Friday, August 22, 2014

Europe Urges Citizens to Avoid U.S. and Mexico Travel

By DONALD G. McNEIL and ANAHAD O’CONNOR—

Hoping to head off a global pandemic of swine flu that has surfaced in North America, the European Union’s health commissioner on Monday urged Europeans to avoid traveling to the United States or Mexico if doing so was not essential.

The warning came as health officials in Spain confirmed early Monday that a man hospitalized in eastern Spain had tested positive for swine flu, becoming what appeared to be Europe’s first case of the disease. Health authorities were also testing 17 other suspected cases across Spain, a major hub for travel between Mexico and Europe.

Britain and other European Union nations had already issued travel advisories for those traveling to Mexico, but the European Union’s health commissioner went a step further on Monday in urging Europeans to avoid nonessential trips. Europeans, she told reporters in Luxembourg, “should avoid traveling to Mexico or the United States of America unless it is very urgent for them.”

The fear that outbreaks of the flu might severely curtail travel was enough to unnerve markets in Europe and Asia, sending stocks tumbling, particularly shares of airlines and other companies in the travel industry.

But Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention in Atlanta, Ga., called the European Union’s advisory against traveling to the United States unwarranted, saying that only 20 cases had been diagnosed here, just one of which required hospitalization.

“We are looking very hard for cases of swine flu,” he told CNN early Monday. “I expect we’re going to find some, and we’ll find some of increasing severity and more of the mild cases. At this point I would not put a travel restriction or recommendation against coming to the United States.”

The European Union’s travel advisory followed an advisory by Hong Kong on Sunday that called for residents of that territory to avoid all travel to Mexico and to try to avoid travel to cities with confirmed cases in the United States.

Other nations also imposed travel bans or made plans to quarantine air travelers over the weekend as additional confirmed cases appeared in Mexico and Canada, and at least 10 suspected cases appeared in New Zealand. Eight of the 20 confirmed cases in the United States were diagnosed in New York City, where Mayor Michael R. Bloomberg was expected to hold a news conference early Monday afternoon.

Top global flu experts struggled to predict how dangerous the new A (H1N1) swine flu strain would be as it became clear that they had too little information about Mexico’s outbreak – in particular how many cases had occurred in what is thought to be a month before the outbreak was detected, and whether the virus was mutating to be more lethal, or less.

“We’re in a period in which the picture is evolving,” said Dr. Keiji Fukuda, deputy director general of the World Health Organization. “We need to know the extent to which it causes mild and serious infections.”

Without that knowledge – which is unlikely to emerge soon because only two laboratories, in Atlanta and Winnipeg, Canada, can confirm a case – his agency’s panel of experts was unwilling to raise the global pandemic alert level, even though it officially saw the outbreak as a public health emergency and opened its emergency response center.

President Obama, said on Monday that the outbreak was “a cause for concern” but not alarm. Speaking at the National Academy of Sciences in Washington, he promised that “Department of Health and Human Services as well as the Centers for Disease Control will be offering regular updates to the American people so that they know what steps are being taken and what steps they may need to take.”

Concerns about the potential economic impact of the outbreak sent stocks tumbling across the globe, hitting travel-related companies particularly hard. Most Asian and European markets were down by the end of trading Monday, with tourism and airline industry stocks leading the decline. Shares of United Airlines, Delta Airlines, and other major carriers plunged as well.

In Spain, the Ibex 35, a benchmark stock index, was off 2.5 percent. A health official there said that the man who tested positive had been hospitalized in Almansa, in eastern Spain, but was not seriously ill. The other suspected cases were scattered around the country, with 10 in the northeastern region of Catalonia and cases in Madrid, Valencia and the Basque regions.

Normally, there are about two dozen flights between Spain and Mexico each day.

Other governments tried to contain the infection amid reports of potential new cases, including in New Zealand. Health officials there said that nine students and their teacher had tested positive for influenza A after returning to Auckland from a trip to Mexico. The W.H.O. was conducting tests to determine if the virus was in fact swine flu. In the meantime, airport workers in Auckland were stepping up their screening of people traveling from North America.

On Sunday, at a news conference in Washington, Homeland Security Secretary Janet Napolitano called the United States’ emergency declaration “standard operating procedure,” and said she would rather call it a “declaration of emergency preparedness.”

