By Deborah Franklin

Sure, they're cute and clever. But, as if the risk of rabies weren't bad enough, some masked critters are loaded with raccoon roundworms that can find their way into humans -- most notably toddlers -- where the parasites can burrow into the eyes or brain, causing blindness, convulsions and even death.

So young. So cute. So chock-full of parasites. (iStockphoto.com)

A recent survey of 119 backyards in suburban Chicago turned up "raccoon latrines" in roughly half. Raccoons tend to choose elevated spots for doing their business -- decks, patios, woodpiles, flat roofs and playhouses.

Wheaton College ecologist Kristen Page and her students found that scat from 21 such spots was heavily contaminated with the worrisome roundworm Baylisascaris procyonis.

Continue reading "Don't Mess With Raccoons" >

by Deborah Franklin

Even before his cause of death was confirmed last night, pop icon Michael Jackson had become yet another poster boy -- this time for the risks of cardiac arrest.

Interestingly, there were fewer medical sidebars to stories of actor Farrah Fawcett's death yesterday, though the form of cancer that killed her may be largely preventable -- with condoms and/or the HPV vaccine -- and is often curable with prompt treatment.

First, Jackson: The Huffington Post suggests the legendary performer might have had a better chance of surviving if he'd collapsed onstage -- in a casino. Automated external defibrillators (foolproof heart zappers designed to be used by a novice in an emergency) are now standard issue in slots caves, and becoming more common in malls, gyms, and sports arenas.

USA Today has an explainer, too, on why the electrical short known as "sudden cardiac arrest" is even more dangerous than a heart attack. "When you look at the heart in ventricular fibrillation, it looks like a bag of squiggly worms," Indiana cardiologist Douglas Zipes told the paper. "The contractions are totally ineffective...Therefore, no blood is pumped to the brain, causing him to black out."

Dr. Zipes even had a musical metaphor befitting the King of Pop:

The heart's pacemaker is the sinus node," Zipes says. "It's the conductor of the orchestra, coordinating the heart's electrical rhythm. When all the instruments are playing in a coordinated manner, the result is music. In ventricular fibrillation, it's as if the orchestra is warming up and what you hear is cacophony.

Continue reading "Morning Rounds: Celebrity Deaths as Teaching Moments" >

by Deborah Franklin

Genes from the Crystal Jelly (Aequorea aequoera) were used to create glow-in-dark monkeys and that could eventually help people with Parkinson disease. Gabriel Bouys, AFP

 

You'll hear about glow-in-the dark monkeys tonight on NPR's All Things Considered, and it's a medical story. Really, it is.

NPR's Nell Greenfieldboyce reports on the success of Japanese researchers who have managed to take a glow-in-the-ultra-violet-light gene from jellyfish and insert it into marmoset embryos. And that's not even the impressive part. The real trick was successfully getting those little embryos to grow up into adult monkeys that passed along the "glowing" gene to their offspring and descendents.

It's not just a party trick. (Scientists who figured out how to use the glow-in-the-dark substance as a label got a Nobel prize last fall.) The goal is to create a good animal model of human disease, a target that's been elusive for many devastating illnesses.

Continue reading "Monkey's Uncle Gets A Human Gene" >

By Richard Knox

Up close and personal with the new H1N1 virus. CDC

 

Margaret Chan, the World Health Organization's director-general, has decided not to declare that the world has entered the first flu pandemic of this century.

But she's leaving open the question -- for now -- of changing the definition of a pandemic.

Chan declared on April 29 that a flu pandemic is "imminent." But she's been under increasing pressure from WHO's member-states to hold off declaring that a pandemic has arrived, based on the WHO's own definition.

Chan now says there's no doubt swine flu will continue to spread -- within the 42 countries already affected and beyond.

By saying that, Chan essentially acknowledges what many have been saying: This genie is out of the bottle.

Continue reading "Why No Flu Pandemic? Define Pandemic" >

By Richard Knox

Please use the door, not the floor, to exit. And wash your hands. BRAYDAWG/Flickr

You know that scene in "Slumdog Millionaire" where our little slumdog gets locked in a privy and, umm, takes the only available route out?

Not a good idea for any number of reasons. But it may be especially inadvisable if swine flu goes pandemic.

The World Health Organization is officially worried about the global implications if swine flu turns out to be transmitted via the fecal route.

"A striking feature of some of the current outbreaks is the presence of diarrhea or vomiting in as many as 25 percent of cases. This is unusual," said Dr. Margaret Chan, the WHO's Director-General at this week's World Health Assembly in Geneva.

"The significance could be especially great in areas with inadequate sanitation, including crowded urban shantytowns," she said.

Dr. Anne Schuchat of the CDC says about one in four U.S. cases of the new H1N1 flu has involved diarrhea and vomiting. Young children seem to be especially prone to intestinal symptoms, which are not usually seen with seasonal flu.

Schuchat says there's no evidence yet that virus can be "shed" in feces, but it's something that might inspire us to redouble our handwashing efforts.

"It's certainly a question we have, since that definitely can happen with viruses," she says.

by Vaughn Ververs

Attorneys for Steve Trunnell has filed a court petition seeking to discover what role a U.S.-owned pig farm played in the outbreak of swine flu that claimed his wife as the first American fatality of the epidemic, the Austin American Statesman reports today.

Conditions At Pig Farm Questioned istockphoto.com

The suit blames U.S.-based Smithfield Foods Inc. of keeping "horrifically unscientific conditions" at a pig farm the company owns near the village of La Gloria in eastern Mexico where the epidemic began in late February. "The conditions in which they allow this pig farm to operate ... would not be allowed in the United States" said Trunnell attorney Marc Rosenthal. From the Statesman:

"Medical authorities have not determined the origins of the swine flu outbreak. Rosenthal said the petition will enable the law firm to investigate the outbreak and gather evidence for a potential wrongful death lawsuit. Damages of up to $1 billion will be sought, he said."

by Richard Knox

For anyone trying to understand the flu situation we're in --- and what we may confront in the coming months --- a new analysis rushed into online publication by Science is required reading.

