Swine flu spreading fast Czech Republic 2011

Doctors report a heightened incidence of swine flu across the country with some regions having crossed the threshold of an epidemic. South Moravia reports a 17 percent increase in flu cases in the past week alone and five schools in the region have closed due to illness. The country’s chief hygiene officer has advised all Czech hospitals to close their doors to visitors. A dozen swine flu patients are reported to be on support ventilation in serious condition.

Precautions to keep swine flu

Here are ten tips for you to keep away from the pandemic.

1. Wash your hands frequently

Use the antibacterial soaps to cleanse your hands. Wash them often, at least 15 seconds and rinse with running water.

2. Get enough sleep

Try to get 8 hours of good sleep every night to keep your immune system in top flu-fighting shape.

3. Drink sufficient water

Drink 8 to10 glasses of water each day to flush toxins from your system and maintain good moisture and mucous production in your sinuses.

4. Boost your immune system

Keeping your body strong, nourished, and ready to fight infection is important in flu prevention. So stick with whole grains, colorful vegetables, and vitamin-rich fruits.

5. Keep informed

The government is taking necessary steps to prevent the pandemic and periodically release guidelines to keep the pandemic away. Please make sure to keep up to date on the information and act in a calm manner.

6. Avoid alcohol

Apart from being a mood depressant, alcohol is an immune suppressant that can actually decrease your resistance to viral infections like swine flu. So stay away from alcoholic drinks so that your immune system may be strong.

7. Be physically active

Moderate exercise can support the immune system by increasing circulation and oxygenating the body. For example brisk walking for 30-40 minutes 3-4 times a week will significantly perk up your immunity.

8. Keep away from sick people

Flu virus spreads when particles dispersed into the air through a cough or sneeze reach someone else's nose. So if you have to be around someone who is sick, try to stay a few feet away from them and especially, avoid physical contact.

9. Know when to get help

Consult your doctor if you have a cough and fever and follow their instructions, including taking medicine as prescribed.

10. Avoid crowded areas

Try to avoid unnecessary trips outside.

First Swine Flu death in India

Swin flu pandemic song
Uploaded by gloubi77. - News videos from around the world.

Pune, August 03 2009: India recorded its first Swine flu death today in Pune.

A young girl named Riya Shiekh died at a private hospital in Pune on Monday, 3rd August.

She was on a ventilator in an ICU for a number of days, reports swin-flu.india.org.

Pune has recorded the most number of cases of Swine flu in India.

India now has over 551 confirmed cases flu out of which 422 have been cured and discharged.

However there have been a number of cases where the virus has reappeared in patients.

Statistics have revealed that children below the age of 15 are more susceptible to the virus.

Q&A: Advice about swine flu fro BBC

Swine flu has spread across the world since emerging in Mexico and is now officially the first flu pandemic for 40 years. Experts fear millions of people will be infected.

What is swine flu and what are the symptoms?

Symptoms:
1. High temperature, tiredness and lowered immunity
2. Headache, runny nose and sneezing
3. Sore throat
4. Shortness of breath
5. Loss of appetite, vomiting and diarrhoea
6. Aching muscles, limb and joint pain


Swine flu is a respiratory disease, caused by a strain of the influenza type A virus known as H1N1.

H1N1 is the same strain which causes seasonal outbreaks of flu in humans on a regular basis.

But this latest version of H1N1 is different: it contains genetic material that is typically found in strains of the virus that affect humans, birds and swine.

Although the strain may have originated in pigs, it is now a wholly human disease.

It can be spread from person to person by coughing and sneezing.

Symptoms of swine flu in humans appear to be similar to those produced by standard, seasonal flu.

A fever - which is a temperature of 38ºC (100.4ºF) - is the key symptom, combined with other complaints which may include a cough, sore throat, body aches, chills and aching limbs. Some people with the virus have also reported nausea and diarrhoea.

As with normal flu, the severity of symptoms will depend on treatment and the individual. Many people have only suffered mildly and have begun to recover within a week.

People are most infectious soon after they develop symptoms, but they cease to be a risk once those symptoms have disappeared. The incubation period may be as little as two days.

Apparently healthy people are dying from the virus. Does that means it is getting worse?

Experts say this does not change anything, and that if anything it is surprising that it has taken this long in the UK for someone without underlying health problems to die.
Apparently healthy people can die of any flu-related virus if it causes complications such as pneumonia so these latest deaths do not give any extra cause for concern.

Indeed, so far, many people who have developed symptoms of infection have not needed drugs to make a full recovery, according to the WHO.

Flu expert Professor Peter Openshaw, of Imperial College London, says about one in every three people who become infected will not realise they have had swine flu because they will have had no or only very few symptoms.

"About 98% of people who get infected will recover fully without any hospital treatment so I think the public needs to be reassured."

The real fear is that the strain will mutate and become more virulent which would pose a greater threat. This has been the feature of previous flu pandemics.

But this has not yet happened - and in any event it is worth remembering that seasonal flu often poses a serious threat to public health - each year it kills 250,000 - 500,000 around the world.

What should I do if I think I have it?

Anyone with flu-like symptoms who suspects they might have the swine flu virus are being advised to stay at home and use the "swine flu symptom checker" on the NHS Direct website, or phone NHS Direct - NHS 24 in Scotland.

