An International Frenzy to Control Swine Flu

The United States has had a measured response to spread of the H1N1 virus.

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During a press conference on the swine flu outbreak in Mexico City last week, an earthquake of magnitude 5.6 rocked the country from Acapulco to the capital. "Great, just what Mexico needs," one of the health officials said. No doubt, an earthquake seems like piling on for a country at the epicenter of a potential global pandemic. Swine flu shuttered Mexico's government operations, schools, and many private businesses, and canceled church services and public Cinco de Mayo festivities .

In the United States, despite initial saturation coverage on cable news channels, the reaction has been more measured. The southern border remains open, and travel hasn't been restricted beyond advisories against nonessential visits to Mexico. Despite an awkward (and quickly retracted) warning from Vice President Joe Biden to avoid air travel and subways, the repeated advice from government—from the Centers for Disease Control and Prevention up to President Obama—was a mantra of basic personal hygiene measures like hand washing. "In essence, everyone needs to be their own infection-control officer," Jeffrey Starke said on Wednesday after treating the country's only fatal case of the disease in Texas.

More than a 30 states have reported cases of the flu, with the total number of confirmed U.S. cases topping 275 . Only one U.S. death was reported—a Mexican toddler visiting Houston—but more than 530 schools in 24 states have been closed, and shipments of Tamiflu were released from national stockpiles. The World Health Organization warned that global pandemic was imminent, raising its alert status to 5 out of 6. During the 2003 SARS outbreak that killed hundreds, the WHO alert peaked at phase 4.

The Department of Homeland Security coordinated the national response, a role developed by the Bush administration, which devoted considerable attention to the threat of infectious viruses over the past few years. While the plans were largely in place, more than a dozen top health positions remain vacant in the Obama administration, from an official head of the CDC to a surgeon general. The crisis, however, did expedite the confirmation of Health and Human Services Secretary Kathleen Sebelius, whose nomination had been stonewalled.

And Sebelius could have a lot of work ahead of her. Virologists say the new strain is a novel hodgepodge of genetic material from three closely related strains of bird, human, and swine influenza. Since it has never been seen before, humans have yet to develop immunities. Moreover, this particular strain is most harmful to young adults whose immune systems are prone to an overreaction that can be fatal. But perhaps the trickiest problem for health workers is that the virus is constantly mutating in unpredictable ways.

One troubling mutation in the genetic code means that it is now spreading between humans, rather than just between pigs and humans in close contact with the animals. U.S. officials meanwhile have urged changing the moniker from swine flu to the more clinical term H1N1 in order to avoid a widespread misperception that the virus is transmitted by eating undercooked pork. (Pork stocks tumbled on Wall Street and Russia banned U.S. pork imports when reports of the swine flu surfaced, despite the fact that doctors say meat cannot transmit the disease.)

The panic underscores the challenge for the U.S. government in helping Americans put diseases like swine flu into perspective. Various flu strains killed more than 36,000 Americans last year. The new flu is believed to be responsible for more than 26 deaths in Mexico in a short period of time, yet its actual mortality rate is unknown. Indications are that it is far less deadly than experts first feared. The actual lethality is unknown because experts still don't yet know the total number of people infected. Disease expert Laurie Garrett says that "without knowing the denominator, you have no way to knowing if what you are seeing is something that exceeds what you'd expect in a normal flu year or something with a higher mortality rate, like we saw in 1918." While the Mexican government had claimed that hundreds of people had perished from the flu, the WHO has confirmed only that a handful of those were actually related to swine flu.