Centers for Disease Control and Prevention

It's a tour de force collaboration by a group called the WHO Rapid Pandemic Assessment Collaboration. Scientists from Britain, Mexico and the World Health Organization sifted various kinds of data from the swine flu epidemic in Mexico to address several critical questions:

-- How fast does this new virus spread as it debuts in a human population?

-- What proportion of a community falls ill when the virus gains a foothold?

-- What percent of infected people get seriously ill or die?

There's still a lot of uncertainty. But the group offers some first-approximation answers to these questions.

First, on efficiency of transmission, the evidence shows the new swine-derived H1N1 virus spreads substantially faster than seasonal flu viruses -- but less efficiently than the 1918 version of H1N1.

Continue reading "First Glimpse At The Big Picture On Swine Flu" >

By Frank James

Why do outbreaks caused by flu and other viruses often seem worse initially than they turn out to be?

That's the question Jon Hamilton examines in a report on All Things Considered this afternoon.

As Hamilton explains, it all has to do with how many people are in the denominator and how sick they are. The relatively fewer there are and the sicker they are, the worse the situation looks. Hamilton talked with Dr. Rob Fowler, a critical care physician in Toronto, to understand what doctors there saw when SARS struck in 2003.

HAMILTON: At first, it appeared that SARS was killing nearly 50 percent of the people who got infected. But as the outbreak progressed it became clear the true death rate was closer to 5 percent.

Fowler says it took awhile before doctors started looking for SARS in people who weren't critically ill. And that made the disease look even more frightening than it turned out to be.

Continue reading "Why Are Virus Outbreaks Often Not As Bad As First Feared?" >

By Mark Memmott and April Fulton

"On the upside of the recent flu mania," NPR's Linton Weeks writes this afternoon, "one oft-neglected, seldom noticed and, come to think of it, very weird body part is receiving a new wave of attention: the elbow."

As Linton notes:

Health officials are recommending that people cough into their elbows as the preferred way to handle expectoration. And almost-surgeon-general Sanjay Gupta of CNN recommends touching elbows instead of shaking hands or bumping fists.

All of a sudden, the status of elbows has been elevated. Elbows are everywhere. Elbows are Elvis.

(Linton hails from Tennessee, so he knows from fried peanut butter, bacon and banana sandwiches.)

Need more proof that elbows are hot? Check out this three-year-old video that's enjoying something of a "flu bounce" these days on the Web:

But wait, there's more. Some other NPR correspondents have gotten into the groove of creating novel and contagion-safe methods of greeting. Cast your vote at "Don't Gimme Five!" for which way you think folks should greet each other these days (Mark prefers the "snap and flick").

NPR health correspondent Allison Aubrey and All Songs Considered host Bob Boilen illustrate one of their "safe" greeting styles -- the "snap and flick." Becky Lettenberger/NPR

 

By Mark Memmott

Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, was the featured speaker at CDC's daily news conference about the flu outbreak. Just click the "play" button in the box below and our updates should flow in automatically:

By Mark Memmott

World Health Organization officials just held their daily news conference about the new flu virus in Geneva. We listened in and added updates as they happened. Be sure to click your "refresh" button to see our latest additions.

Today's briefing was being led by Dr. Marie-Paule Kieny, WHO's director of vaccine research:

11:52 a.m. ET: The news conference just ended.

11:42 a.m. ET: Kieny says that she trusts the manufacturers when they tell WHO how many doses of a vaccine they can produce because "they know and we know that this is not the time to play games."

11:31 a.m. ET: Who will pay to get a vaccine to people in developing countries?

Kieny says "it could be donor countries ... it could be charities" or it could be development banks.

11:22 a.m. ET: Is Kieny worried about the new virus mutating between now and the time when a vaccine is available -- making the vaccine less effective?

"For the time ... everything seems to indicate that the viruses which are being used to make seed strains (for the vaccine) are the right viruses," she says.

11:15 a.m. ET: Manufacturers have the capacity to make about 900 million doses of a vaccine against the new flu virus, Kieny says. Last week, she estimated a capacity of 700 million. Since then, Kieny says, she has reviewed more data and revised upward the estimate.

11:10 a.m. ET: Kieny says WHO is recommending that "all manufacturers put everything in place to be able to start manufacturing" a vaccine aimed at the new flu virus. WHO has not yet recommended that production begin, she says.

11:08 a.m. ET: WHO and U.N. officials have called for a May 19 meeting with vaccine manufacturers, Kieny says. Officials, she adds, will discuss the need for "equitable access" to a vaccine -- the goal being to make it widely available in poor as well as rich nations.

11:06 a.m. ET: Kieny says it is not yet known whether any vaccine created to battle the new virus will require the administering of one or two shots per individual.

By Mark Memmott

Additional testing has boosted the number of confirmed deaths in Mexico related to the new flu virus to 42, Health Minister Jose Angel Cordova told reporters in Mexico City this morning. That's an increase from yesterday's official estimate of 29.

Still, as Reuters writes, "the government says the infection is on the retreat in Mexico."

By Richard Knox

A new discovery from Canada raises the question -- has a new mutation in an ordinary flu virus been causing some of the recent respiratory disease hospitalizations and deaths in Mexico?

It's too soon to tell, but scientists in Vancouver are wondering. They've found two mutations in H3N2, a regular seasonal flu virus that's been circulating in North America since last fall. (The swine flu virus is a type of H1N1.)

The mutations affect a protein called hemagglutinin that sits on the outer coat of Type A flu viruses. That's what the "H" stands for in H1N1, H3N2 and other Type A viruses. (The "N" stands for neuraminidase, another surface protein.)

The new version of H3N2 has shown up in a number of nursing home patients in British Columbia, though not yet in the general community there. And this week the Canadian researchers spotted it when they did a complete genetic analysis of a flu virus that sickened a Canadian traveler who had just returned from Mexico.

Continue reading "Second Strain Might Have Caused Some Severe Cases In Mexico, Investigators Say" >

Good morning.

Looking around the news media world, among the stories making headlines today are:

-- The Monitor (of McAllen, Texas) -- First Diagnosis Didn't Show Swine Flu In Schoolteacher Who Died Tuesday: A 33-year-old schoolteacher from Harlingen, Texas,"had initially tested negative for the disease when she was hospitalized two weeks ago. Dr. Brian Smith, the regional director of the Texas Department of State Health Services, said a more recent test came back positive Tuesday." The woman died yesterday.

