Tuesday, April 28, 2009

The New Swine Flu

Is the new swine flu virus that has killed many people in Mexico and has spread to the United States and other countries the start of a much feared pandemic? Or is this yet another false alarm — the latest in a long history of worrying that some day a hugely lethal flu strain might sweep through the world and kill tens of millions of people, much as it did in 1918-1919?

The answer at this point is that nobody knows for sure. There are some disquieting elements about the severity of the symptoms appearing in Mexico, offset by the apparently far milder behavior of the virus in the United States. Experts clearly need to learn more about the origins, transmissibility and lethality of the new virus in coming weeks.

President Obama hit the right note on Monday when he said there is reason for concern and for a heightened state of alert but no cause for alarm. Although the new strain of influenza is suspected of killing 149 people and sickening some 1,600 others in Mexico, the toll, so far, in this country appears slight. There have been 40 confirmed swine flu cases, the majority — 28 — associated with a single preparatory school in Queens, some of whose students visited Mexico recently.

Only four states other than New York have confirmed cases: seven in California and one or two in Texas, Ohio and Kansas. The illnesses have all been mild; only one patient was hospitalized and no one has died. Four or five days after seeing the first signs of swine flu in New York City, there is still no evidence that it has spread further.

This situation does call for careful surveillance and preparations for the worst. American health officials have taken reasonable steps. They have made preparations to distribute up to a quarter of the anti-flu medicines from the government’s strategic stockpile to states and localities should they be swamped with a wave of swine flu cases. They also have taken preliminary steps toward possible formulation of a vaccine to combat the new strain. Although it would take months to produce such a vaccine, it could be ready should another wave of swine flu emerge in the next influenza season.

Individuals who feel sick are advised to stay home so as not to infect others. They should cover their noses and mouths when sneezing. Healthy people are advised to avoid those who are sick, wash their hands often and thoroughly, and try to stay in good general health. Face masks are of unproven value.

Officials also have recommended that Americans forgo “nonessential travel” to Mexico while criticizing a similar warning from a European Union health official against travel to the United States. The American complaint is less self-serving than it might seem, given that the disease is more widespread and more severe in Mexico. The World Health Organization raised its alert level for the swine flu on Monday but recommended against closing borders or restricting international travel.

While health officials scramble to keep up with the fast-moving virus, it is deeply disquieting that the Obama administration has few of its top health officials in place. The Senate, delayed by Republican objections, is finally scheduled to debate the confirmation of Kathleen Sebelius on Tuesday to be secretary of health and human services. And the White House has yet to announce a nominee for director of the Centers for Disease Control and Prevention. Those are two of the most important positions for dealing with an infectious disease epidemic.

The acting official in charge of the C.D.C. insists that the absence of top leadership has not affected how the health agencies have responded, and he may well be right. But if the Obama administration is to be judged, as it should be, on how well it responds to this potential crisis, it would be best to have the full team in place.


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