Homeland Security and Education Secretaries Media Briefing on Swine Flu Virus H1N1 5/1/09

(Constant Swine Flu updates may be seen here)

Remarks by Secretary Napolitano and Education Secretary Arne Duncan at Today’s Media Briefing on the H1N1 Flu Outbreak

Release Date: May 1, 2009

For Immediate Release
Office of the Press Secretary
Contact 202-282-8010
Washington, D.C.

Secretary Napolitano: This is part of our ongoing effort to keep people posted on what is happening and what we’re seeing, and to begin to address frequently asked questions. And I’m pleased to be joined today by Secretary of Education [Arne] Duncan.

The most frequently asked question we are getting is: why this flu is being treated differently than seasonal flu? In other words, you don’t normally see the Secretary of Homeland Security talking about the seasonal flu outbreak. And the answer is because this is a new strain of flu. And during seasonal flu, which we have every year, and unfortunately it does end up resulting in the hospitalization usually of about 200,000 Americans and about 35- to 36,000 fatalities, that’s the normal with seasonal flu.

But with seasonal flu, we also have a large part of our population that have developed antibodies, or pretty good antibodies, against it, as opposed to what we’re seeing now. And what the H1N1 is is a new strain of flu. And that means that the normal antibodies you would have haven’t yet developed. And that’s why, for example, you will see a population affected like previously healthy adults that wouldn’t be affected as strongly with a seasonal flu. So that’s why all the precautions.

And because this is a new strain of flu, the scientists are still figuring out the epidemiology. They’re still figuring out exactly what we’re dealing with as a flu virus. And for that reason, it’s important to lean into this, as we are, take precautions, as we are, without really knowing whether this is—or what kind of pandemic this will be.

Let me pause a moment on the word “pandemic” because there’s been a lot of concern also raised with the World Health Organization. They’ve gone from level three to four, and four to five. And what happens if they go to level six? Well, a couple of things. One is, what those numbers represent is how widespread around the world a new virus is. In other words, if we’re at level six, it means it’s in a lot of places.

Now, we already know it’s in the United States. It’s been in the United States the last week. So we’ve already been undertaking precautions. What the levels do is tell countries that don’t yet have any illness the things they probably ought to be preparing for because they’d better expect that it’s going to get there sooner or later.

So if this goes to level six, you will hear me say, as I’ve said, is we are already preparing as if it is going to level six because the virus is already in our shores. And we again are relying, in terms of everything we have done and will do, on the best that the scientists can tell us, but realize that the picture for them is changing also. And it changes regularly, and we move with that change as well.

But to recap the last few days, the Department of HHS [Health and Human Services] declared a public health emergency on Sunday to free up resources, to begin prepositioning antivirals and other types of personal protective equipment. That also allowed the execution of an emergency authorization. That allows the antivirals to be prescribed beyond the normal population that they would be given to.

We’ve initiated a process to move millions of treatment courses of Tamiflu and Relenza out to the states. We have a stockpile of 50 million courses. We’re going to move roughly 11 million courses to the states. That movement will be complete by this Sunday. In the meantime, and since we last spoke, HHS has authorized the purchase of replacement. So even as we move antivirals out to the public or out to the states, we’re replacing the national stockpile.

The State Department did issue a travel advisory for nonessential travel to Mexico. We have been providing daily briefings and updates to state and local public health officials and state emergency managers, coordinating our response efforts with them and ensuring an open line of communication. We’re also providing daily briefings to the private sector, keeping them updated, and then really asking them to be partners here, to make sure they have looked at their continuity of business plans, and also make sure that they are thinking about their employees who may indeed, as this goes on, have to stay home from work either because they’re sick or because they’re with a child who is sick, so to be sympathetic to that.

We continue to emphasize that everybody has a role here. This is a shared responsibility, the government, the private sector government—and when I say that I mean all levels: federal, state, local, tribal—but also every individual. It’s the common thing, and you’re going to hear it a lot, which is: cover your mouth when you cough. Wash your hands regularly, and really wash them. Keep them washed. And also, if you are sick, stay away from school. Stay away from the workplace. Stay away from contained places like buses, airplanes, and the like, where you could spread the virus.

The President has requested $1.5 billion in additional funds to help with the costs associated with this outbreak of H1N1. And at his Cabinet meeting this morning, he convened a special Cabinet meeting to discuss the latest developments in the coordination of the government’s response among all the various Cabinet agencies.

So that’s kind of where we are to date. If you need updated numbers and the like, we can get those to you. I want to pause a moment and say that the actual number of cases is probably not the most relevant number. Really, the most relevant number is the number of states that the virus has been confirmed in. And I think we are at 11 confirmed states right now, with several others with suspected cases. And so that map is continually updated, and the National Operations Center, which is located here, updates those numbers twice a day. And when we say “confirmed,” we mean confirmed by the CDC.

So with that, let me introduce the Secretary of Education, Secretary Duncan, to talk a bit about how this is affecting our school-age population.

Secretary Duncan: Thank you so much, Secretary, and thanks so much for your leadership and hard work on this issue. We are all rightly concerned about the potential health impact of this flu. But as Secretary of Education, I am also concerned about the impact of this flu on learning. As of today, about 430 public and nonpublic schools are closed for reasons related to this flu outbreak. And just to put that in a little bit of context, we have almost 100,000 schools in our country. So this is less than half of one percent of our schools that have been impacted.

Let me first speak to parents. The safety of your children is absolutely our number one concern.

To the school superintendents and principals: I urge you to continue to take your cues from public health officials in your area, in your state, and at the Centers for Disease Control and Prevention. Health and safety have to come first. If you have a confirmed case of H1N1 flu among children or adults at your school, or if anyone at your school is personally connected to someone with the flu, like a family member, then the CDC recommends you strongly consider closing school for up to 14 days.

Now to teachers. Teachers, we please ask you to think about reworking upcoming lesson plans so students can do their schoolwork at home, if necessary. Have assignments ready to keep them busy and engaged for up to a week or two, including handouts or books that students can take home so that learning continues. Make sure you know how to reach your students at home in case school does close. Maybe you can continue the classroom conversation and instruction by e-mail or online or by phone.

To parents and guardians, I know it can be inconvenient when your child’s school is closed. If you have to stay home from work, use that opportunity to keep your children—keep your child up to speed. Learn about what they’re learning in school, and keep them on task.

And finally, to our students: you also need to do your part. And the Secretary talked about this idea of shared responsibility. And also, most importantly, this school year isn’t over yet. Don’t fall behind your peers at other schools that are still in session. Keep working hard, and we absolutely want to finish this school year strong. Our basic theme is keep safe and keep learning. Thank you.

Secretary Napolitano: And one addition for that is if a school is closed and children or students are being asked to remain at home, for parents and guardians, that means they are to remain at home. The whole idea is to contain the spread of this virus. And we don’t get the containment feature of closing a school if all our young people do is go to the mall or elsewhere. So if they’re being asked to stay home, that’s exactly what we mean.

And the reason we’re asking that is because this is a flu that is transmittable human to human, and it’s relatively transmissible. So again, close contact can provide an avenue for this flu to go from one to another. That’s why we’re watching and have a containment strategy with all of our advice for the public at large.

CDC press briefing transcripts on swine flu virus (H1N1) for 4/30/09

(Constant Swine Flu updates may be seen here)

Press Briefing Transcripts

CDC Briefing on Public Health Investigation of Human Cases of Swine Influenza

April 30, 2009, 11:30 a.m. EST

>>> As a reminder, if you’re on speaker phone, please pick up your handset before registering your question.  All participants are on a listen-only mode until the Q and A segment.  If you have any objections please disconnect at this time.  Thank you.  You may begin. 

>>> Thank you.  And welcome all to H1N1.  You can imagine there’s a lot of media interest and a lot of reporters calling in.  So do limit yourself to one question.  We will turn it over to Dr. Richard Besser for an update. 

>> Thank you very much, Glen.  Thanks to all of you for being here this morning.  As you know, this is a rapidly evolving situation, a situation filled with uncertainty.  Our goal is to give you information as we have it.  As we get new information, we will be sharing that with you.  As more communities become affected by the H1N1 virus, the activities that public health and the community’s undertaking to control this will become more visible.  And so there’s going to be more concern, there’s going to be more questions.  It’s important that people know where to get answers to their questions and where to find the best, most current guidance we have.  We’re referring people to our website.  I’ll give you more on that in a moment. 

I’ve been trying to make a point that there’s shared responsibility when it comes to preventing infectious diseases, shared responsibility when it comes to finding a new infection for which we have incomplete information.  There’s things the government needs to do, and we’re aggressively doing those things.  There’s things communities need to do, businesses need to do and a lot that individuals need to do.  I’ll go through those again. 

Let me start with an update on our cases.  In the future we may move away from case updates because as we see more cases and more suspect cases, the numbers become a little murkier, and we’ll focus on what that tells us about infections.  Today I’m reporting 149 confirmed cases in The United States.  We have 11 affected states with confirmed cases.  There are many more states that have suspect cases, and we’ll be getting additional results over time.  In New York, there are 50 cases.  Texas, 26.  California, 14.  Again, I’d refer you to the CDC website where you’ll be able to find all of this information.  The new state is South Carolina, which has 10 confirmed cases.  Two in Massachusetts, one in Kansas, one in Arizona, one in Nevada, one in Ohio.  In the future, I think what I’ll do is give you the overall number and refer you to the website.  The age of cases is 16 years with a range of 22 months to 81 years.  The most recent case onset that we have confirmed is April 26th.  The majority of onset cases appear to be after April 18th.  Six of the confirmed cases have been hospitalized, including the unfortunate case we reported yesterday of the child in Texas who passed away. 

I want to put this in context again of the seasonal flu.  Influenza is a virus we see every season — every winter.  It can cause severe disease.  In The United States, there are 36,000 deaths from seasonal flu.  So I think as we see this virus in more communities.  As we see more people who are infected by this virus, we will continue to see a broad spectrum of disease from mild ear infections to more severe infections.  Unfortunately, I do expect there to be more deaths.  As we continue to look, we will see more cases in more states.  And we will see that there are differences in actions across the country.  But this is a good thing.  It’s very important that we look to local and state public health, to look at their situation on the ground, their local contacts until you’re seeing differences, and we hope to learn from these differences in terms of what are the most effective controlled strategies for this new infection.  There are reports that there’s broader school closure in Texas, and we’ll look to see what was the impact of that.  Is that an effective strategy.  We’re also going to hear that emergency declarations are made in different states. 

As you know, we declared a public health emergency in The United States on Sunday.  That gives you additional authority to do things we otherwise would not have.  You’ll see states that are affected, many of them declaring an emergency to allow them to respond as effectively and quickly as possible.  Let me go through some of the public health actions that are under way.  We continue to work with state and local health departments.  We continue to work with the World Health Organization, Pan American Health Organization, and we’re working in part with the tri-national team in Mexico.  Later this afternoon, we’ll be publishing an article in the MMWR that is summarizing some of the data coming out of Mexico.  That’s being reviewed still by the various groups that are authors to that.  Those include the World Health Organization, Pan American Health Organization, Mexico and the United States.  So that will provide additional information on the situation in Canada. 

As you know, last night the World Health Organization raised the pandemic health level to 5.  This is a good thing. It doesn’t impact on what we’re doing here in The United States, but it’s really a wakeup call to the rest of the global community.  If you haven’t been paying attention to what’s going on here and in Mexico, it’s time to pull out your pandemic plan and think what you would do if this infection were occurring in your own borders.  It’s time in the global community as well to think what are the needs of other countries, what are the needs of other countries that don’t have the resources who haven’t been planning intently as we have been here in The United States. 

I want to talk about some of the work we’re doing in the field.  We are sending continuing deploying the stockpile.  This is the collection of anti-viral drugs and materials to be used in hospitals.  We have completed deployment to nine states, and material is moving to the rest of the states.  And so all that should be complete by May 3rd.  There are no reports, and we don’t expect any reports, of shortages, of any anti-virals in any states.  Doing this movement of drugs is a forward leading move in the event this would become much bigger than it currently is.  We have 34 CDC staff employed in the field in five locations, including 11 deaths in Mexico.  One thing about the work in Mexico, I wanted to let you know, that there’s now a lab I’ve been running in Mexico that’s able to do diagnosis and confirmation of the H1N1 virus.  This is a really big step.  It’s going to help us with the studies there because we will really be able to confirm cases and look at the risk factors for those cases, how to treat it.  It’s going to be very helpful in terms of speeding up the course of those studies. 

We’ve expanded greatly our information resources.  We’ve added 50 new staff for our information line, 1-800-CDC-INFO.  The other day with the influx, there was almost a 15-minute wait for some of those calls.  We’re down less than 90 seconds, which is good.  And that’s dramatically reduced the drop rate on calls.  It’s so important that when people want information, they’re concerned, they’re able to get it.  That’s going to help do that.  We’re getting 4,000 calls, over 2,000 e-mails a day.  We’ve added new servers and technology.  We’re getting 6 million to 8 million hits a day on our website.  We’re doing webcasts.  We’re doing one later today.  We’re out there twitting as well.  And I’ve never twitted, but for those who twit, they find it’s a good way to get information. 

We’re issuing more recommendations and guidance.  We’ll be putting out later today information for colleges and universities on what to do should they have cases on their campuses.  We’ve already put out — we always have had guidance for flu outbreak control.  What this will do is provide additional guidance for this new strain of what they should do on campuses.  Basically we want people to review their plans and be ready to implement them, track and report illnesses among students, and promote the same activities we’re asking everyone to do in terms of personal prevention. 

Yesterday we talked a lot about vaccines and the movement towards vaccines and had discussion around growing up the virus so that we’re able to move towards production of a vaccine if we decide that is warranted.  And those efforts still continue to move forward quite successfully. 

Okay.  So in closing, I want to reiterate something that I said repeatedly.  What we call this is much less than what we do.  We continue to be very aggressive in our approach, and we’re going to continue to do that until the situation tells us we no longer need to do so.  There’s no one action that’s going to stop this.  There’s no silver bullet.  But all the effort, the effort of governments, the efforts of communities, the efforts of individuals will help to reduce the impact on people’s health, and that’s very important.  The actions will vary by community, and that’s a good thing.  We’ll learn from that, what things are more effective and what things are not a good use of resources.  Those things that aren’t a good use of resources we want to stop doing those so we can redirect our effort into things showing to work.  I know people are concerned and some people are afraid.  And it’s important that we do what we can to take those concerns and fears, handle them into personal action and personal planning.  Because it can be very empowering.  There are things people can do.  If people start doing these things in terms of hand washing, covering coughs, staying home when they’re sick, it will help not only for this, but when future respiratory illnesses come through, thereby a personal sense of responsibility that it is really not a good thing to try to do things that may spread that virus or infection in the community.

Lastly, I just want to let you know how incredibly proud I am of the people here at CDC.  This goes for the hundreds of people who are working around the clock on this outbreak control but also the thousands of people at CDC who are doing our daily public health work.  While we are responding to this outbreak, we are also doing the work of health in other areas.  I just want to acknowledge that here because they’re not here every day.  They’re doing the work.  And it’s really an incredible effort here at CDC.  And with that, I would like to take your questions.

>> Thank you.  Our first question comes from Maggie from Reuters.  Your light is open. 

>> Thanks a lot.  I would like to ask about the diagnostic tests.  What tests are available?  Can you tell us a little bit about this lab in Mexico, what its capacity is, how long it takes to test someone for H1N1, and where those tests are now so that we can judge a little bit more about the information that comes in, how long it will take to get a confirmation.  Thank you. 

>> Thanks.  Testing is an important part of this.  We may change our strategy around testing if we start to see more cases in the community.  We may look at not doing testing with each case.  But right now what happens is you go to your doctor with flu-like symptoms.  And if the doctor is concerned you might have H1N1 virus, they’ll take say swab in your nose.  That will be sent to a laboratory for culture.  And then from that there will be special testing done to see if this is the commonly circulating strains of flu.  If it’s not, it will be sent on to the state lab for confirmation for testing.  At this point, not every state is able to do the testing for the H1N1.  Up until I think yesterday CDC was the only place here that you could get that done.  We’re in the process of rolling out across the country testing capabilities to every state.  The reason we’re able to do that is that there’s been a major investment over the past five years in our state lab capabilities.  And so these labs are ready to go, when they get their test kits to ramp up and do additional testing.  And so maybe by the end of this conference I can tell you how many states have that so far.  But our goal is to get it out to all the states in the very near future.

>> Can you tell us does Mexico have a test now?

>> We have been working as part of the tri-national team and testing is now available in the laboratory in Mexico to confirm H1N1 disease. 

>> Thank you.  Craig Schneider from Atlanta Journal Constitution.  Your line is open. 

>> Can you tell me where Georgia stands in terms of having the rapid test and their ability to diagnose and so forth?  I understand Georgia, you know, does not have the vast reputation for the communication between doctors and state officials on reporting illnesses. 

>> As a Georgia resident and as a volunteer, I’ve had great experience with the Georgia health department.  But we will get information in terms of whether Georgia has that kit now and, if not, when that might be available.  Let me take a question here in the room. 

>> Thanks.  — Mexican health officials expressing optimism — what is your assessment of the situation in Mexico?  Is it getting better?  And also what’s your assessment of what’s going on in The United States, if it’s getting worse? 

>> I think it’s premature for me to comment on the situation in Mexico.  I’m really looking forward to seeing more data coming out of Mexico to get a handle on that.  What we’ve learned from Mexico will be very important for our situation here, in part to try and help us predict what we might see here in the future.  As I’ve been saying over the past few days, I’m trying to understand why they’re seeing a different picture in Mexico from here is really the critical question, whether it has to do with the steps that were taken early on in Mexico, a difference in the virus, a difference in the individuals sick, a difference in how long it took to go for care or the type of treatment given.  We don’t know the answers to that.  You know, I would love to hear and see confirmation that what you say is true, but I don’t have information one way or the other on that.  Here in The United States we’re seeing ongoing transmission, and that’s what we expect to see with the new flu strain.  A new influenza travels easily person to person.  So what I expect to see here is ongoing transmission in states.  What I expect to see here is a broader spectrum of severity.  We would love to see the same type of cases we’re seeing which is primarily the lessening of cases.  Again, people have growing medical conditions including viruses are not kind to people who have many underlying medical conditions.  Another question here in the room. 

>> Hi, Dr. Besser — from “The Wall Street Journal.”  A couple questions.  One is what is the latest you’re discovering about the virus in terms of the virulence or to other flu strands?  We know it’s a novel virus.  And I also wanted to ask how much better we are prepared with the pandemic — particular things that have been done — with this outbreak? 

>> Thank you.  It’s premature to say anything about virulence compared to other strains.  The virus is being shared and has been shared broadly.  And we look to the research community to be working on addressing those.  Dr. Buttar has been talking a lot about the contributions of NIH.  They’re revved up to be addressing those questions.  In terms of preparedness, it’s really hard to point to one thing.  When you talk about preparedness, you’re talking about systems, integrated systems and systems that are practical.  And pandemic flu, if you look at what we have been practicing for the past five years and what we’ve been planning for, pandemic flu was number one on what we were looking at.  And while micros don’t read the plan and you need to move away from the plan pretty soon after day one, the fact that we’ve been exercising several times a year for a pandemic and the state and local health departments have been getting tremendous resources for this, it has meant that when it arrives we didn’t have to sit down first and say, let’s talk about flu, here’s the things you need to look up for with flu.  And with a lot of emerging infections that’s where the conversation is starting.  What we find is that we can talk about concepts like community mitigation, which is a term for how do you control something in the community?  And the public health community knows what we’re talking about. They’ve been doing planning around that.  And that is — that’s a big piece.  The second piece is laboratory capability, that we have that around the country.  And it’s a precious resource and one that we need to maintain.  Next call from the phone. 

