Current WHO phase of pandemic alert


Pandemic preparedness

In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.

The current WHO phase of pandemic alert is 4.


In nature, influenza viruses circulate continuously among animals, especially birds.

Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is 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.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

CDC Update 04/27/09

Antiviral Drugs
Antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including swine influenza viruses. Antiviral drugs can be used to treat swine flu or to prevent infection with swine flu viruses. These medications must be prescribed by a health care professional. Influenza antiviral drugs only work against influenza viruses — they will not help treat or prevent symptoms caused by infection from other viruses that can cause symptoms similar to the flu.
There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, amantadine and rimantadine). The swine influenza A (H1N1) viruses that have been detected in humans in the United States and Mexico are resistant to amantadine and rimantadine so these drugs will not work against these swine influenza viruses. Laboratory testing on these swine influenza A (H1N1) viruses so far indicate that they are susceptible (sensitive) to oseltamivir and zanamivir.

Benefits of Antiviral Drugs

Treatment: If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. For treatment, antiviral drugs work best if started as soon after getting sick as possible, and might not work if started more than 48 hours after illness starts.
Prevention: Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with swine influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number of days that they should be used will vary depending on a person’s particular situation.

CDC Recommendation

CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.
• Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent influenza A and B virus infection in people one year of age and older.
• Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older.
Recommendations for using antiviral drugs for treatment or prevention of swine influenza will change as we learn more about this new virus.
Clinicians should consider treating any person with confirmed or suspected swine influenza with an antiviral drug. Visit: http://www.cdc.gov/swineflu/recommendations.htm for specific recommendations.

ScienceDaily.com, By Caren Bohan, 2009/04/27 WASHINGTON, Apr. 27, 2009

The outbreak of a flu virus that has led to a U.S. public health emergency highlights the need for a strong government commitment to scientific research, President Barack Obama said on Monday.

U.S. President Barack Obama speaks at the annual meeting of the National Academy of Sciences in Washington April 27, 2009. REUTERS/Kevin Lamarque

During remarks on science and technology that covered topics from climate change to the public-school curriculum, Obama set a goal of devoting 3 percent of gross domestic product to scientific research.

“If there was ever a day that reminded us of our shared stake in science and research, it’s today,” Obama said in a speech to the National Academy of Sciences, a society of scientists and engineers who give advice to U.S. policymakers.

“Our capacity to deal with a public health challenge of this sort rests heavily on the work of our scientific and medical community,” Obama said. “And this is one more example of why we cannot allow our nation to fall behind.”

Obama said that U.S. cases of swine flu were “not a cause for alarm” but the administration was monitoring them closely.
The administration said its declaration of a public health emergency was precautionary. The flu has killed 149 people in Mexico and spread to North America and Europe. Though no one outside of Mexico has died, pandemic fears have been raised.
Obama invoked the space race between the United States and the Soviet Union during the 1950s and 1960s as an example of the importance of a major investment in research, and said science spending as a share of GDP has declined since that “high water mark.”

Through the goal of spending more than 3 percent of GDP on science, “we will not just meet, but we will exceed the level achieved at the height of the space race,” Obama said.

The goal refers to public and private spending. The United States now spends 2.66 percent of gross domestic product on research and development, according to the White House.

Some of the increased spending is included in the $787 billion economic stimulus package that Obama signed in February.

In his proposed fiscal 2010 budget, Obama called for making permanent tax credits for business investment in research and development.

The science speech comes as the White House is trying to highlight Obama’s accomplishments with the approach of the 100-day mark for his presidency on Wednesday.
He also touted his proposals to tackle global climate change, which face a fight in the U.S. Congress, saying it was “this generation’s challenge to break our dependence on fossil fuels.”

The administration on Monday also opened a two-day meeting of major world economies on climate change.

Obama wants to cut U.S. emissions by roughly 15 percent by 2020 — back to 1990 levels — mostly through a cap-and-trade system that limits how much carbon dioxide and other greenhouse gases big factories can emit.

