As swine flu spreads, world watches, worries

While confirmed cases of swine flu increased only slightly Monday, the World Health Organization (WHO) raised its global pandemic flu alert level.

The WHO's decision offered some official guidance to a world that, at least for the day, seemed swept by confusion that unnerved both international travelers and the financial markets. European and Asian markets fell, and stock in airlines and the travel industry fell while those of pharmaceutical companies rose.

A widespread outbreak could batter tourism, food and transportation industries, deepening the recession in the United States and possibly worldwide.

President Obama said the outbreak was reason for concern but not yet "a cause for alarm."

"We are proceeding as if we are preparatory to a full pandemic," said Janet Napolitano, head of the Homeland Security Department, no doubt mindful of the much-maligned response to the Hurricane Katrina emergency.

The WHO's Level 4 means there has been sustained human-to-human transmission. Its alert system was revised after bird flu in Asia began to spread in 2004, and Monday was the first time it was raised above Level 3.

The WHO's emergency panel, meeting in Geneva, also recommended abandoning efforts to contain the flu's spread and recommended borders not be closed or travel bans imposed.

"Because the virus is already quite widespread in different locations, containment is not a feasible option," said Dr. Keiji Fukuda, the organization's deputy director general.

Fukuda emphasized that the committee felt that "a pandemic is not inevitable — the situation is fluid and will continue to evolve."

Meanwhile, the number of deaths blamed on the flu in Mexico climbed to at least 152, while the number of confirmed cases in the United States increased to 50, with 28 of them students from one New York City school.

While the total cases were still measured in hundreds, not thousands, Mexican Health Secretary José Ángel Córdova said the epidemic was entering a dangerous phase, with the number of people infected mushrooming even as authorities ramped up defenses.

"We are in the most critical moment of the epidemic. The number of cases will keep rising, so we have to reinforce preventative measures," Córdova said at a news conference.

None of the U.S. cases have been serious, but Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention (CDC) said he "would not rest on that fact."

"I expect that we will see additional cases, and I expect that the spectrum of disease will expand," he told a news conference.

The WHO also recommended that vaccine-makers keep making seasonal flu vaccine instead of switching over to a new one that matches the swine-flu strain, but it urged vaccine makers to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take six months.

The WHO has no power to enforce any policies on member states, but different countries may have their own pandemic-flu plans that are triggered by changes in the alert level.

Putting an alert at Level 4 or 5 signals that the virus is becoming increasingly adept at spreading among humans. That move could lead governments to set trade, travel and other restrictions aimed at limiting its spread. Level 6 is for a full-blown pandemic, characterized by outbreaks in at least two regions of the world.

Developed nations set their own policies independent of such decisions. Spain and Scotland became the first countries outside North America to confirm cases. Suspected ones appeared in Brazil, Australia, Israel and New Zealand, but confirmation is slow because most nations' laboratories lack the test kit the CDC is developing for the novel virus.

The CDC began sending out the new kits Monday, meaning some states and foreign countries soon will be able to make their own diagnoses — a development that could lead to a sharp increase in confirmed cases.

In some countries, precautions were stringent.

Asian nations activated thermal scanners used during the 2003 SARS crisis to check for signs of fever among passengers arriving from North America. In Malaysia, health workers in face masks took the temperatures of passengers touching down from Los Angeles.

Australia said it would require pilots on international flights to file a report noting any flulike symptoms among passengers before being allowed to land. And China ordered anyone with flulike symptoms within two weeks of arrival to report to authorities.

On Monday morning, the European Union appeared to issue and then rescind a ban on travel to the United States, drawing a rebuke from U.S. officials — who themselves later suggested Americans drop all nonessential travel to Mexico.

However, U.S. airports and border agents waved people through Monday with little or no additional screening for Mexico's swine flu. At the main pedestrian border crossing between El Paso, Texas, and Mexico's Ciudad Juárez, a handful of people wore protective masks and officials handed out a CDC swine-flu flier.

But there were signs of growing unease among the public, even in places where there was no immediate known cause for alarm.

Security guards at all entrances to the University of Chicago Medical Center required anyone walking in to use a liquid disinfectant.

Students at a Chicago school were instructed not to shake hands with anyone, and Southern Illinois University urged students to wash their hands frequently and cover their mouths when coughing.

And in New Mexico, health officials were so besieged by calls from concerned citizens that they set up a swine-flu hotline.

Pharmacies in Manhattan reported paper face masks were selling by the box. One pharmacy owner said he had to order more for the first time since the SARS epidemic six years ago.