>> Thank you.  — your line is open.

>> Thanks so much for doing this.  I would like if possible to get a little more granularity on the planning for potential vaccine.  You talked yesterday about a seed strain being developed and distributed.  Can you let me know if it’s been distributed to all manufacturers and, if not, could you let us know which ones are participating?  Can you talk at all about how working on a seed strain will impact their production of seasonal flu vaccine for the coming year and whether that will work for their timeline?  Pretty much any other detail you might have. 

>> Sure.  I will tell you what I know on that and then I think we should share some additional information around that.  We are growing up the virus that would be used for manufacture.  So we’ve isolated the standard strain.  That being grown up for manufacturers.  It hasn’t been distributed to manufacturers yet.  You grow up the seed stock to a certain level, do pilot testing, look to make sure that what you have hasn’t changed at all, and then that’s able to move forward to the production stage.  In terms of production, what we are talking about, and these are still discussions, is that we would complete the production of next year’s seasonal flu vaccine so we would have next year’s seasonal flu vaccine.  And then manufacturers switch over to manufacturing of vaccines for this H1N1 disease.  That’s what we’re planning for.  We don’t need to make that decision right now.  What we need to be doing right now is growing up enough virus and doing the initial pilot test.  That’s about as far as I can go on that.  And tomorrow let’s have someone here to take some more details on the vaccine manufacturing.  We want to make sure in the vaccine manufacturing we are still able to protect the country from seasonal flu and be able to protect from this if we decided to do so.  Here in the room. 

>> — CBS Evening News with Katie Couric.  Have you done any computer modeling about how many people you think may be affected in the first strain and in 1918 people who were affected by the relatively milder first wave were actually protected when the more serious second wave came?  In that modeling if you’ve done it, have you ever thought what infection now might be protecting people from a potentially second deadly wave?

>> We have done pandemic preparedness.  We have modelers involved now who are giving us their advice and input.  And I think that modeling can take you so far.  It’s very helpful, too, as we consider various potential interventions.  So, for example, the issue of border closure and should you close a border or implement entry or exit screening.  Modeling has been helpful in showing what’s the added value of that.  And what it told us going into this was if you had a pandemic or potential pandemic strain and you implemented very quickly stringent entry screening, you might be able to delay the widespread dissemination in your country by a few weeks.  Now, a few weeks, that doesn’t sound like much.  But if you don’t have it in your border, that few weeks may allow you to do the kinds of things we’ve been doing now, implementing surveillance, distributing countermeasures, doing those kinds of things.  Once it’s already inside, as the president said last night, the horse is out of the barn.  So those measures don’t have any added value.  That’s helpful information as you’re trying to target your resources most appropriately.  The second question about what we know from history about early infections, and the really good one is a challenging one, is if you have a mild infection now it could protect you when the strain comes back at a later time, if it came back at a later time as a more serious strain.  And we don’t know the answer to that.  But it’s something that we’ll be thinking about and looking at.  We’ll be looking to see did those people who had mild infection amount a significant immune response.  It’s hard to predict that if this goes away whether it will come back more severe or like the virus in 1976 would it go away and not come back at all.  So those are some of the discussions that we’ll be able to have once we’re able to knock this one out when we’re moving on to discussing vaccine policy.  Now, I think that as many modelers as you’ll have you’ll have that number of estimates.  It’s useful information, but there’s no number that we have that we’re using.  Yeah? 

>> Hi.  Is it safe to fly?  I ask that because today on the “Today” show, vice president Joe Biden said if it were his family members he would tell them not to fly at all, that it’s not safe.  And what can you tell us about the reported case in west Georgia? 

>> All right.  I think this is what we call in public health a teachable moment.  In terms of what things are indicated and what things aren’t.  There’s a lot of things that we can do to try and reduce our risks.  A lot of things people are doing on their own.  For us in public health it’s important to say what things are evident-based, what things can you do to put yourself at risk and what things can you do to reduce your risk.  In terms of flight, if you have a fever, flu-like symptoms, you should not be getting on an airplane.  That is part of being a responsible part of our community.  You don’t want to put people at risk.  I think flying is safe.  Going on the subway is safe.  People should go out and live their lives.  There are some people who may not be comfortable doing that.  As a public health community, we can put in context what the risk is.  People are doing things to reduce their risk, hand washing, covering of the cough, avoiding ill people.  And if we look to each other to be responsible and not get on airplanes and places when we’re sick, that makes everyone else safer.  In terms of a case here in Georgia, I’d refer you for details on that to the Georgia health department.  They did recently confirm they have a case of H1N1 in Georgia, but I can’t say anything more about that case except they have announced that they have a confirmed case here in Georgia.  Take a question from the phone, please.

>> Thank you.  Steven Smith from the Boston Globe.Your line is open. 

>> Hi.  Good afternoon, Dr. Besser, and thanks for taking the question.  I’m wondering if you can discuss in the week or so that agencies have really been into this what the most important telling scientific discoveries are regarding the virus.  In other words, what have you learned further about its transmissibility, what have you learned about it being capable of in any way of changing its genetic machinery, what are you seeing about its accessibility to anti-virals?

>> I can share a little of that, and then I think tomorrow we’ll have one of the experts from the laboratory come and give you more details on that.  We are seeing strains of the virus.  What we’re looking for is there change as it moves through communities.  And we are seeing slight changes.  But at this point we’re not able to take those changes and say anything about whether it impacts on how severe the infection is.  But that’s going to be very important.  We want to look at as the virus goes person to person, it impacts on how serious an infection could be.  What you would like to see is it’s decreasing as it goes person to person.  We don’t have information yet to link the particular strains that someone has to the seriousness of the infection.  We only have 109 confirmed infections.  We’ll be looking at that.  But we haven’t seen any change in our ability to use the current anti-virals.  We haven’t seen any changes.  That’s something that we’ll continue to look for.  Tomorrow let’s have one of those laboratory experts here to provide more on that.  One of the answers to the question about testing kits, we have a preliminary kit in New York and California.  These are at the research levels to make sure the kit is operating properly.  And then we’ll be sending out kits starting tomorrow to all states, assuming that the research kits that we sent out are working properly.  Whenever you’re developing a new diagnostic you want to make sure it’s working and can work as well as what we have here.  So that’s what’s going on currently.  All right.  Here in the room. 

>> Conley from the “Washington Post.” 

>> I’m wondering if there’s any value in a situation like this in doing any autopsies and if anybody has given thought to that, with the Mexico cases or the one in The United States were related.  Do we know what the actual cause of death has been in most of these, and does that help you in any way by knowing that? 

>> The first question regarding autopsies, there is a lot that can be learned when you’re looking at a new infectious disease of doing autopsies.  They can tell you something about how the infection is causing — is seized and how it’s causing its symptoms.  I don’t have information to share in terms of cause of death.  And I think behind your question is some of the thoughts that in 1918 the pandemic that some of the issue in terms of the high rate of death in the young/healthy was their own immune system revved up and was part of the problem.  That’s a really good question.  That’s something people are thinking about and we’ll be looking for, to see whether the it’s the infection itself, whether its autoimmune reaction to that or whether it’s moving on later.  In earlier pandemics there were bacterial infections afterwards that were a problem.  We have no information on those right now. 

>> I’m assuming it gets a little trickier with other countries. 

>> I’d rather not comment about that particular child or case.  From the phone? 

>> Richard Knox from NPR.  Your line is open.

>> Thank you very much, Dr. Besser.  I wonder if we can find out anything about whether the emerging evidence that the WHO seemed to indicate today of community transmission being seen in New York or elsewhere beyond schools and families of returning travelers from Mexico, any evidence of transmission like casual contact in the community?  And secondly, I wonder — you mentioned there were hospitalized people now and are confirmed cases.  Can you tell us any more about if any of those are critically ill or on ventilators? 

>> I don’t have additional information to share on the hospitalized cases.  I refer you to the state for more information.  And I don’t know if we have it on our website.  Okay.  I don’t have additional information to share on that.  The studies that are going on in the particular states are looking at the issue of transmission to try to understand that dynamic.  We definitely have cases occurring in many states that aren’t related to other clusters.  And how casual the contact was, I don’t think we have information on that.  But our experience from influenza virus in particular is that it’s a virus that spreads pretty easily person to person.  So it doesn’t require as a virus that you have to have close personal contact to acquire it.  It tends to spread fairly easily.  And so we’ll be looking to see whether that’s the case.  But we would expect that it would transmit easier in crowded settings.  Less so in areas that are less densely occupied.  But we don’t know yet how easily.  And the big question is how easily does it transmit.  And those infections are transmitted, are they more serious, less serious and so on.  And we don’t have information to share on that yet.  Two more questions from the phone and then we’ll come back here to the floor.

>> Thank you.  Alice Park from “Time” magazine.  Your line is open.

>> Yes.  I’d like to go back to the vaccine question.  Dr. Besser, is it your opinion that were a vaccine to be created from that seed stock that you’re working on now, that it would be applicable to pieces that are occurring now or as a result of the transmission that’s occurring now or because it takes so many months that we would be looking forward to try to prevent any additional spread of this virus and strain of flu next flu season.

>> We’re hoping to see the transmission now go away with the efforts that are under way.  And with what we know about flu virus transmission, be ready in the fall to vaccinate people if we decide that that is warranted.  And so that would be the plan to work towards developing a vaccine.  It can be administered in the fall if we felt a vaccine administration was the way to go.  Next question from the phone.

>> Thank you.  Steven Ricart from Health Day.  Your line is open.

>> Yes.  I wanted to ask you many outbreaks — there are many more people who are sick but don’t seek medical help.  Sometimes I think that averages 30 to 1.  Do you have any idea what that could be in this case? 

>> They are sick? 

>> They are sick but don’t seek medical attention. 

>> Yeah.  I don’t know.  That’s a tough question.  When there’s an outbreak going on, you can either see people sick who won’t take medical care but often will see individuals who are sick or are a little sick and they’re concerned because of what they’re hearing and they want to be evaluated to make sure that’s not going on.  So we don’t have information on that phenomenon.  We are doing monitoring of E.R. visits in many places across the country as part of a different surveillance systems that are in place.  But I don’t have data that I can pull up of emergency room visits.  And last question here from the floor. 

>> I was wondering if we go ahead, if we make the decision to go ahead with the vaccine, what is involved?  How much time will it take and how quickly can you get something on the market where Americans might be able to get access to it? 

>> We would be targeting the fall.  And then the question is who gets vaccines?  Who do you vaccinate for flu?  And there would be looking to see what we learned now in terms of who are the groups that are at greatest risk from having bad outcome from the flu.  But then we would also want to engage in public discussion around that and to the engagement and input.  It’s less of a science decision than it is societal decision.  Because clearly we would not be looking or able to have vaccine for 300 million people.  And let me put that in context as well.  We’re a resource-rich nation.  And when you’re seeing a new infectious agent, it doesn’t respect borders.  And so part of the discussion is around what is our commitment here, what is our commitment as members of the global community.  And this is something that will undoubtedly require a lot of discussion and public input to see where we want to go.  Thank you very much for your time. 

>> Thank you for joining today’s conference.  You may disconnect at this time. 

End

Department of Homeland Security press release on H1N1 swine flu – transcripts 4/29/09

(Constant Swine Flu updates including links to current press releases may be seen here)

Remarks by Secretary Napolitano at Today’s Media Briefing on the H1N1 Flu Outbreak and the U.S. Government’s Response

Release Date: April 29, 2009

For Immediate Release
Office of the Press Secretary
Contact 202-282-8010
Washington, D.C.

Secretary Napolitano: This is the daily briefing to bring everybody up to speed on where things are with respect to the 2009 H1N1 virus.

The three of us just returned from the Hill. We testified—at least, [Centers for Disease Control and Prevention Interim Deputy Director for Science and Health] RADM [Anne] Schuchat and I testified—before the Senate Homeland Security Committee, and then the three of us were present for a bipartisan briefing at the United States House of Representatives to make sure that the members of Congress are being kept up to speed. And of course, I am delighted to be joined today by the Secretary of Health and Human Services, Kathleen Sebelius, because I have a feeling we’re going to be joined at the hip on this for quite a while as we move forward.

As you know, and I’m sad today to report, that today we had our first confirmed death as a result of the H1N1 virus in the United States. It was a 23-month-old child, and our sympathies go out to her family out of this. But as I said and have been saying, this is a flu, and a flu cycle. We think we’re at the beginning of a flu cycle, which typically brings with it some severe illness and death. Indeed, in the normal seasonal flu cycle, we will have about 36,000 deaths in the United States. That’s a fact that surprises many. But it is part and parcel of an influenza cycle. So our thoughts are with those who have contracted the virus now, and of course for the family of the child who died.

We now have 10 states with confirmed incidents of H1N1—Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York, Ohio, and Texas. We are likely to see more states, more cases, and some more hospitalizations over the coming days, and we are prepared for that.

Every American should know that we are aggressively responding to this outbreak. Antiviral medications are en route to states to supplement their own stockpiles. Indiana, New York, New York City, already have their allocations. Several other states will receive their allocations by today. And all states will receive theirs no later than the third of May.

Let me point out an important difference here. There’s been some confusion between antiviral and vaccine. A vaccine is administered to prevent the flu from occurring. An antiviral is occurred after you get sick to mitigate the symptoms so that you feel better. So it is the antiviral stockpile that I’m referring to now.

We’re also actively monitoring travelers at our land, sea, and air ports. We’re watching them for signs of illness, and we have appropriate protocols in place to deal with those who are sick. Precautions are being taken to protect travelers and border personnel. Anyone exhibiting symptoms is being referred to an isolation room where they can be evaluated by a public health official before proceeding to their destination*.

I know there have been some calls to close the border. I want to address that directly. First of all, it is important to know that we are making all of our decisions based on the science and the epidemiology as recommended to us by the Centers for Disease Control. The CDC, the public health community, and the World Health Organization [WHO] all have said that closing our nation’s borders is not merited here, that the focus, the public health focus, should be on mitigating the impact of this virus. And so we are following those recommendations now.

As I said, we continue to actively monitor those coming across the borders and at our airports, as we’ve been doing all week. And we are also distributing flyers and public health information to individuals. As of today, Customs and Border Protection has referred a total of 49 suspected cases to the CDC or state and local officials. All the results have been negative, except the eight that are still under study.

I know that in addition to travelers, many parents across the country are concerned about school closures, and President Obama spoke about this earlier today. The Centers for Disease Control has recommended that schools with confirmed cases of H1N1 virus or schools with suspected cases linked to a confirmed case consider closing on a temporary basis. Some schools have already followed that advice. The best thing parents can do right now is to make sure you have a contingency plan in place so that you’ve made arrangements to care for your child in the event of a school closure.

This is also a good reminder for businesses to think about contingency planning as well.  As I said, we’re going to be working through this for a while. You have to anticipate what happens if you have employees who are parents. The schools have closed. The employees need to stay home. How do you continue with your business operations? And so all of us should be dusting off our business contingency plans, looking at things such as telecommuting and the like so that operations keep on going.

And of course, we advise anyone with flu symptoms to stay home or consult a doctor if you have severe symptoms. This is a problem that every individual can help us with by adopting common sense solutions or precautions. Cover your mouth or nose when you sneeze. Don’t go to work or school or go on a plane or a bus if you are sick so that you don’t communicate the disease to others. And wash your hands often.

I know that the Secretary of Health and Human Services is going to have more to say on that topic and on others, so let me close here and ask Secretary Sebelius to come forward.

###

*corrected typo; changed destruction to destination

CDC press release on H1N1 swine flu – transcripts 4/28/09

(Constant H1N1 Swine Flu updates including links to current press releases may be seen here)

CDC Briefing on Public Health Investigation of Human Cases of Swine Influenza

April 28, 2009, 2:30 p.m. EST

Before I start, I wanted to call the media’s attention to three new e-mail addresses that we have brought online today to help us manage, as you can imagine, a relatively high volume of media requests.  And so we have tried to structure this.  And again, we’ve never done this before, so it’s going to be a learning experience for us as well.  We’re hopeful this will help us help serve your needs as well.  So we have established three new media websites.  Or e-mail addresses.  The first one is mediaswineflu@cdc.gov.  If you work or for print media, we encourage that one.  If you work in radio, use radioswineflu@cdc.gov.  Television, use tvswineflu@cdc.gov.  We have people assigned to each of those different e-mail boxes.  That’s how we were trying to manage this from a media relations perspective.  This afternoon it will be led by the acting director of disease control and prevention.  I will turn it over to Dr. Besser. 