That proposal is at the heart of a bill under consideration in Congress.

Republicans have criticized the cap-and-trade system as a backhanded energy tax. Some moderate Democrats are also worried about the impact of the plan on jobs and the economy.

ABC News Medical Unit

April 27, 2009

Mexican Hospital Worker
All Mexican Schools Have Been Shut Down Until May 6th

Amid the media flurry surrounding reports of swine flu worldwide, the public may worry about receiving mixed messages on what to do to address the threat.

Seven people in California and Texas have been diagnosed with a unique form of swine flu, U.S….

Health officials learned over the weekend that more than 1,600 people in Mexico are possibly infected with the swine flu virus. With the first confirmed case in Spain, the disease has hit European shores. And the tally of confirmed swine flu cases in the United States has now hit 40, according to a statement by the World Health Organization on Monday. Health officials have warned that this number is likely to rise.

But what does it mean for the public in general, now that there’s an official state of public emergency? “Oprah” Show Health Expert Dr. Mehmet Oz talked to “Good Morning America” this morning about how the public should interpret what’s going on, and what people can do to protect their health.

“We hear the word emergency and, of course, our first reaction is, ‘What’s going on here?'” Oz told “GMA “anchor Robin Roberts. “That’s a very normal response; we’re human. Someone says ’emergency,’ you jump back.”

Still, health officials and infectious disease experts said that the federal government took the step of declaring a public health emergency to mobilize resources to better confront the swine flu menace, however it may evolve.

“We’re not really going to know for sure what’s going on until another week or so,” Oz said.

Even as federal health agencies declared a public health emergency, most infectious disease experts emphasize that there are steps people can take to safeguard their health. These simple preventive measures include washing hands frequently and avoiding people who are coughing or sneezing.

“There is a role for everyone to play when an outbreak is going on to try to reduce the impact,” said Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention. “At an individual level, it’s important people understand how they can prevent respiratory infection. Frequent hand-washing [is an] effective way to reduce transmission of diseases.”

April 27, 2009

Twenty additional cases of swine flu have been confirmed at a New York City school, boosting the total number of cases to 28, New York City Mayor Michael Bloomberg said today.

Bloomberg warned that there are another 17 students from the school, St. Francis Preparatory School in Queens, and as many as 100 of the students have fallen ill and will be tested for the virus.

Some of the school’s students had recently returned from a spring break trip to Mexico.

The mayor expressed optimism, however, over the fact that the disease has not yet been detected anywhere else in the city.

“We are still dealing with a single cluster of swine flu cases, all associated with this one school,” Bloomberg said, adding that to his knowledge all of those infected with the virus were improving.

“So far, we are not seeing a situation comparable to that being reported in Mexico.”

The total number of swine flu cases throughout the U.S. rose to 40 today.

Meanwhile, the U.S. Centers for Disease Control and Prevention plans to announce later today a new travel advisory for Americans visiting Mexico, according to Dr. Richard Besser, acting director of the federal agency.

Besser made the announcement at a Monday afternoon press conference.

Since Sunday, the World Health Organization has adjusted the number of confirmed cases of swine flu in the United States to 40. And while swine flu cases in the United States appear to be less severe than those in Mexico, and no deaths have yet been reported, U.S. health officials warn that the outbreaks could get worse.

“What I want people to understand is that we’re concerned,” Besser told “Good Morning America” today. “People should be concerned. We’ll tell you what we know when we know it.”

The United States has not reported any swine flu fatalities, Besser said Americans need to be prepared for it to get worse.

“I think from what we understand in Mexico, people need to be ready that we can see more severe cases in this country,” he said.

College of Veterinary Medicine at Virginia Tech, April 27, 2009 — The rapidly developing swine flu scare has activated a global response from the public health community and alarmed hundreds of millions of people, but there are a number of reasons why people should remain realistic and calm concerning the scope of the problem, according to Dr. X. J. Meng, a virologist who is on faculty in the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech.

