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Officials in Mexico were criticized as being slow to respond to the spread of A/H1N1 swine flu on Tuesday, April 28. Mexico was reported to have failed to deliver medicine to the families of the dead, two weeks after the first confirmed death from the flu, the Associated Press reported. Also, the government had not determined where the outbreak began or how it spread, the AP said. In Mexico, 159 people may have died of swine flu, but only seven of these deaths have been verified as A/H1N1 by laboratory tests, the New York Times reported today (April 29).

Meanwhile, in the United States, the federal Centers for Disease Control and Prevention reported 64 confirmed cases of swine flu and the first death, a 24-month old child in Texas. The federal Centers for Disease Control and Prevention (CDC) gave no further details. Richard Besser, M.D., the CDC’s Acting Director, said Tuesday that he expected some Americans would die of the flu. Besser was quoted in The New York Times. He characterized these early days of swine flu in the United States as a pre-pandemic period. “As this moves forward, I fully expect that we will see deaths from this infection,” he added.. Most of the U.S. cases (45) were reported in New York City. California had 10 cases, Texas, 6; Kansas, 2; and Ohio, 1.

On Tuesday, President Barack Obama asked Congress for $1.5 billion for supplemental spending to build drug stockpiles, monitor future cases, and help international efforts to control the outbreak.

Michael Osterholm, director of the Center for Infectious Disease and Policy at the University of Minnesota in Minneapolis, was quoted in the New York Times, saying, “The zillion-dollar question is how long will this transmission activity last and what will be the evolving picture of disease severity. If transmission continues and severe illness is documented, WHO will have to raise its pandemic alert level further.”

As of Tuesday night, seven countries had officially reported swine influenza A/H1N1 case, according to the World Health Organization. Mexico had 26 confirmed human cases of infection and seven deaths. Canada (6), New Zealand (3), the United Kingdom (2), Israel (2) and Spain (2), but none of these countries reported any deaths. China, Russia, and eight other countries were preparing to quarantine passengers suspected of having the flu and were investigating possible cases, the Times reported.

WHO advised no restriction of regular travel or closure of borders but Cuba canceled all flights to Mexico and Carnival Cruise Lines canceled stops in Mexico for three cruise ships, Reuters reported. Nine countries banned pork imports: China, Croatia, Indonesia, Lebanon, Russia, South Korea, Thailand, Ukraine, and Ecuador.

New York City Mayor Michael Bloomberg said most of the cases in New York were from St. Francis Preparatory Academy, a high school in Queens. Two other outbreaks at schools were being investigated: one in Queens and one in Manhattan.

“It is here and it is spreading,” said Thomas R. Frieden, M.D., the New York City Health Commissioner.

Perhaps most distressing were news reports of a slow and confused response to the swine flu epidemic by officials in Mexico, the AP reported. Mexico’s health secretary said the agency lacked the resources to visit the families of the dead, meaning physicians could not begin treating those most exposed to and most likely to spread the pathogen. These failures mean health officials do not know how the victims became infected. Such information would be important to those seeking to determine how the epidemic began and how it might be contained, the AP said, which also wrote that health officials in other countries hesitated to criticize Mexican health authorities.

After an outbreak of SARS in late 2002 and early 2003, officials in China were criticized heavily for failing to release details about the disease, its origin and how it spread. Mexico’s Health Secretary Jose Angel Cordova was questioned on Monday about why Mexico took so long to identify the outbreak, attempt to contain its spread, and provide information, the AP said.

“We never had this kind of epidemic in the world. This is the first time we have this kind of virus,” Cordova said.

It remained unclear where and how the epidemic began, how it has spread, who it has killed or how fast it is growing; and the government has yet to take some basic steps critical to containing any outbreak, such as quick treatment of people who had contact with the victims, the AP said.

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