>> Thanks very much, Glen.  Thank you for being with me today for this update on the swine flu outbreak.  As I’ve been saying over the past couple days, this is a situation that is rapidly changing.  We continue to respond aggressively based on what we know and trying to stay ahead of the outbreak.  Our goal remains to minimize the impact of the outbreak on people’s health.  So where are we today?  I wanted to start with the case update.  This is on our website.  There are 64 confirmed cases in the United States in five states.  45 in New York, one in Ohio, two in Kansas, six in Texas and ten in California.  As I’ve been saying, numbers when it comes to an outbreak like this will change.  And through the day you’ll hear different numbers or newer numbers from states.  We will continue to update our numbers once a day for consistency.  But you will find with that that some of our numbers may lag behind what you’re hearing from a particular state.  If you want information about cases in a particular state, the best place to turn for that information is to that state because they’re on the ground.  They’re the ones who are working to investigate and implement control measures.  There are five — there have now been five hospitalized cases.  As I’ve been saying, as we continue to look for cases, as this flu virus infects individuals, we will be seeing a broader spectrum of disease.  What we see in the United States, or have been seeing so far, has been milder, has been less severe than what has been reported out of Mexico.  And as we continue to look, we will continue to monitor that.  So there are five hospitalized cases, three in California and two in Texas.  The median age is 16 years to 64 years.  We expect to see more cases and will continue to report on those.  As we move forward, we may start to move away from specific case numbers and more on to describing states and clusters.  The incubation period in the United States appears to be about two to seven days, which is typical for what you see with an influenza virus.  I want to take a moment and put this into context with seasonal flu.  Many of you are well schooled in influenza and have been covering seasonal flu.  But what we see with seasonal flu is that it can be unpredictable.  On average, in the United States, each year from seasonal flu, we see approximately 36,000 deaths.  And so influenza is a severe infection.  It affects different people differently based on their own immunity, their ability to fight infection and factors around the virus.  Preventive measures, as we’ve been talking about, can help reduce spread and help protect individuals from getting the infection.  Yesterday I talked about the World Health Organization changing the phase from three to four.  And I talked about what that means.  And from our perspective here in the United States, it has very little meaning.  What we do means a lot more than what it is called.  And what we’re doing is being very aggressive, looking at what’s going on at the community level and adjusting and adapting our guidance and our actions based on what’s taking place on the ground.  Let me review some of the many actions that CDC is involved in around the country.  We continue to work with state and local health departments.  We have teams on the ground in Texas and in California.  We continue to work with the World Health Organization, the Pan-American health organization, Canada and Mexico.  Yesterday we issued a travel advisory to Mexico.  That is recommending that nonessential travel to Mexico be postponed.  For individuals who must travel to Mexico, we posted guidance on things individuals can do to reduce their risk of infection while they are there.  We have posted new treatment guidelines.  These were developed in conjunction with the infectious diseases society of America and the advisory committee on immunization practices.  Those groups have provided us with excellent guidance for treating individuals who have swine flu.  It’s important to remember with the guidance documents, because there are a lot on the web, there’s more than a dozen guidance documents that we have put up on the web, and we continue to generate more guidance, guidance is interim.  We change our guidance as we have more information.  And we’re going to continue to do so.  That’s very important.  As we learn something, as it could impact on what public health is doing in the community or what individuals can do, we’re going to change the guidance so that people have the most current information right away.  We continue to deploy material from the strategic national stockpile.  And I talked about this yesterday.  It includes antiviral drugs.  It includes gowns and masks and things that could be used in hospitals to take care of patients.  And this is a forward-leaning step.  There are certain states that have cases, and there are many — most of the states have not yet reported cases.  But every state has requested their portion of the strategic national stockpile, and we’re in the process of delivering that.  And why are we taking this action?  We’re doing so because with any new infectious disease, with any emerging infection, you really can’t predict the course.  And so this is to ensure that if these drugs are needed, states have them on hand, and they don’t have to wait.  There won’t be a delay between the time that they need those drugs and request them and their delivery.  People are concerned, and we’re concerned.  And concern is a good thing.  Concern is especially good if it drives planning and it drives action.  And that’s what we’re encouraging people to do.  At the personal level.  People are concerned, and they say, what can we do to make ourselves safe?  What can we do to protect our family?  And there’s a lot people can do.  Simple things to prevent respiratory infection.  Hand washing.  We say it every day.  People will get tired of hearing it because we are always going to say that.  Hand washing, use of alcohol hand gels can reduce the spread of viruses.  And if people take that step, that can reduce the risk that they’re going to get an infection.  Covering your cough.  Not with your hand, but with your arm or your shoulder.  That can reduce the likelihood that you are going to transmit a virus.  And it’s very important that people follow what we call home isolation practices.  What that means is if you’re sick, if you have a fever and you have flulike illness, stay home.  Don’t go to school.  Don’t send your children to school.  Don’t go to work.  Stay home.  So that you can get better, and you’re going to be less likely to spread the infection to somebody else.  We’re asking in areas where there’s confirmed cases — if you are a confirmed case of swine flu, that not only you stay home, but that the rest of the family think about staying home as well.  Not because they are sick or definitively know that they’re sick, but because there’s a chance that they could be brewing the infection.  And by not spending as much time in the community, they, too, can help reduce the likelihood of transmission.  We’re going to see different actions taken in different communities.  And people are going to question that and say, is that a good thing?  It is a good thing.  We expect and we hope that public health professionals are going to tailor their actions based on what’s going on in their particular communities.  We are in contact with communities that have had cases.  We are working with them and providing our recommendations.  But what you’re going to find is that the people on the ground in a community know that community best and are in the best position to help tailor the recommendations and the actions that are taken.  So in summary, as we move forward, I want to stress that the label of what we call this means a lot less than what we do.  And we continue to be very aggressive.  No single action that somebody takes, whether it be the government, a community, a family or an individual, will halt this.  But the combined actions that we all take together will reduce the impact on our communities and on our health.  It’s a shared responsibility, the things that all of us can do, individuals, families, communities and government.  And I want to thank all of you for covering this story and getting the message right.  I see time and time again those messages of what people can do.  Those are empowering.  And at a time where there’s a lot of uncertainty and a lot of concern, empowering people with those messages of what can you do is really an incredible public service.  And so I want to thank you for that.  And I want to stop now and take your questions.  We’ll start here in the room and then we’ll take a couple here. 

>> Hi, Doctor.  Fox News.  Can you report on the Los Angeles coroner’s office is investigating two deaths to see if they might have been caused by swine flu? 

>> That is not something I’ve heard.  But as I continued to say, as this moves forward, I fully expect that we will see deaths from this infection.  They’re seeing many deaths in Mexico, and we’re trying to learn more about that and why the situation in Mexico is different from here.  And as we continue to investigate cases here, I expect that we will see deaths in this country.  But I don’t have any information on that situation. 

>> Okay.  My second question is I see the state of Indiana is reporting that they have a confirmed case of swine flu which is not included in your total.  Are you guys — how does that work?  Are you coordinating with the states? 

>> We are.  And that kind of gets back to the numbers game that I was dealing with earlier.  You know, it depends when that case was confirmed and reported.  If it has been a confirmed case and it’s been reported and it was after our deadline for our reporting, you’ll see it on our site tomorrow.  So I’d recommend that you go to Indiana on that. 

>> Are you involved in confirming? 

>> Right now we’re involved in confirming each case.  But, you know, the good news is that test kits are coming to states so that confirmation will be able to take place at the state level.  The FDA has been very proactive in forward moving in approving test kits for testing for swine flu.  That’s going to lead to more rapid confirmation.  There’s been a tremendous investment around the country in preparedness.  And a large part of that was on the laboratory systems and state health departments.  And so we’re quite pleased that the state health department lab system is going to be able to serve that important function. 

>> Thanks.  Mike from the A.P.  Hi, Doctor.  Can you tell me more about the five hospitalizations?  Like how old were they?  Did any of them have underlying conditions?  Were there co-infections involved?  Why were these people hospitalized?  What do we know about that? 

>> No, for that I’m going to need to steer you to the folks in California and Texas for information about individual cases.  They’re doing those investigations and can provide you with the most up-to-date information.  I can’t comment on that.  I wouldn’t want to misspeak.  It is — you know, one of the critical parts of investigating a new outbreak is looking at cases in the spectrum of disease and trying to see if you can understand why some people have more of a severe course than others.  And so there will be a lot of attention, and there is a lot of attention being made to hospitalized cases.  But I don’t have information on the specific cases that were occurring in those states.  And they can provide that for you. 

>> Thank you, Cece Connolly from “The Washington Post.”  Can you tell us on if you have working hypotheses why the cases in Mexico have been so much severe.  What do we know about either the sequencing there or the medical facilities or the underlying health of the population?  Can you give us some of your working hypotheses? 

>> You’re hitting on them right there.  And at this point we haven’t been able to rule out or rule in any hypothesis.  When you’re looking at variation and impact of an infectious agent, you look at the host and see, okay, could there be host differences and why some people in Mexico are getting sicker than people here?  You look at the pathogen, and you look at the virus itself and say, has the pathogen, has that virus changed as it’s infected people in Mexico and is now infecting people here?  And then you’ll often look at the environment and the context in which the infection is occurring and seeing, has that had some modification on the impact?  We’re looking at all those things.  So in terms of the host, you’ll look at the immune status of individuals.  You’ll look at the age.  You’ll look at the gender and see if there’s anything there that can shed some light.  You look at the treatment practices and see is there a difference in either how these individuals self-treated when they had an infection, how long people took to seek care, and whether there was a longer delay to seeking treatment.  What type of treatment was received when they came initially to the hospital?  Was flu something they thought of?  Did they quickly get an antiviral?  Were there other treatments that were given alongside of that that could account for the differences?  So those are some of the theories we’re looking at.  Looking at the virus and, you know, the idea that perhaps there’s been a change in the virus would be a very comforting thing if we were able to find that to see that the virus was changing and becoming less virulent, less severe.  Right now it’s premature.  We don’t have any evidence of that, but that’s one of the things that will be looked at.  You’ll look at the virus as it has — what’s called serial transmission.  So if someone has that infection, they pass it on to somebody else, and somebody else.  If you get viruses along the way and can look at those, that can give you a sense as to whether — as it moves from person to person, it’s changing, becoming less severe, more severe, or no change at all.  And that is all very important information in trying to help us predict the course and guide the interventions that are undertaken.  Some questions from the phone. 

>> Thank you.  Again, on the phone lines to ask a question, please press star one.  As a reminder, due to the high interest in today’s topic, please limit yourself to one question.  Alice Park from “Time” Magazine, please go ahead. 

>> Yes, thank you for taking the call.  My question is about the vaccine.  Could you please update us on exactly where the process is?  I think you mentioned you were preparing it.  Has that been finalized?  And secondly, can you address how things might be done differently in preparing a vaccine this time around than had been done in ‘76, the last time we tried to create a swine flu vaccine? 

>> Thanks for that question.  So when you think about a new strain of flu, one of the things that we look at is how is the best way to control for that right now, and how — what is the best way moving into the future?  Right now we don’t have a vaccine that can treat this strain of flu.  The seasonal flu vaccine is a great vaccine.  But it doesn’t protect against the strain of flu that was not circulating at that time.  And at this point we don’t see that there was protective value from that vaccine for this new strain.  Moving forward, though, into the future, vaccine is something that we are looking at very intently.  And as I said before, we’re growing up that seed stock of virus so that if we decide to manufacture a vaccine, we are ready to do so.  And that’s moving forward.  We’re moving forward aggressively so that if a decision is made that we need to rev up production to make that vaccine, we would be ready to do so.  And so there’s active discussions going on about that.  We’re mapping out the decision points.  And we are right in line in terms of the steps we’re taking.  It will be a matter of us deciding not to make a vaccine rather than deciding to move forward.  What we’re doing now is very proactive in terms of growing up the seed stocks for a vaccine.  And so if there’s a decision that, yes, we want to turn production towards making this, we’ll be ready to move with that, and we’ll implement that.  Another question from the phone? 

>> Thank you.  Elizabeth Weise, “USA Today,” please go ahead. 

>> Thanks for taking my call.  A quick follow-up on the vaccine production.  Have you given some of that seed stock to vaccine companies at this point? 

>> Let me get back to you tomorrow with more details on that.  I think that the seed stock is still currently in our control.  But I need to look and see more information on that.  I know it’s being grown up, but I can get back to you in terms of where we are with that stock.  Question here in the room. 

>> Hi.  Daniel Steinberger with CBS news.  First question, school closings.  Do you guys have numbers on that, and is that something you’re looking at or guarding against, you’re concerned about? 

>> One of the recommendations we have on our website in terms of community mitigation, community control, is that if you have a case of swine flu in a school, that you dismiss the students until you have a better handle on transmission in that community and control efforts.  I can’t tell you how many schools have been closed.  That’s a fluid number.  I can tell you that New York City undertook that with the cluster that they’re dealing with, and in Texas with the cluster they were dealing with, they closed schools as well.  I’m not aware of which other areas have closed schools. 

>> Also, you talk a lot about being concerned and acting aggressively and giving tips to people.  At what point do you move beyond concern?  What will it take for the CDC, for the World Health Organization, to move beyond concerned and be afraid or be, you know, very concerned or whatever word you would classify that? 

>> I would say I’m very concerned.  You know, we are — we are dealing with a new strain of influenza.  We’re dealing with a strain of influenza that appears to be moving through our community.  We have this documented in five states.  We’re very concerned.  And because of that, we’re acting very aggressively.  And as we learn more, and if we determine that there are other steps that we could take to help further control that, we’re going to take those steps.  With a new infectious agent, you don’t sit back and wait and hope for the best.  You take bold steps, and then you pull back if you need to.  We are in a pre-pandemic period.  And, you know, that gets to the what do you call this?  And that isn’t very relevant to us since we are an affected country.  That terminology is much more relevant if you’re seeing a cluster of infection somewhere else in the world, and you’re wondering, is this something that’s going to spread from country to country?  When I first started out at CDC as an epidemic intelligence service officer, it was during the cholera pandemic back in the early ’90s.  And we were using the term “pandemic” very readily, and we were looking to see that that strain of bacteria was spreading from country to country.  And it was a pandemic, but it wasn’t in the United States.  And so our approach at that point was there’s a cholera pandemic going on.  What can we do to control it at our border from coming in here?  And I spent time on the border doing education around here’s what you look for for this.  This is a very different situation.  And it’s different because this virus is here in the United States.  And so it changes our control strategies, and it changes our approach. 

>> Hi, Beth Galvin with Fox 5 News.  I was wondering worldwide, do we have an idea of the extent of this virus, and do we have a better idea of how it seems to be moving from person to person, not including people who were in Mexico, moving beyond that. 

>> Right.  You know, two questions.  One, the global picture.  I know that Canada is reporting cases.  I’d refer you to the World Health Organization site to see which country, in particular, are reporting cases.  But we’re hearing through the media of confirmed reports, and we are getting information from World Health Organization.  But again, I’d rather not comment on the data coming from another country.  It does appear that more and more countries are reporting suspect cases.  And as they do that testing, I would expect that we’re going to see that this virus is in many different countries. 

>> [ Inaudible ]

>> Right.  What you do as part of a case investigation when you have a case of flu is you look for any signs of transmission within families or close contacts and circles.  And the information that we’re seeing from the states and locals who are doing that is that this appears to be acting like a normal flu virus which has a fairly high rate of transmission in families.  So they’re seeing people who have either colds or respiratory infections or flulike symptoms.  But the only case in the United States where we have confirmed with virus, person-to-person transmission, was one situation in Kansas.  But that’s not reassuring in my mind.  That’s just a reflection of what testing has been done.  I expect that we are seeing transmission within families, and that is consistent with why we put out the guidance we did about trying to limit transmission within a family to try and prevent that from going further in the community.  More questions from the phone? 

>> Thank you.  Maggie Fox, Reuters.  Please go ahead. 

>> Hi, can you characterize how far back in the past we’re looking at when the latest onset was?  And has there been in blips in pulse net giving us an idea of increased respiratory disease? 

>> Maggie, you’re going to have to hit me with that once more.  Are you looking for when was the first case? 

>> No, when’s the last case.  I’m trying to get a grip on how far back in the past.  I don’t think you guys have any indication of whether it’s actively spreading still, right?  These are past cases that are being investigated.  When was the last onset of illness that you’ve got, and has there been any blip in the surveillance for new hospitalizations for respiratory disease? 

>> Yeah, I’ll need to get back to you with onset dates.  You know, we are seeing active investigations going on in states that are not all retrospective investigations.  What we’re hearing about from state and locals is ongoing respiratory illness that is consistent with swine flu.  And so it’s very important that people understand the signs and symptoms of swine flu.  And if they have those, if they have fever, if they have respiratory symptoms and muscle aches, some may have diarrhea or nausea, that they contact their doctors and be properly evaluated.  In particular, if they’re either connected to a group of other cases or if they’ve traveled to an affected area, in particular, Mexico.  Another question from the phone? 

>> Thank you.  Steven Smith, “Boston Globe.”  Please go ahead. 

>> Hi, Dr. Besser, thanks for taking the questions.  A quick point regarding flu or flu vaccine against the swine flu.  Are you thinking in terms when you talk about revving up production that this would be a vaccine specifically for this strain of H1 or N1, or would there be some way to combine protection against this strain in the seasonal flu that’s already under production in the strains that were selected in February?  And a second question.  When you were talking about some of the major questions still hanging on transmissibility, virulence, can you describe how CDC is going about its hunt for answers to those questions, those in the United States and abroad? 

>> Sure.  Your first question had to do with vaccine and vaccine strategies.  And there are a couple different approaches.  One would be to look to see, can you add another strain of flu to the seasonal flu vaccine?  And that’s an attractive approach in that you would have one vaccine that is covering not just seasonal flu but this new strain that’s circulating.  If that’s possible, that would be great.  We do know, though, that seasonal flu vaccine production is moving forward.  And we don’t want to do anything that would delay production of vaccine for that season.  But that is something under consideration.  We’re also looking at the production of what we would call a monoval, or single vaccine, against in particular strain.  And that would not impact on the current production activity around seasonal flu, but at some point, we would need to rev up that production.  And we’re laying out those time lines to see when would we need to make that decision, get that into production to have it here for next flu season.  There are a number of different courses that we could see with this outbreak.  As many have reported in some situations where there has been a pandemic, they’ve seen an early way that was not very — was not very aggressive.  You’ve seen that go away, and then the next flu season, they’ve seen it come back.  And so that’s something we are keeping in mind.  And that will factor into our decisions as to whether to manufacture a vaccine for controlling this outbreak.  Your question about studies, there are long lists of studies.  And scientists around the country and around the globe are determining what are the most relevant and appropriate studies.  There’s an incredible amount of collaboration in terms of sharing of the strain of flu and sharing ideas around investigations.  We are participating as part of a tri-national team, looking at disease, looking at transmission in Mexico.  We’re also very engaged with state and local public health here in defining what particular studies could we do, should we be doing in these early cases and early clusters to help inform our future decisions?  You know, we’ll be looking very closely to see how effective is school dismissal in halting transmission?  Is that an effective strategy?  Each of the things that we’re doing, we’re trying to evaluate as we go so that when other communities are faced with the same situation, they’ll have more information on which to make their decision.  Another question from the phone? 

>> Thank you.  Yuki Noguchi, National Public Radio, please go ahead. 

>> Yeah, I wanted to ask you about the outreach efforts.  It seems like the social media, your social media has really taken off.  And I’m wondering what kind of response you’re getting from that and what you’re learning from that experience. 

>> That’s a great question, and I hope to be able to give you a little more on that tomorrow.  Communication around this, this outbreak, is so important.  It’s important that people have information.  They know where to turn for information.  Our CDC website, www.cdc.gov/swineflu has current information on the outbreak.  It has case counts.  It has links to World Health Organization, all of our guidance information, information for the public.  We have a Spanish language website.  We are putting up and have put up podcasts so that that’s another way to get information on this outbreak.  But use of the blogosphere and the rest of the new media is also a very important part of communicating nowadays.  And I want to get back to you tomorrow with more information on what we’re doing in that domain. 

>> Hi, Diana Davis from WSB here in Atlanta.  Other than the signs and symptoms that you gave a few moments ago, is there any one thing at this early stage that stands out that can help either adults or parents of young children differentiate whether or not they need to see a physician?  Fever?  Onset?  Degree of fever?  Anything at this early stage? 

>> One — one positive aspect in terms of timing is that we are — we are at the end stages of our seasonal flu period.  If this outbreak had occurred in January or February, it would have been very difficult to detect because of all of the flu activity that’s normally going on.  And so to say to every single person who had flu, they should see their doctor, would mean that a lot of people who have seasonal flu would be flooding doctors’ offices and other points of care.  There isn’t anything that we’ve identified that distinguishes this type of flu from seasonal flu.  And so those signs and symptoms, in particular, in individuals who have traveled since we do have an association with the outbreak in Mexico, that can be helpful.  But I wouldn’t limit it to that because it’s really a minority of cases to date that we’ve been able to identify that travel history.  And that, again, is information that makes us think that this is traveling from person to person and not just everyone that’s gone to a spot where this is taking place.Two more questions from the phone? 

>> Thank you.  Rob Stein, “The Washington Post,” please go ahead. 

>> Thank you for taking my question.  Yesterday the WHO was talking about mitigation.  I was wondering if you could explain a little bit about what’s meant by that, and what exactly are you doing or would you do to mitigate the impact of this virus? 

