code orange days Weighted score: 2.3, fourth-worst in Maryland. • ANNUAL PARTICLE POLLUTION Grade: Pass Score: 14.3 (15 or greater is failing), third worst in Maryland. Queen Anne's County is not ranked because it does not have an air-quality monitoring station. Copyright 2009 Annapolis Capital. Q&A with Howard’s health officer about Md.’s preparedness By Richard Simon Daily Record Wednesday, April 29, 2009 Howard County Health Officer Dr. Peter Beilenson has been preparing county officials for a potential flu pandemic for several years. In June 2008, Beilenson’s staff conducted pandemic flu exercises in Ellicott City’s Chateau Ridgelake neighborhood and in Laurel. Health officials set up a command center and went door-to-door delivering medication to families’ homes. In November, the Howard County Health Department, for the second straight year under Beilenson’s supervision, created a drive-through flu clinic where county residents could pull up in their cars and receive a vaccination. Beilenson said 4,000 people participated over a five-hour period, making it the largest drive-through vaccination site in the country. With the news continuing to emerge about the swine flu virus, Beilenson spoke to The Daily Record about the state’s preparedness and what can be expected if multiple cases arise in Maryland. Question: What was the purpose of Howard County’s flu exercise? Answer: It was [a test to see] how we would deal with an oncoming pandemic flu epidemic that originally started internationally and came to the U.S., then came to Howard County. Amazing enough, it was all done as if it was actually happening. It was great that we did that. Q: What do you think you and your staff learned since the execution of the exercise in June? A: First, communication. One of the things we learned in the exercise was that there wasn’t a single message going out to all key officials in the county. Different things were coming from different places. There wasn’t a unified communication command. So we have done that in this [swine flu] event. We have communications that we send out every day by noon of what’s going on in the county and what’s going on in the country and the world. That way, there is a single source of information so that all people are working on the same page. … The argument is that you don’t want things to go perfectly in an exercise and you want to learn from them, and I think we’ve been able to learn from them. Q: Do you believe that Maryland is prepared for a swine flu outbreak? A: I think Maryland is well prepared. They have opened their emergency operation center at the [Department of Health & Mental Hygiene] downtown. … Right now, there’s no need to talk to the neighboring jurisdictions. If things occur in Maryland, which I think is very likely, then we’ll be working across county lines as well. Q: Gov. Martin O’Malley said Monday that he expects to see swine flu cases arise in Maryland. What do you expect? A: I think if we get cases, it will be more than several. This is acting so far sort of like an out-of-season seasonal flu in terms of symptoms, but it’s not much more serious than the typical seasonal flu. It is novel, so the people who are affected by this actually, at least in Mexico, are young, healthy people, because their immune systems sort of over-react when they are exposed to this new virus, which is what has led to the deaths. In the United States, that has not happened as of yet. It’s very likely that it will start going around the country like a regular seasonal flu. It’s likely that if it comes to Maryland that we’ll have many, many cases. Hopefully, it will remain a relatively moderate strain. At least so far in the United States, the vast majority of people have been able to recuperate at home. I would say there’s better than an even chance that we’ll have cases in Maryland. And if we have cases in Maryland, it will be more than a few. Q: Do you have any theories about why this strain of flu has been more extreme in Mexico, and not here? A: This is my surmisal. I think it’s got to be many more cases in Mexico than they’re saying. Right now they’re saying, 1,500 cases — 150 deaths, which is a 10 percent fatality rate, which is quite high. Of the millions of people with the flu in the United States each year, 36,000 people die, so it’s a tiny percentage. The reason I think there are many more cases in Mexico is that most of the cases in the U.S. are due to travel into Mexico, and these are people from different parts of the country going into different parts of Mexico; Cancun, Mexico City, etc. Don’t tell me that these 60 or 80 people in the United States that have been confirmed so far were all around the same few hundred people that are sick. That doesn’t make any sense. My guess is that it’s much more widespread in Mexico. Copyright 2009 Daily Record. Advocates say report more proof of need for health care reform By Kevin Spradlin Cumberland Times-News Wednesday, April 28, 2009 CUMBERLAND - Health care reform advocates highlighted a report on Tuesday that shows Maryland families are using too much of their pretax income on health care. Ron Pollack, executive director for Families USA, a nonprofit organization that advocates for high-quality, affordable health care for all Americans, said the findings of the report come with a clear conclusion. “High health care costs are not just a problem of the uninsured,” he said during an early afternoon conference call. “More families with insurance are affected. The burden of these (costs are) becoming too great to bear. As a result, they are spending much larger portions of family income on health care costs, and health care is becoming less and less affordable.” “It’s a clear reason,” Pollack said, “why health care reform is overdue.” According to projections in a report released Tuesday, more than a quarter million people in Maryland will spend more than 25 percent of their families’ pretax income on health care this year. More than 1 million people will spend at least 10 percent of their pretax income on health care. Those figures are up from 152,000 and 632,000, respectively, in 2000. “The overwhelming majority of these people are in insured families,” Pollack said. The 35-page report - available online at www.familiesusa.org/assets/pdfs/too-great-a-burden-2009.pdf - concludes that the number of people with high health care costs is on the rise because health insurance premiums are increasing. “As premiums rise, employers are forced to make tough decisions about the coverage they offer to their employees; some drop coverage, others increase the share of the premium that employees must pay, and more offer insurance that covers fewer services and/or requires high out-of-pocket costs,” according to the report. Vinny DeMarco, president of Maryland Citizen’s Health Initiative, said part of his organization’s focus is on the impact to employers, particularly small businesses. “They don’t want to cut back on health care,” DeMarco said. “It’s important to retaining good employees. We come across stories all the time of businesses that are having trouble affording health care and individuals who can’t get employer-based coverage.” Those workers are “spending thousands and thousands” of dollars every year, DeMarco said, on health care coverage on the open market by getting stuck with higher premiums and co-pays “and really not getting the kind of health care they need anyway.” Under the envisioned health care reform, Pollack said the focus would turn to preventive medical care. It could be paid, in part, by creating efficiencies in the health care system. “We have huge numbers of people who are uninsured and under-insured,” Pollack said. “Expanding health care coverage for them, that is clearly an additional cost. Congress and the White House said those initial investments designed to bring everyone into the system must be fully paid for by efficiencies or increased revenues.” He said Families USA supports President Barack Obama’s pledge to commit $634 billion over 10 years for the program. Pollack said another potential source of revenue is adding to the existing tobacco tax. Tiffany Lundquist, a spokeswoman for AARP Maryland, which has been a catalyst in the health care reform initiative Divided We Fail, agreed with Pollack that the program will cost money - but not as much as keeping with the status quo. Many Maryland families, Lundquist said, “are one medical crisis away from financial ruin. The cost of doing nothing is too high. We can’t wait.” Lundquist said Divided We Fail campaign supporters hope for specific policy proposals within a couple of weeks. Advocates feel legislation could be ready for Obama’s signature by early fall. Contact Kevin Spradlin at kspradlin@times-news.com. Copyright © 1999-2008 cnhi, inc. Md. ag secretary to retire Richardson to travel, return to farming By Greg Latshaw Salisbury Daily Times Wednesday, April 29, 2009 SALISBURY -- Worcester County native Roger Richardson announced Tuesday he will step down from his post as Maryland's secretary of agriculture. The lifelong farmer, 75, intends to spend his retirement tilling his Lower Shore grain fields and traveling abroad with his wife of 55 years, Fay Pusey. Replacing Richardson on May 5 will be the deputy secretary of agriculture, Earl "Buddy" Hance, of Calvert County. "It's a mixed feeling. I really hate to leave, but I just feel like, my family, I owe them some things," said Richardson, who served as secretary since 2007. Gov. Martin O'Malley commended Richardson for overseeing a variety of programs. During his tenure, Maryland farmers put farmland into preservation, expanded sales of their crops locally and worldwide and lowered pollution caused by fertilizers with cover crops and other measures. "(Richardson) has been instrumental in working together with the environmental community to help build a sustainable future for Maryland," said O'Malley in a prepared statement. Hance, who was picked by Richardson to serve as deputy secretary, is a fourth-generation farmer. He formerly grew tobacco and now runs a 400-acre family farm in Port Republic with corn, soybeans and commercial greenhouses. "He's a southern Maryland farmer and a good man," said Richardson of the incoming secretary. O'Malley said that Hance has plenty of experience, coming from a background that includes being president of the Maryland Farm Bureau. "I am confident that he will continue the work that Secretary Richardson has done to build our vision for a smarter, greener, more sustainable state, while protecting our family-owned farms and Maryland's rich agricultural heritage," O'Malley said in a prepared statement. Richardson plans on starting his retirement by toiling in the fields. That's because early spring is the heart of planting season at the 3,500 acres his family owns in Wicomico, Worcester and Somerset counties. However, the lulls between planting and the harvest should, hopefully, give Richardson and his wife a chance to travel to Italy this summer, he said. They picked that location, Richardson said, because the family took in an Italian exchange student in the 1970s. Richardson has two daughters, six grandchildren and six great-grandchildren. For Richardson, the hardest part of stepping away from the Department of Agriculture is saying goodbye to co-workers that he believes don't get enough credit. The department's Weights and Measures Division, for example, is responsible for checking the accuracy statewide for the scales at grocery stores and highway rest stops and the dispensing units at gas pumps. "You really hate to leave that group. But seriously, when you're 75, you wonder how much future you have left," Richardson said. glatshaw@dmg.gannett.com 410-845-4643 Copyright 2009 Salisbury Daily Times. Man accused of exposing woman to HIV Alleged gang member charged with knowingly exposing woman he met on Facebook By Patricia M. Murret Montgomery County Gazette Wednesday, April 29, 2009 Montgomery County prosecutors have accused a Germantown man of meeting a recent high school graduate on Facebook and knowingly exposing her to human immunodeficiency virus, or HIV, by having intercourse with her, according to Assistant State's Attorney Stephen D. Chaikin. "It is rare, but not unheard of" to prosecute such cases, said Chaikin. Four other such cases have been filed in Montgomery County since 1989, when it became illegal to knowingly transfer or expose another individual to HIV, according to records compiled by the Montgomery County Circuit Court Administrative Office. All five cases have been filed since 2005. The case marks the second time prosecutors have charged Thomas James Perrera III, 28, of Germantown, with knowingly transferring or attempting to transfer HIV to another person. In 2005, he pleaded guilty to reckless endangerment, after being charged with knowingly exposing another person to HIV, in a case involving consensual unprotected sex with a woman he was dating, according to court documents. Perrera has known for 10 years that he has HIV, according to charging documents in the 2005 case and court documents filed earlier this month in the 2009 case. An informative report filed Feb. 16 by his parole and probation officer states that Perrera has AIDS. Perrera's probation officer states in the report that Perrera "meets young women aged 18-20 on MySpace," which is a popular social networking Web site. He "gets to know them, then has unprotected sex with them for the sole purpose of infecting them with AIDS," the parole and probation report states. Perrera's probation officer also filed an identification report in November 2007 that states that Perrera bites on arrest. On April 14, Chaikin filed a "criminal information" in Circuit Court against Perrera, who lives in the 11500 block of Scottsbury Terrace. A criminal information is a formal criminal charge made by prosecutors without a