For one thing, according to Meng, who is considered one of the world’s leading experts on swine viruses, the Centers for Disease Control in Atlanta and the World Health Organization in Geneva have spent the past several years creating management protocols designed to deal with a global pandemic that might be caused by Avian Influenza H5N1, or “Bird Flu.” Pharmaceuticals have been stockpiled, and outbreak management and risk communication plans have been developed to minimize transmission patterns and contain the scope of a potential outbreak.

“Mortality from flu is generally not considered very high considering the high number of people who are being infected every year,” said Meng, although he does believe that it could spread quickly since it appears to be a novel virus and human-to-human transmission is occurring. “But it does look like one of those bugs that has the potential of leading to a pandemic.”

Meng suggested that possible reasons for the increased mortality rate associated with the Mexican cases as opposed to the American cases could be attributed to differences in the sophistication of the two healthcare systems, it could be the result of “other co-infecting or underlying diseases” that remain unclear at this time or it could be due to the very small number of cases that have been currently diagnosed in the United States.

“We have much to learn about this specific virus,” said Meng, who has a medical doctorate and a Ph.D virologist who frequently works with the National Institutes of Health and other organizations on infectious disease research and containment programs. “But then again, we have much to learn about many other zoonotic disease viruses.”

From SARS to Bird Flu, most of the emerging diseases affecting people today come from pathogens most often associated with animals, according to Meng, who is among a growing legion of scientists trying to convince the federal government to invest more money in studying animal pathogens as part of an overall effort to protect humans from disease. According to a recent article published in Science, Meng said, only $32 million of the $88 billion U.S. Department of Agriculture 2007 budget was allocated for farm animal disease research.

“If we can understand more about these viruses, their transmission behavior, and the mechanism of cross-species infection among animal and human populations, then we can better prepare ourselves for protecting human populations,” said Meng, who recently participated in a National Institutes of Health sponsored expert workshop entitled “Cross Species Infection Workshop” in Washington D.C. that summarized the dangers and called for the need to study the animal viruses in animals such as pigs before they jump species and infect humans.

“It will likely be several days before the virus is fully characterized in the laboratory,” he said. “Once that work is finished, we’ll know a lot more about how to proceed with the management of this situation.”

Meng said that one of the major factors that might minimize the scope of the outbreak and the spread of the virus could be related to the timing of this outbreak. Influenza viruses are “envelope viruses” that can be more efficiently transmitted in cold winter conditions that facilitate the survival of the virus, Meng said, and they typically do not do well in hot summer temperatures. “That is something that may limit the spread of this new virus,” he said.

The strain of swine virus H1N1 responsible for the emerging epidemic does not normally infect people and there are only a few cases of swine flu infections in humans each year in the United States, according to Meng. Because pigs have receptors for human, avian and pig viruses, they serve as a “mixing vessel” for new viruses, he said. This particular strain is believed to include components from pig, bird and human viruses that have been combined through a process known as genetic re-assortment. Humans are likely immunologically naïve to the new virus that has been created, which is why the danger for a potential global pandemic does exist. Materials provided by Virginia Tech.


New York City Mayor Michael Bloomberg discusses cases of the swine flu in New York City, Monday during a news conference.

What some states are doing about the swine flu outbreak:

MINNESOTA: Lab tests on 12 Minnesota patients with flu-like symptoms found no confirmed or probable cases of swine flu, State Epidemiologist Ruth Lynfield said Monday.

Since Thursday, the Minnesota Department of Health has been asking hospitals and doctors to submit specimens if they have patients with the kind of respiratory symptoms typical of influenza. Lynfield said state and local health departments have been preparing for major public health threats for years and are ready to respond. Testing will continue.

WHO: Forty confirmed cases in the United States
GALLERY: Images from the swine flu outbreak
MEXICO CRISIS: Country bears brunt of outbreak

SOUTH DAKOTA: The state has two suspected cases of swine flu, State Epidemiologist Lon Kightlinger said Monday. Test samples from those two adult patients are being sent to the state health lab in Pierre for testing and should be available Tuesday, Kightlinger said. The two recently traveled to Mexico. “We are now casting a very wide surveillance net for swine flu in South Dakota,” he said. “This certainly is a fast-changing situation.”
Health Secretary Doneen Hollingsworth said state health officials are conducting mass immunization exercises and stockpiling anti-viral medication and medical equipment.

