The New York Times, April 30, 2009, by Liz Robbins The World Health Organization raised the alert level of the fast-spreading swine flu virus on Wednesday afternoon, indicating that a “pandemic is imminent,” on the day that a Mexican toddler who had been hospitalized in Houston became the first person to die from the disease on United States soil.

Dr. Margaret Chan, the director general of the organization, said that the “phase 5” alert out of a possible 6 levels signified that at least two countries have spread the virus by human to human contact, and that the highest phase 6 was probably imminent.

“It is really all of humanity that is under threat during a pandemic,” Dr. Chan said. “We do not have all the answers right now. But we will get them.”

By Wednesday afternoon, nine countries had confirmed cases of swine flu, the strain known as the H1N1 virus. Several European nations were making plans to regulate travel involving Mexico, where more than 150 people are suspected to have died and at least 2,400 are suspected to have been infected as a result of the swine flu.

In the United States, Janet Napolitano, the secretary of homeland security, said at an afternoon news conference: “We have been preparing all along as if this is going to be Stage 6. Our efforts have been to stay ahead of the number.”

She added: “We are preparing for the worst, hoping for the best.”

Earlier on Wednesday, President Obama recommended that schools in the United States with confirmed or suspected cases of the disease “strongly consider temporarily closing.”

Texas heeded the warning. It was one of 10 states that had confirmed cases on Wednesday — bringing the number of people infected by the swine flu to 91, according to Dr. Richard E. Besser, acting director of the Centers for Disease Control and Prevention, up from 66 cases in 5 states that were confirmed on Tuesday.

More than half of the cases were in New York, 51, with 16 in Texas and 14 in California. Other states reporting cases were Massachusetts, Michigan, Arizona, Nevada, Indiana, Kansas and Ohio.

But even as Dr. Besser was acknowledging how swiftly the numbers were increasing, Gov. John E. Balducci of Maine reported that there were three confirmed cases in his state, and Illinois was awaiting final confirmation from the centers after its own laboratories identified nine people who were affected by what was probably the same virus strain.

In Texas, which has bore the brunt of the disease in the United States, state officials intensified their efforts to control the virus, shutting schools in five districts in and around San Antonio, Rio Grande (bordering Texas) and Dallas, which would keep about 53,000 students home for two weeks, according to the Texas Education Agency.

Texas also suspended all sporting events until May 11, when it hopes the virus will be under control.

So far in the United States, the 22-month-old Mexican boy who died was one of only five known people to have been hospitalized for the disease.

The youth had traveled with his family on April 4 on a flight from Mexico City to Matamoros, Mexico, and then crossed the border to Brownsville in south Texas, according to the Texas Department of State Health Services. He had “several underlying health problems,” according to the department, developed a fever on April 8, and on April 13 was admitted to the hospital in Brownsville. The next day he was transferred to Texas Children’s Hospital in Houston, where he died on Monday.

The C.D.C. confirmed on Wednesday that the child was “in fact infected with the swine virus,” Dr. David E. Persse, director of emergency medical services in Houston, said in a nationally televised news conference.

That said, Dr. Persse and other officials in Houston tried to calm fears of an outbreak, noting that no other members of the boy’s family had shown symptoms of the virus. And Kathy Barton, a spokeswoman for the Houston Department of Health and Human Services, emphasized that the boy had not posed “any additional risks to the community” after his hospitalization more than two weeks ago.

Still, Texas Gov. Rick Perry declared a state of emergency to be able to better combat the disease, as Texas became the second state after California to do so.

In New York, the state health commissioner Dr. Richard F. Daines, said that officials have confirmed 3 possible new cases in addition to the 51 recorded by the centers in Orange, Cortland and Suffolk Counties. At an afternoon news conference, New York City health officials confirmed 49 cases, up from 44 Tuesday, said Dr. Thomas R. Frieden, the city health commissioner.

The five newly confirmed cases involve three students at St. Francis Preparatory Academy in Queens, the epicenter of the outbreak in New York, a 19-month-old child in the Bronx who has been hospitalized, and a young woman in Brooklyn who was briefly hospitalized and has now been discharged.

“Right now we have no evidence that this is more severe than a garden variety flu in New York City today,” Dr. Frieden said.

In Illinois, officials said Wednesday afternoon that nine people – ages 6 to 57 – appeared to have swine. One of them, a 12-year-old, has been hospitalized, the officials said, adding that most of the cases appeared to be fairly mild. Five of the people are from Chicago, and the rest from nearby suburbs.