>> Thank you.  When we look at global pandemic planning — and again, we’re in pre-pandemic phase four — in global pandemic planning, the initial concept is if you could identify an outbreak in its first spot, where it was first kicking off, you could send in teams and try and quench it, try and contain it, try and knock it out.  And that’s been a lot of our strategy around avian influenza, with surveillance, trying to look and investigate every cluster that’s been taking place around the globe.  That is not a feasible strategy here.  And it’s not a feasible strategy because by the time this is identified, we’re already seeing this in a very diffuse, very wide geographic area.  We’re hearing of cases from many different parts of Mexico.  We have five states with confirmed cases here.  And we’re hearing of many countries around the globe that have suspect cases.  And so the idea of containment, meaning keeping it to one little place, is not feasible.  This is a virus that spreads easily, person to person.  Influenza viruses, in general, again, we’re learning more about this virus, but they spread easily from person to person.  And in general, they can spread before a person is symptomatic.  Again, here we need to look at the transmission with this particular virus.  I wanted to give answers to two questions that I received earlier.  The earliest onset date for a case here was March 28th.  The latest onset date for a confirmed case in the United States is April 24th.  But, again, there’s ongoing work, and we don’t have any evidence that there’s not been transmission since April 24th.  If we’re looking at an incubation period of about two days, there’s a lag time before cases will present.  And then the question about vaccine feed, it has not gone to the manufacturers at this point. 

>> One more question. 

>> One more question from the phone, and then the last question here in the room. 

>> Thank you.  Lauren Neergard of the Associated Press, please go ahead. 

>> Yes, can I ask if you are abandoning the term “swine flu”? 

>> You know, there’s a lot of discussion around what to call this.  In the public, we’ve been seeing a fair amount of misconception, that by calling it swine flu, there could be transmission from pork products.  And that’s not helpful.  That’s not helpful to pork producers.  That’s not helpful to people who eat pork.  It’s not helpful to people who are wondering, how can they get this infection?  When they hear that term, some people think this is transmitted that way.  And so we’re discussing, is there a better way to describe this that would not lead to inappropriate actions on people’s part?  So I don’t know what decision will be made on that.  But any information you can share that this — when it’s described as swine flu, that’s the origin of the strain or one of the components of the strain.  And not a reflection on how the disease is spread currently.  Last question here in the room? 

>> I understand that President Obama has requested $1.5 billion in emergency supplemental funding for swine flu.  Do you know if that’s all destined for CDC?  Did you make that request up the food chain?  Do you know what it’s for? 

>> I hadn’t heard that, but whenever there’s a public health emergency, there are requests in terms of emergency supplemental funding to support all the activities that are going on.  And so each of the departments will look to see what activities are they undertaking?  What will they need and put in requests.  So I hadn’t heard that.  Thank you very much. 

>> Thank you.  And this does conclude today’s conference call.  We thank you for your participation.  You may now disconnect your lines. 

End

Homeland Security press release on swine flu – transcripts 4/28/09

(Constant Swine Flu updates may be seen here)

Remarks by Secretary Napolitano at the Media Briefing on the H1N1 Flu Outbreak
 
Release Date: April 28, 2009

For Immediate Release
Office of the Press Secretary
Contact 202-282-8010
Washington, D.C.

Secretary Napolitano:  Thanks, and good afternoon. I’d like to provide you with the latest information in our efforts to respond to the H1N1 flu outbreak.

First, I’d like to reiterate what President Obama said yesterday. This outbreak is a cause for concern, not yet a cause for alarm. Because the number of confirmed cases continues to rise and will likely rise in the next few days, we recognize that many Americans are rightly concerned about their own health and safety. I share that concern. The President shares that concern. But we are confident in the efforts underway across the federal government and across state and local governments to keep Americans safe and healthy.

The Department of Homeland Security, HHS [U.S. Department of Health and Human Services], the CDC [Centers for Disease Control and Prevention], and our many partners continue to take aggressive action to prevent the further spread of the H1N1 virus and to mitigate its impact. Before I recap those efforts, I want to announce that we are establishing an operations coordination task force to deal with the 2009 H1N1 outbreak. This task force will assist me in my role as the principal federal official of this incident. It will consist of chiefs of staff of relevant departments and agencies, and focus on operations, coordination, and mitigation. As noted earlier today, the President also has requested $1.5 billion to support H1N1 response. So let me recap other efforts underway.

The public health emergency declared by the Department of Health and Human Services on Sunday remains in effect. This clears the way to move resources around to meet needs that might arise, and to coordinate actions across government to address the outbreak.

There are currently 50 million treatment courses of antiviral drugs—Tamiflu and Relenza are the commercial names—in the National Strategic Stockpile. At this stage, we are releasing about 12 million courses of antivirals and key medical equipment to states. This is about 25 percent of the total. We are prioritizing those states where cases have been confirmed.

Materials are currently en route to Arizona, California, Indiana, New York, and Texas. New York and Arizona will receive their materials today, and we estimate all states and territories will receive their allocation by the third of May.

The State Department travel advisory for Mexico remains in effect. It recommends against all nonessential travel to Mexico. The United States Embassy in Mexico City and all of the United States Consulates also have suspended all nonessential services to the public until May sixth.

At our borders, Customs and Border Protection [CBP] continues to watch for signs of illness among travelers entering the United States. All persons entering from a location with reported human infection of H1N1 flu will be processed through all appropriate CBP protocols. These actions match the recommendations by both the CDC and the World Health Organization, based on what we currently know about H1N1.

Our focus at this time is not on closing the border or conducting exit screenings. It is on mitigation. Travelers presenting symptoms, if and when encountered, will be isolated and evaluated by a public health official. Customs and Border Protection is also handing out the CDC Traveler’s Health Alert notices in both English and Spanish to all travelers from Mexico.

The Transportation Security Administration, the TSA, has instituted similar protocols at our airports, watching for individuals exhibiting flu-like symptoms and taking appropriate measures.

We continue to conduct daily conference calls with Homeland Security advisors, state and local elected officials, Fusion Centers, our private sector partners, and congressional representatives, as well as coordinating our efforts with our international partners. We are working in lockstep to respond to this outbreak.

Other departments across the federal government also are taking action. You’ll hear in a moment from Secretary Vilsack, but the Department of Agriculture [USDA] continues to work with state animal health officials to affirm that they have no cases of this virus in their states. To date, no cases have been reported.

The USDA and the United States Trade Representative [Ron Kirk] also are reminding our trading partners that United States pork and pork products are safe, and there is no basis for restricting imports.

You should also know that you cannot get H1N1 from eating pork. Pork products are perfectly safe.

Beyond these efforts, it’s important to recognize that everyone across the United States has a role to play in addressing this outbreak. If you are feeling sick and show signs of the flu, stay home. If your children aren’t feeling well, they should stay home from school. You should wash your hands often and cover your mouth when you cough.

We are working around the clock to monitor the situation. We will keep the public informed as the picture develops. We anticipate holding these briefings on a regular basis to make sure that accurate information is provided to the public.

With that, I’d like to introduce Secretary Tom Vilsack, Department of Agriculture.

Secretary Vilsack:  Thank you very much. And first of all, let me say from a USDA perspective that obviously our hearts go out to all those families who have been affected by the H1N1 virus, those who have lost loved ones and those who are currently with those who are sick.

Obviously, at USDA, we’re also concerned about a lot of hard-working farm families around the United States. We are interested in making sure that they can continue to raise pork and also be able to sell it here in America around the world. So we are aggressively working with our state ag departments and state veterinarians to make sure that we can constantly be aware of any changes in current status. As of today, as Secretary Napolitano indicated, we have no indication that any swine from the United States has been infected. We are constantly getting updates, and if that were to change, we would obviously notify folks immediately.

We have also taken the step of working through our foreign agricultural service as well as with Ambassador Kirk and the Trade Representative’s office to send the message to all of our trading partners that we are open for business. We believe that there is no reason to stop or ban pork or pork products in the United States. As the Secretary indicated, it is perfectly safe to consume pork or products from America. We’re going to continue to trade. And we’re going to continue to work with our trading partners to make sure that we answer any questions that they might have to make sure that the borders are open and trading lanes continue to be open.

I want to take this opportunity to particularly note the efforts of the Japanese government, who have sent a very clear message to our trading partners that this is not a food-borne illness, that you cannot contract it from consuming pork, and that the importation of American pork and pork products is safe.

We’ll continue to work to answer questions from countries that have taken other actions. We are trying to underscore the fact that actions taken to ban or prevent the importation of pork or beef or any other product from the United States is not scientifically based, and could result in some serious trade disruptions. But I’ll let the Trade Representative speak more fully about that.

Ambassador Kirk:  Thank you, Mr. Secretary and Madam Secretary. Thank you for convening this. I’ll try not to repeat those points made by Secretary Napolitano or our Agriculture Secretary.

One, we want to first of all extend our sympathies and concerns to those families that have been affected. This is first and foremost a health crisis, one that has not risen to the level of alarm, as the President said. But secondly, we want to make sure that a handful of our trading partners don’t take advantage of this legitimate concern over public health and engage in behavior that could also damage the world’s economy.

We are suffering through the strongest recession that we have seen in quite some times, and any actions or activity engaged in by any of our trading partners not based on sound science and not based on our rules-based system of governing could do extraordinary damage, not just to our economy but to those of other countries as well. And in that regard, we are especially grateful to Japan for the strong statement that they have made with regards to pork products from the United States, which are safe.

And so we want to say to consumers here and abroad that there is no risk to you. There is no scientific evidence whatsoever that there is any link between consuming pork or prepared pork products and the H1N1 virus.

So for members of the press, Secretary Vilsack and I issued a press statement earlier. I think we have copies of that available for you as well. In the interests of time, I won’t go over that. But I’m prepared to answer any of your questions you might have that can’t be answered by the Secretary of Homeland Security.

Moderator:  Take some questions. Pete?

Question:  Secretary Napolitano, could I ask you to give us some kind of an update of what you’re finding on the borders? Are a lot of people who appear to have symptoms or report illness being set aside for these secondary screenings?

Secretary Napolitano:  To date, no. There’s been very little of that. But again, this is a changing situation. Tomorrow may be a different report. But to date, no.

Question:  Secretary Vilsack, what is the point of monitoring the swine population? If you can’t get this flu from swine, why check swine at all?

Secretary Vilsack:  Because it could impact and affect the industry itself. This is more about the economics of it rather than the human side and human illness side of it.

Question:  Just because of the name, swine flu? I mean, you’re not looking at horses or cows or anything else.

Secretary Vilsack:  Which is precisely the reason why we have asked and there has been a response to change the name of this. This really isn’t swine flu. It’s H1N1 virus. That’s very, very important. And it is significant because there are a lot of hard-working families whose livelihood depends on us conveying this message of safety. And it’s not just simply pork production. It’s also grain farmers because markets are very sensitive. They react to positive news. They also react to negative news.

And the livelihoods of a lot of people are at stake here, and we want to reinforce the fact that we’re doing everything we possibly can to make sure that our hog industry is sound and safe, and to make sure that consumers in this country and around the world know that American products are safe.

Question:  Madam Secretary, there’s a report out of California that authorities there are investigating a possible death from swine flu. And also, separately, a report out of New York that hundreds of school kids may be sick with suspected swine flu. What are you hearing from those two states or other states?

Secretary Napolitano:  We have a number of states that are reporting illness. And as you note, there’s several cases—I think two—in California. But they have not been confirmed that those are actually a product of H1N1, so those diagnoses are going on.

But let me lay some groundwork here for you. It is very likely that we will see more serious presentations of illness and some deaths as we go through this flu cycle. In a normal seasonal influenza cycle, we would anticipate across the United States 35,000 deaths. Of course, this is not a seasonal flu. But I think it would not be unexpected that there will be some more severe illness and some deaths as we proceed forward.

Moderator:  Mike?

Question:  Secretary Vilsack, have you heard any anecdotal stories or evidence of farmers who have been impacted by at this already?

Secretary Vilsack:  The last two days, the pork prices have been down. The last two days, soybean prices have been down. Yesterday, corn prices went down. So virtually anybody who’s in the pork business, in the corn business, or the soybean business has potentially had an impact or effect.

And if this continues, obviously, you have significant potential, which is why it’s important to get this right.  This is not a food-borne illness, virus. It is not correct to refer to it as swine flu because there’s really—that’s not what this is about. It is about a human-to-human transmission, which is why the Department of Homeland Security is taking mitigation steps to minimize those contacts. And it is important to convey the message that consuming pork or pork products will not cause and cannot cause the illnesses that we’re dealing with.

So it’s a very important message to send in terms of the economics of this. And I think Ambassador Kirk is absolutely right about this. Obviously, we’re concerned about people’s safety. But we’re also concerned about the impact on the economy of these farm families.

Moderator:  Tom?

Question:  Can I ask you about the [inaudible]? The question is, have they been used at all? Is anything happening [inaudible] a step up in preparedness or [inaudible]?

Secretary Napolitano:  They have not—you’re talking about the 19 quarantine stations in the airports. To my knowledge, they have not yet been used. But we have sent guidance and protocols out to our TSA workers, and also Customs and Border Protection workers, who are at our airports who have international entrants of what to look for and what to screen for. So they are prepared to use them.

Question:  Are you keeping track of how many people might be set aside for observation by health officials?

Secretary Napolitano:  We are collecting data. But again, I think our best estimate right now is that we are at the beginning of what could be a long flu cycle. And we may see a period of interruption; that is, to say that because we’re at the beginning of the summer, this particular outbreak may die off naturally and we may see a resurgence again in the fall.

So we’re in this for the long haul. That’s why we’ve now set up, on a semi-permanent basis as we go through this H1N1 outbreak, an interagency structure to move us forward. That’s why we’ve got state and local public health and also other authorities working now with us on a daily basis. Because this is going to be a marathon.

Question:  With the distribution of the antiviral drugs, are you providing guidelines to the states about who should get it—health care workers, besides those affected? And also, are you seeing any signs that the general public are trying to get hold of Tamiflu or other antiviral drugs sort of prophylactically? And how much would that affects supplies?

Secretary Napolitano:  Yes. Some of that may be better addressed to the CDC in terms of the Tamiflu and the Relenza. But after the Department of Health and Human Services issued the public health declaration on Sunday, that allowed for the issuance of a subsequent emergency authorization. And what that means is that’s an FDA-related declaration so that Tamiflu, for example, could be prescribed to a child who’s younger than one year old, which normally would not be the case. So that’s all in place right now.

Who actually is getting Tamiflu and how it’s getting out, I don’t have the answer right now. But I can tell you as a former governor that at the state and local level, most states have a pandemic flu plan. And part of that plan, of course, is how medicine and other things are distributed.

Moderator:  Eileen?

Question:  Have the CDC protocols for screening changed between yesterday and today at all? And have we seen any outbreaks such as a ICE [U.S. Immigration and Customs Enforcement] detention centers?

Secretary Napolitano:  The answer is no to the first question. On the second question, we had some suspected cases with regard to a group of detainees, but it turns out it was—their illness was not H1N1.

Moderator:  Spencer?

Question:  Is the U.S. considering requiring additional diagnostic testing of travelers before they enter the U.S., such as air travelers? And will the U.S. provide Tamiflu or other medicines to Mexico?  If so, would it come from civilian, military, or other stockpiles? And just a follow-up on the distribution question. Will it be up to the states to determine when an individual can get medicine, if supplies will be made available prophylactically? And who decides how many a state gets?

Secretary Napolitano:  Last question first. Primarily, the state allocation is based on population. But again, we are distributing first to states that have had confirmed instances.

With regard to the second question, we have no requests from other countries for Tamiflu right now. The World Health Organization has its own stockpile of antivirals, and I think they have something like 150 million courses there. And so I don’t know whether they’ve received any requests to date.

Give me your first question again? I was going backwards.

Moderator:  This is like an eight-part question, Spencer.

Question:  [Inaudible] on follow-up. Are they still testing travelers before they enter the U.S. and considering that for like air passengers?

Secretary Napolitano:  The answer is: not today. But again, we will proceed on a day-to-day basis. And if that changes, we’ll of course immediately let the public know.

Question:  To follow-up, who makes the decision on whether people can get medicine? Do they have to be sick before they can get it?

Secretary Napolitano:  There are—as I said in response to an earlier question, states by and large have pandemic plans and public health authorities have plans for medicine distribution. But right now, given the size of the stockpile we have—the 50 million courses in the national stockpile; the states themselves have something like another 23 million courses—not doses, courses—and I believe the Department of Defense has another seven million courses. So right now, we have the supply to meet the demand.

And I believe—and you can address this to the CDC—but I believe they’re in discussion with the manufacturer to ramp up more production of the antivirals.

Moderator:  Jason, last question.

Question:  Do you think you’re doing enough to protect the airports right now with the airport screenings? The World Health Organization’s avian flu expert said this morning that he felt that those screenings were just for show, and weren’t really effective, and more should be done.

Secretary Napolitano:  Well, I think he was responding to the issue about closing the borders. And what he was saying in the context was that that is not going to mitigate or contain this virus. But our recommendations and the things we are doing on screening match what the WHO and other groups have recommended.

We’re following the advice of the public health specialists. We’re listening to the scientists, the epidemiologists, primarily at CDC. We are matching their advice. And then our job across many departments is to implement that across agriculture, trade, and across, of course, homeland security.

Moderator:  Okay. Thanks, guys.

Question:  Can we have one more question for Ambassador Kirk?

Ambassador Kirk:  I think the Secretary—

Question:  Have you spoken with your Chinese or Russian counterparts about the pork products?

Ambassador Kirk:  I have not. I was scheduled to have a call with my counterpart from Russia, but I delayed that in order to be here. But we’ll be reaching out and talking with all of those countries that have taken steps thus far to limit the importation of American products.

Secretary Napolitano:  Thanks, all.

CDC press release on swine flu – transcripts 4/27/09

(Constant Swine Flu updates may be seen here)

CDC Media Availability on Human Swine Influenza Cases

April 27, 2009, 1 p.m. EST

>>> THANK YOU, THIS IS GLENN NOWAK.

I′M DIRECTOR OF MEDIA RELATIONS AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION, AND WE WELCOME YOU TODAY ON THE BRIEFING FOR THE SWINE INFLUENZA. DR. BESSER IS ACTING DIRECTOR OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION. HE′S GOING TO PROVIDE AN UPDATE ON THE CASES AS WELL AS WHERE WE STAND IN TERMS OF PUBLIC HEALTH AND CDC ACTION. FOR THOSE OF YOU IN THE ROOM, WHEN WE TAKE QUESTIONS FROM THE FLOOR I WOULD ASK THAT YOU WAIT UNTIL WE GET THE MICROPHONE TO YOU. WE WILL TAKE QUESTIONS FROM THOSE PRESENT AND ALSO THE PHONE.

I WILL TURN THE CONFERENCE OVER TO DR. RICHARD BESSER.

>> THANK YOU VERY MUCH AND GOOD AFTERNOON.

I KNOW THERE′S A LOT OF CONCERN AROUND THE COUNTRY ABOUT THIS SITUATION HERE AROUND SWINE FLU AND THE SITUATION GOING ON IN MEXICO. I HOPE THIS AFTERNOON TO SHARE WITH YOU THE CURRENT STATUS OF OUR INVESTIGATIONS AND THE WORK THAT′S GOING ON BOTH HERE AND AROUND THE WORLD TO UNDERSTAND THIS BETTER AND TO CONTROL THIS OUTBREAK OF SWINE FLU.

THIS SITUATION IS EVOLVING VERY QUICKLY.

IT′S CHANGING QUICKLY AND SO YOU WILL CONTINUE TO HEAR

INFORMATION THAT SEEMS IN CONFLICT.