Hollingsworth said South Dakota doctors are being asked to ramp up testing when they see flu patients this time of year, which is typically the end of flu season in the Upper Midwest. She said more suspected cases of swine flu are expected in South Dakota, and some of those will probably be ruled out for the disease.
MICHIGAN: The Michigan Department of Community Health has identified a probable case of swine flu in a 34-year-old Livingston County woman who recently visited Texas and the Mexican border.

She told state health officials she was experiencing flu-like symptoms after returning home. Her state lab results were forwarded to the Centers for Disease Control and Prevention.

“We are monitoring the probable case here in Michigan, and we are informing all doctors on what to look for when they treat sick patients,” said Greg Holzman, chief medical executive for the state Health Department. “This case is not a cause for alarm, but we do want people to be cautious.”

NEW YORK: New York City Mayor Michael Bloomberg confirmed 28 cases of swine flu among students from one high school but said the city is “open for business.” Bloomberg said Monday that the illnesses are all among students at St. Francis Preparatory in Queens.

He said there’s no reason for anyone outside of that high school’s community to stay home. He said 17 probable cases involve students from that school. All of the St. Francis students are improving, Bloomberg said.

PENNSYLVANIA: There are no confirmed cases of swine influenza in the state, but state health officials remain in close contact with federal and local officials.
Health Secretary Everette James said Monday that the state government is spreading the word to the public and health care providers about how they can prepare for a potential impact in Pennsylvania.

The state has asked medical providers to look for patients with influenza-like symptoms who may have been exposed and to report any suspected cases promptly.
NEW HAMPSHIRE: Gov. John Lynch said New Hampshire is prepared to deal with swine flu if it shows up in the state.

Lynch and public health officials are keeping in close contact with health care providers, schools and others to make sure suspected cases are reported. The state has a stockpile of antiviral drugs that can be used to treat swine flu and has requested more from the federal government.

Public health director Jose Montero emphasized that not everyone who has the sniffles needs to get tested. The focus is on people with respiratory systems who have traveled to Mexico and other outbreak sites, or are in contact with those who have.

The state plans to set up a hotline to provide further information.

NEW JERSEY: Though there are no confirmed cases of the swine flu in New Jersey, health officials expect the Garden State to see some.
Health Commissioner Heather Howard said that given New Jersey’s proximity to New York and its diverse population, the outbreak may soon reach across the Hudson River.

Howard said the state is well-prepared, having stocked up on Tamiflu — the medicine used to treat influenza. She says the state increased surveillance of influenza cases and has state testing labs ready to deal with increased volume.

NORTH CAROLINA: Officials at Duke University scheduled a meeting to discuss the nation’s swine flu emergency and how to respond.

Spokesman David Jarmul said Monday’s closed-door meeting is a precaution. He said school officials will discuss how to plan for a potential outbreak and how to communicate such an emergency to the Duke community.

The meeting was coordinated by school President Richard Brodhead and involves health officials, the Office of Student Affairs and the Communications Office. Mike Merson, the head of Duke’s global health program, also will participate.

MAINE: Maine Center for Disease Control and Prevention Director Dora Anne Mills said Monday that several Mainers have been tested for swine flu but the tests came back negative.

Mills said the state is preparing for swine flu’s expected arrival as people who have been traveling during spring break return.

Mills said the state has been preparing for a pandemic for years, and she’s in daily contact with her federal health counterparts. She expects 30,000 to 40,000 doses of antiviral medicine to arrive in Maine from the federal government.

Mills said the goal is to minimize the flu’s impact.

SOUTH CAROLINA: A private school closed after some students returned from a trip to Mexico with flu-like symptoms.

