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Medical detectives probe flu virus spread in NYC
Published in Saudi Press Agency on 02 - 05 - 2009


When a team of medical detectives from New
York City's health department first arrived at a Queens
school stricken by swine flu on April 24, the situation
looked bad, according to AP.
In a matter of days, nearly 660 kids at the St. Francis
Preparatory School had developed fever and a wicked cough.
A third of the student body was sick. Two dozen teachers
and staff also fell ill. Students brought the illness home,
and hundreds of their relatives got sick too.
Within days, 1,000 people connected to the school had flu
symptoms. The virus appeared poised to break out and infect
millions.
But then, the bug took a break.
Only a handful of new swine flu cases have been reported
in the city since April 26. Among those who did become ill,
almost all had either been to Mexico recently or had a
relative at St. Francis Prep.
New York City seems like a perfect lab for cultivating the
flu virus, with more than 8 million people packed together
on subways and sidewalks. It seems remarkable, then, that a
flu so infectious in one school didn't spread quickly
across all five boroughs. Health officials are still trying
to figure out why.
«That is one of the great mysteries of influenza,» said
Dr. Don Weiss, director of surveillance in the health
department's bureau of communicable disease.
Sometimes flu picks up steam and races through a
population, he said. Other times, outbreaks lose their
punch as the virus is passed to its second and third
generation of victims.
Just why the illness spread at St. Francis Prep, but not
elsewhere, is likely to be unclear for some time.
Weiss said public health researchers are trying to answer
a variety of questions: Was the teeming St. Francis campus,
with nearly 2,700 kids, simply ripe for an outbreak? Did
the school's ventilation system play a role? Or is the
virus, perhaps, less contagious as time goes on?
«Now, we start to dig deeper,» he said.
Some experts said if the number of new cases remains low,
the city may have to wait until next flu season to learn
whether the virus is any more dangerous than other strains.
«What these guys really want to know is, how many people
will be infected three, six, nine days from now?» said
Peter Palese, a microbiologist and flu expert at Mount
Sinai Medical School. His prediction: «It will peter out
in our area in the next week or two, and then linger on in
the Southern Hemisphere, and then come back next year.»
City public health officials seem to agree. They have
continued to monitor the spread of the disease, but their
advice to physicians over the past week has been telling.
Patients complaining of flu-like symptoms don't need to be
tested for the new virus unless they are very ill, they
say. Doctors shouldn't prescribe antivirals either, unless
patients are very sick or have underlying illnesses that
could make the flu more dangerous.
Still, the investigation will continue.
New York City's attempt to assess the danger began with a
visit to the school April 24, the day after a nurse phoned
in alarm about scores of students going home sick.
The Department of Health team took samples from a handful
of sick kids and canvassed local doctors' offices for more.
By the next afternoon, a lab had confirmed that at least
eight of them had a new type of influenza _ almost
certainly swine flu, though it would take slightly longer
for the U.S. Centers for Disease Control to confirm the
result.
The city's massive public health agency, one of the
world's largest, with a $1.7 billion budget, began an
all-out press to learn more about how quickly the disease
was spreading.
«Our first question was, is it contained within the
school?» Weiss said. «How infectious is it? How high is
the secondary attack rate?»
Investigators were able to reach 44 of those children who
initially tested positive for swine flu. They assembled a
quick demographic profile of the group: Their median age
was 15. Seventy percent were female. They were, on average,
running a temperature of 102 degrees.
The city distributed influenza test kits to some
physicians' offices near the high school and e-mailed the
student body, asking them to complete an online medical
survey.
From almost the start, there was good news. Most of the
sick students were getting better. Some were already back
to normal. None had been very seriously ill.
But questions remained about whether the illness could
cause havoc, as any flu would if it had a high infection
rate.
The department monitored hospital emergency rooms for
spikes in visits from patients with flu-like symptoms. That
data were reassuring too. The bump in cases appeared to be
mild and possibly motivated by public nervousness.
The city's health lab was staffed 24 hours a day to
process tests for the flu, and samples were regularly flown
to the Centers for Disease Control in Atlanta for
confirmation.
So far, researchers have reached several conclusions about
the city's outbreak, but many questions remain.
It is spreading, they say, albeit slowly. As the weekend
began, the first suspected cases emerged among people who
hadn't been to Mexico recently and had no tie to St.
Francis Prep.
But the transmission rate did not appear dangerously high,
and the symptoms remained mild, Weiss said.
«A week is not enough time for us to be confident that we
wont see serious illness,» he added.


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