US gearing up for second wave of swine flu

With all 50 states and the capital city of Washington DC hit by mid-June, the US has seen over 6,500 hospitalisations and 436 deaths to date. But the epidemic has since been contained and there is little public anxiety and few visible signs of panic.

However, the number of cases could increase rapidly as soon as schools begin to reopen in the next few weeks and could accelerate further as cooler, drier temperatures return, possibly peaking in October, officials fear.

But unlike last spring when the first wave hit the US leading to temporary closure of hundreds of schools across the country, federal, state and local officials are planning a more measured response.

Health officials in various states say they have been preparing all summer for the swine flu's return, with intensified monitoring and plans to distribute vaccine and antiviral drugs and have set up special clinics to treat and vaccinate patients if necessary.

"There's a lot of moving parts to this," says Joseph S. Bresee, who heads the US Centers for Disease Control and Prevention's (CDC) influenza epidemiology and prevention branch. "Hopefully we won't have a panic, but instead we'll have the appropriate level of concern and response."

The Obama administration has been updating recommendations for when to close schools, what parents should do if their children get sick, how doctors should care for patients and how businesses should respond to large-scale absences.

Updated federal guidelines for schools released Aug 7 by the CDC and the US Department of Education discourage schools from closing even if the H1N1 virus, or swine flu, strikes.

They suggest that schools not close unless a mass number of students have confirmed swine flu cases or too many staff members become ill. Also, school officials should be planning for online or distance-learning programmes in the event that schools do close, officials said.

Homeland Security Secretary Janet Napolitano said only schools with "high numbers of high-risk students" showing symptoms should consider closing, but she warned that shutting down a school, even temporarily, "causes a very significant ripple effect" in the community.

Although strains of the virus have emerged that are resistant to Tamiflu, one of two antiviral drugs effective in treating it, scientists say both drugs generally appear to continue to be effective.

The US government shipped 11 million doses of the drugs to states to add to the 23 million they already had on hand and bought an additional 13 million doses to replenish its supplies.

Officials are hoping to navigate a fine line, urging precautions to minimise spread, serious illness and deaths while avoiding undue alarm and misinformation.

"The strategy and the effort on the part of the governments is to make sure we ...collaborate to minimise the impact," said John O. Brennan, the US deputy national security adviser for counter-terrorism and homeland security.

The US, Canada and Mexico have also vowed new vigilance against an expected resurgence of swine flu in coming months and said measures such as general border closures would be unlikely to prevent the spread of the virus.

On the contrary, they could only aggravate the economic and social consequences of a pandemic, US President Barack Obama, Mexican President Felipe Calderon and Canadian Prime Minister Stephen Harper said in a joint communiqué after their Aug 9-10 summit in Mexico.