100-plus swine flu cases confirmed outside Mexico

In an age of widespread air travel, it is difficult, if not impossible, to contain a newly emerged infectious agent, and that is proving to be the case with swine flu, as isolated outbreaks continue to be confirmed around the world, with new cases reported today in Canada, Israel, France, New Zealand, Costa Rica and South Korea.

The total in the United States has now reached 67 and worldwide has climbed to more than 100, not counting the still-unknown number of cases in Mexico. At least some of the new cases, moreover, appear to have risen from human-to-human transmission outside Mexico.

Such community transmission is one of the early earmarks of a pandemic, and if it continues to be observed, experts predicted, the World Health Organization is likely to raise its alert to Level 5, from the currently elevated Level 4. Such an increase might involve more travel restrictions and stronger efforts to control the spread of the virus.

At a morning press conference in Geneva, Dr. Keiji Fukuda, assistant director-general of WHO, said a pandemic is not inevitable, but that if one does occur it is likely to be mild -- a conclusion drawn from the lack of deaths outside Mexico.

But he cautioned that the 1918 Spanish flu pandemic, which killed millions worldwide, started out mild also. In the spring of that year, there was a mild pandemic that petered out, only to return with a vengeance in the fall.

"I think we have to be mindful and respectful of the fact that influenza moves in ways we cannot predict," he said.

Moreover, he added, it is unlikely that health authorities will be able to contain its spread. "At this time, containment is not a feasible option," he said.

One ray of good news is that the outbreak may be leveling off in Mexico, where the first cases appeared. Mexican Health Minister Jose Angel Cordova said today that the number of new cases in that country had declined from 141 on Saturday to 119 on Sunday and 110 Monday.

At least 152 people have died in Mexico from influenza and its complications, and more than 2,000 cases have been reported. It is not clear, however, what proportion of those deaths and cases are attributable to swine flu. So far, only 26 of the deaths have been firmly linked to the virus.

This morning, Mexican authorities ordered all restaurants in Mexico City to begin serving only take-out food in an effort to limit spread of the virus. Officials had already requested that bars, movie theaters and churches in the city close. All schools are closed until May 6.

As more countries around the world warned against unnecessary travel to Mexico, soccer's regional governing body, CONCACAF, said it was canceling a beach soccer tournament scheduled for Puerto Vallarta on Wednesday. The group had already suspended an under-17 tournament, the semifinals of which were to be played Wednesday in Tijuana.

Two new confirmed swine flu cases were reported in Sacramento County on Monday evening, bringing the California total to 13. One new case was reported this morning in Indiana, a young adult in the northern part of the state.

Three new cases were also confirmed in Texas, bringing that state's total to six, and 17 probable cases in New York were confirmed. Authorities had previously confirmed 28 cases in New York, two in Kansas and one in Ohio, and more confirmations are expected hourly as testing continues.

All of the U.S. cases have been mild and only two have involved hospitalizations, both in California.

New Zealand authorities said today that 11 residents who had recently traveled to Mexico showed symptoms of the virus. Swine flu was confirmed in three and the authorities are assuming that all have it, Health Minister Tony Ryall said.

Canadian officials said two new cases have been confirmed in Calgary, the first cases in the central portion of the country, bringing the total in Canada to eight.

Israel's health ministry confirmed two cases in that country among travelers, and Spain confirmed a second case there. South Korean authorities said they have found a case there in a recent visitor to Mexico. There is also a newly confirmed case in Costa Rica and a "probable" case in France.

Two cases had previously been confirmed in Great Britain.

All of the cases have been mild, but the victims have been hospitalized for quarantine, standard procedure in light of fears about the spread of the virus.

In New York, the accounting firm Ernst & Young initially said one of its employees was among the cases confirmed Saturday, but later backed off and said the case was only suspected swine flu. The victim is the mother of one of the students at St. Francis Preparatory School in Queens, where the outbreak occurred among students who had visited Mexico on spring break. (An earlier version of this story had said the parent was a man.)

The firm said the floor of the office building where she works has been sealed off for cleaning and decontamination.