From a related story by The New York Times: Leonel Lopez, the Cameron County Department of Health and Human Services epidemiologist "said that the woman had recently given birth, and added that the baby was in good health. 'I don't want people to panic,' Mr. Lopez said. 'Her death was a combination of a pre-existing health condition and the flu. The flu just made things worse.' "

From a related story at NPR.org: "Tuesday evening, cars filled the driveway and lined the quiet street in front of Judy Trunnell's home in a quiet, new Harlingen subdivision. A woman who came to the door with tear-streaked eyes declined to give her name or to comment on the death, saying 'we're grieving now.' "

-- San Diego Union-Tribune -- Outbreak On Navy Ship Could Be Among Largest So Far: The suspected swine flu outbreak aboard the amphibious transport dock USS Dubuque, "if confirmed ... would be among the largest in the 2-week-old, international epidemic." One case has been confirmed and "about 50 more of the ship's sailors have suspected or probable cases."

-- The Washington Post -- Administration Mulls Three-Shot Regimen: "The Obama administration is considering an unprecedented fall vaccination campaign that could entail giving Americans three flu shots -- one to combat annual seasonal influenza and two targeted at the new swine flu virus spreading across the globe."

-- USA TODAY -- Drug Resistance A Growing Concern: "Fear of swine flu in the early days of the outbreak sent people racing to grab up antiviral drugs just to feel safe, and that has caused concern among experts who worry about the virus developing drug resistance."

-- The Financial Times -- "WHO Tackles China On Swine Flu Measures": "The World Health Organization has asked China to justify its quarantine of travelers from Mexico, as international criticism grew of the aggressive measures adopted by countries that go beyond official scientific advice in responding to swine flu."

-- NPR.org -- "In Mexico, Flu Spoils The Party": "In Puebla and throughout Mexico on Tuesday (Cinco de Mayo) celebrations were subdued, if they existed at all, as the nation remained largely closed for business, and pleasure, under the threat of the swine flu outbreak."

Yesterday in Mexico City's Zocalo plaza, this police officer was wearing a mask as a precaution against the flu. Marco Ugarte/AP

 

By Mark Memmott

Health and Human Services Secretary Kathleen Sebelius and Richard Besser, acting director of the Centers for Disease Control and Prevention, met with reporters in Atlanta this hour. The news: The CDC has, as expected, changed its guidance for schools -- it says they do not always need to shut down if a student or staff member gets the swine flu. (Update at 2:55 p.m. ET: Here's the link to the CDC's new guidelines.)

We used this Cover It Live player to live-blog what they said. Just click the "play" button and our updates should roll in automatically:

By Mark Memmott

Officials at the World Health Organization just held their daily news conference on the flu outbreak. We used this Cover It Live box to post updates as they happened. Click the "play" button and our posts should flow in automatically:

By Mark Memmott

As officials at the Centers for Disease Control and Prevention continue to debate whether to tell U.S. schools that they don't need to automatically shut down if a student or staff member gets the H1-N1 virus, The Seattle Times reports on why officials in Washington are reopening the nine schools in the state that have been closed.

"We are asking parents and families to take primary responsibility for the health of their children," Dr. Jeff Duchin, chief of communicable-disease control for Public Health -- Seattle & King County, tells the Times. "Closing one school at a time was never meant to be a long-term response."

The newspaper adds that:

Duchin said it no longer made sense to automatically shut down a school over an isolated infection. Not only does the virus appear to have already spread throughout the community, Duchin said, but most infected people have become only mildly ill.

By Mark Memmott

More answers to questions sent to us at this Flu Shots post, on Twitter and on Facebook:

-- Sandi G (gubin) asked: "When will public health officials be able to explain why the high early mortality in Mexico? How do they figure this out -- what kind of research are they doing?"

NPR science editor Joe Neel writes: "There evidently was limited capacity in Mexico to do the kinds of testing needed to confirm swine H1N1 flu cases until the weekend of April 25-26. That's when a team from the World Health Organization arrived with test kits to permit more testing and faster results.

"Prior to this, the test was only available in three labs in the U.S. and Canada, and three labs overseas. As scientists go through the samples that were on hand and collect more samples for testing, the data are getting more reliable. As of Monday, there were 757 cases confirmed in Mexico, with 26 deaths. Prior to this, estimates were all over the place, and it wasn't possible to calculate how lethal the virus is. We still won't hear an estimate of this for several days or even weeks. If you want to learn more about the test, you can read about here."

-- Ira Wrotethis (cozumel) asked: "Over the last 5-10 days I have heard about people coming back from Mexico (that) may have the swine flu. Yet no report has yet to divulge where in Mexico these people came from. Did they all come from Mexico City? Were these people at the resorts? ... Would be useful information."

Joe Neel writes:

Continue reading "You Had Some Questions; We Have Some Answers" >

"We are cautiously optimistic that what we are seeing right now is presenting itself as a much milder virus than the initial cases ... in Mexico," Health and Human Services Secretary Kathleen Sebelius told the Council on Foundations this morning, at the group's annual conference in Atlanta.

According to the Associated Press, Sebelius also said that authorities will "continue to accelerate the work on vaccine manufacturing."

By Mark Memmott

Good morning.

As Flu Shots begins another day, here are a few of the stories making headlines:

-- CBS News -- China Quarantines Four Americans: "The American Embassy in Beijing says four U.S. citizens are now or have been quarantined in China due to swine flu fears. Embassy spokeswoman Susan Stevenson said Tuesday two of the Americans were in Beijing while the other pair were in the southern province of Guangdong." She told the Associated Press that two of the Americans have since been released from quarantine.

Related story by Reuters: "Cocooned in tiny rooms for a week, 300 tourists and staff quarantined at a Hong Kong hotel in the battle against swine flu have been painfully adjusting to life in confinement, while aching for release later this week."

