Results of Obama Birth Certificate investigation announced by Sheriff Joe

March 3, 2012

Maricopa County Sheriff Joe Arpaio of Arizona

“Computer generated forgery” is suspect after a six month long investigation conducted by the Maricopa County Sheriffs’ Office in Arizona.

On March 1, 2012 an investigation on the authenticity of President Obamas’ Birth Certificate and other records were made public by the Sheriffs’ Office, which serves nearly four million residents in the fourth largest county in the United States.  Below is video evidence submitted in the press conference.

Preliminary findings were announced to the public personally by the infamous Maricopa County Sheriff Joe Arpaio of Arizona.

The Sheriffs’ Office does not believe that the scanned document is of an original 1961 paper document as represented by the White House

Investigators advised Sheriff Arpaio that the forgers committed two crimes: first, in creating a fraudulent document which the White House characterized, knowingly or unknowingly, as an officially produced governmental birth record; and second, in fraudulently presenting that document to the residents of Maricopa County and to the American public at large as “proof positive” of President Obama’s authentic 1961 Hawaii long-form birth certificate.

According to the U.S. Constitution, “No person except a natural born citizen…” shall be eligible for the Office of the President to assure allegiance by birth to our country. Residents of Maricopa County Arizona had petitioned the Sheriffs’ office to verify the birth certificate for eligibility before the 2012 Arizona presidential ballot is cast. The investigation was conducted by a team of former law enforcement officers and lawyers with law enforcement experience coined the “Cold Case Posse” on a volunteer basis at no cost to the taxpayers.

After concluding probable cause to believe computer-generated forgery, investigators began examining other evidence of President Obama’s life history including:

President Obama’s Selective Service card is most likely also a forgery, revealed by an examination of the postal date stamp on the document;

To quell the popular idea that Obama was actually born outside the United States, the Sheriffs’ Office examined the Records of Immigration and Naturalization Service cards routinely filled out by airplane passengers arriving on international flights that originated outside the United States in the month of August 1961. Those records are housed at the National Archives in Washington, D.C. Interestingly,  records from the days surrounding Obama’s birth, August 1, 1961 to August 7, 1961 are missing. This is the only week in 1961 were these immigration cards cannot be found.

Click on the above video inset to view the entire press conference.

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

April 30, 2009

(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

April 30, 2009

(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


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

April 28, 2009

(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


FDA Failed Again — But No One’s Talking

March 7, 2009

Remember that scene in the movie Slum Dog Millionaire when the empty water bottles were refilled with tap water then sealed with super glue? That was just a movie.

Here in the United States a more sinister act has been perpetrated by a North Carolina pre-filled syringe factory.

On Feb. 23, 2009, two employees of a pre-filled syringe manufacture, AM2PAT, Inc,  plead guilty and were sentenced to 54 months imprisonment for misbranding syringes for distribution. The employees are Ravindra Kumar Sharma, age 54, of Richmond, Virginia and Aniruddha Petel, age 43, of Carpentersville, Illinois.

Criminal complaints included mail fraud, submitting false statements to a US government entity, and knowingly sending misbranded medical devices into interstate commerce with the intent to defraud.

Syringes were misbranded as “sterile,” when, in fact, the requisite sterility testing on these products had not been completed prior to their shipment into interstate commerce.

Paperwork had been falsified or fabricated to indicate compliance.

The company, AM2PAT, Inc. is responsible for 200 to 300 medical patients throughout the country who developed bacterial infections after having been injected by the syringes. Serious illness such as spinal meningitis, permanent brain damage and even death have resulted in some cases.

AM2PAT, which also sold products under the name Sierra Pre-Filled, produced syringes of heparin and saline, which are often used on already vulnerable patients during cancer treatments, kidney dialysis and other procedures. Read more here

A Federal Grand Jury returned a ten-count Indictment against both AM2PAT, Inc., and its former President, Dushyant Pate on February 19, 2009. Charges include making materially false statements to the Food and Drug Administration in the company’s 2003 Notification to the Food and Drug Administration of its intent to market syringes pre-filled with heparin.

A statement made on Feb. 25 indicated authorities searching for the Chicago-based company’s CEO Dushyant Patel, who had been indicted the week earlier. They believe he fled to his native India.

Read the entire US Attorneys’ Office Press Release here

Other articles of interest:
Mark to Market Accounting in the Banking System
https://willnevergiveup.wordpress.com/2009/03/06/fdic/

A fable unfolded: ACORN and a foreclosure “victim”
https://willnevergiveup.wordpress.com/2009/02/23/acorn/

Foreclosures and illegals
https://willnevergiveup.wordpress.com/2009/02/21/foreclosures-illegals/

Illegal Aliens, the US Stimulus Package and the Age of Transparency Unveilled
https://willnevergiveup.wordpress.com/2009/02/05/hr-1/

Mortgage Rescue Bill and YOUR Tax Dollars
https://willnevergiveup.wordpress.com/2008/09/05/mortgage-rescue-bill-and-your-tax-dollars/

Citizenship of Birth Entitlement to End
https://willnevergiveup.wordpress.com/2009/01/30/hj-res-6/

Tax Loophole Proposed
https://willnevergiveup.wordpress.com/2009/01/26/s-261s-261/

Information gathering on US citizens
https://willnevergiveup.wordpress.com/2009/01/23/hr-640/

Gun control legislation
https://willnevergiveup.wordpress.com/2009/01/19/hr-45/

Presidential term limits to vanish
https://willnevergiveup.wordpress.com/2009/01/10/hj-res-5/

Congress to meet in secret locations
https://willnevergiveup.wordpress.com/2009/01/16/h-con-res-1/

Social Security Funds for Native Hawaiian Healthcare
https://willnevergiveup.wordpress.com/2009/01/12/s-52/

What a Russian Newspaper had to say about our Obama
https://willnevergiveup.wordpress.com/2008/12/02/russia/