If swine flu is suspected, your GP should be contacted - and he or she will issue a voucher for anti-flu drugs.

The infected person would then be expected to arrange for a friend or family member to pick up the anti-viral treatment for them from a collection point, most probably a pharmacy.

In the initial phase of the outbreak, lab testing was done to diagnose the flu but this is no longer happening routinely.

How is it treated?

Two drugs commonly used to treat flu, Tamiflu and Relenza, are effective at treating infection.

However, the drugs must be administered at an early stage to be effective.

Use of these drugs may also make it less likely that infected people will pass the virus on to others.

The UK government already has a stockpile of Tamiflu, ordered as a precaution against a pandemic.

However, there is concern that if too many people start taking anti-virals as a precaution, it could raise the risk of the virus developing resistance, reducing the drugs' effectiveness. There is however no evidence at present that this is happening.

In any event there is little point taking these drugs as a precaution as each tablet only provides a day's worth of cover. Given that the virus may be with us for many months - or indeed years - taking a regular pill is ill-advised as the long-term side effects are not known.

What measures then can I take to prevent infection?

As yet there is no vaccine, but manufacturers are trying to develop one. Good progress is being made and the first doses may be available in the UK by August. However the NHS says it may be next year before everyone can be immunised.

Older people and those under 16 - as well as health workers and those with existing clinical conditions - will be given priority.

It is hoped that even if the virus mutates in coming months, the vaccine would still confer a high degree of protection against related strains.

In the meantime, avoid close contact with people who appear unwell and who have fever and cough.

General infection control practices and good hygiene can help to reduce transmission of all viruses, including the human swine influenza.

This includes covering your nose and mouth when coughing or sneezing, using a tissue when possible and disposing of it promptly.

It is also important to wash your hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people, and cleaning hard surfaces like door handles frequently using a normal cleaning product.

In Mexico masks have been handed out to the general public, but experts are sceptical about how useful this is.

Some suggest it may even be counterproductive.

What is the advice for pregnant women?

The Department of Health has clarified its advice on how expectant mothers should protect themselves following a series of apparently mixed messages.

Concerns were heightened after a woman with swine flu died last week shortly after giving birth prematurely.

Pregnant women are among the groups at increased risk from swine flu. It is important that they follow the advice about hand hygiene.

They may also want to avoid very crowded places and unnecessary travel, but experts stressed people should use their own judgement and should carry on with their daily lives.

Where can I get further advice?

Further information and advice on swine flu can be found at websites of leading health and research organisations around the world. The World Health Organisation gives background information on the virus.

The UK's government services website is carrying regularly updated health and travel information. The Health Protection Agency advises the public about what to do if returning from an affected area. NHS Choices outlines how swine flu is different from other flu.

The European Centre for Disease Prevention and Control is another good source of information.

The US government's Centers for Disease Control and Prevention is counting the number of cases in the US.

You can also track spread of swine flu reports using unofficial sources. Google is mapping search term data as an indicator of flu activity both across the US down to state level and in Mexico. Healthmaps maps viruses using news reports. Social media guide Mashable lists a range of ways to track the virus .

Information and links to useful websites are being shared on Twitter, the micro-blogging service, while social networking website Facebook is tracking swine flu discussion amongst users.

For more information read this article

Pregnant women and young children most at risk as swine flu cases hit 100,000

Under-fives and pregnant women are emerging as key swine flu risk groups, according to hospital figures and the age profiles of those who have already died.

The Health Protection Agency (HPA) altered its advice this week to include the youngest age range – the under-fives – in the category of those "predominantly affected" while the Royal College of Midwives gave fresh advice todayon giving expectant women anti-viral drugs.

The shift in emphasis by health officials is a reminder that even if the final death rates from the pandemic are the same as normal seasonal flu, the social impact will be significantly different, with the disease apparently targeting the young more than elderly people. In normal seasonal flu it is the elderly who usually succumb through developing pneumonia.

Altogether, 29 people have died from swine flu in the UK. A patient from Swindon and a female tourist who died in Scotland after being admitted to hospital three weeks ago are among recent deaths. Figures from the West Midlands show that at one stage this month 23 of the 79 patients receiving treatment in hospital for swine flu were less than five years old.

On Thursday the chief medical officer, Sir Liam Donaldson, produced statistics showing that under-fives were three times more likely to need inpatient care than those in other age groups.

At least five of those who died are known to have been young children or babies. The NHS in London today confirmed that a baby less than six months old was among the fatalities. Some, like nine-year-old Asmaa Hussain, from Dewsbury, who suffered from epilepsy, had other prior conditions.

The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists issued joint advice on prescribing anti-virals, suggesting that pregnant women with flu symptoms be given a course of Relenza, using an inhaler.

"It is recommended for pregnant women because it easily reaches the throat and lungs, where it is needed, and does not reach significant levels in the blood or placenta," the advice said. "This has the theoretical advantage of not affecting the pregnancy or the growing baby." It added: "A few cases of severe illnesses among pregnant women and infants have been reported in the UK and from other countries. These have mostly affected women with pre-existing health problems. In previous pandemics, and in reports from some countries in this pandemic, there is evidence that pregnancy can increase the risk for influenza complications for the mother and the foetus."

As many as 100,000 people may now have contracted swine flu in the UK, according to estimates by the Health Protection Agency.