Newberry Academy was closed Monday as a precaution, but educators were not too concerned that their students might be confirmed with swine flu.

Headmaster Bob Dawkins said it’s likely that a student who was sick before boarding the plane for Cancun infected the other students. He said a student who didn’t make the trip also became sick before the others returned from Mexico.

Test results on the students could be in as early as Monday afternoon.

OHIO: An elementary school was closed Monday as health officials worked to contain the spread of swine flu, which sickened a 9-year-old student. The third-grader, who is recovering at home, had recently visited several Mexican cities while on vacation with his family.

Doctor’s offices and hospitals in Elyria were urged Monday to isolate patients who have flu-like symptoms, said Clifton Barnes, a spokesman for the Lorain County Emergency Management Agency.

School officials closed Ely Elementary School for the week at the advice of the U.S. Centers for Disease Control and Prevention, said district spokeswoman Amy Higgins. Parents of its 350 students were called and notified Sunday.

As an added precaution, a cleaning crew went inside the school Sunday night to sanitize doorknobs, desktops and telephones, Higgins said. No additional cases have been reported at the school or elsewhere in the district, she said.

The boy, who returned from Mexico within the past two weeks, started feeling sick Wednesday.

WISCONSIN: Milwaukee health officials are taking steps to prevent the spread of the disease, even though no cases have been identified.

During a news conference Sunday, health officials and Mayor Tom Barrett urged people to follow common sense hygiene such as washing your hands. They are also asking people who are sick to stay home and contact a doctor.

The city has set up an information hotline in English and Spanish. The number is 414-286-3616.

VERMONT: The state Health Department urges health care providers, schools and others to watch for cases of swine influenza.

No cases of swine flu have been reported in Vermont. The Health Department wants Vermonters to take simple precautions to avoid the spread of the flu. The precautions include: frequent hand washing, covering your mouth when you cough, staying home from school or work if you get sick and calling your health care provider if you think you need medical attention.

Health Commissioner Wendy Davis said Vermont is ready in the event of an outbreak in the state.

LOUISIANA: Gov. Bobby Jindal said the state has a plan to get ahead of the swine flu outbreak, and he stressed the importance of citizens taking steps to prevent against illness. Sunday, Jindal said there were no confirmed cases of swine flu in Louisiana.

The governor activated a Crisis Action Team to monitor national trends and report cases in Louisiana.

CONNECTICUT: Gov. M. Jodi Rell ordered the state Health Department to closely monitor the swine flu outbreak, although Connecticut’s Department of Public Health said there are no confirmed cases in the state. Rell said the state will be in close contact daily with hospitals, doctors and other health care providers.

The health department will focus on people who have flu-like symptoms and have traveled recently to affected areas such as Mexico.

TENNESSEE: Health officials have found no cases of swine flu yet, state medical epidemiologist Tim Jones said. “We fully expect to have cases in Tennessee … The harder we look, the more likely we are to find them.” The state has stepped up routine contact with hospitals and health care providers to keep an eye out for possible cases, he said. Tennessee has also requested additional anti-viral medicine from a national stockpile, Jones said.

CALIFORNIA: In Palm Springs, two people who recently traveled to Mexico were described as “high-risk patients” and were tested for the virus at Desert Regional Medical Center in Palm Springs, said Michael Connors, the hospital’s manager of infection prevention. Nose-and-throat cultures were taken and sent to the Riverside County Department of Public Health, Connors said. The patients were then discharged, he said. The county also has received samples from other hospitals in Riverside County, said Barbara Cole, director of Disease Control for the Riverside County Department of Public Health. But no cases of swine flu have been confirmed in Riverside County. Preliminary results were expected late Monday. “We are taking this very seriously,” Cole said.

Roche: WHO Can Treat 5 Million With Tamiflu Fast

PharmaLive.com- Apr. 27, 2009 GENEVA–Swiss drug company Roche Holding AG said Monday the World Health Organization has enough of the anti-flu treatment Tamiflu stockpiled to treat up to 5 million people who come down with the new strain of swine flu that broke out in Mexico.