grand jury indictment. The document charges Perrera with seven counts of reckless endangerment and seven counts of knowingly exposing others to HIV. According to the document, the charges stem from seven sexual encounters Perrera had with an 18-year-old woman last year. County police seized Perrera's computer and believe there may be more victims, Chaikin said. The upcounty community prosecutor is working on the case with county police detectives from the 5th District in Germantown. Perrera's family could not be reached for comment. His attorney, Vickie Tyler, assistant public defender for Montgomery County, did not return several calls for comment. The Maryland General Assembly made it illegal to knowingly transfer or attempt to transfer HIV in 1989 and is one of 32 states with such a measure. Each reckless endangerment conviction in Maryland can bring up to five years in prison and a $5,000 fine, and each conviction for knowingly transferring or attempting to transfer another with HIV can bring up to three years in prison and $2,500 in fines. "Holding him accountable and protecting the community, that's what this whole case is about," Chaikin said. Prosecutors also charged Perrera on April 14 with a felony theft scheme for allegedly stealing more than $500 from the 18-year-old woman. "He was stealing money from her bank account and then when she ran out of money he broke up with her," Chaikin said. Chaikin said he became involved in the case when the alleged victim's mother contacted him. The 18-year-old had moved out of the house and in with Perrera, Chaikin said, adding that her mother researched Perrera's criminal history and saw in his 2005 conviction for reckless endangerment that he also had been charged with knowingly exposing another to HIV. The mother asked police to tell her daughter that Perrera was HIV-positive, Chaikin said. Police charging documents state that the daughter confronted Perrera, who denied that he was HIV-positive. Later, he told her that he was HIV-positive and said he did not tell her because he was afraid she would leave him, according to the charging documents. Perrera's sexual encounters with the 18-year-old alleged victim occurred in June and July 2008, according to the criminal information Chaikin filed. Police directed the mother to Chaikin, who began working the case with police. Police originally filed charges Feb. 24 against Perrera in Montgomery County District Court alleging one count of reckless endangerment and one count of knowingly exposing the woman to HIV, as well as five counts of theft, according to the charging documents. But due to the complexity of the case, which involves medical records and potential DNA information, and the continuing investigation, prosecutors brought the case to Circuit Court on April 14, Chaikin said. Perrera is being held at the Montgomery County Correctional Facility in Boyds on no bond, said Sumita Dutta, a records technician for the county corrections department. Chaikin would not discuss the alleged victim's or Perrera's previous victim's medical status, citing privacy concerns and the ongoing investigation. Police arrested Perrera on Feb. 19 on a bench warrant stating that he violated his probation connected to his 2005 conviction, according to a Feb. 25 parole and probation report. Upon arresting Perrera, police discovered he was armed with a knife, the report states. Police then "mistakenly" released Perrera on his own recognizance and Perrera fled the state to avoid imprisonment, according to the report. He was arrested again on March 2 in Stafford, Va., on another bench warrant. He had violated his probation by leaving Maryland without informing his probation officer, according to a probation officer's report. Perrera is in the Dead Man Inc. gang, according to the report filed by his probation agent and the criminal information document filed by prosecutors. He is 5-foot-9-inches tall, weighs 140 pounds and has "4139" tattooed across his right knuckles, as well as tattooes on his chest, back, neck and upper arms, according to police. A photograph taken by police shows the word "love" written across Perrera's neck. Perrera's alleged victim, who is now 19, was a smart 18-year-old who did well in school and had a good job, said Chaikin. She met Perrera on Facebook, another popular social networking Web site, and they started dating, Chaikin said. She is being tested for HIV every three months, Chaikin said. "When people are exposed to HIV, the body begins to develop detectable antibodies…starting in about two weeks," said Claudia Gray, chief of the Center for Prevention at the Maryland AIDS Administration in the state Department of Mental Health and Hygiene. "Most people will have developed them within three months and nearly everybody will have developed them within six months." According to court records, Perrera served one year in prison for committing reckless endangerment in 2005. Police charging documents from that case show that the woman was his girlfriend and they were having unprotected sex. The victim in the 2005 case learned that Perrera was HIV-positive at Shady Grove Adventist Hospital, where he was having a tumor removed and she heard comments from Perrera's mother and noticed doctors' actions, charging documents state. The documents state that the victim confronted Perrera and that he admitted he was HIV-positive and said he had a low strain of HIV. The victim told police she had asked Perrera several times while they were dating if he had HIV and he had said no, according to the charging documents. A member of Perrera's family told police Perrera had known for 10 years that he was infected, the charging documents state. Montgomery County Circuit Court Judge Michael D. Mason sentenced Perrera in August 2006 to five years in prison and suspended all but one year; he gave Perrera three years probation. Charging documents and reports from probation officers state that Perrera is considered a violent criminal by the justice system. Copyright 2009 Montgomery County Gazette. Hopkins: Suburban expansion to proceed Purchase of hospital will not affect construction, officials say By Andrew Ujifusa Frederick News-Post Wednesday, April 29, 2009 Suburban Hospital's proposed expansion in Bethesda will not be affected by Johns Hopkins Health System's recently-announced purchase of the hospital, according to officials from both organizations. The $230 million expansion that would include upgraded surgical suites and more single-patient rooms is fully supported by Johns Hopkins, according to an April 26 letter from Dr. Edward Miller, dean and CEO of Johns Hopkins Medicine, to Brian Gragnolati, president and CEO of Suburban Hospital Healthcare System. "The integration of Suburban Hospital and JHHS will not cause any modification to the campus enhancement plans as they have been presented in the application for special exception modification and the testimony presented in the pending case before the Board of Appeals," reads part of Miller's letter. The expansion plan, which is being fought by residents of the surrounding Huntington Terrace neighborhood over the proposed closure of one block of Lincoln Street and the loss of 23 hospital-owned homes, is being considered by a Montgomery County hearing examiner. The partnership means that Suburban will join a $4.5 billion medical research and health care network operated by Johns Hopkins Medicine. Gragnolati said the long-term goal is to find ways for Johns Hopkins to help the hospital deliver higher quality health care, especially given possible reforms at the federal level. "You're not going to see immediate changes," Gragnolati said. Ron Peterson, president of Johns Hopkins Health System, said bringing Suburban under the umbrella of Johns Hopkins Medicine could lead to a "direct pipeline" that would bring Suburban patients to Johns Hopkins medical specialists. Peterson also said the partnership could allow new medical programs to begin at the hospital, similar to Suburban's current cardiac treatment program that is run in conjunction with Johns Hopkins and the National Institutes of Health. The hospital could also take advantage of cost savings on equipment and supplies through Johns Hopkins, Peterson said, who added that the partnership represented a move to deal with what he called the "unsustainable cost curve" of current health care treatment. "This is the wave of the future, for academically-oriented organizations to partner appropriately with community-based organizations," Peterson said. Suburban spokeswoman Ronna Borenstein-Levy said the acquisition of the hospital by Johns Hopkins does not require regulatory approval. Asked about any bureaucratic difficulties that could arise by bringing Suburban into Johns Hopkins Health System, Gragnolati said Suburban's priority was making sure it could remain focused on community needs. Peterson said in addition to creating lines of communication between officials such as himself and Gragnolati, Suburban would join a coordinating council of various Johns Hopkins affiliates that would focus on "clinical program opportunities." He also stressed the need for Suburban to remain independent on community matters. "We have talked a great deal about trying to address ways of not causing the local institution to get bogged down in decision-making processes," Peterson said. Gragnolati said the discussions between Suburban and Johns Hopkins about the new arrangement had been underway for some months. "Both organizations didn't need to do this right now. This is something that wasn't done because of an event or activity or a condition," Gragnolati said. "These are two organizations that have had a great history of working together." Copyright 2009 Frederick News-Post. Six-point county worker health and safety initiative announced Announcement comes on national Workers Memorial Day By Margie Hyslop and Janel Davis The Gazette Wednesday, April 29, 2009 A new, six-point plan of health and safety initiatives for county employees was announced Tuesday by County Executive Isiah Leggett (D), along with County Council members Valerie Ervin (D-Dist. 5) of Silver Spring and George L. Leventhal (D-At large) of Takoma Park. The initiatives were announced in recognition of national Workers Memorial Day. Among the new policies, county inspectors will begin to notify the Maryland Occupational Safety and Heath Administration when they see a situation that looks like a workplace safety violation. The state agency, not the county government, remains responsible for enforcement. Concerns about liability delayed the effort, which was recommended by a county workplace safety panel more than two ago because the state agency, MOSH, lacked enough inspectors. "[MOSH] does a great job, but it has so few staff that it would take MOSH 110 years to inspect every Maryland workplace once," Leggett said. "We can't do MOSH's job for them, but we can be the extra eyes and ears they need." Copyright 2009 The Gazette. Keyser water treatment lab will remain open By Sarah Moses Cumberland Times-News Wednesday, April 29, 2009 KEYSER, W.Va. - It wasn’t quite passing with flying colors, but the Keyser water treatment lab will remain open after an inspection Tuesday by the West Virginia Department of Environmental Protection. “It went well,” Mike Kesecker, plant supervisor, said. “Of course, there is a lot of stuff we will continue to do work on, but we’re still open. … We’re taking it one step at a time.” The lab’s violations as cited by the DEP created a document that was over an inch thick, Kesecker said. He said he has been putting in extra hours to get the lab up to specifications. Though the lab will remain open, he said the DEP will return for a followup inspection in September to see if everything is “moving in the right direction,” Kesecker said. Councilman Dave Sowers said these were violations that went back several years, when former plant supervisor Jim Hoffman was employed by the city. He said the council and sewer commission were unaware of many of these violations as Hoffman had failed to informed them. Hoffman took the city council to court over his dismissal from the lab, saying they had overstepped the sewer commission’s authority. He testified at the hearing that he always informed the council of violations if he did not fix them right away and he was not aware of any that were outstanding during his time as a supervisor. However, the list of violations dated back to 2005, Sowers said, and a recent one at the storage and treatment portion of operations was just discovered. Hoffman and employee Jeremy Miner were released following the seizure of files and computers and a subsequent investigation in March under suspicions they were operating their business, J & J Environmental, out of the sewer lab. Councilman William “Sonny” Rhodes said he was pleased to see the work that Kesecker and fellow employee Tom Martin had done, and that DEP was willing to work with them. He said that the inspector, Ellen Herndon, approached the inspection as though this was a new lab as so many changes had been made. Mayor Glen “Bunk” Shumaker said he hadn’t been worried the lab would be closed down, given what had been done over the last few weeks. “I knew (the DEP was) working with us to get everything in compliance to where it needed to be,” he said. “I wasn’t afraid we would get shut down because Mike was working to get us where we needed to be, along with Tom Martin.” Sarah Moses can be reached at smoses@times-news.com.KEYSER, W.Va. - It wasn’t quite passing with flying colors, but the Keyser water treatment lab will remain open after an inspection Tuesday by the West Virginia Department of Environmental Protection. “It went well,” Mike Kesecker, plant supervisor, said. “Of course, there is a lot of stuff we will continue to do work on, but we’re still open. … We’re taking it one step at a