Be careful but don't panic, health officials say about swine-flu scare

Local and state experts seem to agree about the attitude people should take about the swine-flu scare.

Don't panic.

But be careful.

Only 40 cases of the strain of flu that is suspected in the deaths of 149 people in Mexico have been confirmed in the United States so far. Most of those cases are among people who have been to Mexico or been in contact with someone who had been to Mexico, said Dr. Chris Ohl, an associate professor of medicine and a specialist in infectious diseases at Wake Forest University School of Medicine.

No cases have been reported in North Carolina.

Flu season is nearly over, which could stall the spread of the flu, and the virus could mutate into a harmless strain.

But so much is unknown about the disease - how it spreads, the mortality rate, how it kills - that people here should take the same precautions that they would take against other infectious diseases. That means washing hands frequently and covering mouths during coughs and sneezes, doctors and officials say.

"If you get a flu-like illness, stay at home. Stay away from school and from work," Dr. Jeff Engel, the state health director, said yesterday.

Flu symptoms include a mild fever, aches and pains, a runny nose and a headache. A person who develops more severe symptoms - difficulty breathing, severe nausea, vomiting, diarrhea, abdominal pain or chest pain - should seek medical attention, Engel said.

In coming days, the state health department is likely to get reports of suspected swine-flu cases, Engel said. Nasal swabs will be sent to the state laboratory, which can determine if the flu is likely to be swine flu. Only the U.S. Centers for Disease Control and Prevention can confirm it. By Wednesday, state labs should have the capability to confirm the disease, he said.

Experts have little to go on in the United States because the number of cases is still low, and none has been severe. But if the disease spreads, and more severe cases develop, North Carolina and Forsyth County are well prepared to deal with it, officials said.

The state has stockpiled about 660,000 courses of antiviral medicines, and a second stockpile that could be delivered within a week has been requested.

Hospitals say they are ready.

Dr. Jim Lederer, an infectious disease specialist for Novant Health, said that Wake Forest Baptist and Forsyth medical centers have worked closely with the health department on a community plan for a pandemic.

Ohl said that North Carolina maintains good surveillance on influenza cases, "probably better than other states," and that, so far, no one has seen changes in the rate of cases.

"We're increasing our surveillance, both here at Wake Forest Baptist Medical Center as well as at Forsyth and individual physicians' offices."

Dr. Tim Monroe, director of the Forsyth County Department of Public Health, said that his department has systems in place to deal with cases of swine flu, should they appear. If doctors think they have cases of swine flu, they will be instructed to take cultures, which will be sendtto the state for a definitive diagnosis, he said.

"If we have a case, we will go out and investigate it," Monroe said.

"That's what you do at this point with an unusual flu organism like this," he said. "You don't start assuming it's a pandemic."

Theo Helm, a spokesman for the Winston-Salem/Forsyth County Schools, said that the school system will follow the health department's leads on recommendations to deal with the flu.

Student health officials at Wake Forest and Winston-Salem State universities are monitoring the situation and have plans in place should it worsen.

"Our health center, as of now, is just following the general guidelines from the CDC," said Aaron Singleton, the director of news and media relations for WSSU.

Both schools have plans in place to address a flu epidemic. The plans were developed in response to concerns about avian flu but could be applied to a swine flu pandemic. Officials with the schools also said they have been in touch with local, state and federal health departments.

Not just swine.

Calling the disease swine flu is probably a misnomer, said Dr. Barrett Slenning, a professor at the College of Veterinary Medicine at N.C. State University. This type of influenza is a new strain that carries genetic components from pigs, birds and humans. ProMED, a network that monitors emerging diseases worldwide, has dropped the word "swine" in its notifications about the flu.

Official documents, including those sent from Mexico to the CDC and the World Health Organization, don't connect the disease with exposure to swine, Slenning said. They aren't ruling it out, "but they're not talking about it." Most of the cases have occurred in and around Mexico City, a metropolitan area of 20 million people, he said.

"I can just about guarantee you that all of these people have never seen a live pig," he said.

But Engel said that more than half the states in Mexico have reported cases. Because experts now think that the disease is transferred solely between humans, by focusing on pigs, Slenning said, "They're going to lull people into thinking, 'I haven't seen a pig, so I'm not at risk'.

Engel said that reports from Mexico show no evidence of widespread disease in swine there.

Here, Slenning said, "As far as we know, the USDA and the N.C. Department of Agriculture have not been able to identify any of this agent in swine." Surveillance systems within companies and at the state and national levels keep a close watch on diseases in pigs in order to get ahead of any outbreak.

Slenning said that if the disease were to get into North Carolina's pigs, the potential market damage could be substantial, despite experts' assurances that the disease cannot be transmitted through the consumption of pork or pork products.

North Carolina, with more than 10 million, is the second largest producer of hogs in the United States.

n Janice Gaston can be reached at 727-7364 or at jgaston@wsjournal.com.