Today in Hong Kong, police stood guard outside the Metropark hotel where some staff and guests have been quarantined. Mike Clarke/AFP/Getty Images

 

-- The Washington Post -- "Poverty, Tendency To Self-Medicate Help Drive Up Flu Deaths In Mexico": "Several theories have emerged as to why all but one of the confirmed deaths from swine flu have occurred in Mexico. Much of it is speculation -- that Mexico City's 7,300-foot elevation exacerbates respiratory illnesses, that there may be a slight variation between the viral strain prevalent in Mexico and swine flu elsewhere, that Mexico is further along in disease transmission and other countries will eventually see severe cases. But a critical factor, according to specialists here, is that flu victims have delayed checking into hospitals until their condition has deteriorated so much they cannot be saved. While medicines are plentiful and cheap at Mexican pharmacies, swine flu antiviral medication was often not available or prohibitively expensive."

-- The New York Times -- Mexicans Feel Stigmatized: "From Chile, where sports officials declined to host Mexican soccer teams, to China, where the authorities forced even healthy resident Mexicans and Mexican travelers into quarantine, Mexicans say they have been typecast as disease carriers and subjected to humiliating treatment."

-- The Associated Press -- Life Begins To Return To Normal In Mexico City: "Traffic is picking up again, cafes are reopening and cleanup crews are getting universities ready to resume classes. Mexico City has some of its customary bustle back, and the president promises life is returning to normal after a five-day shutdown to contain the spread of swine flu."

-- The Wall Street Journal -- Some Precautions May Soon Be Eased: "Encouraged by signs that a new influenza virus may pose fewer dangers than originally feared, health officials began ratcheting back some initial measures taken to halt its spread. The U.S. Centers for Disease Control and Prevention may scale back its current recommendation to close for up to 14 days any schools attended by, or in areas near, a child who tests positive for the new H1N1 virus as growing evidence suggests most cases of the disease are relatively mild."

-- NPR.org -- "Do Face Masks Protect From Flu?" "Masks are not a foolproof way to prevent the spread of flu bugs. And the Centers for Disease Control and Prevention says it has a lot to learn about the potential effectiveness of masks in controlling swine flu. But as a precaution, experts say, the masks make sense for certain groups: people who are sick; and health care workers who are most likely to come in close contact with infected people."

-- Los Angeles Times -- A "Tenacious Newspaper" Helped Uncover The Outbreak: "It was Easter weekend when people in Oaxaca noticed strange happenings at the state-run Dr. Aurelio Valdivieso General Hospital. Sections were suddenly off-limits. Security guards were added. The cop reporter at the local newspaper, El Diario Despertar, got a tip from a source at the hospital. Not above dressing its journalists up as paramedics, the paper sent two people to investigate. They quickly realized that the hospital was seized by alarm."

By Mark Memmott

Officials at the Centers for Disease Control and Prevention just held their latest news conference about the swine flu outbreak.

We used this Cover It Live box to report about what they said. Just click the "play" button below and our updates should flow in automatically:

By Mark Memmott

World Health Organization flu expert Keiji Fukuda briefed reporters this morning in Geneva. We listened and posted updates here. Click your "refresh" button to make sure you're seeing our latest additions:

11:47 a.m. ET: The news conference just ended.

11:42 a.m. ET: After being asked about the transmission of the disease from a farm hand in Alberta, Canada, to pigs there and whether the disease could then come back to infect people, Fukuda says that "in this instance, we are very clear that pork and pork products. when they are handled right and cooked properly do not pose a risk of infection to people."

And, Fukuda adds, "the people who are getting infected are not getting infected from pigs."

But, he says, WHO is continuing to look at whether there's a chance that animal-to-human transmission might become a problem.

11:34 a.m. ET: "There's not a timetable," Fukuda says, after being asked when the virus might show up in significant numbers in the southern hemisphere. "There's no timetable for how viruses like this spread out."

11:29 a.m. ET: "We expect that you will have peaks of activity in some places ... valleys of activity in some places," Fukuda says, as he cautions that the outbreak will likely ebb in parts of the world even as it picks up in others. "It's a mixed picture. This is what we have seen in other pandemics."

11:20 a.m. ET: More on the issue of what a "phase 6" declaration would mean. Fukuda says the goal is to "capture how far" the virus is spreading. It is not by itself a measure of the flu's severity.

11:11 a.m. ET: As it considers whether to raise its outbreak status from "phase 5" to "phase 6," Fukuda says, WHO is looking for "evidence of sustained community transmission" in other regions of the globe (beyond North America). It is also watching for signs that the cases are not almost all "travel related," he says.

11:06 a.m. ET: "We're not quite certain how this is going to evolve," Fukuda cautions. But, he adds, "this is the best surveillance we've ever had" -- so authorities are closely monitoring the outbreak.

11:05 a.m. ET: Fukuda says WHO's latest figures show 1,025 confirmed cases in 20 countries. The death toll stands at 26.

by April Fulton

School closings continue to grow around the country. Today, 19 schools in the Detroit area have closed, adding to the nearly quarter of a million kids out of class in this country due to swine flu concerns.

But as NPR's Larry Abramson learns today, there are indications this tactic could wane as the new flu strain shows it is less lethal than fear.

In a piece he is developing for All Things Considered this afternoon, Abramson interviews Michael Osterholm, director of the Center for Infectious Disease Research and Policy in Minnesota.

Osterholm says we may well see public health officials moving toward more traditional approaches in which sick children will be kept at home and schools will only be closed if there's evidence of high risk.

Osterholm defends the decisions to close schools early in the outbreak, as the virulence of the disease was unknown.

But as our understanding of the virus advances, it may be time to dial it down.

By Mark Memmott

Mexico's Health secretary just said that most businesses in his country will be allowed to reopen on Wednesday, NPR's Carrie Kahn reports from Mexico City.

According to the Associated Press, Health Secretary Jose Cordova said that signs of an ebbing in the swine flu outbreak that struck his nation have prompted the decision. Mexico has been hit harder than any other country. (Go here for an interactive map on confirmed cases across the globe.)

The AP adds that:

Mexico City Marcelo Ebrard says cafes, museums and libraries will reopen this week but that health officials need to finish inspecting schools before students can return to class.