YOU WILL SEE NUMBERS IN ONE PLACE THAT MAY BE DIFFERENT FROM ANOTHER. TODAY I′LL GIVE YOU THE NUMBERS AS WE HAVE THEM, BUT ASK YOU TO FOCUS A LITTLE LESS ON THE SPECIFIC NUMBERS AND MORE WHAT IT TELLS US. WHAT WE LEARN FROM THE NUMBERS IS HOW DISEASE MAY BE SPREADING AND WHERE IT′S NOT SPREADING.

IT TELLS US SOMETHING ABOUT TRANSMISSION AND I′LL SHARE THAT INFORMATION WITH YOU.

WE CONTINUE TO APPROACH THIS INVESTIGATION AND OUR CONTROL EFFORTS AGGRESSIVELY.

THAT′S BECAUSE YOU DON′T KNOW GOING INTO AN OUTBREAK WHAT IT WILL LOOK LIKE IN THE END, AND WE WANT TO BE AGGRESSIVE. WE WANT TO TAKE BOLD ACTION TO MINIMIZE THE IMPACT ON PEOPLE′S HEALTH FROM THIS INFECTION.

WHERE ARE WE TODAY IN TERMS OF CASES?

WE ARE OFFICIALLY REPORTING 40 CONFIRMED CASES IN THE UNITED STATES IN FIVE STATES.

THESE ARE THE SAME STATES THAT WE REPORTED YESTERDAY. NEW YORK, OHIO, KANSAS, TEXAS AND CALIFORNIA.

THE ONLY CHANGE IN CONFIRMED CASES FROM YESTERDAY IS 20 ADDITIONAL CASES IN NEW YORK CITY AND THESE ARE ASSOCIATED WITH THE SAME SCHOOL OUTBREAK THAT WE TALKED ABOUT YESTERDAY AND REALLY REPRESENT ADDITIONAL TESTING IN THAT GROUP, NOT AN ONGOING SPREAD OF THAT CLUSTER.

OF THE 40 CASES, WE ARE ONLY AWARE OF ONE INDIVIDUAL WHO IS HOSPITALIZED AND ALL PEOPLE WHO HAVE BEEN INFECTED AND WERE SICK HAVE RECOVERED.

THE MEDIAN AGE IS 16 YEARS WITH A RANGE IN AGE OF 7 TO 54 YEARS AND AS I′VE BEEN TRYING TO STRESS, AS WE CONTINUE TO LOOK I EXPECT THAT WE WILL SEE CASES IN OTHER PARTS OF THE COUNTRY, AND I WILL FULLY EXPECT THAT WE′LL SEE A BROADER RANGE IN TERMS OF THE SEVERITY OF INFECTION.

THANKFULLY, SO FAR WE HAVE NOT SEEN SEVERE DISEASE IN THIS COUNTRY AS HAS BEEN REPORTED IN MEXICO.

SO FAR, CDC HAS CONFIRMED 26 CASES IN MEXICO, BUT, CLEARLY, FROM THE REPORTS COMING OUT OF MEXICO THIS IS A SMALL FRACTION OF WHAT THEY′RE SEEING.

THESE ARE THE NUMBER OF CASES THAT WE HAVE CONFIRMED HERE IN OUR LABORATORY.

I WANT TO TALK ABOUT SOME OF THE PUBLIC HEALTH ACTIONS THAT CDC HAS TAKEN AND THAT STATE AND LOCAL PUBLIC HEALTH ARE TAKING AND THAT THE GLOBAL COMMUNITY IS TAKING.

WE CONTINUE TO WORK WITH STATE AND LOCAL PUBLIC HEALTH TO INVESTIGATE AND UNDERSTAND WHAT′S GOING ON. WE′RE CONTINUING TO PROVIDE SUPPORT IN THE LABORATORY TESTING THAT′S TAKING PLACE AND AS WE INVESTIGATE WE′LL CONTINUE TO LEARN MORE ABOUT HOW THIS DISEASE AND HOW THIS INFECTION IS TRANSMITTED AND HOW IT CAN BE PREVENTED AND CONTROLLED.

WE′RE WORKING WITH THE WORLD HEALTH ORGANIZATION. WE′RE WORKING WITH THE PAN-AMERICAN HEALTH ORGANIZATION AND WORKING AS PART OF A TRI-NATIONAL TEAM THAT′S ON THE GROUND IN MEXICO TRYING TO INVESTIGATE AND UNDERSTAND THE DISEASE TRANSMISSION THERE.

WE HAVE FOLKS ON THE GROUND AND WE WILL BE SENDING ADDITIONAL PERSONNEL TO THE GROUND TO UNDERSTAND THIS — THIS OUTBREAK. YESTERDAY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES DECLARED A PUBLIC HEALTH EMERGENCY.

THIS IS IN RECOGNITION THAT THIS IS A SERIOUS EVENT AND WE′RE TAKING IT SERIOUSLY AND ACTING AGGRESSIVELY, BUT WHAT IT ALSO DOES IS IT GIVES US ADDITIONAL AUTHORITY. IT ALLOWS US TO MOVE PRODUCTS AND DISPENSE DRUGS IN A WAY THAT WE COULDN′T BEFORE AND STREAMLINED THE PROCESS BY WHICH THE GOVERNMENT WORKS AND SO IT′S PRIMARILY A REFLECTION OF THAT. IT′S SOMETHING THAT WE DO WHENEVER WE FEEL THAT WE WANT TO HAVE THE ABILITY TO MOVE QUICKLY AND SWIFTLY.

WE WILL BE DISTRIBUTING YELLOW CARDS AT PORTS OF ENTRY. THESE WILL PROVIDE INFORMATION ON SWINE FLU SO THAT PEOPLE COMING INTO THE UNITED STATES WILL HAVE INFORMATION ABOUT THIS OUTBREAK AND WHAT TO DO IF THEY BECOME SICK AND WHAT THINGS THEY CAN DO IN THE LIKELIHOOD THAT THEY DO BECOME SICK.

LATER TODAY WE WILL BE RELEASING A NEW TRAVEL ADVISORY FOR MEXICO. THIS IS OUT OF THE ABUNDANCE OF CAUTION AND WE WILL BE RECOMMENDING THAT NON-ESSENTIAL TRAVEL TO MEXICO BE AVOIDED. WE′LL ALSO BE INCLUDING IN THERE STEPS PEOPLE CAN TAKE SHOULD THEY NEED TO TRAVEL TO MEXICO DURING THIS TIME.

AGAIN, THIS IS OUT OF AN ABUNDANCE OF CAUTION AS WE LEARN MORE. YOU CAN LOOK TO SEE OUR TRAVEL RECOMMENDATIONS REFLECT THAT. YESTERDAY WE ANNOUNCED THE RELEASE OF MATERIAL FROM OUR STRATEGIC NATIONAL STOCKPILE.

THIS IS A STOCKPILE OF MEDICATIONS AND OTHER SUPPLIES THAT CAN BE VERY HELPFUL IN MANAGING AN OUTBREAK AND AGAIN, AS A FORWARD-LEANING MOVE WE RELEASED 25% OF THE STATE′S ALLOCATION OF THE STOCKPILE.

THIS IS 11 MILLION COURSES OF ANTIVIRAL DRUGS. THESE ARE EN ROUTE TO AFFECTED STATES OF CALIFORNIA, NEW YORK AND TEXAS AS WELL AS OTHER STATES AROUND THE COUNTRY. YESTERDAY WE ISSUED ON OUR WEBSITE AND WE′VE SENT OUT NEW GUIDANCE, REFINED GUIDANCE ON WHAT COMMUNITIES CAN DO WHEN THEY HAVE A CASE OF SWINE FLU IN THEIR COMMUNITY. THIS PROVIDES GUIDANCE ON WHAT PEOPLE WHO HAVE THAT INFECTION SHOULD DO AND CLEARLY THAT′S STAY HOME.

DON′T GO OUT IN THE COMMUNITY DURING THE PERIOD OF YOUR INFECTION WHICH IS ABOUT SEVEN DAYS, BUT YOU SHOULD STAY HOME UNTIL AT LEAST ONE DAY PAST YOUR SYMPTOM PERIOD.

IF YOU DO GO OUT, IT PROVIDES GUIDANCE INTO HOW YOU CAN INTERACT SAFELY IN THE COMMUNITY.

IT PROVIDES RECOMMENDATIONS IN TERMS OF CONTACT, AVOIDING CROWDED PLACES AND TRYING TO STAY HOME AS MUCH AS POSSIBLE. IT TALKS ABOUT THE CLOSURE OF A SCHOOL OR DISMISSAL OF STUDENTS AT A TIME WHEN THERE′S AN IDENTIFIED CASE IN THE SCHOOL. AGAIN, THIS IS OUT OF AN ABUNDANCE OF WHERE THERE′S BEEN ADDITIONAL TRANSMISSION AND IT TALKS ABOUT OTHER GATHERINGS. WE KNOW THAT IN SOME COMMUNITIES WHERE THERE′S BEEN A CASE, THEY′VE CANCELED SCHOOL FUNCTIONS RELATED TO THAT AFFECTED SCHOOL. WE THINK THAT MAKES SENSE.

ALL OF THESE GUIDELINES NEED TO BE TAILORED BASED ON THE LOCAL SITUATION AND WE EXPECT TO SEE AND IT′S APPROPRIATE TO SEE DIFFERENT APPLICATION OF THESE GUIDANCES IN DIFFERENT PARTS OF THE COUNTRY.

I — I ALWAYS LIKE TO MAKE THE POINT THAT CONTROL OF AN OUTBREAK OF INFECTIOUS DISEASE IS A SHARED RESPONSIBILITY AND THERE ARE THINGS THAT INDIVIDUALS NEED TO DO AND THERE ARE THINGS THAT COMMUNITIES NEED TO DO AND THERE ARE THINGS THAT THE GOVERNMENT NEEDS TO DO AND IT′S IMPORTANT THAT INDIVIDUALS REALIZE THEY HAVE A KEY ROLE TO PLAY IN REDUCING THEIR OWN LIKELIHOOD OF GETTING INFECTED. THOSE ARE THE TYPICAL GUIDELINES FOR RESPIRATORY INFECTION. FREQUENT HAND WASHING IF YOU DON′T HAVE ACCESS TO SOAP AND WATER AND ALCOHOL GEL AND COVERING YOUR COUGH OR YOUR SNEEZE, THAT′S VERY IMPORTANT.

IF YOU′RE SICK, AND IF YOU HAVE A FEVER AND YOU′RE SICK OR YOUR CHILDREN ARE SICK, DON′T GO TO WORK AND DON′T GO TO SCHOOL. THAT CAN HELP REDUCE THE LIKELIHOOD THAT YOU WILL SHARE THAT INFECTION, BUT IT′S ALSO TIME FOR PEOPLE TO BE THINKING ABOUT,

WHAT WOULD I DO IF MY CHILD′S SCHOOL WERE CLOSED?

WHAT WOULD I DO FOR CHILD CARE?

WOULD I BE ABLE TO WORK FROM HOME?

IT′S TIME TO THINK ABOUT THAT SO THAT YOU′RE READY IN THE EVENT THAT THERE WERE A CASE IN YOUR CHILD′S SCHOOL. 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? THINK ABOUT THAT.

THERE′S BEEN TREMENDOUS PLANNING THAT′S BEEN GOING ON AROUND THE COUNTRY OVER THE PAST NUMBER OF YEARS. IT′S TIME FOR PEOPLE TO REVIEW THOSE PLANS AND THINK ABOUT WHAT THEY WOULD DO.

IT′S TIME FOR SCHOOLS AND FAITH-BASED ORGANIZATIONS TO THINK ABOUT AS WELL, WHAT WOULD I DO IF THERE WERE AN ONGOING OUTBREAK IN MY COMMUNITY.

HOPEFULLY THIS OUTBREAK WOULD NOT PROGRESS, BUT LEANING FORWARD AND THINKING ABOUT WHAT YOU WOULD DO IS ONE OF THE MOST IMPORTANT THINGS INDIVIDUALS AND COMMUNITIES CAN UNDERTAKE RIGHT NOW. IT MATTERS LESS WHAT WE CALL THIS THAN WHAT ACTIONS WE TAKE, AND WE ARE ACTING AGGRESSIVELY BASED ON WHAT WE KNOW TODAY AND WHETHER THE TERM CHANGES, THAT′S NOT GOING TO CHANGE OUR APPROACH TO THAT SITUATION AND THAT′S A VERY IMPORTANT POINT. WE TRIGGER OUR ACTIONS BASED ON WHAT′S GOING ON IN THE COMMUNITY AND NOT BASED ON WHAT LABEL IS PUT ON A PARTICULAR OUTBREAK. THERE′S NO SINGLE ACTION THAT WILL CONTROL AN OUTBREAK, BUT THE COMBINED ACTIONS THAT WE ARE PROPOSING AND THEY′RE BEING UNDERTAKEN AROUND THE COUNTRY WILL HELP TO STEM THE TIDE OF ANY INFECTIOUS DISEASE OUTBREAK AND THIS ONE IN PARTICULAR. I WANT TO REITERATE THAT EVERYONE HAS A RESPONSIBILITY AND IT′S BEEN ABSOLUTELY INCREDIBLE TO SEE PEOPLE AROUND THE COUNTRY STANDING UP AND TAKING RESPONSIBILITY AND DOING THE THINGS THAT THEY NEED TO DO TO HELP REDUCE THE IMPACT OF THIS OUTBREAK. I WANT TO RECOGNIZE THAT MUCH IS UNKNOWN.

WE WILL CONTINUE TO GIVE YOUR INFORMATION AS WE KNOW IT AND PROVIDE AS MANY OPPORTUNITIES AS POSSIBLE FOR YOUR QUESTIONS TO BE ANSWERED.

AND LASTLY, I REALLY WANT TO RECOGNIZE THE INCREDIBLE WORK BEING DONE BY THE MEDICAL PROVIDER COMMUNITY AND THE PUBLIC HEALTH COMMUNITY.

THESE PERIODS OF UNCERTAINTY WHERE WE′RE WORKING WITH VERY LIMITED KNOWLEDGE, AND VERY LIMITED INFORMATION ARE VERY DIFFICULT AND PEOPLE ARE DOING AN OUTSTANDING JOB ACROSS THE COUNTRY, TRYING TO UNDERSTAND THIS.

SO, THANK YOU AND I′D BE HAPPY TO TAKE YOUR QUESTIONS.

>> THANK YOU.

>> WE′LL GO AROUND THE ROOM AND THEN WE′LL GO TO THE PHONES.

>> DR. BESSER, FOX NEWS.

IS THE CDC WORKING ON A VACCINE SPECIFICALLY FOR THIS NEW SUBTYPE OF SWINE FLU OR ARE EXISTING VACCINES EFFECTIVE SO FAR? WE DON′T THINK THAT ANY OF THE EXISTING VACCINES ARE EFFECTIVE AND WHENEVER WE SEE A NEW STRAIN OF INFLUENZA WE LOOK TO CREATE WHAT′S CALLED THE FEED STOCK AND THAT′S THE STOCK OF THE VIRUS THAT WOULD BE USED IN THE EVENT WE DECIDE TO MAKE A VACCINE. THERE ARE DISCUSSIONS ONGOING ABOUT WHETHER TO MAKE A VACCINE AND WHETHER THAT SHOULD BE UNDERTAKEN.

IT′S NOT AN EASY DECISION.

IT WOULD INVOLVE LOOKING AT WHAT VACCINE IS NEEDED FOR NEXT

YEAR′S FLU SEASON.

WHETHER THIS IS A STRAIN THAT WE WANT TO LOOK TO INCLUDE AND THERE ARE TRADEOFFS THERE, BUT THOSE DISCUSSIONS ARE UNDER WAY SO THAT IF WE DECIDE TO MANUFACTURE A VACCINE WE′D BE READY TO START THAT PROCESS.

>> WSB TELEVISION IN ATLANTA.

SO FAR THE ILLNESS IS MORE SEVERE IN MEXICO AND LESS SEVERE AMONG

THE CASES HERE.

IS THAT OPTIMISTIC TO YOU?

DO YOU THINK THAT — THAT PATTERN OR IS IT TOO EARLY TO TELL?

>> THAT IS A CRITICAL QUESTION, WHAT WE NEED TO KNOW IS WHY WE′RE SEEING A DIFFERENT DISEASE SPECTRUM IN MEXICO THAN WE′RE SEEING HERE. I WOULDN′T BE OVERLY REASSURED BY THAT.

THERE ARE MANY REASONS THAT COULD EXPLAIN THAT AND AS WE GATHER INFORMATION, WE HOPE TO SORT THAT OUT, BUT I WOULDN′T — I WOULDN′T REST ON THE FACT THAT WE HAVE ONLY SEEN CASES IN THIS COUNTRY THAT ARE LESS SEVERE.

AS WE CONTINUE TO LOOK I EXPECT THAT WE WILL SEE ADDITIONAL CASES AND I EXPECT THAT THE SPECTRUM OF DISEASE WILL EXPAND.

>> I WAS TOLD THAT SOME GOVERNMENT AGENCIES IN NEIGHBORING STATE, ALABAMA, THAT WORKERS ARE BEING ORDERED TO WEAR MASKS AT WORK.

IN A WORKPLACE WHERE THERE HAS BEEN NO ACTIVE SIGN OF DISEASE IS

THAT RECOMMENDED AT THIS POINT?

>> I′M NOT AWARE OF ANY STATES UNDERTAKING THAT.

IN TERMS OF OUR RECOMMENDATIONS WE WOULD NOT RECOMMEND THAT PEOPLE GENERALLY WEAR MASKS IN THEIR WORKPLACE AS A PRECAUTIONARY MEASURE. AS A DOCTOR AND AS A PARENT THE ISSUE OF MASKS COME UP AND PEOPLE SAY WOW? SHOULD I WEAR MASKS?

IS THAT GOING TO PROTECT ME.

ANYTHING THAT YOU CAN DO TO PREVENT INFECTION ARE CRITICALLY IMPORTANT.

MASKS, THE EVIDENCE OF THEIR VALUE OUTSIDE OF HEALTHCARE SETTINGS AND OUTSIDE OF SETTINGS WHERE YOU ARE COMING DIRECT FACE-TO-FACE WITH SOMEONE WHO HAS AN INFECTIOUS DISEASE, THE EVIDENCE THERE IS NOT VERY STRONG.

I KNOW SOME PEOPLE FEEL MORE COMFORTABLE HAVING A MASK AND THERE ARE CERTAIN CIRCUMSTANCES WHERE THAT MAY BE OF VALUE, BUT I WOULD RATHER PEOPLE REALLY FOCUS HAND WASHING, NOT GIVING THAT LITTLE KISS OF GREETING WHEN YOU′RE MEETING SOMEBODY RIGHT NOW. DOING THOSE SORTS OF THINGS AND COVERING YOUR COUGH AND YOUR SNEEZE AND THEN IF YOU FEEL MORE COMFORTABLE WITH A MASK, IF YOU′RE IN A COMMUNITY OR SETTING WHERE THERE′S ONGOING DISEASE TRANSMISSION AND THEN YOU CAN THINK ABOUT THAT, BUT THE OTHER THINGS WHERE THERE IS THAT EVIDENCE ARE THE THINGS WE′RE REALLY TRYING TO PUSH.

ON THE PHONE?

OKAY.

>> DANIEL STEINBERG WITH CBS NEWS.