time.” The lab’s violations as cited by the DEP created a document that was over an inch thick, Kesecker said. He said he has been putting in extra hours to get the lab up to specifications. Though the lab will remain open, he said the DEP will return for a followup inspection in September to see if everything is “moving in the right direction,” Kesecker said. Councilman Dave Sowers said these were violations that went back several years, when former plant supervisor Jim Hoffman was employed by the city. He said the council and sewer commission were unaware of many of these violations as Hoffman had failed to informed them. Hoffman took the city council to court over his dismissal from the lab, saying they had overstepped the sewer commission’s authority. He testified at the hearing that he always informed the council of violations if he did not fix them right away and he was not aware of any that were outstanding during his time as a supervisor. However, the list of violations dated back to 2005, Sowers said, and a recent one at the storage and treatment portion of operations was just discovered. Hoffman and employee Jeremy Miner were released following the seizure of files and computers and a subsequent investigation in March under suspicions they were operating their business, J & J Environmental, out of the sewer lab. Councilman William “Sonny” Rhodes said he was pleased to see the work that Kesecker and fellow employee Tom Martin had done, and that DEP was willing to work with them. He said that the inspector, Ellen Herndon, approached the inspection as though this was a new lab as so many changes had been made. Mayor Glen “Bunk” Shumaker said he hadn’t been worried the lab would be closed down, given what had been done over the last few weeks. “I knew (the DEP was) working with us to get everything in compliance to where it needed to be,” he said. “I wasn’t afraid we would get shut down because Mike was working to get us where we needed to be, along with Tom Martin.” Contact Sarah Moses at smoses@times-news.com. Copyright © 1999-2008 cnhi, inc. *National / International* Swine flu continues to spread; Obama asks $1.5 billion to fight it By Thomas H. Maugh II Tribune Newspapers Wednesday, April 29, 2009 Outbreaks of swine flu continued to be confirmed around the world Tuesday, with new cases reported in Canada, Israel, France, New Zealand, Costa Rica and South Korea, and the White House asked Congress for an additional $1.5 billion to fight the outbreak. President Barack Obama, in a letter to Congress, asked for the funds with "maximum flexibility to allow us to address this emerging situation." The letter said the money could go toward stockpiling anti-viral medicine, vaccine development, disease monitoring and diagnosis, and assisting international efforts to limit its spread. "In our opinion, this is about prudent planning moving forward," White House press secretary Robert Gibbs told reporters. Also Tuesday, Homeland Security Secretary Janet Napolitano said she is forming a swine flu task force to coordinate U.S. efforts, and she noted that the government has made 12 million doses of anti-viral drugs available to states. She said her agency is resisting calls from Capitol Hill to screen inbound air travelers from Mexico and those crossing at border checkpoints. "Our focus is not on closing the border or conducting exit screening," she said. "It is on mitigation." The total number of confirmed swine flu cases in the United States had reached 67 by late Tuesday afternoon and worldwide had climbed to more than 100, not counting the still-unknown number of cases in Mexico. At least some of the new cases appear to have risen from human-to-human transmission outside Mexico. Such community transmission is one of the early earmarks of a pandemic. If it continues to be observed, experts said, the World Health Organization is likely to raise its alert to Phase 5, from the currently elevated Phase 4 on a scale of six. Such an increase might involve more travel restrictions and stronger efforts to control the spread of the virus. At a Tuesday morning news conference in Geneva, Dr. Keiji Fukuda, assistant director-general of WHO, said a pandemic is not inevitable but if one does occur it is likely to be mild - a conclusion drawn from the lack of deaths outside Mexico. But he cautioned that the 1918 Spanish flu, which killed millions worldwide, started out mild also. In the spring of that year, there was a mild pandemic that petered out, only to return with a vengeance in the fall. "I think we have to be mindful and respectful of the fact that influenza moves in ways we cannot predict," he said. It is unlikely, he said, that health authorities will be able to limit the current outbreak's spread: "At this time, containment is not a feasible option." One ray of good news is that the outbreak might be leveling off in Mexico, where the first cases appeared. Mexican Health Minister Jose Angel Cordova said Tuesday that the number of new suspected cases of swine flu in that country had declined from 141 on Saturday to 119 on Sunday and 110 Monday. At least 152 people have died in Mexico from influenza and its complications, and more than 2,000 cases have been reported. It is not clear, however, what proportion of those deaths and cases are attributable to swine flu. So far, only 26 of the deaths have been firmly linked to the virus. Mexican authorities ordered all restaurants in Mexico City to begin serving only take-out food in an effort to limit spread of the virus and closed down archaeological sites to limit assemblies of people. Officials had already requested that bars, movie theaters, pool halls, gyms and churches in the city close. All schools are closed until May 6. The Mexico City Chamber of Commerce estimated the capital is losing about $60 million a day from reduced tourism, trade and other business. At least five people were in U.S. hospitals with swine flu as the number of cases nationwide rose to 66 on Tuesday. Most of the nation's confirmed cases were in New York City, where the health commissioner said "many hundreds" of schoolchildren were ill with what was "most likely swine flu." The city announced 45 confirmed cases, all associated with a Catholic high school. There have been no known deaths from the virus outside of Mexico. The Los Angeles County coroner's office had said it was investigating two deaths thought to be linked to swine flu, but in a statement Tuesday it said no links could be found. "I fully expect we will see deaths from this infection," said Dr. Richard E. Besser, acting director of the Centers for Disease Control and Prevention. All types of flu kill people, experts said, and there is no reason to believe this one should be different. Also Tuesday, Cuba became the first country to suspend flights to and from Mexico, ordering a 48-hour cessation. Mexico has been a major transit point for flights to that isolated country. Cuba has not reported any cases of swine flu. Argentina later canceled all flights to and from Mexico for five days. The Carnival and Royal Caribbean cruise lines also said their ships will not stop in Mexico until at least next week. In Baltimore, two passengers on an AirTran Airways flight from Cancun who reported feeling ill were examined and released by medical officials at Baltimore-Washington Thurgood Marshall Airport after it was determined there was no public health threat, airline and airport officials said. The examinations were done out of "an abundance of caution," said Christopher White, an airline spokesman. Neither he nor Jonathan Dean, an airport spokesman, could say what symptoms the pair had. The officials handed out cards that instructed the passengers to seek medical attention if symptoms develop in coming days, and they retained contact information provided by the passengers when they booked the flight in case they need to relay any health information later. Copyright 2009 Tribune Newspapers. U.S. reports first swine flu death Toddler dies in Texas as virus spreads into 10 U.S. states Associated Press By Lauran Neergaard Baltimore Sun Wednesday, April 29, 2009 WASHINGTON - Virulent swine flu spread to 10 U.S. states from coast to coast Wednesday and swept deeper into Europe, extending its global reach as President Barack Obama mourned the first U.S. death, a Mexican toddler who had traveled with his family to Texas. Total American cases surged to nearly 100. The World Health Organization raised its pandemic alert for swine flu to the second highest level , meaning that it believes a global outbreak of the disease is imminent. 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. In Washington, Homeland Security Secretary Janet Napolitano was questioned closely by senators about whether the U.S. should close its border with Mexico, where the outbreak apparently began and the casualties have been the greatest, with more than 150 deaths. She repeated the administration's position that questioning of people at borders and ports of entry was sufficient for now and said closing borders "has not been merited by the facts." Dr. Richard Besser, the acting chief of the Centers for Disease Control, said in Atlanta that there are confirmed cases now in ten states, with 51 in New York, 14 in California and 16 in Texas, where officials said Wednesday they were postponing all public high school athletic and academic competitions until May 11. Two cases have been confirmed in Kansas, Massachusetts and Michigan, while a single cases have been reported in Arizona, Indiana, Nevada and Ohio. In a possible outbreak north of the Mexican border, the commandant of the Marine Corps said a Marine lieutenant in southern California might have the illness and 39 Marines were being confined on their California base until tests come back. Marine General James Conway told a Pentagon briefing an initial test indicated the sick Marine -- who was not identified -- might have swine flu but his illness did not appear life-threatening. Obama said he wanted to extend "my thoughts and prayers" to the family of a nearly two-year-old Mexican boy who died in Houston, the first confirmed U.S. fatality among more than five dozen infections. Health officials in Texas said the child had traveled with his family from Mexico, to Brownsville on April 4 and was brought to Houston after becoming ill. He died Monday night. "This is obviously a serious situation," and "we are closely and continuously monitoring" it, Obama said of the spreading illness. Meanwhile, Egypt's government ordered the slaughter of all pigs in the country as a precaution, though no swine flu cases have been reported there. Egypt's overwhelmingly Muslim population does not eat pork, but farmers raise some 300,000-350,000 pigs for the Christian minority. The disease is not spread by eating pork, and farmers were to be allowed to sell the meat from the slaughtered animals. In fact, officials appeared to go out of their way on Wednesday to not call the strain "swine flu." Obama called the bug the "H1N1 virus." "The disease is not a food-borne illness," Rear Adm. Anne Schuchat, CDC's interim science and public health deputy direct, told the Senate Homeland Security Committee. She said the strain is particularly worrisome because "it's a virus that hasn't been around before. The general population doesn't have immunity from it." People have various levels of protection against other more common types of flu because they are exposed to it over time, and that protection accumulates. She suggested that some older people might have more resistance to this particular strain than younger people because its traits might resemble outbreaks of decades ago. Germany became the latest country to report swine flu infections. It reported four cases on Wednesday. New Zealand's total rose to 14. Britain had earlier reported five cases, Spain four. There were 13 cases in Canada, two in Israel and one in Austria. Obama said it is the recommendation of public health officials that authorities at schools with confirmed or suspected cases of swine flu "should strongly consider temporarily closing so that we can be as safe as possible." He was underscoring advice that the CDC provided earlier to cities and states, and that some schools -- most prominently in New York City -- already have followed. "If the situation becomes more serious and we have to take more extensive steps, then parents should also think about contingencies if schools in their areas do temporarily shut down, figuring out and planning what their child care situation would be," Obama advised. He advised people to take their own precautions -- washing hands, staying home if they are sick, and keeping sick kids home. Obama said the federal government is "prepared to do whatever is necessary to control the impact of this virus." He noted his request for $1.5 billion in emergency funding to ensure adequate supplies of vaccines. CDC for days has said people with flulike symptoms should stay home -- but now also is stressing that other family members should consider staying home or at least limiting how much they go out until they're sure they didn't catch it. Besser, the acting CDC director, called it "an abundance of caution," but stressed that it's voluntary and that the government hasn't urged actual quarantine, which isn't really effective with flu. Associated Press writers Lara Jakes in Washington, Mike Stobbe in Atlanta, Patrick McGroarty in Berlin and Maamoun Youssef in Cairo contributed to this report. Copyright 2009 Baltimore Sun. U.S. has first death from swine flu By Maggie Fox and Doina Chiacu Reuters Wednesday, April 29, 2009 WASHINGTON (Reuters) - A government official confirmed the first U.S. death from the new H1N1 swine flu on Wednesday, a 23-month-old child who died in Texas. It is the first death from swine flu reported outside Mexico, the country hardest hit by the influenza