Alan David must keep working at his Mexico City newsstand. Carrie Kahn/NPR

 

By Marisa Penaloza

MEXICO CITY -- Alan David, a drink and magazine stand attendant, is hard at work near the Templo Mayor Museum in the city's historic center. The lanky 22-year-old with a shaved head and deep voice shouts out "three for 10 ...water, sodas, juices, your choice" over and over, but not many are responding to his call today. The area is typically swamped by locals and tourists, but today hardly anyone is here -- except of course, those who can't afford to stay home, like David.

"How am I going to eat?" asks David, "I can't stay home, I have to work to feed my family." When asked if he wishes he could stay home, David can't even dream of such a luxury, "I eat what I work" he says.

The Mexican government has launched a campaign asking people to stay home, wash their hands, wear face masks and refrain from greeting people with a kiss or a hand shake, a social ritual ingrained in Mexicans' DNA.

It shut down all but essential services, including most government offices around Zocalo and private business. And, all public events have been canceled here to avoid high concentrations of people. (Related story: "Mexican Soccer Teams Play To Empty Stadiums.")

David says sales have dropped between 60 and 80 percent since last week, when the world learned about the influenza virus in his country. He says he keeps up with the news and is aware of the outbreak. He isn't wearing a mask though. "It gets in the way at work, but I put it on during my commute" he says, "I take a bus and the metro to and from work and my biggest concern is bringing something home to my 2-year-old daughter and my wife." They are staying home.

By Mark Memmott

One of the most important lessons learned from the 1918 flu pandemic that killed tens of millions of people around the world is that when governments lie, people die needlessly, a leading expert on that World War I-era outbreak just told Morning Edition's Steve Inskeep.

John Barry is the author of The Great Influenza: The Epic Story of the Deadliest Plague in History, and is a distinguished visiting scholar at the Center for Bioenvironmental Research of Tulane and Xavier universities. (Barry's Tulane bio is online here.)

He told Steve that "in 1918, governments did not tell the truth ... The surgeon general of the United States said this was ordinary influenza by another name. ... Nothing to worry about if normal precautions are observed"

Continue reading "Expert On 1918 Outbreak Says Governments Have Learned" >

By Mark Memmott

Why do schools close for days or weeks when only a handful of students or staff have the virus?

If you get the swine flu now will you be protected if it reappears in the fall or winter?

The disease can be transmitted from humans to pigs. Can it be spread to other animals and then back to humans?

Those are just a few of the many questions you may have. What others occur to you? Add them to the comments thread on this post, and watch for some to be answered on the air, in Flu Shots, in stories on NPR.org and by the team at NPR's On Health podcast.

Update at 3:25 p.m. ET: Thanks to all those who have sent in questions so far -- either in the comments thread with this post, on Twitter or on Facebook.

Frank has answered one reader inquiry here. Flu Shots will take a swing at more of them in coming days, as will NPR.org's Health & Science pages, the On Health podcast and National Public Radio.

By Mark Memmott

As he made the rounds of the morning TV news shows today, the acting director of the Centers for Disease Control and Prevention said that authorities are seeing "encouraging signs" -- most notably that the virus so far does not appear to be more severe than a standard seasonal flu.

Here's how Dr. Richard Besser put it on NBC's The Today Show:

By Jason Beaubien

MEXICO CITY -- There was a disturbing quiet here over the weekend.

This sprawling metropolis of 20 million people felt unsettlingly peaceful. Streets were empty. Birds that would have been getting drowned out by the traffic before stepped up to center stage and made a huge racket.

It reminded me of the feel in the U.S. in the wake of the 9/11 attacks. I remember those days right after the Twin Towers fell. There were no airplanes in the sky. It was unclear when things would return to normal. And it felt like the world had changed.

It feels similar right now in Mexico City.

Continue reading "In Mexico City, An Eerie Quiet -- And A Friendly 'Buenas Dias!"" >

The word today that public service ads about the outbreak are headed to TV and radio stations reminded some of the PSAs that were put on television during the swine flu scare in 1976.

The 2009 version is a very straight-forward and informational spot narrated by acting Surgeon General Stephen Galson about the importance of washing your hands and staying home if you'r sick. It's nothing like the old ads.

Our thanks to readers Chris Balmes and Hannah Wood for calling our attention to these blasts from the past:

As NPR's Scott Horsley reminded listeners this week on All Things Considered, the 1976 vaccine and the push to give it to every American had some frightening results. The campaign was called off later that year after it was feared the vaccine might have caused some cases of a rare nerve disorder.

by Rebecca Davis

A Veracruz, Mexico, health official checks a masked boy for swine flu. Carrie Kahn/NPR

NPR's crack health and science team takes a break from reporting on the 2009 H1N1/swine flu outbreak to look back at the week's events. In this podcast special, health and science editors and reporters discuss how the outbreak unfolded and the status of the vaccine.

They also examine this recurring question: The virus doesn't seem all that bad here -- is everyone overreacting?

Don't be too comforted, they caution. There's still a lot we don't know about this new strain of flu. So -- listen in and find out more:

You can sign up to receive our latest NPR: On Health Podcasts here.

Also, if you have questions you're not finding answers to about the swine flu -- please write us at NPRHealth@npr.org ... And early next week, we'll post another podcast with answers!

By Mark Memmott

Dr. Marie-Paule Kieny, director of the Initiative for Vaccine Research at the World Health Organization, spoke with reporters this hour in Geneva. We listened in and passed along updates in the Cover It Live box below. Just click the "play" button and our posts should flow in automatically:

By Mark Memmott

Fiona Fleck, one of the World Health Organization's spokeswoman, has suggested that perhaps the mini-controversy over what to call this strain of flu could be settled by the public.

According to The New York Times: "Maybe, she suggested, there could be a competition, and members of the public could come up with a better name."

So, Flu Shots readers, let's take her up on her offer.

-- Should it still be the "swine flu"?
-- Or the very technical H1-N1 now preferred by the scientists and many elected leaders?
-- Something else entirely?

The ever-irreverent Jon Stewart offers "Snoutbreak '09" as a possibility.

Update at 3:45 p.m. ET. Some of the best names so far.