WHERE IS THE CDC AND OTHER HEALTH ORGANIZATIONS WHERE ARE THEY IN TRACKING THE ORIGIN, PERHAPS PIG FARMS AND OTHER CASES?

>> WE ARE UNDERTAKING WORK WITH THE USDA ON THAT FACT AND THE ISSUE OF WHERE DID THIS COME FROM?

IT REMINDS ME OF AN IMPORTANT POINT.

SOME PEOPLE WORRY ABOUT PORK PRODUCTS BECAUSE WE CALL THIS THE SWINE FLU.

YOU CAN′T GET THIS FROM EATING PORK.

COOK YOUR PORK APPROPRIATELY SO THAT YOU DON′T GET OTHER INFECTIOUS DISEASES, BUT INFLUENZA IS NOT TRANSMITTED BY EATING PORK OR PORK PRODUCTS.

THEY ARE SAFE.

WHAT WE DO AS WE INVESTIGATE THE CASES WE LOOK FOR ANY CONNECTIONS AND SEE IF ANY OF THE INDIVIDUALS WHO HAVE BEEN SICK HAVE BEEN EXPOSED TO PIGS OR SWINE AND WE′RE NOT FINDING THAT LINKAGE HERE.

I KNOW THAT IN THE INVESTIGATIONS IN MEXICO THEY′LL BE LOOKING AS

WELL TO SEE IS THERE ANY CONNECTION?

CAN WE UNDERSTAND HOW THIS MAY HAVE FIRST STARTED?

I WILL TAKE I QUESTION FROM THE PHONE.

>> AGAIN ON THE PHONE LINES IF YOU WOULD LIKE TO ASK A QUESTION, PLEASE PRESS STAR ONE.

OUR FIRST QUESTION COMES FROM BETSY McKAY, WALL STREET JOURNAL.

>> HI, DR. BESSER.

THANK YOU.

I HAVE A COUPLE OF QUESTIONS.

AS YOU PROBABLY KNOW, W.H.O. HAS A PANEL MEETING RIGHT NOW WHETHER TO RAISE THE PANDEMIC LEVEL ALERT.

SO I′M WONDERING IF THAT DOES HAPPEN AND IF IT′S RAISED TO LEVEL FOUR OR FIVE, WHAT SPECIFIC ACTIONS WOULD THAT TRIGGER HERE IN THE UNITED STATES?

THE SECOND QUESTION I WANTED TO ASK WAS YOU′VE TALKED ABOUT HOW MUCH BETTER PREPARED WE ARE SINCE SARS AND DEFINITELY A LOT OF MONEY HAS GONE INTO PREPAREDNESS, BUT YOU FACE A COUPLE OF LIMITING FACTORS RIGHT NOW.

ONE IS THAT THE AGE HASN′T BEEN CONFIRMED AND SECONDLY, STATE AND LOCAL HEALTH DEPARTMENTS ARE FACING A REAL FUNDING CRUNCH IN THE RECESSION AND I′M WONDERING IF YOU CAN ADDRESS THOSE TWO.

WHAT DO YOU NEED TO MORE EFFECTIVELY DO YOUR JOB AND ARE THOSE LIMITING YOU?

>> YOUR FIRST QUESTION ABOUT W.H.O., THE EXPERT COMMITTEE IS MEETING TODAY TO LOOK AT THE CURRENT SITUATION AND SEE WHETHER ANY CHANGES NEED TO BE MADE IN TERMS OF PHASES.

THAT GOES ON A COMMENT I MADE EARLIER ABOUT IT, IT DOESN′T REALLY MATTER FROM OUR PERSPECTIVE WHAT YOU CALL THIS.

OUR ACTIONS ARE BASED ON WHAT′S TAKING PLACE IN OUR COUNTRY AND IN OUR COMMUNITIES.

IT MAY HAVE MORE RELEVANCE TO A COUNTRY THAT HAS YET TO SEE CASES IN TERMS OF WHAT THEY WOULD START TO DO.

HERE, WE ARE ACTING AGGRESSIVELY AND WHETHER THEY GO FROM PHASE THREE TO A PHASE 4 WOULD NOT CHANGE ANYTHING THAT WE ARE CURRENTLY DOING.

IN TERMS OF PUBLIC HEALTH INFRASTRUCTURE WHETHER YOU′RE LOOKING AT THE FEDERAL LEVEL OR STATE OR LOCAL LEVEL, IT′S CRITICAL TO OUR SUCCESS IN RECOGNIZING OUTBREAKS AND BEING ABLE TO RESPOND TO OUTBREAKS.

THE LACK OF A SECRETARY OF HEALTH HAS WANT IN ANY WAY LED TO DIMINISHED ACTIVITY IN OUR DEPARTMENT APPROACHING THIS PROBLEM. WE HAVE AN OUTSTANDING DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT IS AGGRESSIVELY ADDRESSING THIS ISSUE.

WE LOOK FORWARD TO HAVING LEADERSHIP IN POSITIONS, BUT THAT HASN′T IMPACTED OUR ABILITY TO RESPOND.

>> YOU ASKED A QUESTION ABOUT STATE AND LOCAL PUBLIC HEALTH INFRASTRUCTURE AND I HAVE TO BE HONEST ON THAT THE ECONOMIC REALITIES THAT BEEN VERY HARD ON STATE AND LOCAL PUBLIC HEALTH. WE AS A NATION RELY ON PUBLIC HEALTH PERSONNEL AT THE STATE AND LOCAL LEVELS TO IDENTIFY THESE OUTBREAKS AND IDENTIFY THEM QUICKLY AND BE ABLE TO RESPOND AND WE HAVE AN OUTSTANDING PUBLIC HEALTH SYSTEM, BUT IT IS IN A TOUGH SITUATION.

WE HEAR ABOUT TENS OF THOUSANDS OF STATE PUBLIC HEALTH WORKERS WHO ARE GOING TO BE LOSING THEIR JOBS BECAUSE OF STATE BUDGETS AND IT IS VERY IMPORTANT THAT WE LOOK AT THAT AND WE LOOK AT THAT RESOURCE BECAUSE THIS OUTBREAK WAS IDENTIFIED BECAUSE OF A LOT OF THE WORK GOING ON AROUND PREPAREDNESS.

MEXICO, YES, HAD BEEN HAVING AN OUTBREAK OF FLU, BUT THE FIRST CASE OF SWINE FLU WAS IDENTIFIED IN SAN DIEGO AS PART OF A STUDY THAT WAS PART OF PREPAREDNESS, TO TRY AND DEVELOP NEW TEST KITS THAT DOCTORS CAN USE IN THEIR OFFICE.

THAT KIND OF INVESTMENT IN PREPAREDNESS IS WHAT LED TO THIS. AS WE′RE LOOKING NOW AT HOW ARE WE — HOW ARE WE SUPPORTING STATES, ONE OF THE THINGS WE′RE DOING IS WE′RE HELPING STATES SUPPORT THEMES AND SO WE′RE SENDING TEST KITS TO STATES SO THAT STATES WILL BE ABLE TO DO THEIR OWN TESTING TO DETERMINE DO THEY HAVE THIS ISOLATED FLU?

WE′RE NOT SENDING IT TO ALL STATES AT FIRST.

WE′RE ROLLING THIS OUT, BUT THAT INFRASTRUCTURE, THAT ABILITY AND THE LABORATORY NETWORK THAT′S BEEN BUILT OVER THE PAST DECADE IS ONE OF THE BACKBONES THAT WE COUNT ON TO BE ABLE TO IDENTIFY AND CONTROL OUTBREAKS.

ANOTHER QUESTION FROM THE PHONE?

>> THANK YOU.

OUR NEXT QUESTION DOLLARS JOANNE SOUTH EARNER, NATIONAL PUBLIC RADIO. PLEASE GO AHEAD.

>> HI AND THANKS.

HAS ANYONE HAD A CHANCE TO LOOK BACK, YOU MENTIONED SAN DIEGO, HAS ANYONE LOOKED FURTHER BACK TO FIGURE OUT WHETHER THE SARS WAS AROUND WEEKS AND MONTHS AGO IN THIS COUNTRY?

>> THAT′S A GOOD QUESTION AND WE HAD NOT SEEN THIS VIRUS IN THIS COUNTRY.

IN ADDITION, WE′VE BEEN ASSISTING THE MEXICAN GOVERNMENT IN LOOKING AT THE STRAINS OF FLU THAT THEY′VE SEEN THROUGH THEIR SEASON AND IN LOOKING AT THE ANALYSIS FROM THAT, THIS WAS NOT SOMETHING THAT THEY WERE SEEING CIRCULATING THERE.

WE KNOW AT LEAST UNTIL MARCH AND THE ANALYSES OF THE LATER STRAINS I DON′T THINK HAS BEEN COMPLETED, BUT WE ARE TRYING TO UNDERSTAND WHERE IT FIRST AROSE AND WHERE IT MAY HAVE FIRST AROSE AND WHAT THAT MAY TELL US ABOUT WHERE IT CAME FROM AND HOW IT CAN BE CONTROLLED.

>> THANK YOU.

OUR NEXT QUESTION COMES FROM HELEN GRANWELL, THE CANADIAN PRESS.

>> HI, THANK YOU VERY MUCH FOR TAKING MY QUESTION. DR. BESSER, YESTERDAY YOU SAID SO FAR IN THE UNITED STATES, I THINK YOU SAID, ANYWAY, THERE′S ONLY BEEN ONE CASE WHERE KNOWN HUMAN-TO HUMAN TRANSMISSION OCCURRED.

I′M WONDER WHETHER YOU TELL US WHETHER THAT′S STILL THE CASE OR IF YOU′RE SEEING GENERATIONS OF SPREAD AND I WOULD HAVE A FOLLOW-UP IF I COULD, PLEASE.

>> WE ONLY HAVE ONE CASE OF DOCUMENTED BY VIRAL TESTING PERSON TO-PERSON SPREAD, BUT I WOULDN′T BE REASSURED BY THAT.

WE′RE SEEING SIGNIFICANT RATES OF RESPIRATORY INFECTION AMONG CONTACTS, AND I WOULD EXPECT THAT SOME OF THOSE INDIVIDUALS WILL

END UP TESTING POSITIVE FOR THE SWINE FLU VIRUS.

SO, YEAH.

THANKS FOR THAT QUESTION.

I DON′T WANT THAT TO BE TOO REASSURING.

THIS VIRUS IS ACTING LIKE A FLU VIRUS AND FLU VIRUS IS SPREAD FROM PERSON TO PERSON.

>> GREAT.

THE OTHER QUESTION I WANTED TO ASK YOU ABOUT HOW YOU STRIKE A BALANCE TO HAVE A MEASURED RESPONSE BECAUSE OBVIOUSLY THERE′S BEEN TONS OF PLANNING DONE IN THE PAST FEW YEARS IN RESPONSE TO THE THREAT OF H1, BUT THOSE RESOURCES ARE EXPENSIVE TO PUT TOGETHER AND THEY ARE PRECIOUS AND I WOULD IMAGINE THAT YOU MIGHT NOT WANT TO BLOW THROUGH A WHOLE BUNCH OF THE STOCKPILED ANTIVIRALS, FOR INSTANCE, AT THIS POINT BECAUSE WHO KNOWS HOW THIS VIRUS IS GOING TO CONTINUE TO BEHAVE IN THE FUTURE OR HOW H5 WILL CONTINUE TO BEHAVE IN THE FUTURE.

HOW DO YOU STRIKE THE BALANCE?

>> THAT′S A GREAT QUESTION.

EVERY OUTBREAK IS UNIQUE.

EVERY NEW STRAIN OF VIRUS IS UNIQUE AND UNTIL THE OUTBREAK HAS PROGRESSED YOU DON′T KNOW WHAT IT′S GOING TO DO AND SO IT′S A MATTER OF MAKING DECISIONS WITH INCOMPLETE INFORMATION AND SO IF YOU LOOK AT SOME OF THE DECISIONS WE′VE MADE, THE DECISION ABOUT PROVIDING ANTIVIRALS AND MATERIAL TO PEOPLE AROUND THE COUNTRY, WE ARE SENDING FOR 25%.

WE′RE NOT SENDING FOR THE ENTIRE STOCKPILE AND WE′RE SENDING OUT SUPPLIES SO THAT IN THE EVENT THIS WERE TO BECOME SOMETHING MORE SERIOUS, THE HEALTH DEPARTMENT AND DOCTORS WOULD HAVE WHAT THEY NEEDED TO TAKE CARE OF PEOPLE.

AS INFORMATION CHANGES, OUR LEVEL OF RESPONSE CAN CHANGE. IF WE WERE TO START TO SEE A MUCH MORE SEVERE COURSE OF ILLNESS IN THE COUNTRY, WE MIGHT RECOMMEND DIFFERENT CONTROL MEASURES AND COMMUNITIES THAN WE′RE CURRENTLY DOING.

RIGHT NOW WE′RE AT THE RIGHT LEVEL IN TERMS OF WHAT WE′RE RECOMMENDING FOR RESPONSE BASED ON WHAT WE KNOW. A QUESTION HERE IN THE AUDIENCE.

>> WHAT ARE THE SIGNS THAT SWINE FLU IS IN METRO ATLANTA.

>> I THINK AS WE CONTINUE TO LOOK FOR CASES OF SWINE FLU WE′LL FIND THEM.

THE RECOMMENDATIONS WE HAVE IN TERMS OF INDIVIDUALS, KNOWING WHAT THE SIGNS AND SYMPTOMS ARE.

IF YOU HAVE FEVER AND FLU-LIKE ILLNESS YOU SHOULD TALK TO YOUR DOCTOR. YOUR DOCTOR CAN TALK TO YOU ABOUT WHETHER TESTING IS — OR TREATMENT IS APPROPRIATE.

IN PARTICULAR, IF YOU HAVE — IF YOU TRAVELED TO MEXICO AND YOU HAVE THOSE SYMPTOMS WE SHOULD SEE YOUR DOCTOR BECAUSE THAT′S AN AREA WHERE WE KNOW TRANSMISSION IS OCCURRING.

I DON′T KNOW THE ODDS OF SOMEBODY IN ATLANTA HAS THIS INFECTION, BUT IT′S IMPORTANT THAT PEOPLE IN ATLANTA AND PEOPLE IN DALLAS AND PEOPLE IN PHILADELPHIA AND PEOPLE IN SMALL TOWNS KNOW ABOUT THIS, THAT THEY PAY ATTENTION AND THAT THEY UNDERSTAND THAT THEY HAVE A RESPONSIBILITY HERE IN TERMS OF PROTECTING THEMSELVES AND ALSO KNOWING WHAT THE SIGNS ARE AND WHAT THEY SHOULD DO IF THEY′RE ILL.

ANOTHER QUESTION IN THE ROOM?

>> MATT GUPMAN, ABC NEWS.

YOU MENTIONED THE LAST 20 WERE ALL FROM THE SAME SCHOOL IN NEW YORK. WHAT DOES THAT TELL US ABOUT THE SPREAD OF THE VIRUS?

IS THAT SPREADING?

>> IT REALLY DOESN′T TELL US VERY MUCH.

THE ADDITIONAL CASES FROM NEW YORK REPRESENT ADDITIONAL TESTING, NOT ONGOING TRANSMISSION AND SO IT DOESN′T TELL US VERY MUCH. WE′RE CONTINUING TO LOOK AROUND THE COUNTRY.

HEALTH OFFICIALS AROUND THE COUNTRY ARE LOOKING AND DOING TESTING. SO, YOU KNOW, THE GOOD NEWS IS THAT WE HAVEN′T IDENTIFIED IT IN ADDITIONAL STATES, BUT I WOULDN′T PUT TOO MUCH ON THAT.

OVER THE COURSE OF THE NEXT WEEK OR TWO, WE′LL KNOW A LOT MORE ABOUT DISEASE TRANSMISSION AND HOW THIS WILL GO.

>> WE′LL TAKE A QUESTION FROM THE PHONE.

>> OUR NEXT QUESTION COMES FROM ELIZABETH WEISS, USA TODAY.

>> HI, THANKS FOR TAKING MY CALL.

ON THE FLU CALL EARLIER TODAY THEY SAID THAT THE CDC HAS ALREADY BEEN ABLE TO CULTURE THE WILD TYPE VIRUS AND YOU GUYS WERE ALREADY INCUBATING IT IN EGGS WHICH IS THE FIRST STEP TOWARD THE CREATION OF A VACCINE.

I JUST WANTED TO CONFIRM THAT IS THE CASE.

>> I THINK THAT′S WHAT I WAS DESCRIBING BEFORE IN TERMS OF GROWING A SEED STOCK FOR MANUFACTURING.

THAT′S A MORE TECHNICAL DESCRIPTION OF WHAT I LAID OUT.

>> THANK YOU.

OUR NEXT QUESTION COMES FROM MIKE STOBY, ASSOCIATED PRESS.

>> HI.

THANK YOU FOR TAKING THE CALL.

TWO QUESTIONS, ACTUALLY.

THE FIRST ONE HAS TO DO WITH SYMPTOMS.

DOCTOR, INITIALLY THE CDC DESCRIBED RESPIRATORY ILLNESSES IN CONFIRMED U.S. CASES, BUT IN THESE NEW YORK ONES IT SOUNDS LIKE IT′S MORE OF A STOMACH PROBLEM, GASTROINTESTINAL.

ARE THERE DIFFERENT SETS OF SYMPTOMS OR IS EVERYONE EXPERIENCING

RESPIRATORY AND I HAVE A FOLLOW-UP QUESTION.

>> THAT′S A GOOD QUESTION.

THE PRIMARY SYMPTOMS THAT WE HEAR ABOUT OF FEVER, COUGH, RESPIRATORY SYMPTOMS ARE STILL ONES PEOPLE NEED TO LOOK FOR. WE DO KNOW THAT THERE ARE INDIVIDUALS WHO HAVE HAD GASTROINTESTINAL SYMPTOMS OF DIARRHEA AND VOMITING

AND SO IF YOU HAVE THOSE SYMPTOMS IT DOESN′T RULE OUT THE FACT THAT THIS COULD BE SWINE FLU.

SOME OF THE CASES HAVE REPORTED THAT, AND I CAN — WE CAN GET BACK AT A FUTURE BRIEF IN TERMS OF WHAT PROPORTION OF THE CASES. THE MORE THE CASES ARE INVESTIGATING THE BETTER SENSE YOU′LL HAVE OF THE FULL SPECTRUM OF DISEASE HERE IN THE UNITED STATES AS WELL AS WHAT WE′RE HEARING FROM MEXICO.

>> MY SECOND QUESTION HAD TO DO WITH INFECTIOUSNESS.

DO WE HAVE ANY INFORMATION YET ON WHETHER THESE ARE LARGE DROPLETS THAT ONLY SPREAD ABOUT FIVE FEET OUT OR SMALL DROPLETS THAT FILL A ROOM FROM TEN FEET OUT IN THE SUPER SPREAD TYPE SITUATION?

>> IT′S TOO EARLY TO BE ABLE TO ADDRESS THAT QUESTION?

>> THANK YOU.

>> OUR NEXT QUESTION?

>> KEN MILES WITH THE ATLANTA JOURNAL CONSTITUTION.

ARE STATE AND LOCAL HEALTH AGENCY REQUESTING GUIDANCE IN DEALING WITH THIS AND WHAT ARE THEY BEING TOLD?