outbreak. The official gave no other details on the case. U.S. officials have confirmed 65 cases of swine flu, most of them mild. Web link: http://www.reuters.com/article/topNews/idUSN2938123420090429 Copyright 2009 Reuters. Local Health Agencies, Hurt by Cuts, Brace for Flu By Kevin Sack New York Times Thursday, April 30, 2009 The recession has drained hundreds of millions of dollars and thousands of workers from the state and local health departments that are now the front line in the country’s defense against a possible swine flu pandemic. Health officials in affected states said they had thus far been able to manage the testing and treatment of infected residents and mount vigorous public education campaigns. But many said they had been able to do so only by shifting workers from other public health priorities, and some questioned how their depleted departments might handle a full-fledged pandemic. “I’m very concerned,” said Robert M. Pestronk, executive director of the National Association of County and City Health Officials. “Local health departments are barely staffed to do the work they do on a day-to-day basis. A large increase in workload will mean that much of the other work that is being done now won’t be done. And depending on the scale of an epidemic, capacity may be exceeded.” At a news conference on Monday, Dr. Richard E. Besser, the acting director of the federal Centers for Disease Control and Prevention, said the public health system was in “a tough situation.” “We hear about tens of thousands of state public health workers who are going to be losing their jobs because of state budgets,” he said. “It is very important that we look at that resource because this outbreak was identified because of a lot of work going on around preparedness.” Mr. Pestronk’s group estimates that local health departments lost about $300 million in financing and 7,000 workers in 2008, a year when more than half of all agencies shed employees. There were about 160,000 health department workers in 2005, according to the group. Mr. Pestronk said he expected to lose at least another 7,000 jobs this year. State public health agencies lost an additional 1,500 workers through layoffs and attrition from July 2008 to January 2009, according to the Association of State and Territorial Health Officials. The group anticipates 2,600 job losses in the coming fiscal year. South Carolina’s Department of Health and Environmental Control, which also staffs local health departments, has lost $30 million in state money and a third of its 6,000 employees over the last decade, said Thom W. Berry, a spokesman. The department is currently investigating several “probable” cases of swine flu. In New York City, which has the highest concentration of confirmed flu cases, federal grants for emergency preparedness have fallen to $23 million, from $28 million a year ago, said Andrew S. Rein, the city health department’s executive deputy commissioner. In California, which has 14 confirmed cases, the Department of Public Health recently absorbed a 10 percent budget cut ordered by Gov. Arnold Schwarzenegger to help close a massive budget gap. It did so without laying off workers, instead slashing grants to local health departments, said Dr. Bonnie Sorensen, the chief deputy director of policy and programs. During the flu scare, about 100 state health workers have been diverted from other duties, she said. On Tuesday, Mr. Schwarzenegger declared a state of emergency that calls for all California agencies to assist the health department. It gave the department special powers to enter into contracts, suspend competitive bidding and waive certification requirements for laboratories. The federal disease control agency has shipped equipment and chemicals used to test for swine flu to California so the state can hasten its laboratory work without sending samples elsewhere. “The bottom line is, we are prepared,” Mr. Schwarzenegger said this week. The White House asked Congress on Tuesday to provide $1.5 billion in emergency financing to battle the swine flu outbreak, but it is not clear how that money might flow downstream. Public health officials said Congress had missed an opportunity by excising nearly $900 million in proposed financing for pandemic flu preparation from this year’s stimulus bill. It was to be the final installment of President George W. Bush’s request for $7 billion in federal spending on vaccines, medical equipment and planning. Congress last allocated money for pandemic planning by state and local governments in 2006 — about $600 million over two years, said Dr. Paul E. Jarris, executive director of the Association of State and Territorial Health Officials. “The entire system is lining up to decrease resources at the time we need them most,” Dr. Jarris said. “We have to realize that we’re at the starting line. The stress will come if this escalates.” Jeffrey Levi, executive director of the Trust for America’s Health, said the financial strain made “it more important that we luck out” with a mild outbreak. Dr. Alvin D. Jackson, the state health director in Ohio, which has one confirmed case of swine flu, said his agency’s state appropriation had declined by about $10 million over the last two years. He said his budget to prepare communities and hospitals for an influenza pandemic had dropped to $34 million, from $55 million in 2004. “Right now we’re O.K.,” he said. “We feel that we can do an excellent job protecting our citizens. But looking forward, we do understand that some additional resources would be appreciated.” But in Cleveland, Dr. Terry Allan, the Cuyahoga County health commissioner, said the decline in state and federal money had prompted a 25 percent cut in spending on pandemic preparedness over the last two years. That had cost the department at least 10 workers, he said, and further cuts are anticipated. “Those are people we would have had available to expand and build on our plans for social distancing, for mobilizing antivirals,” he said. “Our plan is not adequate. It’s barely started.” Copyright 2009 The New York Times Company. Experts Study Differences in Flu's Severity By Rob Stein Washington Post Wednesday, April 29, 2009 Health authorities raced yesterday to unravel the many mysteries about the ominous new swine flu spreading around the world, including how widely the virus might cause the severe form of illness that so far has been restricted to the epicenter of the outbreak in Mexico. As the number of confirmed infections in the United States jumped again and cases were confirmed for the first time in Britain, New Zealand and Israel, researchers searched for clues as to how readily the virus causes the pneumonia that has hospitalized and killed patients in Mexico. Only a handful of patients in the United States and elsewhere outside Mexico have been hospitalized, severe complications have been relatively rare, and no one has died. "We still do not have a good explanation for why the pattern of cases in other countries appear relatively mild while the pattern of cases in Mexico appear to be much more severe," said Keiji Fukuda of the World Health Organization. "This will be the object of a great deal of research and attention, but at this time, we can't say why there appears to be a difference." Experts said there are several possibilities: Victims in Mexico may be more vulnerable because of nutritional deficiencies, other infections or some other factor; medical care may be better in the United States and elsewhere; the virus could be weakening as it spreads; or too few cases may have occurred outside Mexico for severe illnesses to emerge. "This is the mystery," said Arnold Monto, an influenza expert at the University of Michigan. "You could speculate about so many things. It's an incredibly important question." Several officials said some deaths outside Mexico are probably inevitable. "I fully expect we will see deaths from this infection," Richard E. Besser, acting director of the Centers for Disease Control and Prevention in Atlanta. "They're seeing many deaths in Mexico, and we're trying to learn more about that and why the situation in Mexico is different from here. And as we continue to investigate cases here, I expect that we will see deaths in this country." Among the most severe U.S. cases has been an adult in California's Imperial County who ended up on a ventilator, said county health officer Stephen W. Munday. Several experts said they think the most likely reason for the milder illnesses outside Mexico was that there have been too few cases reported elsewhere to see the full spectrum of disease the virus is causing. "The most obvious explanation is there have been many more cases in Mexico," said Frederick G. Hayden, a University of Virginia influenza expert. "So what we're seeing is the small number of people developing complications, some of whom have gone on to have to fatal outcomes." If that is the case, the number of hospitalizations would increase and deaths would probably occur as the virus spreads, even if the proportion of patients who become severely ill is relatively small. During the devastating 1918 Spanish flu pandemic, about 2 percent of patients died, meaning 98 percent recovered. "We could be at that same level and in that ballpark," Hayden said. "We just don't know." Another possibility is that patients in Mexico experiencing the most severe illness have been infected with something else, as well, perhaps a bacterium. "We've known for decades that influenza is notorious for increasing the risk of secondary bacterial complications," Hayden said. Also, many of the Mexican victims may have delayed treatment. "Probably, very valuable time was lost," said Julio Frenk, the dean of the Harvard School of Public Health who was Mexico's health minister between 2000 and 2006. It is also likely that many Mexicans are more poorly nourished than Americans and "more susceptible to infection," he said. Although so far genetic analyses of the viruses in Mexico and elsewhere appear identical, scientists will be studying samples as the virus passes from one person to another for any sign that it might be becoming less threatening. "If you get viruses along the way and can look at those, that can give you a sense as to whether, as it moves from person to person, it's changing, becoming less severe, more severe or no change at all, and that is all very important information," Besser said. WHO's Fukuda said it is possible that even if the virus spreads widely, it could produce a "mild" pandemic, but he cautioned that the 1918 pandemic had a mild first wave and then returned to cause millions of deaths. President Obama, meanwhile, asked Congress yesterday for an additional $1.5 billion to fight the swine flu. The money could be used to produce more antiviral drugs, work on developing a vaccine or fight the spread of the disease, White House press secretary Robert Gibbs said. The request came as the number of U.S. cases climbed from 48 to at least 64, with at least 45 in New York, one in Ohio, two in Kansas, six in Texas and 10 in California. Only five U.S. patients have been hospitalized. New York officials said there are signs that the outbreak continues to spread. Mayor Michael R. Bloomberg (I) said there are probably hundreds of cases at St. Francis Preparatory School, where the outbreak began, and new cases were suspected at a Queens public school for autistic children and a Catholic school in Manhattan, along with scattered cases in Brooklyn and the Bronx. In addition to the U.S. and Mexican cases, at least six have been confirmed in Israel, at least two in Spain, two in Britain and two in New Zealand, according to WHO. Israeli officials said they had confirmed two more cases, both in men who recently returned from Mexico. Although WHO recommended against travel restrictions, Cuba and Argentina banned travel from Mexico. Several countries, including France, Britain, the Netherlands and Italy, advised residents to avoid unnecessary trips to Mexico. In India, officials were searching for 500 British tourists to check them for swine flu and said they would increase the number of health surveillance booths at nine international airports to screen travelers. Chinese officials reported no confirmed cases on the mainland, but state media reported that a Hong Kong woman who developed flulike symptoms after a trip to the United States was being tested. Correspondents Jill Drew in Beijing, Edward Cody in Paris, Howard Schneider in Jerusalem and Emily Wax in Mumbai and staff writers Keith B. Richburg in New York, Spencer S. Hsu and Michael D. Shear in Washington, Ceci Connolly in Atlanta, and Ashley Surdin and Karl Vick in Los Angeles contributed to this report. Web link: http://www.washingtonpost.com/wp-dyn/content/article/2009/04/28/AR2009042800757_pf.html Copyright 2009 Washington Post. WHO Raises Swine Flu Alert; Virus Claims First Life in U.S. By Rob Stein, Spencer S. Hsu and William Branigin Washington Post Wednesday, April 29, 2009 The World Health Organization today raised its pandemic threat alert level for swine flu, as the infection spread to more locations across the country and around the world and U.S. health officials reported the first confirmed death in the United States from the illness -- a toddler from Mexico who died in Texas. The WHO raised the alert level to "phase 5," its second-highest level, which means that human-to-human spread of the virus has been found in at least two countries in one WHO region. While most countries will not be affected at this stage, according to WHO, the declaration of phase 5 represents "a strong signal that a pandemic is imminent and that the time to finalize the organization, communication and implementation of the planned mitigation measures is short." In making the announcement, WHO Director-General Margaret Chan urged countries to activate their pandemic