Our thanks to those who've offered suggestions, either as comments on this post or over at Twitter (where you just need to add #NameThatFlu to a tweet for it to become part of the discussion) and Facebook. Here are some we especially like, starting with five from this post's comment thread:

-- Snaflu -- (suggested by anon ymous).
-- The Virus formerly known as Swine Flu -- (Memo Benumea).
-- Unnecessarily-overhyped-uberfluenza -- (Dylan Holycross).
-- Influenza nervosa -- (Susan Williams).
-- SPAMdemic -- (Bill Doyle).

-- Hamageddon -- (Paul, at Facebook).
-- FARS -- (Laura, at Facebook).
-- The Baconic Plague -- (Karl, at Facebook).
-- Madsow -- (Caged Heat, at Twitter).
-- Wiburculosis -- (ylifactory, at Twitter).

Update at 1:05 p.m. ET:

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told NPR's Joanne Silberner about the switch to calling the disease the "2009 H1-N1 flu" earlier this week:

by April Fulton

The CDC's Morbidity and Mortality Weekly Report is normally great story fodder for science geeks like us, but this week, it may get a boost in readership because provides a helpful tick-tock on the detection and response to the swine-origin influenza A (H1N1) virus as it evolved in Mexico.

Number of confirmed (N = 97) and probable (N = 260) cases of swine-origin influenza A (H1N1) virus by date of illness onset, Mexico)

CDC

While the report illustrates how little we still know about how the virus evolved, it aims to put everyone on the same page. The report notes the importance of continuing to investigate transmission, goeographic distribution, and the clinical spectrum of the disease.

"The epidemiologic characterisitics of this outbreak underscore the importance of monitoring the effectiveness of community mitigation efforts, nonpharmaceutical interventions, and clinical management practices in anticipation of a possible pandemic," the report says.

Some highlights:

Continue reading "Mexico: What Did We Know And When?" >

By Mark Memmott

Someone who should know whether it's safe to fly commercial during the flu outbreak says she did just that last night.

Rear Admiral Anne Schuchat, interim deputy director for Science and Public Health at the Centers for Disease Control and Prevention, told Morning Edition's Steve Inskeep today that while respiratory illnesses can spread in confined places, healthy travelers don't need to be very worried:

Vice President Joe Biden, of course, has taken some heat for suggesting otherwise.

By Richard Knox

Sorry, but here's another reason to worry about swine flu.

It's the possibility that the newly discovered virus will become resistant to the only two drugs now available to treat it -- Tamiflu and Relenza.

It's not an idle threat. Most of the ordinary flu viruses circulating this year are resistant to Tamiflu. Those resistant viruses are a type called H1N1. That's the same family as the swine flu virus, although the new bug is genetically different.

So it's not far-fetched that swine flu could also acquire the genes that confer Tamiflu resistance. That could be disastrous if swine flu goes pandemic.

But there may be a way to hedge against that problem. Researchers say doctors should hold off using Tamiflu at first and use Relenza instead. Using computer models, the researchers calculate that Tamiflu resistance could be substantially delayed if only 1 percent of the population were treated with Relenza first.

That would preserve supplies of Tamiflu, the mainstay drug in pandemic flu stockpiles.

Delaying drug resistance could ease the burden on the medical system from treating people with severe flu complications. Meanwhile, more people could get vaccinated against swine flu, preventing them from getting sick in the first place.

"The proposal would be to take our limited Relenza stockpile and use it as much as possible at the beginning of a swine flu outbreak," says Marc Lipsitch of the Harvard School of Public Health. He's a coauthor of a report in the Public Library of Science/Medicine. It was funded by the Hong Kong government and the U.S. National Institutes of Health.

Lipsitch says using Relenza to delay Tamiflu resistance would also prevent the spread of resistant flu viruses.

Relenza can't be used for everybody. Tamiflu is a pill, but Relenza has to be inhaled. It's not approved for young children or people with asthma.

By Mark Memmott

Elected officials and health authorities need to deliver "consistent, clear, but honest messages about what is going on" when nations are faced with serious threats such as the swine flu outbreak, a University of Michigan expert on such crises just told All Things Considered co-host Michele Norris.

"People react much better and have much more predictable reactions when they know they're (being) told as much information as is available ... and that they're (being) given sound advice," added Sandro Galea, director of the Center for Global Health at the University of Michigan and a professor of epidemiology at the university's School of Public Health.

Galea also said studies show that after an initial period of confusion during crises, most people quickly adapt and "the confusion typically gives way to rational behavior."

As for Vice President Joe Biden and the comment he made today that he's told his family not to travel on commercial airplanes or to "go anywhere in confined places now," Galea said Biden was guilty of "perhaps underestimating the weight of his words as a public official." That's "problematic," said Galea, because Bidens words were "in direct contrast to what other public officials are saying."

Michele's conversation with Galea is scheduled to be part of today's ATC broadcast. Click here to find a local NPR station.

By Mark Memmott

The man who runs the Centers for Disease Control and Prevention disagrees with Vice President Joe Biden about whether it's safe or not to fly during this flu outbreak.

"This is what we call in public health a teachable moment," Dr. Richard Besser just told reporters dialed into his daily conference call.

Asked about Biden's comment today that he "wouldn't go anywhere in confined places now," and specifically not a commercial airplane, Besser said that:

"If you have a fever and flu-like symptoms you should not be getting on an airplane. ... (But),
I think flying is safe. Going on the subway is safe. People should go out and live their lives."

By Mark Memmott

Health officials continue to stress that anyone suffering from flu symptoms should stay home unless those symptoms become severe. At that point, get to a doctor or hospital.

Here's how Keiji Fukuda, the World Health Organization's flu expert, just put it during his daily conference call with reporters:

"One of the most important steps people who may be ill can take is to stay at home. ... By staying at home they can get rested. ... And it also will reduce the contact they have with other people."

Update at 11:21 a.m. ET: Why did WHO increase its alert to "Phase 5" yesterday (one step below a declaration that a pandemic is underway) from "Phase 4"?

Fukuda says a key reason was evidence that the disease is "really beginning to act like a human virus ... in a way that suggested it was really becoming part of the community -- not just travel related cases."

By Mark Memmott

"I would tell members of my family -- and I have -- that I wouldn't go anywhere in confined places now," Vice President Joe Biden said today as he made the rounds of the morning TV news shows. "It's not just going into Mexico. If you're any place in a confined aircraft and one person sneezes, it goes all the way through the aircraft."

