By BRIAN KNOWLTON
Published: May 3, 2009
WASHINGTON — The number of confirmed cases of swine flu continued to increase on Sunday, affecting additional countries in Europe and Latin America and increasing the likelihood that the World Health Organization might raise its alert to the highest level.
But health officials in the United States expressed cautious optimism about the course of the disease. And the Mexican health minister said that in his country, the hardest hit and where the flu was first reported, the worst had passed.
Homeland Security Secretary Janet Napolitano predicted on Sunday that W.H.O. might “very well” elevate its flu alert from Level 5 to Level 6, the highest, this week. W.H.O. officials have also indicated that such a move may be imminent.
Ms. Napolitano emphasized, however, that even the highest-level W.H.O. warning was not in itself a cause for grave concern. It would indicate that the current flu strain has reached pandemic status, but there can be a pandemic of a mild disease, and this strain is looking milder than first thought.
“Level 6, which they very well could go to this week, all that means is that it is widespread around the world,” Ms. Napolitano said on CBS’s “Face the Nation.”
Other American health officials spoke of “encouraging signs” in the flu’s course, even while cautioning of the substantial uncertainties surrounding any new strain.
The W.H.O. said Saturday that there was still no evidence of the flu’s sustained spread outside North America, a requisite condition for raising its alert level.
Still, 19 countries have now been affected, including Colombia, which on Sunday reported the first confirmed case of swine flu in South America.
The course of the disease in Mexico, where 19 confirmed deaths have been linked to the flu with many other deaths suspected, is now “in its phase of descent,” Health Minister Jose Angel Cordova told a news conference, Reuters reported. Scientists suspect many of the dead in Mexico might have waited too long — a week on average — to seek help.
Worldwide, about 800 people have been infected, predominantly in North America. Spain now has 44 confirmed cases, more than any other European country, but all the patients had responded well to treatment, the health ministry said. And Britain, Italy and Germany reported new cases, The Associated Press reported.
In Spain, all but four of the cases involved a patient who had recently traveled to Mexico, the Spanish Health Ministry said. Spain is a hub for travel to Mexico, with dozens of flights each day between the two countries.
The ministry said it would be seeking to tighten controls at airports Monday but did not offer any details about addition measures. Passengers arriving from affected areas this week have been filling questionnaires about possible virus symptoms, and cabin crews have been supplied with gloves and masks in an effort to isolate suspected cases and contain contagion.
In the United States, officials said that 226 people had confirmed cases of the the flu in a total of 30 states, but they expected the virus to spread throughout the country. A day earlier, officials had reported 160 cases in 21 states.
Still, Ms. Napolitano and other top officials — who appeared on no fewer than five morning television programs with a message mixing caution and measured reassurance — emphasized that since its deadly initial spread in Mexico, the disease had generally shown a milder face.
Dr. Richard Besser, acting head of the Centers for Disease Control, pointed to “encouraging signs” that the current strain might end up being no worse than a normal seasonal flu. In New York City, for example, the disease had spread quickly through a private high school in Queens, but the cases were “not that severe, and that’s encouraging,” he said on “Fox News Sunday.”
Kathleen Sebelius, who just last week was confirmed as secretary of health and human services, told Fox that there was cautious optimism in part because “the lethality which initially presented itself as part of the Mexican situation — deaths of an age group you don’t typically see” — was not being seen elsewhere.
In Mexico, nine of the 19 dead were between the ages of 21 and 39, which is unusually high.
But experts were careful to balance their cautious optimism with warnings that the flu might yet get worse.
“These viruses mutate, these viruses change, these viruses can further reassort with other genetic material, with other viruses,” said Dr. Michael Ryan, W.H.O.’s global alert and response director. “So it would be imprudent at this point to take too much reassurance.”
Infectious disease experts say it will be important to watch what this virus does in coming weeks and months, particularly in the Southern hemisphere, which will soon confront its winter flu season. If H1N1 takes hold there, that will be a red flag to scientists.
“This virus could dampen here during the summer per usual, and go to the Southern Hemisphere and pick up steam there and come back to bite us in our winter season next January and February, and it might come back in a more virulent form,” said Dr. William Schaffner, a public health and infectious disease expert at Vanderbilt University.
The U.S. health officials, quite indirectly, took exception with advice from Vice President Joseph R. Biden Jr., who said last week that he would urge his family to avoid travel if it involved “confined spaces,” such as on an airplane or a subway.
Ms. Sebelius said that she would not discourage travel unless the traveler is sick and suggested that that was what Mr. Biden had meant to say.
Exceptionally strong measures by some countries to stop the spread of the flu have led to backlashes. Egypt ordered all pigs killed, provoking violent weekend clashes between police and angry pig farmers. Scientists say the disease is not spread by consuming properly prepared pork. And Mexico complained of the quarantining of dozens of its nationals in China.
Health professionals were studying a new development in Canada, where a swine herd on a family-run farm in Alberta Province apparently contracted the virus from a worker who had visited Mexico. The man-to-pig transmission appeared to be a first for this strain. Both the man and the swine have recovered; the herd remains quarantined.
There has been heated debate about whether the virus, formally known as H1N1, could infect pigs, even though its genetic makeup clearly points to its having originated in swine at some point.
The quarantine of dozens of Mexicans in Singapore, Guangzhou and Hong Kong — as well as other guests and workers in a Hong Kong hotel — brought a pointed complaint from the Mexican foreign minister, Patricia Espinosa.
“Mexican citizens showing no signs at all of being ill have been isolated under unacceptable conditions,” Ms. Espinosa said, Reuters reported. “These are discriminatory measures, without foundation.”
She criticized also China — which insisted it had acted responsibly after one Mexican traveler showed flu symptoms — as well as Argentina, Peru, Ecuador and Cuba for suspending flights from Mexico.
Contributing reporting were Denise Grady, Liz Robbins and Donald G. McNeil Jr. from New York, Victoria Burnett from Madrid, Ian Austen from Ottawa and Larry Rohter from Mexico City.
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