>> WE ARE WORKING VERY CLOSELY WITH STATE AND LOCAL PUBLIC HEALTH. IN SOME OF THE STATES WE HAVE TEAMS ON THE GROUND ASSISTING IN

CALIFORNIA AND TEXAS.

WE HAVE A LOT OF GUIDANCE POSTED ON OUR WEBSITE IN TERMS OF WHAT PEOPLE SHOULD LOOK FOR, IN TERMS OF SIGNS AND SYMPTOM, WHAT DOCTORS SHOULD LOOK FOR AND HOW TESTING SHOULD BE DONE.

WE HAVE INFORMATION ON INFECTION CONTROL PRACTICES THAT SHOULD BE APPLIED IN HEALTH CARE SETTINGS AND WE RECENTLY YESTERDAY POSTED THE GUIDANCE ON WHAT COMMUNITIES SHOULD DO IF THERE′S A CASE IN YOUR COMMUNITY.

WE WILL CONTINUE TO POST GUIDANCE AND EXPAND ON THAT AS THIS GOES FORWARD. A QUESTION FROM THE PHONE.

>> THANK YOU, OUR NEXT QUESTION COMES FROM ROB STEIN, WASHINGTON POST.

>> HI, THANKS VERY MUCH FOR DOING THIS.

>> I HAD A COUPLE OF QUESTIONS.

ONE WAS OVER THE TOTAL 40 CASES, WHAT IS THE TOTAL NUMBER OF HOSPITALIZATIONS SO FAR AND DO YOU HAVE — NEW YORK IS REPORTING 17 PROBABLE CASES.

DO YOU HAVE A TOTAL, A TALLY OF PROBABLE CASES THAT ARE PENDING IN THE UNITED STATES AND THE LAST QUESTION WAS I WAS JUST WONDERING WHAT YOU THOUGHT ABOUT THE COMMENTS FROM THE EU HEALTH MINISTER TODAY ABOUT NOT TRAVELING TO THE UNITED STATES.

>> IN THE UNITED STATES OF THE 40 CASES THAT ARE CONFIRMED

THERE′S BEEN ONE HOSPITALIZATION.

IN NEW YORK CITY, I DON′T HAVE A NUMBER OF PROBABLE CASES, BUT PROBABLE CASE NEY GENERAL, WE HAVE A DEFINITION ON THE WEBSITE SO THAT WOULD BE SOMEONE THAT HAD COMPATIBLE SYMPTOMS WITH AN EPIDEMIOLOGIC LENGTH FOR WHICH THERE′S BEEN TESTING DONE AND IT′S NOT CONFIRMED.

IN TERMS OF REPORTED COMMENTS FROM THE EU ABOUT TRAVEL TO THE UNITED STATES, BASED ON THE SITUATION IN THE UNITED STATES RIGHT NOW I THINK IT IS QUITE PREMATURE TO PUT TRAVEL RESTRICTIONS ON PEOPLE COMING TO THE UNITED STATES.

WE HAVE 20 CASES OF SWINE FLU.

WE′RE DOING ACTIVE SURVEILLANCE.

SO FAR WE′VE SEEN ONE HOSPITALIZATION.

AS THE SITUATION CHANGES, THEN THAT NEEDS TO BE EVALUATED BY INDIVIDUAL COUNTRIES AND DIFFERENT COUNTRIES WILL TAKE A DIFFERENT APPROACH AND HAVE A DIFFERENT LEVEL OF CONCERN, BUT FROM WHAT WE KNOW TODAY I THINK IT′S PREMATURE ON PUTTING A TRAVEL RESTRICTION ON PEOPLE COMING TO THE UNITED STATES.

>> THANK YOU.

OUR NEXT QUESTION COMES FROM MAGGIE FOX, REUTERS.

>> THE CDC IS GETTING EITHER BETTER OR WORSE?

>> AS WE LOOK AROUND WE WILL CONTINUE TO SEE MORE CASES AND IT′S REALLY OVER TIME WE′LL BE ABLE TO SEE MORE ABOUT THAT.

IN TERMS OF GETTING BETTER, WE WOULD LOVE TO SEE IN MEXICO THAT THE NUMBER OF CASES IS GOING DOWN AND THAT PEOPLE ARE RECOVERING, AND THAT WOULD BE A WONDERFUL THING TO SEE.

IF WE SEE NUMBERS OF CASES GOING UP, THAT′S NOT SOMETHING WE′D LIKE TO SEE.

IT′S HARD TO KNOW WHAT THE COURSE OF AN OUTBREAK IS GOING TO LOOK LIKE UNTIL YOU′RE MUCH FURTHER INTO IT.

ANOTHER THING THAT′S IMPORTANT TO NOTE IS THAT WE′RE NEARING THE END OF FLU SEASON AND OFTEN IN OUTBREAKS OF INFLUENZA YOU′LL SEE A DECLINE IN THE NUMBER OF CASES BECAUSE IT′S THE END OF FLU SEASON AND WE CAN′T REST TOO COMFORTABLY ON THAT BECAUSE SOMETIMES IT COMES BACK AGAIN IN THE FALL WHEN FLU SEASON COMES BACK. SO WE′LL BE WATCHING CLOSELY TO SEE THE NUMBER OF CASES AND THE SEVERITY OF CASES AND AGE GROUP OF CASES AND THAT SORT OF THING. TWO MORE QUESTIONS FROM THE PHONE.

>> THANK YOU.

OUR NEXT QUESTION COMES FROM MAGGIE FOX, REUTERS. PLEASE GO AHEAD.

>> WANTED TO ASK WHAT STRESS CONTINUES TO BE ON PERSONAL RESPONSIBILITY.

I KNOW UNDER PRESIDENT BUSH THAT WAS THE FOCUS. WILL CDC CONTINUE TO RECOMMEND THAT FOCUS NOW?

>> I THINK THAT THERE′S RESPONSIBILITY AT MANY LEVELS, BUT IT IS SO IMPORTANT TO START AT THE LEVEL OF INDIVIDUAL RESPONSIBILITY FOR HEALTH.

WHETHER YOU′RE TALKING ABOUT THE IMPORTANCE OF EATING RIGHT AND EXERCISING FOR PREVENTION OF CHRONIC DISEASE OR WASHING YOUR HANDS, COVERING A ROUGH AND NOT GOING AROUND OTHER PEOPLE WHEN YOU′RE SICK FOR INFECTIOUS DISEASE, IT STARTS WITH PERSONAL RESPONSIBILITY, BUT IT DOESN′T END THERE.

THERE ARE SO MANY THINGS THAT TAKE PLACE AT THE COMMUNITY LEVEL AND AT THE GOVERNMENTAL LEVEL THAT ARE SO IMPORTANT IN TERMS OF CONTROLLING AN OUTBREAK OF INFECTIOUS DISEASE.

>> THANK YOU.

OUR NEXT QUESTION COMES FROM ELIZABETH LANDAU, CNN.

>> HI, THANKS FOR TAKING MY QUESTION.

FIRST OF ALL, AT THE BEGINNING YOU SAID YOU SHOULDN′T EVEN, LIKE, GIVE A LITTLE KISS OF GREETING.

IS THAT ONLY IN AFFECTED AREAS AND IS THAT FOR EVERYONE AND SECONDLY, THERE′S BEEN A WATER SHORTAGE IN MEXICO CITY. COULD THAT POSSIBLY HAVE ANYTHING TO DO WITH IT?

>> WOULD YOU MIND REPEATING THE FIRST QUESTION? I MISSED THAT.

>> OH, SORRY.

WHEN YOU WERE TALKING ABOUT PRECAUTIONS SUCH AS, YOU KNOW, COVERING YOUR COUGH AND WANT –

YOU KNOW, DON′T EVEN GIVE PEOPLE — YOU KNOW, A KISS OF GREETING. IS THAT ONLY AFFECTED AREAS OR FOR EVERYONE.

>> I THINK COVERING YOUR COUGH IS SOMETHING YOU SHOULD ALWAYS DO. IT′S VERY — IT′S AN APPROPRIATE WAY TO REDUCE THE LIKELIHOOD OF TRANSMISSION OF AN INFECTIOUS DISEASE.

IN TERMS OF HOW YOU GREET SOMEBODY, IF YOU′RE IN AN INFECTED AREA OR IF YOU HAVE THE SWINE FLU IT′S PROBABLY BEST NOT TO — TO NOT GIVE A KISS, BUT WE′RE NOT RECOMMENDING AN END OF AFFECTION DURING THE PERIOD.

IT′S A PERIOD OF TIME WHEN WE NEED A LITTLE MORE AFFECTION, BUT DOING IT IN A WAY THAT ISN′T GOING TO TRANSMIT A RESPIRATORY DISEASE WOULD BE A CDC APPROACH.

>> ONE LAST QUESTION FROM THE ROOM.

>> YOU TALKED A LITTLE BIT ON FRIDAY ABOUT, YOU KNOW, IF IT WAS STRIKING HEALTHIER, YOUNGER PEOPLE AND NOT SOMETHING THAT WE SEE WITH SEASONAL FLU.

HAVE YOUR PEOPLE LEARNED ANYTHING ON THE GROUND ABOUT WHAT′S HAPPENING FROM AND WHY IT SEEMS TO BE HITTING HARD, YOUNGER PEOPLE?

>> WE′RE JUST STARTING TO GET SOME INFORMATION THERE AND SO IT′S A LITTLE EARLY TO SAY, BUT THAT′S AN IMPORTANT THING THAT WE′LL LOOK AT BECAUSE THE AGE DISTRIBUTION CAN BE USEFUL WHEN YOU′RE LOOKING AT AN EMERGING INFECTIOUS DISEASE, IN TELLING YOU SOMETHING ABOUT WHETHER CERTAIN PARTS OF THE POPULATION WOULD HAVE BUILT-IN IMMUNITY AND WHETHER THE AGENT IS CAUSING PROBLEMS BY ITSELF OR HOW THE HOST IS RESPONDING.

IT′S TOO EARLY TO SAY ANYTHING THAT′S GOING ON IN MEXICO. THANKS VERY MUCH.

>> THANK YOU ALL FOR ATTENDING TODAY′S PRESS BRIEFING. WE′LL PROBABLY BE BACK HERE AGAIN TOMORROW. THANK YOU.

End

Swine flu — transcript of declared emergency in US

APRIL 26, 2008 (1PM PST) -The ongoing post for the current “Mexican Cocktail” flu virus report has lead you here. Below is the transcript from Homeland Security declaring the health emergency:

Press Briefing on Swine Influenza with Department of Homeland Security, Centers for Disease Control and Prevention, and White House

Release Date: April 26, 2009

For Immediate Release
Office of the Press Secretary
Contact: 202-282-8010

Secretary Napolitano, Department of Homeland Security
John Brennan, Assistant to the President for Homeland Security and Counterterrorism
Dr. Richard Besser, Acting Director, Centers for Disease Control and Prevention
Robert Gibbs, Press Secretary

Mr. Gibbs: Good afternoon, guys. Thank you for taking some time out of your Sunday afternoon. We wanted to bring together many of the people that have the primary governmental responsibility in dealing with the situation and to discuss the government’s capacity and capability to discuss the steps the government is taking to address this.

Three people we’ll hear from today and then we’ll take some questions: First, John Brennan, Assistant to the President for Homeland Security and Counterterrorism; Dr. Richard Besser, the Acting Director of the Centers for Disease Control and Prevention, and Janet Napolitano, the Secretary of Homeland Security.

So with that I’ll turn it over to Mr. Brennan.

Mr. Brennan: Thank you, Robert. And thank you, everyone, for coming here today.

Obviously, President Obama is very concerned about the recent cases of swine flu that have been identified in the United States, as well as the outbreak in Mexico. The President’s thoughts are with those who have been affected by this illness. He is monitoring the situation very closely and has supported a very active, progressive and coordinated response by his administration.

The President wants Americans to be fully informed of the situation, which is why we have convened this press briefing today. The vast majority of these cases have occurred in Mexico. Building on the close bilateral cooperation that President Obama advanced during his recent visit to Mexico, he has asked me to publicly convey his full support to President Calderón, the Mexican government and the Mexican people in their efforts to contain the outbreak.

Both the U.S. and Mexican governments are taking steps to reduce the potential for further transmission. Our goal is simple: to communicate information quickly and clearly for our citizens, to rapidly address any new cases that emerge, and to have the capacity to effectively limit the spread.

At this point a top priority is to ensure that communication is robust and that medical surveillance efforts are fully activated. This will enable both the rapid identification and broad notification of any new cases that may occur in the U.S., as well as in Mexico.

We believe that our increased surveillance efforts have resulted in the identification of new cases over the last 24 hours. Early identification is vitally important to the overall effort. In the event that additional cases or sites of infection occur within the United States we want to recognize them quickly and then respond rapidly with appropriate guidance for the public health community and the general public in the infected area. We also want to ensure medical surveillance and testing and the provision of medications and medical supplies are distributed where necessary.

I would like to share with you some of the steps the administration has taken to ensure that information about this evolving event is flowing swiftly among federal, state and local partners, between U.S., Mexican, Canadian and other governments and with the World Health Organization.

First, the President is receiving regular updates and briefings on the situation. I updated the President earlier today. The President has reviewed our national capabilities to mitigate the effects of a broader outbreak in the United States and the steps we are taking to support state and local governments and their public health experts.

I am consulting closely with Secretary Napolitano, who is the principal federal official for domestic incident management with responsibility for spearheading our efforts. The Homeland Security Council has convened an interagency body of senior federal experts to facilitate coordination among the federal departments and agencies that have a role in recognizing, responding to, and communicating with domestic and international partners regarding health incidents that have the potential for significant impact to our nation’s well-being.

This group has been conferencing daily to share updates and to identify actions we can take now to respond to developments in an accelerated and effective manner. The information and decisions of the group are reported daily to senior leaders in the federal government and throughout the White House. Additional reports are provided as new information of significance becomes available.

While the President and his administration are actively coordinating the overall government response, individual departments and agencies with specific responsibilities as well as unique expertise and experience in dealing with public health risks are leading key elements of the effort.

For example, the Department of Health and Human Services is responsible for the overall effort to coordinate disease surveillance, medical preparedness, and guidance to public health professionals in the event that further cases are detected. The Departments – Centers for Disease Control and Prevention has responsibility for identifying and tracking the spread of the disease and for communicating health-related information to the government, media, and public. To this end, the CDC has held regular public briefings since Friday.

In a moment, Dr. Richard Besser, the Acting Director of the Centers for Disease Control and Prevention, will provide an update on the situation in the United States and Mexico, as well as where health professionals and the public can go for reliable information and guidance on swine influenza.

As I mentioned, Secretary Napolitano and the Department of Homeland Security have the overall lead for coordinating the federal response to an influence epidemic in the United States. The department is closely coordinating with Health and Human Services and CDC to monitor the situation.

After Dr. Besser speaks, you will hear from Secretary Napolitano, who will update you on the department’s efforts to coordinate response preparations and actions to date. The Secretary also will describe actions that are underway to ensure communication of timely and accurate information at land borders and at ports of entry as well as to travelers who seek additional information.

Clearly we all have individual responsibility for dealing with this situation. We should all be practicing good hygienic practices, such as hand-washing on a regular basis; if you feel sick, it makes sense to stay home; and then also following the other practices that are common sense when we deal with an outbreak of flu every year.

I would ask that you hold your questions until after Dr. Besser and Secretary Napolitano have finished their remarks.

Dr. Besser: Thank you, Mr. Brennan. First, I want to say that our hearts go out to the people in Mexico and the people in the United States who’ve been impacted by this outbreak. People around the country and around the globe are concerned with this situation we’re seeing, and we’re concerned as well. As we look for cases of swine flu, we are seeing more cases of swine flu. We expect to see more cases of swine flu. We’re responding and we’re responding aggressively to try and learn about this outbreak and to implement measures to control this outbreak.

Let me provide for you an update in terms of where we are today and what kinds of public health actions are being taken here as well as abroad. Today we can confirm that there are 20 cases of swine flu in the United States. We have five affected states: There are eight cases confirmed in New York City, there’s one case confirmed in Ohio, two in Kansas, two in Texas, and seven in California.

And again, as we continue to look for cases, I expect that we’re going to find them. We’ve ramped up our surveillance around the country to try and understand better what is the scope, what is the magnitude of this outbreak.

The good news – all of the individuals in this country who have been identified as cases have recovered. Only one individual had to be hospitalized. But I expect as we continue to look for cases, we are going to see a broader spectrum of disease. What we know about this virus is it looks to be the same virus as is causing the situation in Mexico. And given the reports out of Mexico, I would expect that over time we’re going to see more severe disease in this country.

There are some things that it’s important people understand: Flu viruses are extremely unpredictable and variable; outbreaks of infectious disease are extremely unpredictable and variable. And so over time what we say about this and what we learn will change. Expect changes in terms of the number of cases. We’re going to try and give you consistent information and have it on our web site once a day, so that we don’t get into the situation where you’re hearing different numbers of cases throughout the day – we’re going to report that daily.

We expect that we’re going to be changing our recommendations over time based on what we learn. And that’s an important thing. You’ll start to see different activities taking place in different parts of the country, depending on the local outbreak picture – and that’s good. You want people to respond based on what the situation is in their community, based on what situations are in particular countries.

Because of this speed in which things are progressing, you will at find – at times find inconsistent information, and we’re going to work really hard to make sure that that doesn’t stay up for long. But as we’re updating recommendations and they’re going out through various sources, you may find some inconsistency and we will work to minimize that.

This is moving fast, but I want you to understand that we view this more as a marathon. We do think that this will continue to spread, but we are taking aggressive actions to minimize the impact on people’s health.

It’s important that people understand that there’s a role for everyone to play when there’s an outbreak going on. There are things that individuals do, there’s things that families do, communities do to try and reduce the impact. At the individual level, it’s important people understand how they can prevent respiratory infections. Very frequent hand-washing is something that we talk about time and time again and that is an effective way to reduce transmission of disease. If you’re sick, it’s very important that people stay at home. If your children are sick, have a fever and flu-like illness, they shouldn’t go to school. And if you’re ill, you shouldn’t get on an airplane or another public transport to travel. Those things are part of personal responsibility in trying to reduce the impact.

It’s important that people think about what they would do if this outbreak ramps up in their community. We understand that in New York City there’s a cluster of disease in a school and New York City has announced that they’re not having those children come back to school on Monday, so that they can understand better about transmission in that school. There’s a similar situation in Texas. Those are very smart public health decisions. If there are other communities where we saw cases in a school, we would be recommending that they take those actions as well.

So it’s time for people to be thinking – forward-thinking about, well, if it were my child’s school, what would I do, how would I be prepared for that kind of an event. We view the public as partners in the efforts to try and control what’s going on.

There are a number of sources of information. I want people to know that the CDC web site – www.cdc.gov – has our latest information on swine flu. There’s a link from there to very current information and there’s a link there to a Spanish language site as well.

So let me talk about some of the public health actions that are going on. We are working very closely with state and local public health on the investigations going on around the country. We’re providing both technical support on the epidemiology as well as support on the laboratory in terms of confirming cases.

We’re also doing a lot of work with the World Health Organization, the Pan American Health Organization, and the governments of Mexico and Canada on this outbreak. There’s a tri-national team that is working in Mexico to try and understand better the spread – why are they seeing more severe disease in Mexico than we are here? That’s a critical question. We’re working to assist Mexico in establishing more laboratory capacity in-country. That, again, is very important because when you can define someone as a truly confirmed case, what you understand about how they acquire disease takes on much more meaning.