Fears that meningitis could be confused with swine flu were raised today after news that Gemma Drury, 17, of Brimington, Chesterfield, was first diagnosed with swine flu but then rushed to hospital with meningitis days later.

The Department for Children, Schools and Families said today that some schools and nurseries might not open as usual at the start of the autumn term.

The Department of Health dismissed fears that the threat of high death rates could endanger the international supply of vaccines. The UK has ordered 132m doses of vaccine, sufficient for all the UK population. The first doses could be ready as early as August.

Italy yesterday advised its citizens to take extra precautions when travelling to Britain. Italy's health ministry said travellers should first visit their doctor to see if they have any conditions that put them at risk, and should avoid crowded places.

Swine flu may keep some schools shut in September

Some schools in England could remain closed in September if the swine flu pandemic escalates over the summer, the government has admitted.

The Department for Children, Schools and Families (DCSF) said that, while it was expected schools and nurseries would open as usual at the start of the academic year, it could not be "certain what the situation will be" in the autumn.

Decisions on closures would be taken shortly before the start of the autumn term, a message to schools across the country from the department said.

The DCSF guidance, issued as many schools broke up for the summer today, said it was monitoring the spread of the H1N1 virus on a day-by-day basis. A message will be sent to schools in the last week of August telling them what to do at the start of term, it added.

The DCSF said: "As the summer term is drawing to an end, it is important to ensure that everyone will be in a position to know what will happen at the start of the autumn term.

"We expect that schools and early-years and childcare settings will reopen as usual but at this time we cannot be certain what the situation will be then; we will need to monitor developments over the summer, and take decisions based on the best advice available shortly before the start of term."

About 1,000 schools have already recorded cases of swine flu, although most have remained open, according to the DCSF.

The message to schools follows a warning from the government's chief medical officer, Sir Liam Donaldson, that up to 65,000 people could die from swine flu in the UK in a worst-case scenario.

A planning document published by the Department of Health yesterday suggested that if the current growth in cases was sustained, the number of cases could peak in early September, with up to 30% of the population suffering illness.

There are also suggestions the spread of the virus could begin to slow over July and August before a resurgence in the autumn when schools reopen.

Margaret Morrissey, of the lobby group Parents Outloud, said ministers should have closed schools across the country early for the summer.

"I do think the government has had a major event of mismanagement here. They should have shut down schools and public places, not for ever, but to stop the virus spreading," she said.

In swine flu hotspots, schools should remain closed until children had been vaccinated, Morrissey suggested. "We might have to, in some schools, keep them closed until the vaccine is in place," she said.

The campaigner also called for the government to hand money to employers so that their staff can stay at home with their children if they are affected by swine flu.

"We helped the banks out, how about helping parents?" she said.

"There could be a decision that schools have got to say to parents, 'If your finances can be supported, do you agree with having the school closed until the children are vaccinated?'"

But she added that if it was possible to open schools in September then that should happen.

At the start of the outbreak, affected schools were closed, but the Health Protection Agency is no longer recommending that approach because swine flu is now widespread within communities.

HPA guidance says: "People are likely to be repeatedly exposed to the virus in their everyday lives. Closing a school will no longer be effective in slowing the spread of the virus as people could still be exposed outside the school.

"In some special circumstances – for example, a school with children who are particularly vulnerable to infection – then school closures might still be recommended."

Parents expressed concern yesterday about the now rapid spread of the virus, and some admitted they were scared and unsure how to respond to the situation.

Gloria Newell, 49, a housing officer, who was picking up her nine-year-old daughter, Natasha, from St Mary's Church of England school in Islington, north London, said: "I am just astonished. The figures are quite shocking. There seems to be nothing really in place to cope with this. We have heard about a national vaccination scheme but we do not know when it might be in place."

In north London, another mother, Amal Khaireddine, 30, was concerned about her sons Joseph, five, Shamus, six, and Ryan, eight, all pupils at Hugh Myddelton school in Islington, where there had been several cases of swine flu. "They had sore throats and temperatures and I did what you should do and called the GP. They said … not to worry. But I think they should have been tested, some swabs should have been taken … all you are told is check the NHS website, but that is not 100% safe."

In nearby Culpepper Gardens, Richard O'Connell, 63, said he had taken his two-year-old grandson, Alfie, to the doctor because of a high temperature and had been told not to worry. "But you do worry because you don't know what to do … it's all very well telling people to look at the NHS website but what of those of us who do not have a computer?"

Anne Alexander, 62, a retired playschool worker from Highbury, north London, believed the publicity was causing "mass panic". Collecting her nine-year-old granddaughter, Niamh Stepto, from school, she said: "The reality is that it may only be as serious as normal seasonal flu."

Paola Domizio, a pathologist and mother of year-old twins Aron and Susha, said : "I'm undecided whether to panic or not. Certainly it is alarming that so many young children may be susceptible. But what can you do? Even if you keep them in all day there are no guarantees. If a vaccine is developed I suppose children will be vaccinated, but until then all you can do is follow the guidelines. So I can't say that I'm particularly panicking, although the figures do sound alarming."

Important information about swine flu

Swine flu is the common name that has been given to a new strain of influenza. It is called swine flu because it is thought to have originated in pigs, but this is not known for certain.