According to the AP, Biden appeared on ABC-TV's Good Morning America, CBS-TV's The Early Show" and NBC-TV's The Today Show show.

Biden offered his thoughts about flying on Today. Here's the video. The vice president talks about whether folks should fly about 2:30 into the 6:08 interview.

Update at 12:15 p.m. ET: The head of the Centers for Disease Control and Prevention says Biden is wrong.

Update at 11:45 a.m. ET. The Air Transport Association of America chief calls Biden's comments "extremely disappointing":

"Vice President Biden's comment that people should avoid air travel in response to the H1N1 flu outbreak was extremely disappointing," ATA President and CEO James May says in a statement e-mailed to reporters. "The airlines have been working daily with government agencies, none of whom suggest people avoid air travel, unless they are not feeling well. The fact is that the air onboard a commercial aircraft is cleaner than that in most public buildings."

Update at 11:25 a.m. ET. NPR's Yuki Noguchi writes that:

The Obama administration has not issued a general advisory about air travel or public transportation. The travel industry was quick to respond today after hearing what Biden had to say.

In a statement, the U.S Travel Association did not mention Biden specifically, but denounced "recent comments" by "elected officials" as "inflammatory."

Roger Dow, president and chief executive of the Travel Association added that:

"According to President Obama, swine flu is a cause for concern, but not panic. President Obama's measured and responsible comments are appropriate and should provide useful guidance to other elected officials."

Update at 9:05 a.m. ET. This statement was just sent to reporters by Biden spokeswoman Elizabeth Alexander:

"On the Today Show this morning the vice president was asked what he would tell a family member who was considering air travel to Mexico this week. The advice he is giving family members is the same advice the administration is giving to all Americans: that they should avoid unnecessary air travel to and from Mexico. If they are sick, they should avoid airplanes and other confined public spaces, such as subways. This is the advice the vice president has given family members who are traveling by commercial airline this week. As the president said just last night, every American should take the same steps you would take to prevent any other flu: keep your hands washed; cover your mouth when you cough; stay home from work if you're sick; and keep your children home from school if they're sick."

By Mark Memmott

Good morning. We'll start the day with a quick look at some of the latest news:

-- The Associated Press -- Health Officials Fear Large Number Of Deaths: "World health officials are very worried about the potential for massive numbers of deaths worldwide from the mutated virus, even though the epidemic so far has claimed only a confirmed eight lives in Mexico and one in the United States. Roughly 170 deaths are suspected of having been caused by the virus in Mexico. Switzerland on Thursday became the latest country to report a swine flu infection -- a 19-year-old student who health officials said was mistakenly released from a hospital and then hastily readmitted. European Union health ministers planned emergency talks in Luxembourg to coordinate national efforts in preventing the spread of swine flu in Europe."

-- NBC News -- Mexico Shuts Down Most Of Government And Economy: "Mexico's government is suspending all nonessential activity of the federal government and private business as the number of confirmed swine flu cases jumped."

-- The New York Times -- "Containing Flu Is Not Feasible, Specialists Say": "Experts on the global movement of flu say ... the world ... must bow to the inevitable: closing borders would not only fail to stop the virus, but would also cause economic collapse and possibly add to the death rate."

(Related: On the morning TV news shows today, Vice President Joe Biden repeated the administration's view that it would be a mistake to close U.S. borders.)

-- NPR.org -- "Flu Prompts A World Of Different Reactions": "Political leaders and public health authorities around the globe are grappling with a fundamental question as new swine flu cases are reported daily: how to address the problem but not exacerbate it."

-- The Seattle Times -- "Six Probable Swine Flu Cases Identified in Washington": "Six probable cases of swine flu have been identified in Washington State -- three in Seattle, two in Snohomish County and one in Spokane County, public health officials announced at a news conference Wednesday evening in Seattle."

-- USA TODAY -- "States, Hospitals Roll Out Emergency Plans": "Health departments and hospitals are shifting into emergency mode as clusters of swine flu develop across the USA, and some are activating pandemic plans for the first time."

-- The Wall Street Journal -- Mexican Officials Don't Think Farm Was Source: "Mexico's top government epidemiologist said Wednesday that it is "highly improbable" that a farm in the Mexican state of Veracruz operated by Smithfield Foods Inc. is responsible for the nation's swine-flu outbreak. Miguel Angel Lezana, the government's chief epidemiologist, said in an interview that pigs at the farm are from North America, while the genetic material in the virus is from Europe and Asia."

By Mark Memmott

British news media, such as The Independent, are already making the connection to Typhoid Mary.

The story:

Maria Adela Gutierrez, a 39-year-old census taker in Oaxaca, Mexico, died of the H1NI/swine flu on April 13. As The Independent says, her job put Gutierrez in contact "with at least 300 unsuspecting members of the public when the disease was at its most virulent."

But did Gutierrez spread the disease?

The Los Angeles Times reports that "Martin Vazquez Villanueva, the regional health secretary in Oaxaca, denied local news reports that said she had infected 20 people, as well as her husband and children."

But according to The Independent, after Gutierrez became ill "state health authorities began to track down every person she'd had recent contact with and conduct check-ups.

"That discreet search ... turned up more than 300 people, including many members of the public whom she'd interviewed as she knocked on doors in late March and early April. Local sources told Veratect, the US disease-tracking company which sounded the alarm, that between 33 and 61 of those interviewees 'exhibited symptoms' of a flu-like illness, though none have died."

by April Fulton

From President Obama on down, U.S. government officials are uniformly calling the swine flu by the uncatchy, but technically proper, H1N1.

It doesn't exactly roll off the tongue, or off the keyboard like swine flu.

Reasons for the shifting name are probably due to the fact that Muslims and Jews do not eat pork and consider it unclean, adding insult to injury for anyone afflicted with swine flu, although as of yesterday, the World Health Organization said they had no plans to change the name.

A high-level CDC official told NPR's Brenda Wilson today that if someone is diagnosed with swine flu in a country dominated by one of these religions, it implies a link with something they are not comfortable with. People in public health circles also have concerns about calling a disease by the name of a country, such as Mexico, which is the one most associated with the outbreak.