We issued two days ago an outbreak notice on our web site regarding travel to Mexico. It indicated that if you are traveling to Mexico, that you look at that to see what precautions could you take as an individual to reduce the likelihood that you became ill. We’re going to continue to evaluate the situation in Mexico, and if need be we will increase the warnings based on what the situation warrants.

Later today we’re going to be putting out some additional community guidance so that public health officials will know what our general recommendations are should they see cases in schools or additional cases in their community.

And I think that the last thing I want to mention is that whenever we see a novel strain of influenza, we begin our work in the event that a vaccine needs to be manufactured. So we’ve created that seed stock, we’ve identified that virus, and discussions are underway so that should we decide to work on manufacturing a vaccine, we can work towards that goal very quickly.

Our support to the states and locals will continue. We provide epidemiologic support, laboratory support, and we provide them support in terms of their medications and other material that they need to work on this outbreak.

So thank you very much, and I’ll turn it over to the Secretary.

Secretary Napolitano: Thanks, Dr. Besser. A number of things going on and the purpose of today, this briefing, is to give you the most current information about what is happening. And as has been mentioned before, this is a changing picture. And so we intend to conduct these types of briefings daily for a while so that, you know, it can help up communicate to the public what is happening and so that with knowledge people know what kind of issue we’re dealing with.

The first thing I want to announce today is that the Department of Health and Human Services will declare today a public health emergency in the United States. That sounds more severe than really it is. This is standard operating procedure and allows us to free up federal, state, and local agencies and their resources for prevention and mitigation; it allows us to use medication and diagnostic tests that we might not otherwise be able to use, particularly on very young children; and it releases funds for the acquisition of additional antivirals.

So you’ll see those declarations coming out today. And when I say “standard operating procedure,” that’s exactly what I mean. We issued similar declarations for the recent floods in Minnesota and North Dakota and for the inauguration.

Second, I want to give you some information about where we are with respect to antiviral drugs. These are the kinds of things you would take should you get sick with this strain of flu. We have 50 million treatment courses of antiviral drugs – Tamiflu and Relenza – in the strategic national stockpile. We are releasing 25 percent of those courses, making them available to all of the states, but particularly prioritizing the states where we already have confirmed incidents of the flu. In addition, the Department of Defense has procured and strategically prepositioned 7 million treatment courses of Tamiflu.

The United States Department of Agriculture is heavily involved in monitoring and testing to ensure that there is no issue with our food supply, and everything looks fine. I want to underscore that you cannot get the swine flu from eating pork. So that’s very important. And we’re screening and testing livestock to monitor any developments there.

Next, in the Department of Homeland Security, we have a number of components with direct responsibility here. The CBP is inventorying for every duty station and every employee our resources, personal protective equipment, and so forth, to make sure that we have adequate supplies on hand at the borders themselves.

Secondly, we have implemented passive surveillance protocols to screen individuals who may arrive at our borders. All persons entering the United States from a location of human infection of swine flu will be processed through all appropriate CBP protocols. Right now those are passive. That means that they’re looking for people who – and asking about, are you sick, have you been sick, and the like; and if so, then they can be referred over for further examination.

Travelers who do present with symptoms, if and when encountered, will be isolated per established rules. They will be provided both with personal protective equipment and we will continue to emphasize universal health measures like hand-washing and gloves. And if and when the situation develops all CBP sites can implement and we can deploy additional personnel to the borders.

In addition, at the TSA, many of the similar measures are being implemented there with respect to the protection of our TSA workers and also their experience with travelers. To date, the State Department has not issued official travel advisories for particularly Mexico, but again, as I said earlier, these situations are very fluid and so you need to keep up to date on that. In addition to the CDC website, the Department of State has a website that will keep travelers posted on what the situation is not only with our neighboring countries, but with countries around the world.

As I said earlier, our intent is to update you daily on this situation so that you can know what is happening within the federal government. State and local governments obviously now are in the loop. State and local public health authorities obviously are working very hard and will be working hard, because as the doctor said, this will be a marathon, not a sprint, and even if this outbreak is a small one, we can anticipate that we may have a subsequent or follow-on outbreak several months later, which we will be prepared for.

And again, the government can’t solve this alone. We need everybody in the United States to take some responsibility here. If you are sick, stay home. Wash your hands, take all of those reasonable measures; that will help us mitigate, contain how many people actually get sick in our country.

Thank you.

Mr. Gibbs: With that, let’s take a few questions.

Question: Thanks, Robert. Are there any U.S. clusters that suggest this is easily spread? Have we seen any pockets of suspected cases in the U.S. that suggest this could be on the scale of Mexico? And you say it’s a marathon. How long is this marathon going to be?

Dr. Besser: Thanks for those questions. In terms of duration, my comment earlier about every outbreak is unique is really important to remember. And so it’s very hard to say. There’s one thing in our favor; we’re nearing the end of the flu season, we’re nearing the end of the season in which flu viruses tend to transmit very easily. And so we would expect to see a decline in cases, just like we’re seeing a decline in cases of seasonal flu, at some point.

The issue of clusters is an important one, and New York City earlier talked about their school cluster, and that’s important. Some of our early epidemiologic investigations are showing that contacts of people who have been diagnosed have a significant rate of respiratory infection – not confirmed to be this; we only have one documented by viral isolate case in this country of person-to-person spread – and that was an individual who had gone to Mexico and came back, and then there was a spouse who was diagnosed as well, and both are doing well.

Question: Robert, how concerned are you about the potential for this outbreak to set back the hopeful economic recovery both here in the United States and globally? And secondly, what if anything are we meant to read into the fact the President Obama decided to go golfing today? Is this part of your effort to reassure Americans that there’s no need to panic?

Mr. Gibbs: I’m not sure I would draw a direct conclusion between the news today and the President’s golf. (Laughter.)

I think as Mr. Brennan said, the President has been updated regularly on this and we’ll continue to do so as we will continue to regularly update you.

In terms of anything that is affected economically both here and worldwide, I think it’s probably far too early to determine whether that will be a case or whether that will have some factor. We just want to ensure that people understand the steps that are being taken both here and throughout government to address the situation, as well as, as each of these speakers have said, understand the individual responsibilities that people have. If you have questions, go to the CDC website at cdc.gov. And as the doctor mentioned, there’s also a Spanish version of that site.

Question: First to you, Robert. Why was it necessary to have the President checked this morning?

Mr. Gibbs: The President hasn’t been checked this morning.

Question: Ms. Jarrett indicated today on a Sunday morning program that he had been.

Mr. Gibbs: I will double-check. I don’t know of any reason why he would have been.

Question: And Dr. Besser -

Mr. Gibbs: Let me expand that a little bit. I think these guys obviously have more medical degrees than I do, but the incubation period for this is a 24-48 hour incubation period. The doctors advised us that the President’s health was never in any danger. We’ve been gone from Mexico for now more than nine days.

Question: Dr. Besser, you mentioned seed stock for vaccines. What is the threshold that you have to meet before you consider developing that vaccine and deploying that vaccine?

Dr. Besser: There are a number of things that we look at going into the decision as to whether to make a vaccine. One is the severity of the strain, its sustainability in the community; do we anticipate that it’s a virus that will be here next flu season – so you want to prepare for that. Then there are issues in terms of production. Currently manufacturers are working on seasonal flu vaccine for next season, which has three types of influenza virus – or influenza antigen in it. We have to have discussions to determine could they add a fourth; would it require substituting or changing production in another way?

All of those discussions are underway, so that if there’s a decision to move in that direction we’d be ready.

Question: I notice that you’re not recommending that people, even if they’re ill, become vaccinated. Has the President been vaccinated by Tamiflu or Relenza? And at what level does this have to get before we go from a public health emergency to a federal pandemic plan?

Dr. Besser: I wanted to clarify a couple things you said. Oseltamivir and zanamavir are not vaccines. Those are antiviral drugs that can be used to treat somebody who is ill.

One of the points I didn’t make before is that if someone is ill with flu-like symptoms, in particular if they’ve traveled to an area that’s been involved, they need to contact their doctor and determine what type testing and treatment is indicated.

At this point there is not a vaccine for this swine flu strain. It’s a new strain of influenza. And so what we’re talking about is whether it’s warranted at this point to move toward manufacturing a vaccine.

Question: Two questions. First, I want to know if the public health emergency declaration allows the federal government to invoke any kind of quarantine powers. And if so, how would that be used? And second, we’ve been hearing for years that we could have another 1918-like pandemic. So based on what you know right now, how likely is it that this could be a very, very severe outbreak?

Secretary Napolitano: The public health declaration does not, in and of itself, convey quarantine authority. And most quarantine authority is held at the local and state level, and we’re nowhere near that sort of a decision. The decisions that have been made to date are the common-sense ones, the few places where we’ve had a U.S. outbreak, to close a school here, close a school there. But most quarantine authority is held at the state and local level. And this declaration does not, in and of itself, provide that.

Dr. Besser: The other part of your question had to do with 1918 and what we’re seeing here. One of the very important issues that we’re looking at is how severe is this outbreak that’s taking place. What we’re seeing in this country so far is not anywhere near the severity of what we’re hearing about in Mexico, and we need to understand that.

It’s also important to recognize that there have been enormous efforts going on around the country and around the world for pandemic preparedness and that our detection of this strain in the United States really came out as part of that. There was work going on in San Diego in terms of developing a point of care test kit, something that could be used in doctors’ offices, that detected a strain they couldn’t identify, and that was identified in our laboratories as the swine flu strain. And so that – really some of the preparedness activities, the laboratory capability that we have now is not what it was five years ago, let alone in 1918. We understand a lot about how flu should be managed and treated.

Question: And if I could just follow with one other question. Relenza and Tamiflu, how effective are they in treating this particular strain, if at all?

Dr. Besser: At this point, it’s premature to talk about how effective they are. Those are some of the studies that we would want to undertake and assist Mexico in undertaking. We do know from seasonal flu that early treatment with antivirals can shorten the course of illness. But in terms of this situation, we know that the strain is susceptible, it’s not resistant to those drugs. It is resistant to other drugs, amantadine and rimantadine. But it’s not resistant to oseltamivir and zanamavir, which are the drugs that we’ve been stockpiling.

Secretary Napolitano: I just wanted to clarify – on the declaration of emergency, I wish we could call it declaration of emergency preparedness, because that’s really what it is in this context. It’s similar to what we do, for example, when we know – when a hurricane may be approaching a site, we will go ahead and issue an emergency declaration that allows us to preposition – frees up money, resources to get pre-positioned, to get ready. A hurricane may not actually hit a particular landfall, but it allows you to undertake a number of preparatory steps. And really that’s what we’re doing right now, the government. We’re leaning forward, we’re preparing in an environment where we really don’t know ultimately what the size or seriousness of this outbreak is going to be.

Question: Dr. Besser, you said we were likely to see more cases and the CDC’s Dr. Ann Schuchat said yesterday, “We do not think we can contain the spread of this virus.” What exactly does that mean?

Dr. Besser: In strategies for outbreak control there’s a concept of containment where if you can detect it very quickly in one community, that you could swoop in and try and quench it and knock it out so it doesn’t go further. We don’t think that that’s a possibility, but we do think that it’s very possible to mitigate or reduce the impact of this infection around the country.

In terms of detection, what we’re seeing in this country is mild disease – things that would never have been detected if we weren’t ramping up our surveillance. And so my comment there is that by our efforts of asking doctors to culture – we are asking doctors when they see someone who has flu-like illness who has traveled to an affected region to do a culture – take a swab in their nose and send it to the lab so we can see, is it influenza, is it this type. And I expect that as we do that we’re going to find cases all – in many different parts.

When I mentioned the states we’re seeing cases in right now, they’re not all contiguous. The travel patterns of people now are such that we would expect that we’re going to see cases in more states.

Question: If I could follow up on that, is it true that it took a week until after Mexico had invoked its own protective measures before the U.S. was notified of this? And is it a significant concern that HHS is in charge of this at a time when it doesn’t have a Secretary?

Dr. Besser: In terms of detection and reporting, you know, the confirmation of swine flu from Mexico was shared with us immediately. There was great collaboration between Canada and Mexico on doing that testing. I’m in daily communication with their public health leadership and the collaborations have been absolutely superb. We share information about what we’re seeing here and they’re sharing information about what they’re seeing in Canada and in Mexico.

Question: They sent those tests to Canada rather than the U.S., apparently because of paperwork.

Dr. Besser: Well, we have – there are quite a number of isolates that we’ve tested here from Mexico as well.

Mr. Gibbs: In terms of a Secretary, I think these guys have given you a pretty good indication of the response mechanisms that are in place and that have been activated relating to this. So I think it’s all hands on deck and we’re doing fine. I would say we’re hopeful that we have a new Secretary very shortly.

Yes, ma’am.

Question: Secretary Napolitano, I believe Japan and South Korea have both now announced that they’re going to begin testing on passengers coming in from the U.S. Why is the U.S. not doing that with passengers coming in from Mexico? And then also, do you have any indications – I know it’s still very early yet – but any indications that perhaps this might have been caused by bioterrorism, this new strain of flu?

Secretary Napolitano: I’ll let John answer the second part. With respect to that, we’re doing, as I said, passive surveillance now. Right now we don’t think the facts warrant a more active testing or screening of passengers coming in from Mexico, although obviously we are letting air carriers and our employees at the gates on those flights make sure that they are asking people if they’re sick; and if they’re sick, that they shouldn’t board the plane – you know, that sort of thing, passively.

But again, this is a changing dynamic that we may increase or decrease that as the facts change over the next 24, 48, 72 hours.

Dr. Besser: Yes, the question about the strain that we’re seeing here, we analyzed that strain and are continuing to do further analysis of that strain and we expect to see the emergence of new flu strains. That’s something that we are continually watching for to ensure that we’re ready should a strain emerge that there’s not immunity and protection in the community for it. This strain is not unlike other new strains that have emerged. It’s an assortment – it’s got genetic components from a number of sources, including human, swine, and avian sources. And that’s something that you see with new strains.

And so there’s nothing that we have seen in our work that would suggest anything but a naturally occurring event.

Question: But from a security perspective, nothing to rule it out either – the possibility of bioterrorism?

Mr. Brennan: We are looking at all different aspects here, but as the doctor said, there is no evidence whatsoever that we have seen. But clearly, in order to make sure that we’re doing everything possible, we’re looking at all potential explanations here – but no evidence whatsoever on the bioterrorism -

Question: How do the – Madam Secretary, how do the stocks of effective antivirals today compare to previous outbreaks – SARS, for example? And will DOD stocks be available for the public, or are those just for DOD?

Secretary Napolitano: Right now the DOD stocks I believe are for the DOD personnel, but I’ll have to confirm that for you later. I believe that to be the case. We have 50 million courses that are in the national stockpile. As I said, we’re freeing up a quarter of those for use by the states, in addition to whatever state stockpiles they have, should they need it. Priority will go to the states that have confirmed outbreaks of disease. And I don’t have the history on how that compares to what we had on hand for SARS.

Dr. Besser: The strategic national stockpile has considerable assets for treating flu. In addition to the antivirals, there’s the supplies should we see hospitalizations that would warrant support. SARS is a different picture in that there were – there was not a medication that people could take to treat it, and so this is a very different situation.

And as part of our planning for a large outbreak this pre-deployment of availability is a leaning-forward step. We know that many states aren’t seeing any cases, but it was our belief that having things there ahead of time was the way to go, rather than waiting until it got to a point where people were asking.

Question: Secretary Napolitano, you mentioned the quarantine power and, you know, that’s really a state and local issue. What additional authority does the President have, what other powers does he have to contain this, to mitigate it, whatever. What else can he do?

Secretary Napolitano: I don’t want to give you a legal brief on that right now, but that’s -

Question: Perhaps later? (Laughter.)

Secretary Napolitano: Yes, exactly. (Laughter.)

We want to make sure that it’s very precisely explained to you and to the public. So perhaps we could brief that to you later on this week.

Question: But there are additional things? You guys are confident that – measures that you can take, beyond a declaration of emergency – things that you can do at the federal level?

Secretary Napolitano: Yes.

Question: Okay. And Robert, actually, can you follow up on that eco question, on the eco trade. I just want to be clear, you’re not at all studying this, measuring what sort of effect this could have economically – you’re just not at that level yet?

Mr. Gibbs: I’ll check with NEC. I don’t know of anything related to that at this point, but we can certainly check.

Yes, ma’am.

Question: What haven’t you banned U.S. travel to Mexico and why haven’t you changed the U.S. alert level in the face of this – unless the declaration of public health emergency is doing that?

Dr. Besser: I can comment. We have at CDC posted an outbreak notification regarding Mexico, and we’re continuing to watch the situation there and evaluate. And should it be warranted, we would make a change in that regard.

In terms of the stages and phases of pre-pandemic situations, the real important take-away is that we have an outbreak of a new infectious disease that we’re approaching aggressively. And it matters much less what you call it. Those things are designed to trigger actions, but we trigger our actions based on what we’re seeing here in-country as well as what we see around the globe. And given that this new strain is something we’re experiencing here on the ground, we’re being very aggressive and addressing that based on what we’re seeing in each community.

Question: What has been discovered so far about why people in Mexico have died, but not elsewhere?

Dr. Besser: That’s an unanswered question. We have folks on the ground and we haven’t been able to find an answer for that. There are a number of different hypotheses and I’m hoping that we’ll be able to shed some light on that as these teams get more established and continue their studies.

Question: For Dr. Besser, is there evidence of ongoing transmission in Mexico, or are the cases being picked up there ones that happened in the last couple of weeks and are over? Or are there new chains of transmission being generated?

Dr. Besser: Again, I don’t want to comment on the situation on the ground in Mexico. I’ve not heard that it is stopping. Their overall flu surveillance is only showing a small increase from what they would see annually, which, again, makes it difficult to use some of the surveillance tools to measure the impact of a new strain when you’re in the midst of another flu season.

Question: Just to follow up on what the President – for you, Robert – what the President – did you say that he has not been treated with any kind of -

Mr. Gibbs: I said yesterday that he had not been. I will recheck with the doctor. Again, based on the incubation period, neither he, nor anybody that he traveled with, nor anybody in the press corps that I’m aware of would have exhibited any symptoms that would have caused any heightened awareness.

Question: But the doctor didn’t check him out -

Mr. Gibbs: No. Again, in the absence of symptoms – I think this probably goes without saying, too – in the absence of symptoms, you shouldn’t go get tested. That’s going to crowd any sort of either public health or private health infrastructure. If you are sick or you do have symptoms, then you should take precautions. But there’s not reason to believe that his – or anybody that traveled with him – health was in any sort of jeopardy.

Question: Just to follow up on the HHS question. Apparently, HHS — CDC, Surgeon General assured there are no -

Mr. Gibbs: I thought he was doing a pretty good job. (Laughter.)

Question: But it raises a political question about how movement there has been stalled because of HHS. I mean, do you have – has the President expressed concern about the fact that you don’t have a team in place there, or at the -

Mr. Gibbs: No, because – I want to be very clear here. There is a team in place. The team is – part of it is standing behind me, and part of it is working as we speak to identify exactly what the doctor and others have talked about. I think this notion somehow that if there’s not currently a Secretary, that there’s not the function that needs to take place in order to prepare for this either this or any other situation is just simply not the case.

Thanks, guys.