One public elementary school, on the North Side of Chicago, closed for the day because of a probable case, and the school officials in Chicago said they were conducting checks on attendance data from all of the city’s schools to determine whether other closures may be needed.

Mr. Obama, in his most extensive remarks to date on the spread of the swine flu, which he referred to as the H1N1 virus, spoke a day after asking Congress to provide $1.5 billion in emergency funds to fight the disease, and his comments appeared to reflect a deepening sense of the risk the still ill-understood flu might pose.

By urging parents to make contingency plans in the event of school closings — simply placing children in crowded day-care centers was “not a good solution,” he noted — Mr. Obama indicated that his administration was contemplating the possibility, at least, of a serious increase in the flu’s prevalence.

Kathleen Sebelius, at her first news conference since being sworn in on Tuesday as President Obama’s secretary of health and human services, echoed the President’s concern.

“Unfortunately, we’re likely to see additional deaths from this outbreak,” Ms. Sebelius said Wednesday.

Officials around the world seem to be girding themselves for the worst, as well. In France, the health minister took the extraordinary step of calling for a suspension of all flights from the European Union to Mexico.

France’s request to suspend all flights from the European Union to Mexico will be made at a meeting of European Union health ministers, scheduled for Thursday in Luxembourg, French Health Minister Roselyne Bachelot said. The World Health Organization has argued against such travel bans, contending that they are an ineffective way to stop to spread of the disease.

Cuba and Argentina have both banned flights to Mexico, while Americans have been advised only to “avoid all nonessential travel to Mexico.”

Mexico City, one of the world’s largest cities, has taken drastic preventative steps, shutting down schools, gyms, swimming pools, restaurants, and movie theaters. Many people on the streets have donned masks in hopes of protection.

Mexico’s health secretary, Jose Cordova said late Tuesday that emergency measures to curb the disease’s spread there appeared to be working and that the death toll was “more or less stable.” The confirmed number of deaths held at 7, the health ministry said, although 159 deaths were attributed to flu-related causes. Germany confirmed three cases of the disease and Austria had one confirmed, as four European nations have now reported cases. Germany’s disease control agency, the Robert Koch-Institut, said the three include a 22-year-old woman hospitalized in Hamburg; a man in his late 30s being treated at a hospital in Regensburg, north of Munich, and a 37-year-old woman from another southern town.

Health and airport authorities in Munich said the first direct flight carrying vacationers back to Germany since the outbreak of the disease in Mexico was expected and might be quarantined if passengers showed symptoms of swine flu.

Austria’s health ministry said a 28-year-old woman who recently returned from a month-long trip to Guatemala via Mexico City and Miami has the virus but is recovering, according to The Associated Press.

Spain said Wednesday that the number of confirmed cases of the flu had risen to 10, including one person who had not recently visited Mexico, according to Reuters. In addition, the health ministry said authorities were observing 59 suspected cases.

In London, Prime Minister Gordon Brown told Parliament that three more cases of swine flu had been confirmed in Britain, one of them a 12-year-old girl, in addition to a Scottish couple, bringing the total to five. All three had recently travelled from Mexico, had mild symptoms and were responding to treatment, he said. A school attended by the 12-year-old in southwest England had been temporarily closed, he added.

Canada has 13 confirmed cases, all of which are mild, Canada’s chief public health officer, Dr. David Butler-Jones, said Tuesday.

New Zealand officials said on Wednesday that 14 cases had been confirmed there. New Zealand has been screening all arriving air passengers, and Dr. Fran McGrath, the deputy director of public health, said that five foreign travelers were being treated under quarantine for mild cases of the flu. All five were being “kept in isolation” at an undisclosed location in Auckland.

Also on Wednesday, at least 10 countries — including China, Russia, Ukraine and Ecuador — banned the importation of all pork products despite a declaration from the W.H.O. that “there is no risk of infection from this virus from consumption of well-cooked pork and pork products.”

Egypt went even further, ordering the culling of all pigs in the Arab country as a precaution against swine flu, the country’s health minister said. While most Egyptians are Muslim and do not eat pork, it is available, and is mostly consumed by the Christian minority and foreigners.

“It is decided to slaughter all swine herds present in Egypt, starting from today,” Health Minister Hatem el-Gabali said in a statement published by state news agency MENA.


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