“That is on 24 hours standby,” said Roche spokeswoman Martina Rupp.

The WHO-controlled stockpiles are in addition to millions more treatments held ready by 85 to 90 governments, Rupp told The Associated Press.
Three-fifths of the WHO stockpiles are held at Roche facilities in the United States and Switzerland and the remaining amount is stored by WHO at different locations around the world, Rupp said.

The stockpiles held at Roche have been donated to WHO and they can be shipped as soon as WHO gives the word, Rupp said.

“They are actually for those countries that are not so well prepared yet,” Rupp said.

The firm based in Basel, Switzerland, also can ramp up production to make 400 million treatments a year, and already has key ingredients ready, she said. Roche has agreements with drug makers in South Africa, India and China that allow for more production, but she said she was unable to give figures for production under sublicense agreements.

Britain and Japan have recently given new orders for Tamiflu because they are doubling their stockpiles, Rupp said.

Tamiflu has been regarded as a first defense against an influenza pandemic since it was shown to be effective against the bird flu outbreak in Asia in recent years. WHO has said it also is effective against the new strain of swine flu.

A full treatment takes five days — 10 capsules taken two a day starting within 48 hours of the onset of symptoms.

Countries are rushing to develop contingency plans in case the suspected swine flu being blamed for over 1,600 infections and suspected in up to 103 deaths in Mexico spreads rapidly around the world.

Roche began increasing production of Tamiflu in 2005 after the outbreak of bird flu in Asia, but Rupp said it began cutting back in 2007 as government stockpiles filled up.

The company built up the capacity to make 4 billion capsules a year, or 400 million treatments, Rupp said.

“It was a capacity that was never used because demand was just not that high,” she said. “It’s obvious. You cannot keep that up and not use it. So we announced that we are going to scale it down.”

At the same time Roche said it would keep enough ingredients on hand to expedite the ramp up of manufacturing if needed, said Rupp.

She noted that WHO said in 2005 that stockpiling in advance is the only way to ensure sufficient supplies are available at the start of a pandemic and that anti-viral medicine is just part of the overall plan that countries have to have in place.

Roche shares rose 4.3 percent to 145.60 Swiss francs ($127.88) on the Zurich exchange Monday.


The New York Times, April 28, 2009 — Sorting through the “marquee flus” of recent years — SARS, avian flu and now swine flu — is complicated.

The three come from different viruses and carry different kinds of danger, depending on ease of transmission and virulence. As a benchmark, the deadliest influenza pandemic in the past century, the Spanish influenza of 1918 to 1919, had an estimated mortality rate of around 2.5 percent but killed tens of millions of people because it spread so widely.

The new swine flu cases are caused by an influenza strain called H1N1, which appears to be easily passed from person to person. Mexican health authorities have confirmed 149 deaths from that flu and are investigating the illnesses of 1,600 people, and the United States, Canada, Spain and other countries have confirmed or are investigating cases.

But doctors have little information yet on the mortality rate, as there is no reliable data on the total number of people infected. Reports from the United States suggest that some cases may be mild and therefore may go undetected — allowing the disease to spread further. Flu experts are trying to determine if this year’s flu shots, which contain H1N1 strain, offer any protection.

In contrast, the lethal avian flu that has kept world health authorities anxious for years is caused by H5N1 influenza virus. It has killed 257 of the 421 people who have contracted it, or 61 percent. But it has shown very little ability to pass from person to person, mainly infecting poultry, and some experts have suggested that there may be something about the H5N1 virus that makes it inherently less transmissible among people.

SARS — severe acute respiratory syndrome — is both easily spread and virulent. In the 2003 outbreak in Hong Kong, it killed 299 of the 1,755 people it infected there, or 17 percent.

The lessons learned from SARS did not gone to waste in Hong Kong. While Mexico struggles to confirm cases of swine flu and sends samples to the United States, Hong Kong is already performing swift genetic tests on patient samples and will have laboratories doing so at six local hospitals by Thursday. Tens of thousands of doctors and nurses, including retirees and those with medical training who have moved to other occupations, are tracked on databases and ready to be mobilized.

