World gears up for swine flu’s return

By Rob Stein

updated 8:04 a.m. ET Aug. 10, 2009

As the first influenza pandemic in 41 years has spread during the Southern Hemisphere's winter over the past few months, the United States and other northern countries have been racing to prepare for a second wave of swine flu virus.

At the same time, international health authorities have become increasingly alarmed about the new virus's arrival in the poorest, least-prepared parts of the world.

While flu viruses are notoriously capricious, making any firm predictions impossible, a new round could hit the Northern Hemisphere within weeks and lead to major disruptions in schools, workplaces and hospitals, according to U.S. and international health officials.

"The virus is still around and ready to explode," said William Schaffner, an influenza expert at the Vanderbilt University School of Medicine who advises federal health officials. "We're potentially looking at a very big mess."

President Obama arrived in Mexico on Sunday for a two-day summit that will include discussions on swine flu, along with Mexico's drug wars, border security, immigration reform and economic recovery.

"Everyone recognizes that H1N1 is going to be a challenge for all of us, and there are people who are going to be getting sick in the fall and die," said John O. Brennan, the U.S. deputy national security adviser for counterterrorism and homeland security. "The strategy and the effort on the part of the governments is to make sure we ... collaborate to minimize the impact."

Since emerging last spring in Mexico, the virus, known as H1N1, has spread to at least 168 countries, causing more than 162,000 confirmed cases and playing a role in at least 1,154 deaths, including 436 in the United States.

Worrying signs
Scientists have been closely monitoring the flu's spread for clues to how much of a threat it might pose this fall. So far, no signs have emerged that the virus has mutated into a more dangerous form. Most people who become infected seem to experience relatively mild illness.

Still, the virus has caused major outbreaks involving a disproportionate number of younger people in Australia, New Zealand, Argentina and other countries, prompting schools to close, causing theaters to shut down, and straining some emergency rooms and intensive care units, sometimes forcing doctors to postpone other care, such as elective surgeries.

Swine flu has also begun to spread in South Africa, where at least two deaths have been reported; the national laboratory, meanwhile, was overwhelmed last week with samples that needed testing. In India, a 14-year-old girl became the first person to die from the disease in that densely populated nation.

In Britain, meanwhile, where anxiety was increasing because of high-profile cases including "Harry Potter" films actor Rupert Grint, health officials were trying to determine the cause of a sharp rise in reported cases in recent weeks.

"This is something that we could see here soon," said Arnold S. Monto, a University of Michigan infectious-disease expert who advises the World Health Organization, the U.S. Centers for Disease Control and Prevention, and other federal health agencies. He noted that some emergency rooms were overwhelmed by last spring's outbreak in New York City. "We have to be worried about our ability to handle a surge of severe cases."

Concern about a second wave has prompted a flurry of activity by federal, state and local officials, including intensifying flu virus monitoring and making plans to distribute vaccine and antiviral drugs and other treatments if necessary.

"There's a lot of moving parts to this," said Joseph S. Bresee, who heads the CDC's influenza epidemiology and prevention branch. "Hopefully we won't have a panic, but instead we'll have the appropriate level of concern and response."

The Obama administration has been updating recommendations for when to close schools, what parents should do if their children get sick, how doctors should care for patients and how businesses should respond to large-scale absences. Officials are hoping to navigate a fine line, urging precautions to minimize spread, serious illness and deaths while avoiding undue alarm and misinformation.

"The last time we had anything similar to this was prior to the Internet," said one senior official who spoke on the condition of anonymity last week during one of a series of background briefings for reporters.

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