flu response plans. "This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions now should be undertaken with increased urgency and at an accelerated pace," she told a news conference in Geneva. Saying that influenza viruses are "notorious for their rapid mutation and their unpredictable behavior," Chan told reporters, "This is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic." U.S. officials said they are already treating the swine flu outbreak as a "phase 6" event -- the highest alert level -- in terms of preparations and informing the U.S. public. In a news conference in Washington, Homeland Security Secretary Janet Napolitano said the U.S. government is taking action "as if this were stage 6." She said the administration is trying to "stay ahead of whatever number WHO assigns" and prepare "for a situation in which this becomes a full-fledged pandemic." She said, "We're preparing for the worst and hoping for the best." Earlier, Richard E. Besser, acting director of the Centers for Disease Control and Prevention in Atlanta, said there are now 91 confirmed swine flu cases in 10 states -- up from 64 cases in five states in the CDC's report yesterday. He said New York has 51 confirmed cases; Texas 16; California 14; Massachusetts, Michigan and Kansas two each; and Arizona, Nevada, Indiana and Ohio one each. But he cautioned that "these numbers are almost out of date by the time I say them." The 91 cases cited by CDC do not include the child who died or a U.S. Marine who was confirmed this afternoon to have swine flu. Testifying on Capitol Hill, senior U.S. homeland security and health officials rejected the idea of closing the border with Mexico, saying such a response would be ineffective in stemming the spread of the disease. In Geneva, meanwhile, a senior official at the World Health Organization, Keiji Fukuda, said new cases suggest the virus is spreading more easily among people, including those who have not been to Mexico, the epicenter of the deadly influenza strain. "It is clear that the virus is spreading, and we don't see evidence of it slowing down at this point," said Fukuda, the WHO's acting assistant director-general for health security and environment. As the U.S. caseload climbed again, officials reported six probable cases in Marylnd and four probable cases at the University of Delaware, the closest so far to the Washington area. Cases were reported in Germany for the first time, and researchers searched for clues as to how readily the virus causes the pneumonia that has killed scores of patients in Mexico. Houston health officials said today that a nearly 2-year-old toddler died Monday night in a hospital in the city after developing a fever and other flu symptoms. The child, who was not immediately identified, had traveled by plane with his family from Mexico City to a town near the U.S. border April 4. He then crossed into the United States to visit relatives in the border town of Brownsville and developed flu symptoms April 8. Several days later, with his condition worsening, the boy was admitted to a Brownsville hospital. He was transported to Houston for additional treatment the next day. It is not known whether the child contracted the virus in Mexico or on the U.S. side of the porous border. Officials said the child had underlying health problems. His relatives are healthy and have not been infected, officials said. President Obama today offered his "thoughts and prayers and deepest condolences" to the toddler's family and to other victims and their loved ones. He said U.S. authorities were monitoring the spread of the virus carefully, and he urged local authorities to report all suspected cases and close schools where infections are reported to minimize spread of the disease. Private citizens, Obama said, should take care to wash their hands frequently, stay home from work or school if they are sick and cover their mouths when coughing. "We need your assistance," Obama said. Obama and other U.S. officials took care today to refer to the flu strain as the H1N1 virus, instead of swine flu, which officials said is a misnomer that unfairly gives pork a bad name. Agriculture Secretary Tom Vilsack and other officials stressed that no swine herds in the United States or Mexico are known to be infected with the virus. In any case, they said, the illness is not food-borne and cannot be contracted by eating pork or pork products. Nevertheless, at least 17 countries have imposed partial or total bans on pork imports, threatening a major U.S. export market. U.S. officials have warned that such bans could damage the world's trading system. The fatality in Texas elevated debate over tightening border controls with Mexico, but top U.S. health and homeland security officials rejected such calls during testimony today at a hearing of the Senate Committee on Homeland Security and Governmental Affairs. Asked by Sen. John McCain (R-Ariz.) what, if any, conditions would warrant closing the U.S.-Mexican border, Rear Adm. Anne Schuchat, the CDC's interim deputy director for science and public health, said bluntly, "Going forward, there is no circumstance in which closing the border would have value." Schuchat said that in 2007, the Bush administration modeled the spread of infectious disease and conducted a formal U.S. policy analysis, which concluded that once cases emerged in Canada or Mexico, the ability to stop a virus from spreading into the United States ends "within days." With the illness confirmed in several states, she said, the probability now is that a person's exposure to the virus in the United States comes from someone who has had no direct contact with Mexico. "It really is not an effective approach to block things at the border," Schuchat said. "Assets really need to be focused elsewhere, and the border is a real diversion." Sen. Joseph I. Lieberman (I-Conn.), chairman of the Senate Homeland Security Committee and normally a voice of moderation on such matters, warned Napolitano that she should at least be open to considering further border checks, such as on temporary workers coming from Mexico, "because I think if you don't, there will be growing pressure to really close the ports of entry." Napolitano responded that any requirement to screen all individuals crossing the border will create delays, long lines and economic and personal costs. "We are going to have to be able to explain what is the advantage of that . . . other than symbolism in terms of preventing disease in our country," Napolitano said. "Right now, scientists are telling me beyond symbolism we don't get an advantage" in stopping the spread of the disease. Napolitano later said that federal border agents at unspecified land ports of entry have so far referred 49 travelers entering through U.S. border checkpoints to federal, state or local health officials because they displayed suspicious flu-like symptoms. She said 41 of the travelers were subsequently cleared and that eight others remain under investigation, with diagnostic tests not yet completed. "As of today, U.S. Customs and Border Protection has referred a total of 49 suspected cases to CDC or to state and local officials," she said. "All the results have been negative, except the eight that are still under study." Texas, meanwhile, issued a "disaster declaration" to help respond to the outbreak, allowing the state to implement emergency measures and seek federal funding. "Texans need to know there is no cause for panic, and Texans can be assured that the state will take every necessary precaution to protect the lives of our citizens," Gov. Rick Perry (R) said. "My office, along with the Department of State Health Services and other state, local and federal partners, have a plan in place to protect Texans should there be a pandemic flu outbreak or other health emergency." Only a handful of patients in the United States and elsewhere outside Mexico have been hospitalized with the flu so far. Severe complications outside Mexico have been relatively rare, although officials acknowledged yesterday that they see some U.S. fatalities as inevitable. Houston health department spokeswoman Kathy Barton said the case involving the toddler "posed extremely limited risk to Houston because [he] came in on a medical transport and never left the hospital." But she urged residents of the city to continue to take precautions, saying other cases were likely to occur as part of the ongoing outbreak. A Marine at Twentynine Palms in California has swine flu, and as a result more than 30 other Marines who had contact with him have been quarantined, according to the Marine Corps. "That quarantine will last four or five days," said Marine Corps spokesman Maj. David Nevers. The infected Marine "is feeling well, his condition continues to improve," Nevers said, and none of the other Marines exposed are displaying any symptoms. Officials at the base are "aggressively working to contain the potential for the scope to expand" through preventive measures, Nevers said. According to the WHO and national governments, 10 countries now have confirmed infections. At least 18 other nations have reported suspected swine flu cases. France, which has two suspected infections, said today it would urge the 27-nation European Union to suspend all flights from member countries to Mexico in an expanded effort to limit exposure to swine flu infections. French Health Minister Roselyne Bachelot, speaking after a crisis meeting with President Nicolas Sarkozy, said E.U. health ministers will deal with the proposal tomorrow in Luxembourg. She said the bloc's transport ministers also will be asked to back the decision. Luc Chatel, a French government spokesman, said the suspension would not apply to flights arriving in Europe from Mexico. Canceling these flights would force travelers to take roundabout routes, complicating efforts to track the sources of infection among sick people in Europe, he explained. Sarkozy's administration, in one of a number of such precautions urged by individual European governments, has been advising French nationals since yesterday to avoid travel to Mexico except for imperative reasons. The French National Health Watch Institute said about 30 people in France are being investigated for possible infections, most of them after trips to Mexico. Of those, it said, a man and a woman hospitalized in the Paris region after returning from Mexico are considered likely to test positive for swine flu. The institute's director, Françoise Weber, told reporters that test results for the couple were likely by the end of the week. In the meantime, she said, they are doing well and showing symptoms of an ordinary flu. Among the most severe U.S. cases until now has been an adult in California's Imperial County who ended up on a ventilator, said county health officer Stephen W. Munday. In addition to the U.S. and Mexican cases, at least six have been confirmed in Israel, at least two in Spain, five in Britain and two in New Zealand, according to WHO. Israeli officials said they had confirmed two more cases, both in men who recently returned from Mexico. On Wednesday, German health officials said three citizens who recently returned from Mexico had tested positive for swine flu. The patients were all expected to make a full recovery, officials said, though they warned that the virus was likely to spread and that they were monitoring other suspected cases in Germany. British Prime Minister Gordon Brown said today that all of those known to be infected in his country had been in Mexico recently and were responding well to treatment. "All of them have mild symptoms. All of them are receiving and are responding well to the treatment that has been effective so far, the use of Tamiflu," Brown said. Brown said Britain had heightened airport checks of travelers who might have the flu and significantly expanded its stock of anti-viral medicines. The government had also ordered millions of extra face masks and planned to deliver information leaflets to every household in the country on the swine flu. In Devon, in western England, authorities closed a school after one of its students was confirmed to be infected. Correspondents Jill Drew in Beijing, Craig Whitlock in Berlin, Mary Jordan in London, Edward Cody in Paris, Howard Schneider in Jerusalem and Emily Wax in Mumbai and staff writers Keith B. Richburg in New York, Ceci Connolly in Atlanta, Ann Scott Tyson, Michael D. Shear and Debbi Wilgoren in Washington and Ashley Surdin and Karl Vick in Los Angeles contributed to this report. Copyright 2009 Washington Post. Scientists struggle to understand swine flu virus Associated Press By Mike Stobbe Washington Post Wednesday, April 29, 2009 ATLANTA -- Mexico's health secretary may have thought he was allaying fears about swine flu when he suggested that the nation's swine flu death rate was 6 or 7 percent. In reality, that would mean a monstrous killer virus _ and no experts are close to saying that. The secretary's comment reflects how much remains unknown about the new flu virus _ most notably how lethal it is and why it seems so much deadlier in Mexico than anywhere else. American health officials believe they are getting closer to answering those questions, or, at least, to ruling out wrong-headed theories. "We've begun to knock off hypotheses," said Dr. Scott F. Dowell, director of global disease detection with the U.S. Centers for Disease Control and Prevention. Among the factors disease detectives have discounted are Mexico's air pollution, secondary infections and poor health care. But they still do not know why so many Mexicans have died, although it could be because many more people actually have had the virus than health officials realize. In Mexico, the virus is suspected of killing more than 150 people and sickening more than 2,400. Recent information suggests swine flu-related hospital admissions and