There are now at least 68 confirmed cases of swine flu in five states. The U.S. Centers for Disease Control and Prevention said Monday that the new count includes "a number of hospitalizations" but they did not say how many. CDC officials had said there had been just one person hospitalized.
The cases are still only in the five states where they previously were reported. There are 17 new cases in New York City, four more in Texas and three additional cases in California.
That brings the total confirmed cases to 45 in New York City, 10 in California, six in Texas, two in Kansas and one in Ohio.
In New York Monday night, the accounting firm Ernst & Young notified its employees that one of its workers at its Times Square offices has come down with swine flu.
Officials across the country are bracing for the worst: From New York to California, and states in between, local and federal governments are stepping up the fight against swine flu.
"We are proceeding as if we are preparatory to a full pandemic," Secretary of Homeland Security Janet Napolitano said Monday.
But the acting director of the Centers for Disease Control and Prevention warned not to be overly reassured by that.
"I expect that we will see cases in other parts of the country," Dr. Richard Besser said Monday. "And I would fully expect that we'll see a broader range in terms of the severity of infection."
The government said it was shipping millions of doses of flu-fighting medicine from a federal stockpile to states along the Mexican border or where the virus has been detected.
But the American reaction to swine flu, which has killed up to 149 people in Mexico and on Monday led the World Health Organization to raise its alert level, was mostly limited to steps that hospitals, schools and mask-wearing individuals took on their own.
The CDC believes there is no evidence the virus is spreading outside infected communities. But with no specific vaccine to fight the flu, the U.S. government has shipped 11 million doses of the antiviral drug Tamiflu to states from a federal stockpile, with priority going to states with confirmed cases and states that border Mexico.
Appearing on CBS' The Early Show Tuesday, Secretary of Homeland Security Janet Napolitano said the nation is prepared for dealing with the outbreak. "We are much more prepared than we would have been, say, 10 years ago," Napolitano told anchor Julie Chen.
"There actually has been a lot of preparation for pandemic out of the expectation we would see avian flu. Now, of course, we're seeing swine flu. Many of those preparations are directly applicable … at a local level, at the state level.
"At the federal level we're coordinating amongst many, many departments to make sure that, should this erupt into a full-fledged pandemic, we're as prepared as we could be," she said.
Napolitano said officials have been following the advice of public health professionals to issue an advisory against non-essential travel to Mexico, but who likewise said that closing the border wouldn't actually help keep out the disease at this stage.
Beyond the actions of government agencies, Napolitano suggested that Americans should be conscious of their own health, and if they have a fever and heavy cough to seek medical attention if they believe they've been exposed. "And don't contaminate others. Don't go to school. Don't go to work and the like."
Napolitano said quarantines at U.S. airports have not been activated but that they could be is warranted. "It would take, first of all, public health officials concluding that that would have an impact on the spread of disease," she said. "And then secondly, being able to detect those who are coming in to the country that should be quarantined. But right now, if someone is coming in, and they are suspected of having the swine flu, they are moved or can be moved to a secondary inspection, and put in an isolated room."
Public health experts cautioned that screenings were not foolproof. People with the flu can spread the virus to others before any symptoms show up.
"It's not a perfect solution," said Greg Gray, director of the Center for Emerging Infectious Diseases at the University of Iowa College of Public Health, who estimated the screenings would pick up 80 to 90 percent of cases.
Gray said he believed the U.S. response was appropriate given how little researchers know about the potency.
"The virus is here in North America, and it's likely to show up on every continent, I think, by the end of the week," he said. "It's hard to stop."
In other countries, precautions were far more stringent. Asian nations activated thermal scanners used during the 2003 SARS crisis to check for signs of fever among passengers arriving from North America. In Malaysia, health workers in face masks took the temperatures of passengers touching down from Los Angeles.
Australia said it would require pilots on international flights to file a report noting any flu-like symptoms among passengers before being allowed to land. And China ordered anyone with flu-like symptoms within two weeks of arrival to report to authorities.
The European Union's health commissioner urged Europeans to put off nonessential travel to part of the United States, but Dr. Richard Besser, acting head of the CDC in Atlanta, said the recommendation was unwarranted.
"At this point I would not put a travel restriction or recommendation against coming to the United States," he said.
In the U.S., protective steps were more scattered.
A South Texas school district was closed, and residents of Guadalupe County, outside San Antonio, were asked to avoid public gatherings and stay home if they are ill.
Security guards at all entrances to the University of Chicago Medical Center required anyone walking in to use a liquid disinfectant. At Rush University Medical Center, anyone seeking treatment for fever, runny nose and coughs was being tested for flu with nasal swabs.
Elsewhere, there were signs of growing unease among the public, even in places where there was no immediate known cause for alarm.
Students at a Chicago school were instructed not to shake hands with anyone, and Southern Illinois University urged students to wash their hands frequently and cover their mouths when coughing. There were no known swine flu cases in Illinois.
And in New Mexico, which also had no reported cases, health officials were so besieged by calls from concerned citizens that they set up a swine flu hot line.
Pharmacies in Manhattan reported that paper face masks were selling by the box. One pharmacy owner said he had to order more from his wholesale supplier for the first time since the SARS epidemic six years ago.
And yet in the subways and on the streets, it was all but impossible to find anyone wearing a mask.
At the main pedestrian border crossing between El Paso and Mexico's Ciudad Juarez, a handful of people wore protective masks and officials handed out a swine flu flier provided by the Centers for Disease Control and Prevention.
But there were no extra screenings for swine flu, and it mostly looked like a typical day at the border. Suddenly faced with a new and unforeseen threat, people entering the country who said they felt unwell were questioned about their symptoms. But there were no reports of anyone refused entry.
Jorge Juarez and Miranda Carnero, both 18, crossed the border wearing bright blue masks. "It's just a precaution," said Juarez, who lives in El Paso and drew a smiley face on his mask.
Passengers from a Mexico City flight that arrived at Newark Liberty International Airport in New Jersey said they were surprised customs officials did nothing more than hand them an informational flier.
"Everyone's afraid. But when we got here, they said 'Welcome to America. You don't need that,'" said Alejandro Meneses of Fair Lawn, N.J., pointing to a paper mask hanging from his neck.
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