Contingency plans are ready to keep public transport, electricity, food supplies, telecommunications and other vital services running even if large numbers of people fall ill. And at a time when many hospitals in the United States are already at full capacity and keep few extra beds in reserve, Hong Kong has 1,400 beds in respiratory isolation units, mostly built over the past six years for fear that bird flu or SARS would become a serious problem, and 15 times as many beds as the territory needs on an everyday basis.

For a population of seven million people, Hong Kong has stockpiled 20 million treatment courses of Tamiflu, a medicine to which the new swine flu virus has not yet developed resistance. Hong Kong also has Asia’s best-known flu specialists and extensive research labs that were expanded in response to fears of SARS or a long-feared pandemic of bird flu, which is caused by a different influenza virus from swine flu.

Government lawyers are also moving quickly, carrying out all the procedures on Monday to make swine flu a disease for which health professionals are required by law to notify the authorities of any suspected case. The Hong Kong government also has broad and detailed legal powers to quarantine possible cases and suspend a range of civil liberties in order to track down anyone who has been in contact with a carrier of a communicable disease; many other countries, including the United States, are still debating how to handle legal issues during a possible pandemic.

SARS “gave us a lot of valuable insights and practical experience in managing a large outbreak,” said Gabriel Matthew Leung, Hong Kong’s under secretary for food and health.

Hong Kong is unusually vulnerable to flu. World Health Organization officials describe Hong Kong and its labs as their sentry for flu in Asia, because the territory’s tests may uncover infected people arriving from other places that are either unequipped to identify influenza or have a habit of keeping medical problems a secret.

Still, in a measure of the terror that SARS has left, the territory’s stock market suffered some of the heaviest losses in Asia on Monday on swine flu fears. The Hang Seng Index fell 2.74 percent. Shares of Cathay Pacific, the dominant airline here, dropped 8 percent and shares of mainland China’s Air China fell 12.8 percent on fears that many passengers will stop flying.

• The Wall Street Journal
• April 27, 2009


The spread of swine flu roiled trading in everything from livestock futures to the Mexican peso to airline stocks on Monday. Traders fretted about possible cutbacks in consumer spending on travel and food products perceived to be less safe because of the disease outbreak.

Broad-based stock averages traded in a narrow range, though the swine-flu scare’s effects were more evident elsewhere in the U.S. market. The Dow Jones Transportation Average, for instance, tumbled almost 5%. Among airline bellwethers, AMR was down 12%, while Continental Airlines was down 16%.

The Mexican peso plunged 4% versus the dollar, and Mexican shares fell 4.3%. Pork bellies fell 4.4%, pacing a broader pullback in raw materials as investors worried about possible derailment of what many had interpreted as a budding recovery in the global economy.

“The swine flu is undermining confidence and contributing to risk aversion” in an array of assets, said Paresh Upadhyaya, a currency portfolio manager at Putnam Investments in Boston.

He and other investing pros drew comparisons Monday to the outbreak of the respiratory disease SARS beginning in late 2002 in Asia, leading to big pullbacks in tourism and other industries in the region.

Upadhyaya said he was already bearish on the peso in light of the weak prospects for exports of goods from Mexico to the U.S. thanks to a long-running recession here.
“The flu story just underlines that outlook for us,” said Upadhyaya. “This is coming at a time when the Mexican economy was already very vulnerable.”

The dollar weakened versus the Japanese yen but rose against the euro and British pound as investors sought safe havens. The U.S. Dollar Index jumped 1.2%.
Treasury prices edged higher. The benchmark 10-year note was up 15/32 to yield 2.933%.

The Dow Jones Industrial Average was off 37 points, or 0.5%, at 8,039 in recent trade. The Nasdaq Composite Index fell 0.7%. The S&P 500 was off 0.9%, led by declines of about 2% each in basic materials and energy.