The most common symptoms are fever, sore throat, diarrhoea, headache, feeling generally unwell and a dry cough – in other words, symptoms very similar to seasonal influenza. Most people recover within a week, even without special treatment.

Pandemic
The virus was first identified in Mexico in April and has since become a pandemic, which means it has spread around the globe. It has spread quickly because it is a new type of influenza virus that few, if any, people have full resistance to.

Flu pandemics are a natural event that occur from time to time. Last century, there were flu pandemics in 1918, 1957 and 1968, when millions of people died across the world.

So far the new virus is known to have infected 77,000 people in over 100 countries around the world. However, this figure is almost certainly a large underestimate because it reflects only those cases which have been confirmed by laboratory tests.

In the majority of cases the virus has proved relatively mild. However, more than 300 people have died globally and its 'risk profile' is still not fully understood. For this reason, and because all viruses can mutate to become more potent, scientists are advising caution.

The situation in the UK
There have been nearly 10,000 cases confirmed in the UK since the outbreak started here on 27 April. Of these, over 100 have involved hospitalisation, and 15 people have died.

The UK formally moved from a 'containment' to a 'treatment' phase for swine flu on 2 July. This meant that intensive efforts to contain swine flu, via automatic school closures, for example, ended in order to free up capacity to treat the increasing numbers of people who are contracting swine flu daily.

As in other countries, the majority of cases reported so far in the UK have been mild. Only a small number have led to serious illness, and these have frequently been where patients have had underlying health problems.

There has been an argument put forward that government should restrict antivirals to those groups who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, then the NHS should let the virus run its course, treating it with paracetamol and bed rest as you would normal flu.

However, the government's Scientific Advisory Group on Emergencies (SAGE) believes that there is still some doubt about the risk profile of the virus. For instance, there are reports of some cases in Argentina where young, healthy adults have apparently become extremely ill from swine flu.

While there is still this doubt, the government has decided to continue offering the antiviral medicines Tamiflu or Relenza to everyone with swine flu at their doctor’s discretion.

High-risk groups
Some people are more at risk of serious illness if they catch swine flu, and will need to start taking antivirals as soon as they are confirmed with the illness. On occasion, doctors may advise some high-risk patients to take antivirals before they have symptoms if someone close to them has swine flu.

The risk profile of the virus is still being studied but it is already known that the following people are particularly vulnerable:

people with:
- chronic lung disease,
- chronic heart disease,
- chronic kidney disease,
- chronic liver disease,
- chronic neurological disease,
- immunosuppression (whether caused
by disease or treatment), and
- diabetes mellitus,
patients who have had drug treatment for asthma in the past three years,
pregnant women,
people aged 65 years and older, and
children under five years old.
Swine flu vaccine
A vaccine to protect against swine flu is being developed but it is not available yet.

The first batches of vaccine are expected to arrive in late August, and 30 million double doses – enough for half the population – are expected to be available by the end of the year.

The government has ordered enough vaccine for the whole population and, when it becomes available, will focus on those at the greatest risk first.

Catch it, bin it, kill it
Although the UK has moved to a treatment phase for swine flu, it is important that people continue to do everything they can to stop the virus from spreading.

The key is to practise good respiratory and hand hygiene. In other words, remember to Catch it, Bin It, Kill It. Catch your sneeze in a tissue, place it quickly in a bin and wash your hands and surfaces regularly to kill the virus.

UK moves from swine flu 'containment' to 'treatment'

The UK has moved from the 'containment' to the 'treatment' phase of swine flu as the number of people catching swine flu continues to rise.

'Containment' to 'treatment'
As Swine Flu spreads and more people start to catch it in their communities, the government has moved from efforts to contain the virus to treating the increasing number of people who have the disease.

The move from containment to treatment will apply in all four nations of the UK- England, Scotland, Wales and Northern Ireland.

This means that:

GPs will be able to diagnose swine flu on the basis of symptoms rather than waiting for laboratory testing

all tracing of people who have been in contact with a sufferer will stop

people who may have been exposed to the virus will not be given anti-viral drugs

anyone who is diagnosed with swine flu will continue to be offered anti-virals until further notice
Local primary care trusts will also begin to establish anti-viral collection points in their local communities. These could be at a designated pharmacy or a community centre, depending on local need.

Health Secretary Andy Burnham said:"Most cases of swine flu have not been severe and we are in a strong position to deal with this pandemic.

"But we must not become complacent and, while doubt remains about the way the virus attacks different groups, today's decision on the move to the treatment phase reflects our caution."

Global swine flu cases

There are now over 70,000 confirmed cases in over 100 countries. The countries with the most cases are:


• United States of America 27,717 (127 deaths)
• Mexico 8,279 (116 deaths)
• Canada 7,775 (21 deaths)
• United Kingdom 6,133 (3 deaths)
• Chile 5,186 (7 deaths)
• Australia 4,038 (7 deaths)
• Argentina 1,488 (21 deaths)
• China 1442
• Japan 1049
• Philippines 861

Exit, first flu victim

The number of inmates in the isolation ward of the Infectious Diseases Hospital, where swine flu suspects and patients are quarantined, has dropped from seven to two since Sunday.

Seven-year-old Shruti Ghosh, the city’s first swine flu victim, was released from the Beleghata hospital on Monday.

Sourav Lahiri, who got himself admitted on Saturday with fever, tested negative for swine flu and was also released during the day.

