Will swine flu end up sweeping the globe in a flu pandemic? The Centers for Disease Control and Prevention announced this week that it’s taking some aggressive precautions—just in case.The federal agency reported Monday that there were 40 confirmed US cases of swine flu, which were mostly mild infections seen in New York, Ohio, Kansas, Texas, and California. There are 26 confirmed cases in Mexico, but there are thought to be hundreds more (including reports of 149 deaths).

April 27, 2009


By Theresa Tamkins
MONDAY, April 27, 2009 (Health.com) — Will swine flu sweep the globe in a flu pandemic? The Centers for Disease Control and Prevention announced that it is taking some aggressive precautions — just in case.

The federal agency reported Monday that there have been 40 confirmed cases of swine flu in the United States, which were mostly mild infections seen in New York, Ohio, Kansas, Texas, and California. There are 26 confirmed cases in Mexico, but there are thought to be hundreds more not yet confirmed (including reports of 149 deaths). There have also been six cases in Canada and one in Spain.

It sounds scary, but it doesn't mean it's time to panic. Experts have long been searching for new flu viruses because they are known to periodically appear and sweep the globe; for example, there were at least three pandemics in the 20th century and just as many "pandemic threats." The last pandemic was the 1968 Hong Kong flu, so experts say a new one is overdue and they are on high alert for potential candidates.

All this preparation is a good thing. Better surveillance likely picked up the swine flu cases early, and one reason the government declared a public health emergency is to free up huge stockpiles of antiviral medication. (About 11 million courses of antiviral medication were shipped to affected states). "There's been tremendous planning that's been going on around the country over the past number of years," said Richard Besser, MD, the acting director of the CDC, at a press briefing.

Although it’s not time to panic, it is a good time to become more informed about swine flu and to contemplate "what if?" scenarios, including what you plan to do if your child's school is closed or you can’t go to work.

"It's time for businesses to review their plans and think about 'What would I do if some of my workers couldn't come to work? How would my business function?'" said Dr. Besser. "Think about that."

The good news is that there is a wealth of information about swine flu online, and it's constantly being updated. For example, you can follow current cases on Google maps and get CDC updates via Twitter, as well as find information on the CDC's and the World Health Organization's websites.

Health.com talked with Brian Currie, MD, vice president and medical director for research at Montefiore Medical Center in the Bronx, N.Y., to get the facts about swine flu. Dr. Currie is an expert in disaster and bioterrorism preparedness. Here are his responses to some frequently asked questions.

Are we in the midst of a global flu pandemic?
I wouldn't exactly call it a pandemic yet. A pandemic implies a huge spread across the world. Experts have been anticipating something like this would happen and we are somewhat prepared for it, but probably not ideally at the moment. This is a new strain that's just been discovered, so there’s no vaccine for it — which is usually the most effective way to control dissemination. However, we do have a surveillance system and it looks like it was picked up very early, and we do have stockpiles of antiviral medications that are available if we need them.

Where did the virus come from, and why are experts concerned?
What you have is a swine flu virus that has picked up parts of human flu and mutated to incorporate them so that it can infect humans and cause human-to-human transmission as well. It has made a lot of the changes it would need to become a pandemic. Unlike what's happening in Mexico, where there has been a lot of mortality, all of the cases that have occurred in the United States have been relatively mild disease. So it looks like as it spreads, it's attenuating or becoming less virulent, so that would be the saving grace here.

Isn’t avian flu supposed to be the big risk in terms of a global pandemic?
We knew it was going to be avian flu or swine flu that made the jump into humans and we've always been concerned about flu viruses that infect swine, birds, and humans — there are 30 or so in total. Some of the strains that can infect other species cannot typically infect humans. Human strains can infect pigs, so what happens is that pigs get infected with swine flu and human flu at the same time. They recombine the genetic material, so when they produce new viruses it's got part of the human and part of the pig; you worry that if it gets enough of the human virus, it will be able to bind to human receptors.

Can I get swine flu from eating pork?
Absolutely not. It can’t be transmitted through the food chain. You’re not going to get it from eating pork.

Some of the swine flu cases have included symptoms such as diarrhea or vomiting. What symptoms should I look for?
Typically what you are looking for is a sore throat, runny nose, high fever, and aching all over your body — a real good case of flu knocks people right on their backs.

I was sick a week ago — could I have had swine flu?
Unless you had contact with pigs or people from Mexico, it’s probably unlikely — although anything is possible.

What’s the best way to avoid swine flu? Should I wear a mask in public?
At the moment [wearing a mask in public] is a bit much. Basically you should practice good hand hygiene and try to avoid contact with people coming from areas where there are known cases.

Read CDC recommendations regarding the use of respirators and face masks and the best ways to avoid the flu.

Should I keep my children home from school?
There's only one school [in the New York area] where they have found cases and it's limited to that school so far, so there is really no reason not to send your children to school at this point.

Should I cancel travel plans?
[The United States is] one of the sites people are worried about coming to now; Europe is telling people no unnecessary travel to Mexico and the United States, so we’re being targeted rather than targeting other people. The caution would be, if you really don’t have to go, then put [trips] off and wait until we have more information.

Read the travel advisory issued by the CDC, which recommends delaying any non-essential travel to Mexico.

Should I get a flu shot?
No. In fact, it’s pretty unlikely that a flu shot will protect you against this strain.

If I think I’m getting sick, should I take an antiviral drug?
Currently what they are suggesting is if you are young and healthy, just go home and wait it out. That way we can keep the Tamiflu for people who have other chronic illnesses that put them at high risk — for example, those who are pregnant or the elderly. Those are people we are likely to test; then if they are positive, we’ll treat them.

Read CDC recommendations on what to do if you get sick.

If I have to fly, should I take any special precautions when traveling in a plane?
No, just stay away from people who look overtly ill. (And airports are generally screening people for symptoms.)

Should I go to the grocery store and stockpile food in the case of a quarantine?
No, just stay calm. The story is unfolding very rapidly and we’ll have more information shortly. But signs are encouraging so far, at least for what’s here in New York. If what’s happening in Mexico occurs someplace else, it could be another issue. Every U.S. case has been mild, so that’s in our favor. At the same time, there have been almost 200 [reported] deaths in Mexico.