World on alert as flu epidemic fear grows

Death toll rises to 103

The world's governments raced to avoid both a pandemic and global hysteria as more possible swine flu cases surfaced from Canada to New Zealand and the United States declared a public health emergency.

"It's not a time to panic," the White House said.

The death toll from the disease has risen to 103 in Mexico, the outbreak's epicentre. Churches, markets and restaurants have been closed. Few people ventured on to the streets, and many wore face masks.

Mexican Health Minister Jose Angel Cordova told Mexican television that around 400 people were in hospital out of a total of around 1600 suspected cases.

While the only deaths so far have been in Mexico, the flu is spreading with 20 cases in the United States and six in Canada, and possible infections also popped up as far afield as Europe, Australia and New Zealand.

The US declared the health emergency so it could ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually need them – although with 20 confirmed cases of people recovering easily, they don't appear to for now.

NO PANDEMIC - YET

Make no mistake: There is not a global pandemic – at least not yet.

It's not clear how many people truly have this particular strain, or why all countries but Mexico are seeing mild disease. Nor is it clear if the new virus spreads easily, one milestone that distinguishes a bad flu from a global crisis.

But waiting to take protective steps until after a pandemic is declared would be too late.

"We do think this will continue to spread but we are taking aggressive actions to minimise the impact on people's health," said Dr Richard Besser, acting chief of the Centres for Disease Control and Prevention.

President Barack Obama's administration sought to look both calm and in command, striking a balance between informing Americans without panicking them.

Obama himself was playing golf while US officials used a White House news conference to compare the emergency declaration with preparing for an approaching hurricane.

"Really that's what we're doing right now. We're preparing in an environment where we really don't know ultimately what the size or seriousness of this outbreak is going to be," Homeland Security Secretary Janet Napolitano told reporters.

Earlier, White House press secretary Robert Gibbs said the outbreak was serious, but that the public should know "it's not a time to panic."

A pandemic would deal a major blow to a world economy already suffering its worst recession in decades, and experts say it could cost trillions of dollars.

A 1968 "Hong Kong" flu pandemic killed about 1 million people globally.

Scientists have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. Swine flu contains DNA from avian, swine and human viruses.

MEXICO SHUTS DOWN

In Mexico, soldiers handed out 6 million surgical-style masks to deal with the deadly flu strain.

Special laboratory tests to confirming how many died from it and not something else is taking time.

Mexico City, one of the world's biggest cities, practically ground to a halt on Sunday with restaurants, cinemas and churches closing their doors and millions staying at home.

Worshipers were told to follow Sunday church services on television and some residents abandoned the capital, a rambling, chaotic city of some 20 million people.

Michelle Geronis, 22, a film student, took a bus to be with her family in the central state of Aguascalientes.

"My parents heard the news and said, 'You know what? You'd better get here,"' she said.

TAKING ACTION

The outbreak has snowballed into a huge headache for Mexico, already grappling with a violent drug war and economic slowdown, and has become one of the biggest global health scares in years.

"(We are) monitoring minute by minute the evolution of this problem across the whole country," Mexican President Felipe Calderon said as health officials counted suspected infections from the tropical south to the arid northern border.

The World Bank said it would send Mexico with $US25 million in loans for immediate aid and $US180 million in long-term assistance to address the outbreak, plus advice on how other nations have dealt with similar crises.

The World Health Organisation and US were following a playbook of precautions developed over the past five years to prepare for the next super-flu.

The WHO on Saturday asked all countries to step up detection of this strain of A/H1N1 swine flu and will reconsider on Tuesday whether to raise the pandemic threat level, in turn triggering additional actions.

A potential pandemic virus is defined, among other things, as a novel strain that's not easily treated. This new strain can be treated with Tamiflu and Relenza, but not two older flu drugs.

Also, the WHO wants to know if it's easily spread from one person to a second who then spreads it again – something US officials suspect and are investigating.

"Right now we have cases occurring in a couple of different countries and in multiple locations, but we also know that in the modern world that cases can simply move around from single locations and not really become established," cautioned WHO flu chief Dr Keiji Fukuda.