But the S&P’s health-care category was up about 1%, helped by bets on companies that may offer remedies for swine flu, which has killed 20 people in Mexico.

Officials in other countries, including the U.S., are taking measures to counteract the spread of the strain. Meanwhile, investors are wondering to what extent cutbacks in travel or changes in commodity consumption will derail what many had interpreted as a budding recovery in the global economy.

“It’s all very speculative right now,” said Todd Leone, head of listed trading at Cowen & Co. in New York. “We have to see how this is going to play out and how widely the flu really spreads.”

Traders work on the floor of the New York Stock Exchange Monday, as fears over the swine flu depressed stocks and other assets.

In particular, Leone said several drug stocks were being roiled Monday on sketchy hopes that they might offer a flu remedy. GlaxoSmithKline rose about 8%, while Roche Holding was up nearly 6%. Both make drugs to fight various strains of the flu, though it remains unclear what impact swine flu in particular might have on their sales.
Among the travel-related names suffering big declines were Delta Air Lines, off 14%; Continental Airlines, off 15%; and Starwood Hotels, off 11%. Cruise-ship operator Carnival sank 14%.

Selling in the commodity markets was also widespread, with lean hogs and pork bellies leading the plunge, down 4.4% and 3.7%, respectively. Lean hogs are trading down the daily limits, and pork bellies have picked up a little after hitting the floor earlier in the session at the Chicago Mercantile Exchange.

Analysts said that market’s reaction so far has been based more on sentiment, although the long-term effect on the market’s fundamentals may be less than expected, since there’s not yet any evidence that consumers can get swine flu from eating pork.

“Whenever we have a virus named after an animal, people will reduce the consumption,” says Anne C. Frick, vice president of futures research at Prudential Bache Commodities, LLC.

Also driving the markets down is the growing fear that the pandemic risk might slow down the recovery of global economy. Russia and China have banned imports of pork and pork products from Mexico and parts of the U.S., leading to concerns over lower consumption of the meat. Trade restrictions have raised fresh questions about the already-fragile global trade system fraught with recession. About 25% of U.S. pork was exported last year, according to the U.S. Meat Export Federation, which is in the process of determining the potential impact on the industry.

The fear has spread to other commodities, such as grains, energy and metals. Soybeans, which are a key ingredient in hog feed, fell 3.4%. Crude-oil futures were down more than $1, trading under $51 a barrel, reflecting concerns that fuel demand might suffer from cutbacks in travel. The broad Dow Jones-AIG Commodity Index was off 2.2%.

Traders are exiting from the markets, waiting for clearer indications as to whether this outbreak is going to stabilize or expand greatly, says Richards Feltes, senior vice president of MF Global Research.

Even live cattle, which could benefit if consumers substitute beef for pork, was down 1% to settle at 82.6 cents a pound in Chicago.

Shares of meat producers also traded lower Monday. Smithfield Foods fell 11% despite its announcement that it’s found no signs or symptoms of swine flu in its herd or employees in Mexico. Tyson Foods was off 9%.

“For now, I’m thinking the effects of swine flu on the markets will be short-lived,” said Darin Newsom, senior commodity analyst at the research firm DTN in Omaha, Neb. “I don’t think it’s quite at the pandemic level that everyone fears it is.”

He added: “There are still a lot of fundamental reasons to believe in a recovery.” In particular, Newsom said that copper prices, which have risen sharply this year, are signaling strong conviction that raw-material demand is due for a continued bounce.

The swine-flu worries followed a weekend G7 meeting in which global financial leaders provided a sanguine outlook. “There are signs that the pace of deterioration in economic activity and trade flows has eased,” said Treasury Secretary Timothy Geithner.

“This is going to hurt at a time when we’ve had a pickup [in equity markets]. On the other hand, it could just be an excuse for people to take money off the table,” said David Morrison, a trader at GFT Global.

-By Peter A. McKay at peter.mckay@wsj.com and Carolyn Cui at carolyn.cui@wsj.com

Steve Goldstein contributed to this article.

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