“Shruti’s course of Tamiflu is over and she is not having fever anymore. Her parents have been asked to keep her quarantined at home for a few more days,” said Tapas Sen, the nodal officer for tackling swine flu in the state.

Shruti’s mother Sonali, who was staying with the girl in the 20-bed ward that has been divided by a curtain to separate male and female patients, had tested negative for swine flu.

The Oman residents had arrived in Calcutta last Tuesday after holidaying in Australia. Shruti was suffering from cough and fever when she landed at the city airport and was taken straight to the hospital.

The Delhi-based National Institute of Communicable Diseases, where nasal and throat swabs were sent for test, informed the hospital on June 25 that the girl was suffering from swine flu.

The only ones left in the Beleghata isolation ward are four-year-old Suchismita Das, who had tested positive for swine flu on Saturday, and her mother.

“Suchismita’s condition is stable. Her fever has subsided but she is still on medication,” said a source in the hospital.

Suchismita and her parents arrived in Calcutta from Bangkok, where they had gone on a holiday, early on Friday.

Prem Chand Yadav and Suchismita’s father Partha were released on Sunday after their swab tests proved negative.

Lahiri, 26, was the only patient who had voluntarily walked into the hospital and wanted to be tested for swine flu. He had been suffering from fever since returning from Bangkok a week ago.

Flu Pandemic Seminar 9th July LONDON

Aimed at CEOs, Directors, Senior Managers, Facility Managers, and business consultants.

This seminar is to help enable business and public bodies to plan for a possible flu pandemic. It covers all the essential information relating to affects of a pandemic, how to mitigate its impact and how to develop a pandemic plan.

Seminar Outline



Understand - the affect of a pandemic on the organisation
Businesses need to understand the affect of the pandemic on their business model. Restrictions on travel, restrictions on large gatherings, reduced staff attendence and disruption to supply all have significant impact on the successful operation of business and organisation.


Mitigate - the impact of the pandemic on the organisation
Businesses will need to take action to ensure that the impact of a flu pandemic is minimised. Supply chain is particularly important here, with supplies being stockpiled and alternative suppliers considered. Infrastructure amends will also need to be considered, including rerouting of telephone systems and purchasing of laptops.


Plan - for the action taken leading up to, and during the pandemic
This will be a series of actions which should be implemented as each of the WHO phases are reached. It is essential to have the plan written and, ideally, tested, as soon as possible.


The seminar will use case studies, exercises and personal experiences of developing pandemic plans within a number of different organisations to help develop the participant understanding of business continuity.

The Flu Pandemic seminar costs £400 (Excluding VAT).

The seminar runs from 10 am to 4 pm.

Book Here Now

Synthetic flu vaccine option?

A company claims it has created a synthetic version of the swine flu vaccine. CNN's Dr. Sanjay Gupta reports.
Watch the Videos now .

China quarantines U.S. school group over flu concerns

A group of students and teachers from a Maryland private school have been quarantined in China because of swine flu concerns, a school spokeswoman said Thursday.

The Chinese government has confined 21 students and three teachers to their hotel rooms in Kaili, China, because a passenger on their plane to China was suspected of having swine flu, or H1N1, said Vicky Temple, director of communications for the Barrie School in Silver Spring, Maryland.

Temple said the students and teachers are occupying two floors of a four-star hotel in the Guizhou province city in southern China.

The quarantine will end Friday, and the students are scheduled to return to the United States on Sunday, Temple said.

Mike Kennedy, the head of Barrie School, said U.S. consular officials have since told the school that the plane passenger does not have swine flu, or H1N1.

"So now our question has been for the last 24 hours, can this quarantine be lifted even sooner than sometime on Friday so these kids can get out and enjoy a little bit of China," he said.

"Since about noon on Monday, they have been in their hotel rooms," he said. "They've missed the lion's share of the itinerary."

China's state-run Xinhua news agency reported that the Guizhou province's health bureau announced this week that it had discovered two dozen Americans who had been within four rows of the suspected swine flu case on the plane.

The plane had departed Friday from San Francisco, California.

Kennedy said the students and teachers are permitted to speak to one another through the open doors of their hotel rooms, but are not allowed to leave. "They're being well taken care of, but they are in their hotel rooms," he said.

"It's very frustrating," he said, but added, "I understand and I'd like to say that the Chinese officials have been as kind and friendly to our kids and chaperones as they can be."

State Department spokesman Ian Kelly said in a Thursday afternoon briefing that he was aware of the report but said he didn't have any details on the circumstances or what the U.S. officials might be doing about it.

Home Remedies to Avoid Swine Flu

Always cover your mouth and nose when coughing or sneezing; ideally use something disposable like a tissue. Avoid touching your face, nose or mouth too frequently with your hands since swine flu appears to be transmitted through respiratory droplets in the same fashion as the common cold.

Wash your hands frequently with soap and water since swine flu like other viruses can be contracted by touching objects contaminated by the virus. It's unsure how long the swine flu virus can survive on surrounding surfaces.

Though alcohol based hand sanitizers don't routinely kill viruses they probably do offer some limited protection in preventing swine flu infections.

If swine flu infections have been medically confirmed in your area consider avoiding large public gatherings. Individuals can be contagious with the swine flu virus for several day before demonstrating any signs or symptoms of infection. Be particularly careful about indoor gatherings where air circulates poorly.