There is no vaccine against swine flu, but the CDC has taken the initial step necessary for producing one – creating a seed stock of the virus – should authorities decide that's necessary.

ATTENTION ON TRAVELLERS

Worldwide, attention focused sharply on travellers.

"It was acquired in Mexico, brought home and spread," Nova Scotia's chief public health officer, Dr Robert Strang, said of Canada's first four confirmed cases, in student travelers.

Canada became the third country to confirm cases, in six people.

New York Mayor Michael Bloomberg confirmed on Sunday that eight schoolchildren there had caught the swine flu virus, although the cases were mild and the illness did not appear to be spreading rapidly to the general population.

The school will be closed Monday and Tuesday.

Another 12 cases have been confirmed in California, Kansas, Texas and Ohio, and Homeland Security Secretary Janet Napolitano said the government would declare a public health emergency.

New Zealand said 10 students who took a school trip to Mexico "likely" had swine flu. NOe fo the 10 were seriously ill.

Two people were in a southeast Queensland hospital with flu symptoms similar to swine flu, but tests later proved negative.

Spanish authorities had seven suspected cases under observation.

China, Russia and Taiwan began planning to put quarantine travelers arriving from flu-affected areas if they have symptoms. Italy, Poland and Venezuela advised citizens to postpone travel to affected parts of Mexico and the US

The US hasn't advised against travel to Mexico but does urge precautions such as frequent hand-washing while there, and began questioning arriving travelers about flu symptoms.

Flu is characterized by a sudden fever, muscle aches, sore throat and dry cough. Victims of the new strain have also suffered more vomiting and diarrhoea than is usual with flu.

NO RISK FROM PORK

People are not at risk of being infected with swine flu through exposure to pork, the WHO said.

"Right now we have no evidence to suggest that people are getting infected from exposure to pork or to pigs so right now we have zero evidence that exposure to meat leads to infection," Keiji Fukuda, acting WHO director-general for health security and environment, told a teleconference.

Fukuda was commenting on reports that some countries may ban imports of meat from Mexico or other countries where swine flu has been detected.

The WHO advises that the swine influenza virus is killed by cooking temperatures of 70 degrees Celsius, corresponding to the general guidance for preparing pork and other meat.

LOST TIME

Mexico appears to have lost valuable days or weeks in detecting the new flu strain.

The first death was in southern Oaxaca state on April 13, but Mexico didn't send the first of 14 mucus samples to the Centers for Disease Control and Prevention until April 18, around the same time it dispatched health teams to hospitals looking for patients with severe flu or pnuemonia-like symptoms.

Those teams noticed something strange: The flu was killing people aged 20 to 40. Flu victims are usually either infants or the elderly. The Spanish flu pandemic, which killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults.

A team from the CDC was in Mexico to help set up detection testing for the swine flu strain, something Mexico previously lacked.

Health authorities noticed a threefold spike in flu cases in late March and early April, but thought it was a late rebound in the December-February flu season.

Testing at domestic labs did not alert doctors to the new strain. Health Secretary Jose Cordova acknowledged Mexican labs lacked the profiling data needed to detect the previously unknown strain.

Even though US labs detected the swine flu in California and Texas before last weekend, Mexican authorities as recently as Wednesday were referring to it as a late-season flu.

But mid-afternoon Thursday, Mexico City Health Secretary Dr Armando Ahued said, officials got a call "from the United States and Canada, the most important laboratories in the field, telling us this was a new virus."

Asked why there were so many deaths in Mexico, and none so far among the US cases, Cordova noted that the US cases involved children – who haven't been among the fatal cases in Mexico, either.

"There are immune factors that are giving children some sort of defense, that is the only explanation we have," he said.

Another factor may be that some Mexican patients may have delayed seeking medical help too long, Cordova said.

Others are forced to work and leave their homes despite health concerns.

Wearing two dirty, blue surgical masks she says she found and a heavy coat, Daniela Briseno swept garbage early Sunday morning from the streets in Mexico City.

"This chill air must be doing me harm. I should be at home but I have a family to support," the 31-year-old said.

- AP, Reuters