deaths may have peaked and are declining, but no other country has shown any numbers close to those seen in Mexico. The only other country to report a swine flu death is the United States, and that involved a toddler from Mexico who was visiting Texas with his family. The leading theory remains that the virus itself is not significantly different in Mexico, but that the outbreak has for some reason just hit harder there, infecting more people overall. The more people who are infected, the more likely there will be severe cases and even deaths. When the Mexican health secretary spoke this week about a 6 or 7 percent death rate, his figures were based on the number of deaths divided by the number of suspected infections. But authorities cannot be certain how many people have been infected, especially those who suffered only mild symptoms. Mexican authorities have not tried to count mild cases, focusing instead on the severely ill and the dead. So the death rate may be much lower than 6 or 7 percent _ and probably is, according to some experts. A 6 to 7 percent death rate would make the Mexican swine flu nearly three times deadlier than the worst flu pandemic in the last 100 years _ the 1918 Spanish flu, which killed an estimated 20 million to 50 million people worldwide. That seems unbelievably high for this new virus, said Richard Webby, a flu researcher at St. Jude Children's Research Hospital in Memphis. Webby and others do not believe the swine flu in Mexico is different from what's been seen in U.S. patients. The virus samples in both countries match. The CDC sent four epidemiologists and one lab scientist to Mexico over the weekend to investigate the disease there, and the agency expects to send a half-dozen more people this week, said Dowell, of the CDC. Among the hypotheses being ruled out as explanations for Mexico's higher death rate: _ A second infection complicating the flu cases. A common danger in flu is that the patient is co-infected with pneumonia or other bacteria, which can lead to death. But lab tests of 33 Mexican patients, including seven who died, did not find that problem. _ Low-quality health care. CDC investigators have not seen any obvious problem. They have found capable doctors and well-equipped, high-quality hospitals, Dowell said. _ A medicine is compounding the problem. Investigators have looked into whether patients who got sick had taken some over-the-counter medicine or folk remedy that actually made things worse. Such a problem has sometimes occurs in children recovering from flu who are given aspirin _ a severe illness called Reye's syndrome, which causes vomiting, lethargy and even seizures. But there's no evidence of something like that in Mexico, Dowell said. _ Altitude or air pollution: Mexico City's altitude and its infamous air pollution have raised speculation that those factors may have made people more susceptible to the virus. But severe cases are being reported over much of Mexico, including coastal communities and places with cleaner air, making that theory unlikely. The CDC has also been investigating when the swine flu first hit Mexico. Some have wondered whether it's possible people have been getting sick with the virus for months, but the illness went undetected because special swine flu tests were not used to diagnose patients. But CDC officials say no, the flu probably did not hit Mexico until March at the earliest. An analysis of hundreds of samples from Mexico that were collected from January to March never turned up the swine flu virus, Dowell said. There's also the question of where it started _ a standard inquiry of public health investigations since at least the mid-19th century. One of the heroes of public health history is John Snow, a London physician who helped end an 1854 cholera outbreak by determining that cases were clustered around a water pump and that the disease was spread through water. The pump handle was removed, and the cholera deaths subsided. But flu is different because it's spread by human-to-human contact. Scientists know it's more difficult to pin down the origin of a novel strain of influenza to a specific country, let alone a village or pig farm. Knowledge of the origin is also less useful than in a cholera outbreak. "Flu, unlike cholera, spreads around the world in a matter of weeks. You can't remove the pump handle" to stop the epidemic, said Dr. Andrew Pavia, a University of Utah pediatrics professor who leads the Infectious Diseases Society of America's pandemic flu task force. A current theory is that the outbreak started in the town of La Gloria on the eastern coast of Mexico, because a 5-year-old boy was the first known case. He first suffered flu-like symptoms in late March. However, Mexican health officials have downplayed claims the outbreak started in La Gloria, because mucous samples of other patients from there found nothing. Dowell said the place of origin is a secondary concern at the moment. "That probably will be useful in the long term. But for the present, our team in the field is focused on things that will make the most difference for mitigation" of the outbreak, he said. Associated Press Writer Olga R. Rodriguez in Mexico contributed to this report. © 2009 The Associated Press. U.S. Warns Other Nations Not to Ban Pork By Spencer S. Hsu Washington Post Wednesday, April 29, 2009 U.S. officials said yesterday that they are renaming the swine flu crisis the "2009 H1N1 virus outbreak" and warned other countries not to "ban or prevent" imports of U.S. pork or other products. "This really isn't swine flu. It's H1N1 virus," Agriculture Secretary Tom Vilsack said. "We want to say to consumers here and abroad that there is no risk to you. There is no scientific evidence whatsoever that there is any link between consuming pork, prepared pork products and the H1N1 virus," U.S. Trade Representative Ron Kirk added. Prices of U.S. pork, corn and soybeans dived Monday after Russia, China and the Philippines suspended pork imports from Mexico and some U.S. states, despite the absence of any link between pork consumption and the influenza A virus called H1N1. "We want to make sure that a handful of our trading partners don't take advantage of this legitimate concern over public health and engage in behavior that could also damage the world's economy," Kirk said. "Any actions -- activity engaged by any of our trading partners not based on sound science and not based on our rules-based systems of governing could do extraordinary damage, not just to our economy but to those of other countries, as well." Copyright 2009 Washington Post. Pork Industry Fights Concerns Over Swine Flu By Andrew Martin and Clifford Krauss New York Times Wednesday, April 29, 2009 The swine flu is producing global hesitation over eating pork. As more cases of the new influenza emerged on Tuesday, deepening worries about a possible pandemic, several nations slammed their borders shut to pork from the United States and Mexico. Wall Street analysts predicted a sharp decline of pork sales in grocery stores, and some consumers began steering clear of pork chops. The pork industry reacted with frustration. Medical authorities say that people cannot contract the swine flu from eating properly cooked pork. There is no evidence so far that the people who are becoming sick were in contact with pigs. In fact, authorities are not even sure how susceptible pigs are to infection with the new flu. Senator Tom Harkin, Democrat of Iowa, convened a hearing on Tuesday on a subject he described as “the so-called swine flu,” even as a campaign was mounted by farm groups to rename the virus “North American influenza.” “Swine flu is a misnomer,” said C. Larry Pope, the chief executive of Smithfield Foods, who said he feared panic among consumers. “They need to be concerned about influenza, but not eating pork.” Researchers say that based on its genetic structure, the new virus is without question a type of swine influenza, derived originally from a strain that lived in pigs. But the experts are still sorting out how long ago it infected pigs and how much it might have mutated when it jumped to humans. “It’s fair to say that at some point the virus passed through a pig,” said Dr. Paul A. Offit, an infectious disease expert at Children’s Hospital of Philadelphia. “It could have been months; it could have been years ago.” Even if pigs were the original source of the disease, experts said they did not appear to be playing any role in its transmission now. The virus is passing from person to person, they said, most likely by the spread of respiratory droplets. The assurances from medical authorities have not forestalled a pork panic. Several countries on Tuesday announced that they were banning some or all pork products from the United States, angering trade negotiators and hog farmers. To date, countries including the Philippines, Kazakhstan, Ukraine and Ecuador have banned pork from the United States, with Mexican pork exports also covered by most of those bans. China banned pork from certain states, and Russia banned all meat imports, not just pork, from certain states. Trade officials said it was not uncommon for countries to impose trade restrictions upon news of an outbreak, either as an emotional response to appease consumers or a convenient excuse to impose a trade barrier. For instance, South Korea banned American beef for five years because of fears of mad cow disease. The challenge, the officials say, is persuading those countries to reverse the restrictions so they do not become permanent. “If you don’t reverse bad policy quickly, people get used to it,” said Allen F. Johnson, a former chief agriculture trade negotiator for the United States trade representative and now a consultant. On Tuesday, the Obama administration’s chief trade representative, Ron Kirk, urged trading partners to base their decisions on science and international trade obligations, and he suggested that bans on American pork “may result in serious trade disruptions without cause.” Some hog producers were furious at the trade bans, saying they were simply a political ploy by countries to give their own farmers a leg up. “We are in a very economically stressed economy, and anything a country can do to discredit another country’s product, they will do that for trade advantage,” said Scott Burroughs, the chief operating officer at Nebraska Pork Partners. While it may be too soon to know how the swine flu outbreak will affect pork sales, early indications are mixed. Pork sales at Wal-Mart are down by high single digits, a spokeswoman said. However, pork sales have remained constant at Publix, a grocery chain based in Florida. At a grocery store in downtown Houston, Gina Tran, a homemaker, said she usually bought pork but had stopped because of safety concerns. “People in Mexico ate some pork and got sick, right?” said Ms. Tran, who was looking for selections in the beef case. (That is not what happened, as far as anyone knows.) Yvonne Enard, a retired warehouse worker, said she too believed there was a connection between pork and swine flu but figured it would be safe to eat anyway. “I’ll buy it, but I wouldn’t buy it from just any store, and I would season it and cook it very well,” she said. Denise Grady contributed reporting. Copyright 2009 The New York Times Company. World takes drastic steps to contain swine flu Associated Press By William J. Kole and Maria Cheng Washington Post Wednesday, April 29, 2009 From Egypt's order that all 300,000 pigs in the country be slaughtered to travel bans and putting the kibosh on kissing, the world is taking drastic _ and some say debatable _ measures to combat swine flu. Egypt ordered the pig slaughter even though there hasn't been a single case of swine flu there and no evidence that pigs have spread the disease. Britain, with only five cases, is trying to buy 32 million masks. And in the United States, President Barack Obama said more of the country's 132,000 schools may have to be shuttered. At airports from Japan to South Korea to Greece and Turkey, thermal cameras were trained on airline passengers to see if any were feverish. And Lebanon discouraged traditional Arab peck-on-the-cheek greetings, even though no one has come down with the virus there. All this and more, even though world health experts say many of these measures may not stop the disease from spreading. On Wednesday, the World Health Organization raised its pandemic alert to the second-highest level, meaning it believes a global outbreak of the disease is imminent. "Scientifically speaking, the main thing is that every virus behaves differently," said Joerg Hacker, president of the Robert Koch Institute, Germany's top public health authority. "At the moment, the main issue is to get to know this virus, how it works." In Germany, where officials confirmed three cases, Lufthansa announced that starting Thursday it will put a doctor aboard all flights to Mexico, the epicenter of the outbreak. Experts said that makes sense: The doctors will be able to field questions from uneasy passengers and tend to anyone who might fall ill. The World Health Organization said total bans on travel to Mexico _ such as one imposed by Argentina, which hasn't had any confirmed cases _ were questionable because the virus is already fairly widespread. Roselyne Bachelot, France's health minister, said she would ask the European Union to suspend all flights to Mexico at a meeting Thursday in Luxembourg. Travel bans were effective during the 2003 outbreak of SARS in Asia, because that illness can be transmitted only by people who already show symptoms. With flu, by contrast, the incubation period ranges from 24 hours to four days, meaning people often are infectious before they have symptoms. Health officials don't know enough about swine flu right now to say what the precise incubation period is, but if it's similar to other