If you're really paranoid and don't mind looking odd then consider wearing a respiratory mask.. This barrier method does offer some basic protection against infection though not all masks are created equally. Higher quality masks capable of filtering out some respiratory infections are more expensive.

If you start feeling ill with cold or flu-like symptoms do not go to work. Stay home and begin the usual home remedies for colds and flu. Contact your health care provider, local health department or hospital emergency room if your symptoms worsen or fail to improve for information about where to go to be screened for possible swine flu infection.



What is Swine Flu? its signs and symptoms
In this video, Dr. Joe Bresee with the CDC Influenza Division describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.

What is H1N1 (swine flu)?
H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

To be more specific, Swine flu is a respiratory disease, caused by influenza type A which infects pigs. There are of many types, and the infection are constantly changing. Until now it had not normally infected humans, but the latest form clearly does, and is spread from person to person - probably through coughing and sneezing.

The World Health Organization has confirmed that at least some of the human cases are a never-before- seen version of the H1N1 strain of influenza type A. H1N1 is the same strain which causes seasonal outbreaks of flu in humans on a regular basis. But this latest version of H1N1 is different: it contains genetic material that is typically found in strains of the virus that affect humans, birds and swine.

Flu viruses have the ability to swap genetic components with each other, and it seems likely that the new version of H1N1 resulted from a mixing of different versions of the virus, which may usually affect different species, in the same animal host.

Pigs provide an excellent 'melting pot' for these viruses to mix and match with each other.

Symptoms of swine flu in humans appear to be similar to those produced by standard, seasonal flu. These include fever, cough, sore throat, body aches, chills and fatigue. Most cases so far reported around the world appear to be mild, but in Mexico lives have been lost.

Why is this new H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian genes and human genes. Scientists call this a “quadruple reassortant” virus.

Novel H1N1 Flu in Humans

Are there human infections with this H1N1 virus in the U.S.?
Yes. Cases of human infection with this H1N1 influenza virus were first confirmed in the U.S. in Southern California and near Guadalupe County, Texas. The outbreak intensified rapidly from that time and more and more states have been reporting cases of illness from this virus.

Is this new H1N1 virus contagious?
CDC has determined that this new H1N1 virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

What are the signs and symptoms of this virus in people?
The symptoms of this new H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.

How severe is illness associated with this new H1N1 virus?
It’s not known at this time how severe this virus will be in the general population. CDC is studying the medical histories of people who have been infected with this virus to determine whether some people may be at greater risk from infection, serious illness or hospitalization from the virus. In seasonal flu, there are certain people that are at higher risk of serious flu-related complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with chronic medical conditions. It’s unknown at this time whether certain groups of people are at greater risk of serious flu-related complications from infection with this new virus. CDC also is conducting laboratory studies to see if certain people might have natural immunity to this virus, depending on their age.

How does this new H1N1 virus spread?
Spread of this H1N1 virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How long can an infected person spread this virus to others?
At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. CDC is studying the virus and its capabilities to try to learn more and will provide more information as it becomes available.
Exposures Not Thought to Spread New H1N1 Flu

Can I get infected with this new H1N1 virus from eating or preparing pork?
No. H1N1 viruses are not spread by food. You cannot get this new HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of the novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.

Can the new H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of the H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 virus would also be similarly disinfected by chlorine.

Can H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Prevention & Treatment

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against this new H1N1 virus. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these everyday steps to protect your health:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

* Avoid touching your eyes, nose or mouth. Germs spread this way.
* Try to avoid close contact with sick people.
* Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

Other important actions that you can take are:

* Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
* Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs, tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. If you are sick, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where people have been identified with new H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people, except to seek medical care.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children, emergency warning signs that need urgent medical attention include:

* Fast breathing or trouble breathing
* Bluish or gray skin color
* Not drinking enough fluids
* Severe or persistent vomiting
* Not waking up or not interacting
* Being so irritable that the child does not want to be held
* Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

* Difficulty breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting
* Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat infection with this new virus?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with the new H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current outbreak, the priority use for influenza antiviral drugs during is to treat severe influenza illness.

The US authorities say that two drugs commonly used to treat flu, Tamiflu and Relenza, seem to be effective at treating cases that have occurred there so far. However, the drugs must be administered at an early stage to be effective. Use of these drugs may also make it less likely that infected people will pass the virus on to others


What is CDC’s recommendation regarding "swine flu parties"?
"Swine flu parties" are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is to become infected with what for many people has been a mild disease, in the hope of having natural immunity to the novel H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend "swine flu parties" as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. They should stay home from work or school for 7 days after the onset of illness or until at least 24 hours after symptoms have resolved, whichever is longer.

Contamination & Cleaning

How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface.

What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.

Eating utensils should be washed either in a dishwasher or by hand with water and soap.

The first case has already been reported from India from neighboring state of Andhra Pradesh.

What about bird flu?
The strain of bird flu which has caused scores of human deaths in South East Asia in recent years is a different strain to that responsible for the current outbreak of swine flu.

The latest form of swine flu is a new type of the H1N1 strain, while bird, or avian flu, is H5N1.

Experts fear H5N1 hold the potential to trigger a pandemic because of its ability to mutate rapidly.