NPR's Brian Naylor reports today that DHS Secretary Napolitano and Rear Admiral Anne Schuchat, Interim Deputy Director for CDC, insisted on calling it H1N1 at a Senate Homeland Security and Governmental Affairs hearing today.

And newly-confirmed HHS Secretary Kathleen Sebelius issued a statement today, announcing a briefing she would hold to update everyone on the flu, using the H1N1 moniker.

Trend alert: We are seeing a transition the scientific name for the virus.

By Mark Memmott

Dr. Keiji Fukuda, the leading flu expert at the World Health Organization, is this hour holding what has become his daily news conference Geneva. We'll pass along highlights as they happen. Be sure to hit your "refresh" button to see our latest updates:

Update at 11:38 a.m. ET: The news conference just ended. Toward the end, Fukuda is asked if it is important at this time to find out where the flu originated.

"It would be interesting," he says, "(but) at this point we have higher priorities." It is "critical" at this point, he adds, "to answer the most urgent issues of how this is evolving, where it's going ... and what steps might be taken to protect people."

(See our earlier post about one young boy who's been referred to as a possible "patient zero".)

Update at 11:32 a.m. ET. What would spur WHO to change this to a "Phase 5" outbreak (one level below "pandemc") from its current "Phase 4" rating?

"What we are also looking for is whether we are seeing transmission of this virus out into the community itself," Fukuda says. "We want to look carefully for that ... before we really move to Phase 5."

11:25 a.m. ET. WHO's numbers don't match up exactly with what individual countries are reporting, but for what they're worth here are Fukuda's latest:

Canada: 13 cases; no deaths. U.S.: 64 cases; 1 death. Mexico: 26 cases; 7 deaths. Israel: 2 cases; no deaths. Spain: 4 cases; no deaths. United Kingdom: 2 cases; no deaths. New Zealand: 3 cases; no deaths.

Totals: 114 cases; 8 deaths

11:14 a.m. ET: Fukuda says the situation is "moving closer to 'Phase 5,' " but is not there yet.

Right now, WHO considers the situation to at "Phase 4." What is "Phase 5"? Here is WHO's definition:

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6 is a pandemic, according to WHO's definitions.

11:13 a.m. ET: "Where are we, what's going on and where might we be going?" Fukuda asks. "It's clear that the virus is spreading and we don't see any evidence of it slowing down at this point."

11:12 a.m. ET: The latest tests, Fukuda says, confirm that the flu begin as a swine virus -- but that it is now moving from person-to-person.

11:10 a.m. ET: Fukuda begins with some updates on the numbers. The major changes since yesterday include seven new cases in Canada (bringing the total there to 13), and the first death in the U.S.

By Mark Memmott

A five-year-old boy from a small village in Mexico is generating headlines across the news media universe about whether he might be "patient zero" -- that is, the first person to have gotten this swine flu.

But as readers of the stories will quickly see, the caveats come quickly.

-- "Edgar Hernandez, officials say, tested positive for swine flu in early April," CBS News' Early Show reports. "But, it's unclear if Hernandez is indeed the first case of the new flu spreading around the world."

-- Edgar Hernandez is a playful five-year-old with spiky black hair and a Cheshire cat grin," says The Wall Street Journal. "He also happens to be the earliest known victim -- so far -- of the swine flu that is spreading across Mexico, the U.S., and beyond. ...

"Mexican officials hope Edgar's case can help piece together the epidemic's early days. But so far, his case is raising more questions. While other villagers also got bad colds at roughly the same time as Edgar, he appears to be the only one in the area who contracted the deadly swine flu. Adding to the mystery, no one else in the family got swine flu, though Edgar sleeps in the same bed with his three-year-old baby brother and his parents."

-- "Although authorities have not determined that swine flu started in La Gloria, a village of about 2,500 people in the state of Veracruz, Edgar, who got sick in late March, is the earliest confirmed case of the virus in Mexico," reports The Washington Post. "He was just one of several hundred people from La Gloria and surrounding areas that fell ill around that time in an unexplained outbreak that left two children dead and prompted authorities to fumigate the entire village."

Why does it matter if young Edgar was "patient zero" or something close to that? Here's how the Los Angeles Times answers that question:

The boy at the center of efforts to trace this new, deadly flu strain could barely keep still. A parade of visitors, many of them journalists, on Tuesday stopped by the small concrete home where Edgar Hernandez lives with his mother and 3-year-old brother.

Edgar, who is 5, (not 4 as government officials previously reported) is the earliest known victim of the disease in Mexico. How he contracted it could be a key clue in figuring out the virus' path.

By Mark Memmott

If the swine flu outbreak seems to end in coming weeks, that doesn't mean all is well, NPR science correspondent Richard Knox writes:

Beware the Ides of September ... or maybe November.

That's the ominous warning today from Dr. Keiji Fukuda, the World Health Organization's top flu expert. (His official title is acting assistant director-general for Health Security and Environment.)

During what has become Fukuda's daily "virtual press conference" from Geneva, I asked him what he would think if cases of swine flu fall off over the next couple of weeks as travel to Mexico dries up and travelers stop exporting the virus to all parts of the world. Would that mean the virus can't sustain human-to-human-to-human transmission very well?

No such luck, Dr. Fukuda responded.

"I don't think we will be able to conclude that in the next few weeks, no matter what happens," he said.

It's the nature of flu viruses, Fukuda added, to have peaks of activity in cool weather and go underground in the summer.

"So when we see ... a new virus which clearly is able to transmit among people," Fukuda said, "I think it would be very hard for us to know, even if the activity goes down and it becomes very quiet over the next few weeks ... whether the virus has disappeared until several months have gone by at least."

That's the reason why so much is being made out of the relatively small number of swine flu cases popping up all over the world. If the swine flu virus runs true to form and hides out over the next few months, it might use its vacation time to develop mutations that make it more dangerous for humans. Then, like the horror movie icon Freddie Krueger, it could come baaaack. Maybe around Halloween.

That's what happened in 1918. Author John M. Barry notes that the first wave, which began in March, "was extremely mild." But by autumn, the world was gripped by the worst pandemic ever.