“It’s like declaring one for a hurricane,” she said. “It means we can release funds and take other measures. The hurricane may not actually hit.”

American investigators said they expected more cases here, but noted that virtually all so far had been mild and urged Americans not to panic.

The speed and the scope of the world’s response showed the value of preparations made because of the avian flu and SARS scares, public health experts said.

The emergency declaration in the United States lets the government free more money for antiviral drugs and give some previously unapproved tests and drugs to children. One-quarter of the national stockpile of 50 million courses of antiflu drugs will be released.

Border patrols and airport security officers are to begin asking travelers if they have had the flu or a fever; those who appear ill will be stopped, taken aside and given masks while they arrange for medical care.

“This is moving fast and we expect to see more cases,” Dr. Besser said at the news conference with Ms. Napolitano on Sunday. “But we view this as a marathon.”

He advised Americans to wash their hands frequently, to cover coughs and sneezes and to stay home if they felt ill; but he stopped short of advice now given in Mexico to wear masks and not kiss or touch anyone. He praised decisions to close individual schools in New York and Texas but did not call for more widespread closings.

Besides the eight New York cases, officials said they had confirmed seven in California, two in Kansas, two in Texas and one in Ohio. The virus looked identical to the one in Mexico believed to have killed 103 people – including 22 people whose deaths were confirmed to be from swine flu – and sickened about 1,600. As of Sunday night, there were no swine flu deaths in the United States, and one hospitalization.

Dr. Fukuda of the W.H.O. said his agency would decide Tuesday whether to raise the pandemic alert level to 4. Such a move would prompt more travel bans, and the agency has been reluctant historically to take actions that hurt member nations.

Canada confirmed six cases, at opposite ends of the country: four in Nova Scotia and two in British Columbia. Canadian health officials said the victims had only mild symptoms and had either recently traveled to Mexico or been in contact with someone who had.

Other governments issued advisories urging citizens not to visit Mexico. China, Japan, Hong Kong and others set up quarantines for anyone possibly infected. Russia and other countries banned pork imports from Mexico, though people cannot get the flu from eating pork.

In the United States, the C.D.C. confirmed that eight students at St. Francis Preparatory School in Fresh Meadows, Queens, had been infected with the new swine flu. At a news conference on Sunday, Mayor Michael R. Bloomberg said that all those cases had been mild and that city hospitals had not seen a surge in severe lung infections.

On the streets of New York, people seemed relatively unconcerned, in sharp contrast to Mexico City, where soldiers handed out masks.

Hong Kong, shaped by lasting scars as an epicenter of the SARS outbreak, announced very tough measures. Officials there urged travelers to avoid Mexico and ordered the immediate detention of anyone arriving with a fever higher than 100.4 degrees Fahrenheit after traveling through any city with a confirmed case, which would include New York.

Everyone stopped will be sent to a hospital for a flu test and held until it is negative. Since Hong Kong has Asia’s busiest airport hub, the policy could severely disrupt international travel.

The central question is how many mild cases Mexico has had, Dr. Martin S. Cetron, director of global migration and quarantine for the Centers for Disease Control, said in an interview.

“We may just be looking at the tip of the iceberg, which would give you a skewed initial estimate of the case fatality rate,” he said, meaning that there might have been tens of thousands of mild infections around the 1,300 cases of serious disease and 80 or more deaths. If that is true, as the flu spreads, it would not be surprising if most cases were mild.

Even in 1918, according to the C.D.C., the virus infected at least 500 million of the world’s 1.5 billion people to kill 50 million. Many would have been saved if antiflu drugs, antibiotics and mechanical ventilators had existed.

Another hypothesis, Dr. Cetron said, is that some other factor in Mexico increased lethality, like co-infection with another microbe or an unwittingly dangerous treatment.

Flu experts would also like to know whether current flu shots give any protection because it will be months before a new vaccine can be made.

There is an H1N1 human strain in this year’s shot, and all H1N1 flus are descendants of the 1918 pandemic strain. But flus pick up many mutations, and there will be no proof of protection until the C.D.C. can test stored blood serum containing flu shot antibodies against the new virus. Those tests are under way, said an expert who sent the C.D.C. his blood samples.

Reporting was contributed by Victoria Burnett in Madrid, Sheryl Gay Stolberg from Washington, Jack Healy from New York, Keith Bradsher from Hong Kong and Ian Austen from Ottawa.

source: The New York Times