However, up until now it has remained very much a disease of birds.

Those humans who have been infected have, without exception, worked closely with birds, and cases of human-to-human transmission are extremely rare - there is no suggestion that H5N1 has gained the ability to pass easily from person to person.

US swine flu deaths hit double-digits

SALT LAKE CITY – Swine flu forced Christina Huitron to make a choice no mother should ever have to make.

On Wednesday she told doctors to take her 21-year-old son off life support, making Marcos Sanchez the nation's 10th fatality associated with the newly discovered virus that continues to spread across the globe.

"I knew he was suffering," Christina Huitron told KSL-TV. "I don't know how he was feeling, but I just knew I had to do it because he was passing away slowly anyways, and I didn't want him to suffer anymore."

Sanchez checked into a suburban hospital Saturday, vomiting blood and burning with fever, Huitron told The Salt Lake Tribune. By Tuesday he was suffering from multiple organ failure.

Dr. David Sundwall, executive director of the Utah Department of Health, said Marcos, the state's first swine flu fatality, was overweight and had chronic medical conditions, including respiratory problems, that put him at risk.

"This is not a person who was overall genuinely healthy," Sundwall said.

Sanchez had not traveled recently. Dagmar Vitek, medical director for the Salt Lake Valley Health Department, said an investigation to determine how he contracted the virus was under way. Utah has 122 confirmed cases of the virus.

In neighboring Arizona, health officials said Wednesday a 13-year-old boy from Tucson also has died with swine flu. The teenager died Friday of complications from the flu. He had been hospitalized May 10.

Pima County Health Department spokeswoman Patti Woodcock said an older sibling of the teen is hospitalized with the virus, while other family members have recovered.

Swine flu has sickened more than 11,000 people in 41 countries and killed 85, according to the World Health Organization, whose figures often trail those of individual countries. Mexico has reported 75 deaths, the U.S. 10, and one in both Canada and Costa Rica.

In New York City, officials, colleagues, friends and family gathered Wednesday at a funeral home to remember Mitchell Wiener, an 55-year-old assistant principal who died of swine flu Sunday.

"Whenever I needed help, I used to always go to him," student Jeffery Grey told reporters outside the funeral home. "I really don't know who to go to now when I need help."

Two more New York City public schools closed because of swine flu, bringing the number of city public and private schools shuttered within the last week to 23. One school closed Thursday across the Hudson River in Fort Lee, N.J., another closed in Reno, Nev., and four schools closed in Lodi, Wis., after students were sickened.

Judy Davis, a spokeswoman for the Washoe County District Health Department in Nevada, said state, county and school officials agreed that closing Mendive Middle School in Sparks was "best course of action" to prevent further spread of the flu after five students were sickened and one was hospitalized.

But experts said closing schools once students were already ill would do little to halt the virus' seemingly inexorable spread.

"As a disease containment measure, it is not likely to be effective," said Dr. Paul Biddinger, associate director of the Center for Public Health Preparedness at the Harvard School of Public Health.

(This version CORRECTS that Patti Woodcock is a spokeswoman for the Pima County (Ariz.) Health Department, not the Arizona Department of Health Services.)

Swing Flu is Slowing Down in Mexico

Influenza A(H1N1) Swine Flu which is dangerous Virus or Flu and this Swing Flu or Influenza A(H1N1) which is coming from the pig. The Mexico has been affected greatly and for this reason they announced to close the schools,cafe,shops and restaurants. But the good the news is the swine flu influenza outbreak have been dropping, according to health officials.

Mexico’s Secretary of Health told reporters over the weekend that the epidemic in that country had peaked and the number of new cases was on the decline. He also complained that some countries – most notably China – had reacted inappropriately by quarantining some travelers arriving from Mexico, even though they showed no symptoms of influenza. We’ll look at how various countries have acted – even over-reacted in some cases – to protect their borders and their citizens from the possible pandemi

According to BBC:

Restaurants and cafes in Mexico City are to reopen on Wednesday after the country recorded a fall in new cases of the swine flu virus.

Libraries, museums and churches are to follow suit a day later but cinemas, theatres and bars are to remain closed, the mayor’s office said.

Government officials are meeting to discuss when schools and businesses across the country can resume work.

More than 1,000 cases of the virus have been reported in 20 countries.

Confirmed cases in the US have risen from 226 to 286, spread over 36 states, with most patients suffering mild symptoms. One death has been confirmed - that of a Mexican two-year-old boy who was visiting Texas.

Officials say the rise in cases in recent days was due to results of lab tests coming through, rather than because of a new surge in cases.

The UN says it has seen no evidence of a spread at community level in Europe and Asia - a development that would trigger the highest level of alert.

Dr Keiji Fukuda, deputy chief of the World Health Organization (WHO), told reporters it was essential that surveillance remained strong worldwide.

Transmission to people who have not visited Mexico has been confirmed in six countries.

The virus is suspected of claiming 101 lives in Mexico though the number of confirmed cases there is 26, its health minister said on Monday.

After Mexico accused China of unfairly quarantining some of its citizens, the two countries sent planes to pick up each other’s citizens.