flu, people are likely able to spread it before they're sick. "WHO does not recommend closing of borders and does not recommend restrictions of travel," said Dr. Keiji Fukuda, the Geneva-based organization's flu chief. "From an international perspective, closing borders or restricting travel would have very little effect, if any effect at all, at stopping the movement of this virus." Nor will killing pigs, as Egypt began doing Wednesday, infuriating pig farmers who blocked streets and stoned Health Ministry workers' vehicles in protest. While pigs are banned entirely in some Muslim countries because of religious dietary restrictions, they are raised in Egypt for consumption by the country's Christian minority. Unlike bird flu, where the H5N1 strain that spread to humans was widespread in bird populations and officials worried about people's exposure to infected birds, WHO says there is no similar concern about pigs _ and no evidence that people have contracted swine flu by eating pork or handling pigs. "There is no association that we've found between pigs and the disease in humans," WHO spokesman Dick Thompson said. But that hasn't stopped governments from banning pig products. Macedonia ordered a halt to all live pig imports and on Tuesday, Mexico City closed down all its popular streetside taco stands for at least a week. Dr. Nikki Shindo, a WHO flu expert, said the agency will consider requests to stop calling the disease swine flu, since the virus is not food-borne and has nothing to do with eating pork. U.S. Agriculture Secretary Tom Vilsack and others have suggested a new name, arguing that swine flu implies a problem with pork products. China, Russia and Ukraine are among countries that have banned pork imports from Mexico and parts of the United States affected by swine flu. But some anti-flu measures have merit, such as Obama's admonition Wednesday that more American schools might have to be closed temporarily if swine flu cases spread. Already tens of thousands of students in Texas, New York, California, Chicago and elsewhere are out of school. The WHO said closing schools and public places, along with banning or restricting mass gatherings, can be a way to contain the spread of disease. Epidemiologists call it "social distancing," and the idea is simple: If you keep people who have the virus away from others, you can stop the chain of transmission. "That's a technique we would be recommending in a pandemic," said WHO's Thompson. "We would recommend it to nations as a useful technique to be applied given the special circumstances of each nation." Officials in Hong Kong, which has no confirmed cases, said workers were scrubbing public toilets every two hours in an effort to improve hygiene. "Not only will we be stepping up our usual efforts, but also we will make special efforts to make sure that our back alleys, public housing estates, recreation and transportation facilities are thoroughly cleansed and disinfected," said Gabriel Leung, undersecretary for the Food and Health Bureau. Experts, however, said it's debatable how much good disinfecting public places will do. It probably helps cut down on bacteria and kill viruses lurking on surfaces, but it's unclear whether it would stop person-to-person transmission. Ditto the advice to stop kissing on the cheek, which was among the earliest measures _ along with refraining from handshakes _ to be recommended by authorities in Mexico. WHO's Thompson was noncommittal on the "don't kiss" advice, saying only: "There are different national circumstances that health officials are going to know far better than we will. It's up to them to make that call." But at a news conference announcing the elevated pandemic level, WHO chief Margaret Chan went further, suggesting it was time to rethink the traditional three kisses on the cheek popular in Switzerland and elsewhere in Europe. "Perhaps instead of having the traditional three hugs to say hello and welcome your friends, maybe you don't do that anymore," she said. "Don't hold each other and hug their face three times." The flu virus is airborne and spread through tiny particles _ mostly through sneezing and coughing. That helps explain why governments worldwide have been distributing millions of face masks, even though the U.S. Centers for Disease Control and other agencies have questioned their effectiveness. Some doctors warn masks might even be harmful, causing people to take risks _ like venturing into crowds or neglecting to wash hands _ in the mistaken belief the mask protects them. More expensive high filtration masks like those used by health professionals can filter out fine particles carried in the air, but even these must be used properly to give real protection. Other measures, such as installing thermal cameras at airports to screen passengers from infected countries, are simply inconclusive. Scanners were set up across Asia during the SARS outbreak, but officials aren't sure they caught any cases. WHO says the usefulness of such devices is debatable. Amid the flurry of measures being taken, fear mingled with a sense of fatalism. "You can't protect yourself _ not in the way that people are traveling nowadays," said Karin Henriksson, 56, of Stockholm. "Then you would have to put the entire population in quarantine. And you can't do that, can you?" Kole reported from Vienna; Cheng, an AP Medical Writer, from London. © 2009 The Associated Press. In AIDS Treatment, Sooner Is Better, Study Finds By Roni Caryn Rabin New York Times Thursday, April 30, 2009 Powerful drugs are available to treat H.I.V., but doctors have long argued about when to start therapy. Is it is better to treat patients early, exposing them to risky side effects, or to wait until the disease is more advanced? A new analysis suggests that sooner is better than later. The study, which is not the final word on the matter, tracked the survival rates of 17,517 asymptomatic North American patients with H.I.V. who started drug therapy at different points, as determined by blood levels of the immune system’s CD4 cells, which decline as the infection progresses. The analysis found that asymptomatic patients who postponed antiretroviral treatment until their disease was more advanced faced a higher risk of dying than those who had initiated drug treatment earlier. The paper, posted online this month, was to be published Thursday in The New England Journal of Medicine. “This has been one of the most important questions in the last decade: what the optimal timing is for starting therapy,” said Dr. Mari M. Kitahata, director of clinical epidemiology at the Center for AIDS and S.T.D. at the University of Washington in Seattle and the paper’s first author. “Our study provides evidence that patients would live longer if antiretroviral treatment was begun when their CD4 count was above 500.” That could mean starting drug treatment several years earlier than is currently recommended, since national guidelines now advise starting antiretroviral therapy in asymptomatic patients when their CD4 counts dip below 350. A separate report published online two weeks ago in the journal Lancet came to a similar conclusion. It found that, in a study of 45,000 American and European patients, starting treatment when the CD4 count fell to 350 saved lives. The new study suggests, however, that even earlier treatment may be beneficial. The study analyzed two groups of H.I.V.-positive patients who received care from 1996 to 2005 in the United States and Canada, were asymptomatic and had never previously been on antiretroviral therapy. The first group had 8,362 patients, 2,084 of whom started therapy when their CD4 counts were from 351 to 500 cells per cubic millimeter, and 6,278 with similar counts who postponed therapy until their counts fell to 350 or less. Among those who deferred therapy, the risk of dying was 69 percent higher, the researchers found. In the second group, made up of 9,155 patients with CD4 counts of more than 500, 2,220 started therapy within six months, while 6,935 postponed therapy. Of those, 3,881 had counts that dropped, and 539 initiated antiretroviral therapy within six months of a count of 500 or less. Among those who deferred therapy, the risk of dying was 94 percent higher than those who initiated therapy early on. The new analysis is an observational study, not a clinical trial, and as such does not provide definitive answers, said Dr. Paul E. Sax, clinical director of the division of infectious diseases at Brigham and Women’s Hospital in Boston, who wrote an editorial accompanying the paper. Nevertheless, he said, “This, together with all of the other data accumulating around this subject, supports earlier intervention.” Copyright 2009 The New York Times Company. Siblings who kept sister in shed sentenced to jail Bay City News Service Washington Examiner Wednesday, April 29, 2009 Two siblings who were arrested when authorities found their developmentally disabled sister living in a shed behind their home were sentenced to six months in jail in San Mateo County Superior Court Tuesday morning. Bertha Lozano, 46, and her brother Jesus Ramirez, 53, were also given three years' probation with the condition to not have any contact with their 58-year-old sister, who has been placed in the care of county adult protective services, Chief Deputy District Attorney Steve Wagstaffe said. Lozano and Ramirez struck deals with prosecutors earlier this year to avoid a prison sentence. Lozano was convicted of one count of neglect of a developmentally disabled person, and Ramirez was convicted of grand theft, according to Wagstaffe. Ramirez was also told to pay $67,325 in restitution, Wagstaffe said. The two were arrested after San Mateo County sheriff's deputies responded to their house at 698 MacArthur Ave. in the unincorporated Redwood City area on Nov. 18 to investigate a separate incident and found their sister living in the backyard shed. Mark Meyers, a sheriff's deputy who went to the house the evening of the arrest, testified he was standing in the home's kitchen when he saw the developmentally disabled woman waving to him from the backyard. The woman, who is diagnosed with mild mental retardation and a psychotic disorder, showed Meyers her living quarters, which consisted of an 8-by-12-foot metal shed. The shed, according to Meyers' testimony, contained a mattress with a thin blanket, a portable toilet unattached to running water and a space heater. A Barbie doll and coloring book were also found in the shed, Meyers said. Meyers also testified the woman told him she received $700 a month from Supplemental Security Income, which she would cash downtown with Ramirez. But the district attorney's office contended no bank account had been established in the woman's name and that she was not benefiting financially from cashing the checks with her sibling. Ramirez was then accused of stealing her money. Lozano and Ramirez were ordered to report to county jail by July 11. With credit for time served, they each have 54 days left to spend in jail, according to Wagstaffe. Copyright 2009 Washington Examiner. Judge Allows Asbestos Case to Continue By Kirk Johnson New York Times Wednesday, April 29, 2009 MISSOULA, Mont. — A federal judge on Tuesday said that despite the “failings” of federal prosecutors, he would not dismiss criminal charges against W. R. Grace, the big chemical products company, over the asbestos poisoning of the small town of Libby, Mont. The judge, Donald W. Molloy, also said he would not throw out the testimony of the prosecution’s star witness, Robert H. Locke, a former Grace executive who Judge Molloy has said lied on the witness stand. The judge allowed Mr. Locke to be recalled before the jury so defense lawyers might challenge the credibility of his testimony. And Judge Molloy himself took the first shot, instructing the jurors that they should view everything they had heard from Mr. Locke with “great skepticism.” Mr. Locke had testified that company insiders knew of the dangers of the asbestos-laced vermiculite from the Grace mine and mill in Libby, dating back to the 1970s, and were involved in a conspiracy to cover up the knowledge. The judge also said federal prosecutors from the Department of Justice and the United States Attorney’s Office were guilty of an “inexcusable dereliction of duty” in handling Mr. Locke’s testimony, in not turning over to the defendants information about the depth of his relationship with the prosecution. The defense team then got its turn. “The name of the process here is the whole truth, Mr. Locke,” said the lead defense lawyer, David M. Bernick, whose tone was often scathing and contemptuous. Mr. Bernick also used his cross-examination to take shots at the prosecutors. Mr. Locke, for example, originally testified to about six meetings with the prosecution team; e-mail and testimony released by the prosecutors showed the number to be more than 20. “The government, when they put you on the stand, knew about all the meetings?” Mr. Bernick said. “Yes,” Mr. Locke replied. In pushing further on how many meetings had occurred and what Mr. Locke had testified earlier, Mr. Bernick said, “The purpose was to be candid — you failed that test, correct?” “I was wrong,” Mr. Locke said. Vermiculite from Libby was sold under the name Zonolite, and had numerous uses, like in household insulation and gardening. But the mineral was also interlaced with naturally occurring and deadly asbestos, and that mix — product and byproduct — is at the heart of the case. Grace, which bought the mine in 1963 and closed it in 1990, was indicted in 2005 along with some of its former executives on charges that they knowingly released a hazardous air pollutant, then conspired to conceal their involvement or obstruct the government’s investigations. The executives — one has died, and charges against another, Robert Walsh, were dismissed on Monday by the judge — face up to 15 years in prison if convicted of the most serious charges. The company could face fines and other penalties totaling hundreds of millions of dollars. Judge Molloy has not ruled on a defense motion to order an acquittal for lack of evidence. At least several hundred people have died from asbestos-related diseases in Libby, and many more have been sickened. Copyright 2009 The New York Times Company. Institute of Medicine Calls for Doctors to Stop Taking Gifts From Drug Makers By Gardiner Harris New York Times Wednesday, April 29, 2009 WASHINGTON — In a scolding report, the nation’s most influential medical advisory group said doctors should stop taking much of the money, gifts and free drug samples they routinely accept from drug and device companies. The report, by the Institute of Medicine, part of the National Academy of Sciences, is a stinging indictment of many of the most common means by which drug and device makers endear themselves to doctors, medical schools and hospitals. “It is time for medical schools to end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy,” the report concluded. The institute’s report is even more damning than a similar one released last year by the Association of American Medical Colleges, which proposed tough new rules governing interactions between companies and medical schools. In the wake of the association’s report, many schools and medical societies toughened their policies. The institute’s imprimatur is certain to accelerate this process. “With the I.O.M.’s endorsement, issues that were once controversial now are indisputable,” said Dr. David Rothman, president of the Institute on Medicine as a Profession at Columbia University. “Conflicts of interest in medicine are no longer acceptable.” The report calls on Congress to pass legislation that would require drug and device makers to publicly disclose all payments made to doctors. Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin, have co-sponsored legislation that would do just that. Both senators said they welcomed the institute’s endorsement. “It’s a shot in the arm to the reform movement to have the prestige and policy heft of the Institute of Medicine on the side of transparency,” Mr. Grassley said. “The more disclosure, the better, for holding the system accountable and building public confidence in medical research and practice.” Drug companies spend billions of dollars wooing doctors — more than they spend on research or consumer advertising. Much of this money is spent on giving doctors free drug samples, free food, free medical refresher courses and payments for marketing lectures. The institute’s report recommends that nearly all of these efforts end. The largest drug makers agreed last year to stop giving doctors pens, pads and other gifts of small value, but company executives have defended other marketing tactics as valuable to both doctors and patients. Medical device and biotechnology companies have yet to swear off free trips or even pens. A 2007 survey found that more than three-quarters of doctors accepted free drug samples and free food, more than a third got financial help for medical refresher courses and more than a quarter were paid for giving marketing lectures and enrolling patients in clinical trials. Among the most controversial of the institute’s recommendations is a plan to end industry influence over medical refresher courses. At present, drug and device makers provide about half of the financing for such courses so that doctors can often take them without charge. Even as they have acknowledged the need for other limits, many medical societies and schools have defended subsidies for education as necessary. “As science progresses, it’s going to get harder and harder to get doctors to keep pace,” said Dr. Jack Lewin, chief executive of the American College of Cardiology. “I think industry has some responsibility toward education.” By contrast, the American Psychiatric Association recently announced that it would phase out industry financing for medical refresher courses at its conventions. The institute acknowledged that many doctors depended on industry financing for refresher medical courses but said that “the current system of funding is unacceptable and should not continue.” The report recommended that a different system be created within two years. Mr. Kohl said that he had been investigating refresher medical courses, and that the industry’s role has tainted some courses with bias. Dr. Bernard Lo, the director of the Program in Medical Ethics at University of California, San Francisco, who served on the institute’s committee that wrote the report, said in an interview that doctors “need to do a better job in addressing conflicts of interest that would lead to bias or threaten public trust.” Dr. P. Roy Vagelos, a former Merck chief executive, said he had worried for years that drug and device companies wielded too much influence over doctors. “I think medical centers and companies will start to listen to these recommendations and to take them very seriously,” Dr. Vagelos said. The institute recommended that doctors stop giving free drug samples to patients unless the patient was poor and the doctor could continue to provide the medicine to the patient for little or no cost. By contrast, many free drug samples go to patients with insurance coverage or to doctors and their families, the report said. Copyright 2009 The New York Times Company. *Opinion* Why the insurers will win in Obama’s health reform By Timothy P. Carney, Examiner Columnist Washington Examiner Commentary Wednesday, April 29, 2009 President Barack Obama and Sen. Ted Kennedy look likely to give the health insurance industry exactly what it wants on health care reform. This would be an ironic outcome, considering how activists on the Left have demonized the insurers, and how crucial health care reform is to liberals who care about policy. While Obama and congressional Democrats will claim the insurers’ victory as a win for the forces of equality and progress, the more hard-core Left — the progressives who formed much of Obama’s base — will swallow this as a bitter pill or even a deal with the devil. The industry will win because of its influence, but also because its proposed policies of bigger government with “pro-business” incentives are a combination that congressional leaders always favor. Leading the insurance industry’s campaign this year has been the trade group America’s Health Insurance Plans, which has spent $4.3 million on lobbying in the past six months. AHIP’s plan boils down to a package of mandates and subsidies. To begin with, Congress would place two mandates on insurance companies: First, insurers must thoroughly cover everyone who wants, and will pay for, insurance, regardless of health, age or pre-existing conditions (this is known as “guarantee issue”). Second, insurers would be required to charge customers the same regardless of health (called “community rating”). For their part, insurance companies want a third mandate, called the individual mandate, under which the federal government forces people to buy and maintain health insurance. The policy rationale for the individual mandate is to guarantee that the pool of insured people includes the young as well as the old, so that risk is spread. The benefit for insurers is obvious: You must buy their product. The next request from the insurers is also unsurprising — Washington should subsidize people’s insurance. It’s unclear, now, just who would be subsidized. Maybe younger people, who would face the largest burden from the mandates, should be subsidized. Maybe the poor and middle class, on whom the individual mandate would impose a difficult new cost, should get assistance. Insurers and the Obama administration also agree that Washington should work to lower health care expenses. How much money is wasted on name-brand drugs instead of generics? How much do doctors and hospitals overcharge or conduct unnecessary tests or procedures? How much do medical equipment makers or sellers hawk extravagant or unneeded wares that eventually end up in health insurance premiums? One form these cost controls could take is called “comparative effectiveness research” (statistical analysis of the costs and benefits of certain treatments and drugs) whose use in the U.K. has been criticized as “rationing.” But insurance companies fear the proposal that government should be an insurer. The liberal desire — a single-payer system with government, in effect, the only insurer for all Americans — is not seriously on the table for now, in part because insurers, drug makers and other health care industries oppose it. Instead, Obama has called for the “public option.” He wants the federal government to compete with private insurance companies, offering individuals the same insurance plan members of Congress have. Insurers and conservatives oppose this plan as a Trojan horse for government-run health care. Private insurance companies don’t think they can compete with government’s nearly unlimited resources. Obama and the insurers also disagree on the individual mandate, potentially a regressive tax imposing cost on everyone, regardless of ability to pay. The policy debate is nascent in Congress, but already there are important cracks in Democratic support for the public option. The Washington Post editorial page, an important voice within the Democratic congressional caucus, wrote Monday, “It is difficult to imagine a truly level playing field that would simultaneously produce benefits from a government-run system.” But there is room for compromise. The insurers, obviously, wouldn’t mind if the government insures the most costly patients — those with chronic illness, for instance. If Obama signed a measure including a public option that was expansive but expensive — just what a very sick person needs — private insurers could lower their premiums because their pools would be healthier. The insurers’ heavy lobbying and generous campaign contributions add to their influence. It also helps that their call for more government involvement in the industry dovetails with Democrats’ goal. In the end, Obama will increase government, and the affected industry will rejoice, and profit. Copyright 2009 Washington Examainer. Swine flu outbreak poses medical, and political, risks USA Today Editorial Wednesday, April 29, 2009 We don't know yet how bad this outbreak of swine flu is going to get. At worst, it could turn into a full-fledged pandemic. At best, the outbreak could burn out in the USA with a domestic tally not much larger than the 200 mostly mild cases suspected or confirmed as of Monday. Much of this is up to the nature of the virus itself. But for insight on how the situation should be handled, the nation's last encounter with swine flu is instructive. It was a fiasco. In 1976, a single death from swine flu in New Jersey and fears that the disease might have spread sent the government into overdrive. Almost overnight, it created a program to vaccinate all Americans. But the feared epidemic never materialized. The vaccine, it appears, turned out to be deadlier than the disease. As for the current outbreak, the facts so far present a puzzling contrast between Mexico (where as of Monday 1,995 suspected cases had resulted in hospitalization since mid-September and 149 had died, many of them young adults) and the U.S. (where no one had died and only one case had required hospitalization). To put those numbers in context, about 36,000 Americans die each year from complications of flu, and more than 200,000 get sick enough to be hospitalized. The 1976 experience demonstrates why it's necessary to avoid hysteria. The outbreak began with a handful of cases at a New Jersey army base, where one new recruit had respiratory symptoms, collapsed and died of pneumonia. Tests showed that he and others at Fort Dix were infected with a flu strain health officials believed had not been seen for 50 years. It appeared to resemble the virus that had caused the infamous 1918 flu pandemic, which killed millions worldwide. The government moved with too much speed and too little thought. President Ford pledged that the government would vaccinate "every man, woman and child" in the USA. In October, the program began, and nearly 45 million Americans were vaccinated. Within weeks, though, the program was suspended. Those vaccinated were getting sick, but not from influenza. All told, more than 500 of those vaccinated got a rare neurological illness, Guillain-Barre; dozens died. It was a medical and political debacle, one that spawned fears of flu vaccinations lingering to today. The strain of the current virus might be entirely different, so the lesson of history should not tie the hands of officials today, but it should set the tone for a calm, measured reaction that involves preparations for the worst but avoids stirring panic. On Monday at least, that appeared to be the case. President Obama said there was reason for a "heightened state of alert," but not a cause for alarm. The government released 25% of its anti-flu drugs to the states. Public health officials urged simple precautions: Wash your hands frequently. Stay home if you're sick. Close schools if there's a flu outbreak. Such actions are effective, particularly at a time when there are still many unanswered questions. For instance, can states and communities quickly distribute the drugs the federal government is releasing to them? Most urgently, why have so many young adults — who usually fare well in flu outbreaks compared with infants and the elderly — died in Mexico? Troublingly, the same thing happened in 1918. Until the answers are known, the best medicine has already been prescribed: smart preparation and a big dose of caution. Copyright 2009 USA Today. BACK TO TOP


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