In other developments

• Canada’s confirmed number of cases rose to 140

• Of nine new confirmed cases of swine flu in the UK, seven appear to have been acquired from people who had not been to Mexico; total confirmed cases stood at 27

• About 250 recruits and personnel at an army camp in the western Swiss canton of Fribourg were placed under quarantine after two recruits reported having flu symptoms

‘Phase of decline’

Mexico’s shutdown is credited with stemming the spread of the virus but it badly affected the country’s economy.

President Felipe Calderon went on national TV on Sunday night to say a nationwide shutdown and an aggressive information campaign appeared to have helped curtail the outbreak in Mexico.

“We have succeeded in detaining or at least slowing the spread of the virus precisely because the measures have been the correct ones,” he said.

Swine flu has been confirmed as the cause of 26 deaths in Mexico and 701 people have been infected, Health Minister Jose Angel Cordova said on Monday.

Earlier, he had said the epidemic was “in its phase of decline”, having peaked between 23 and 28 April.

Talking about the possible reopening of schools, he warned it would “not happen just like that”. “There will have to be training, preparations for teachers and parents,” he told reporters.

Inhabitants of the capital interviewed by Reuters news agency on Sunday spoke of their frustration at the upset caused by the restrictions.

“They should open everything back up so we can work,” said Alberto Vazquez, 28, who washes cars for a living.

“These last days have been hard on us. If we don’t work, we don’t eat.”

‘Deceptive’ virus

Mexico has criticised China for placing in quarantine up to 70 Mexicans even though they showed no sign of having contracted swine flu.

A Mexican-chartered plane has left for Beijing to pick up Mexican citizens from different Chinese cities.

China, which denies discrimination, sent a plane in the opposite direction to pick up 200 Chinese nationals stranded in Mexico City.

A Mexican man staying in a Hong Kong hotel was confirmed to have contracted the virus on Friday. More than 250 guests and staff at the hotel are being held under quarantine for a week.

Canada asked China for an explanation on Monday after it also quarantined a group of at least 20 Canadian students, none of whom had shown any flu symptoms, in the north-eastern town of Changchun.

WHO chief Margaret Chan said there was “no indication” that swine flu, or H1N1, might develop into a pandemic similar to the Spanish Flu which killed tens of millions at the end of World War I.

Addressing a meeting of the UN General Assembly in New York by video link from Geneva, she also cautioned against complacency: “Flu viruses are very unpredictable, very deceptive… We should not be over-confident. One must not give H1N1 the opportunity to mix with other viruses.”

UN chief Ban Ki-moon, in New York, said the WHO did not plan to raise its pandemic alert to the highest level if the outbreak continued in its current pattern.

The severity of the swine flu virus remains uncertain, the BBC’s Imogen Foulkes reports from Geneva.

Health experts worldwide want to know which population groups are most vulnerable and why the virus has caused severe pneumonia among some patients, and diarrhoea - not normally associated with flu - in others, our correspondent says.

On Tuesday the WHO will hold a meeting of doctors and scientists to discuss these questions. The answers, the WHO says, will help all those working to control and treat the virus.

UK had again hit Swin Flu more cases observed

14 further patients under investigation in England have today (Sunday) been confirmed with swine flu bringing the current total number of confirmed UK cases to 101.

There are six adults and eight children among the new confirmed cases in the East of England, London and the South East regions – 11 contacts of previously confirmed cases, 2 returning travellers and one whose source of infection remains under investigation.

155 cases are currently under laboratory investigation in the UK. These cases change on a daily basis. Because of the time-lag between the reporting of symptoms, the testing and the results, the new cases reported daily may have recovered and may now be symptom-free.

Public gatherings
There are no restrictions on public gatherings like music festivals. The Department of Health is advising people to carry on with their daily lives as normal.

For Immediate Help

I have flu-like symptoms - what should I do?

Stay at home and rest.
Take medicines such as aspirin, ibuprofen or paracetamol to relieve the symptoms (following the instructions with the medicines). Children under 16 must not be given aspirin or ready-made flu remedies containing aspirin.
Drink plenty of fluids.
Phone your GP or NHS Direct if you have recently travelled to Mexico or the US or you have been in contact with someone who has confirmed or probable swine flu.
Phone your GP or NHS Direct if you develop complications such as shortness of breath.
Before you call, check your symptoms with this symptom checker.

What can I do to protect myself and my family?

Good hygiene is the key. You can reduce, but not eliminate, the risk of catching or spreading influenza by:

Using a tissue to cover your nose and mouth when coughing or sneezing.
Disposing of used tissues promptly and carefully.
Maintaining good basic hygiene, for example washing your hands frequently with soap and water to reduce the spread of the virus from your hands to your face, or to other people.
Cleaning hard surfaces (eg kitchen worktops, door handles) frequently using a normal cleaning product.

What is the current state of alert?

The swine flu alert level from the World Health Organization (WHO) remains at Phase Five, which means there is human-to-human spread of the virus in at least two countries in the same region. Phase Five is a strong signal that "a pandemic is imminent and that the time to finalise the organisation, communication, and implementation of planned mitigation measures is short," says the WHO. This is something that is already well under way in the UK.

As further information becomes available, WHO may decide to either revert to Phase Four or raise the level of alert to Phase Six, the highest level. The decision to move to Phase Five was based primarily on data demonstrating sustainable human-to-human transmission of the virus.

The WHO has defined six stages in the development of a pandemic. A virus outbreak is only classified as a pandemic at Phase Six.