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U.S. Department of State

Diplomacy in Action

2009 H1N1 Flu Also Known as the Swine Flu

FPC Briefing
Rear Admiral Steven K. Galson M.D.
Acting Surgeon General of the United States
Rear Admiral Mitchell L.Cohen, M.D., Director, Coordinating Center For Infectious Diseases of the Centers for Disease Control
Foreign Press Center
Washington, DC
May 1, 2009


Date: 05/01/2009 Location: Washington, DC Description: 05/01/09: Rear Admiral Steven K. Galson M.D., Acting Surgeon General of the United  States and Rear Admiral Mitchell L.Cohen, M.D. (at podium), Director, Coordinating Center For Infectious Diseases of the Centers for Disease Control brief on the N1H1 Flu at the Washington Foreign Press Center. State Dept Photo

2:00 P.M., EDT

Video

MODERATOR: Ladies and gentlemen, good afternoon. Thank you all for coming. I am Haider Karzai with the U.S. Department of State’s Foreign Press Center here in Washington. It’s my great pleasure today to introduce today’s guests. To my right is Rear Admiral Steven Galson, the Acting Surgeon General of the United States. And to my left is Rear Admiral Mitchell Cohen, Director of the Coordinating Center for Infectious Disease – of the Centers for Disease Control.

As usual, we will begin our session with brief opening remarks by our guests. And then we will go to our Q&A period. Before I give the podium to our guests, I would like to ask you to turn off your cell phones or switch them to vibration mode. Thank you.

Admiral.

RADM GALSON: Thank you very, very much, and we’re really very pleased to be here. I know you’re probably wondering why we’re wearing uniforms, so I want to just pause and explain that to you. We are both officers in the United States Public Health Service, which is a uniformed service of the United States, separate from all the others. We’re public health professionals, doctors, nurses, social workers, and a whole range of other health care professionals.

So thank you all for joining us today and for taking the time to learn more about the 2009 H1N1 flu virus. I know that people in communities all around the United States, and in fact, all around the world have questions about this flu outbreak. And at times like this, clear, accurate information is one of the most powerful tools. I know you appreciate that.

As this nation’s Acting Surgeon General and the father of three, I know families want to know what they can do to protect themselves and their children in these times. It’s important to know that the world is better prepared for a potential influenza pandemic than any time in history. Preparedness measures over the last few years have made us a better prepared nation here in the U.S. and a better prepared world. There have been preparations going on all around the world as well.

Public health experts in the governments of the United States, Canada, and Mexico are working closely together to investigate and control the current outbreaks of H1N1 influenza. The U.S. is communicating and coordinating with the World Health Organization, with the Pan American Health Organization, and other international partners, such as the European CDC in Stockholm, to respond to this rapidly changing situation. WHO’s pandemic phase, as I know you’ve seen from the news, remains at five today.

Communities across the world are looking for information about the steps that they can take to stop the spread of the virus and care for anyone who might be infected. If you are sick, you should stay home from work. If your children are sick, you should keep them home from school, and you should stay out of public spaces. If your children are sick, call your physician, as well as if others in your family are sick.

And everyone should remember to wash their hands and cover their mouths when they cough or sneeze. You can also use an alcohol-based hand disinfectant. Keep your hands away from your eyes, your nose, and your mouth because this is how germs spread. So these simple hygiene steps can help keep us healthy.

We want to take your questions and hear your concerns, but first, I want to give you a brief overview of some of the steps we’re taking to respond to the outbreak. Since the first cases of the 2009 H1N1 flu virus were discovered, the Department of Health and Human Services in the U.S. has worked to combat this outbreak and protect the American people. We have 50 million treatment courses of the antiviral drugs Tamiflu and Relenza in the U.S. strategic national stockpile, and we’ve sent 11 million of these courses already to the affected states in the U.S.

Last night, our Health and Human Services Secretary Kathleen Sebelius announced that the U.S. Federal Government will purchase an additional 13 million treatment courses to help fight influenza, including the 2009 strain. The additional national courses are going to be added to our stockpile. And the secretary also announced that the department will begin providing 400,000 treatment courses to Mexico to help slow the spread of this virus.

I want to be clear; we know that these drugs are effective in treating patients who have acquired the current virus. Our FDA, our Centers for Disease Control, and the National Institutes for Health are also working to develop a safe and effective vaccine that will help protect us from this H1N1 flu virus.

Finally, we’ve posted comprehensive information about what you can do to protect yourself and the steps that you should take if you’re sick at the Centers for Disease Control website www.cdc.gov/h1n1flu. HHS remains committed to working with our sister agencies such as USAID, who support WHO, PAHO, and all of our other international partners.

Every single day we’re going to learn more about this virus. We’re keeping the American public updated. We will probably see some surprises. One thing about influenza virus is we know that they’re unpredictable. We’ll continue to strive to keep the U.S. and international public as aware as possible as things do change.

So with that, I’m going to stop. Dr. Cohen is going to give some remarks and then we’ll come back for your Qs and As. Thank you.

RADM COHEN: Thank you, Admiral Galson, for your remarks and also for your leadership during this challenging time.

The international community has done a great job in sharing information and assisting others. As Admiral Galson has said, the world is better prepared today to handle an influenza outbreak. Countries are making their investigations publicly available, which helps us understand the disease, and it also helps us to design appropriate prevention strategies.

Over the next days and weeks, it’s critical that we continue this dialogue in order to maintain a heightened surveillance in the United States and globally to detect new outbreaks of disease, to better characterize the severity of the disease, and to respond rapidly to mitigate the impact on families and communities, and to adapt our interventions to better control the disease. Because as the Admiral pointed out, you cannot always predict what’ll happen with influenza, so we have to maintain a great deal of flexibility to respond to the changes that may occur with this virus.

The world is now benefiting from the preparedness measures undertaken from the threat of the H5N1 avian influenza. We can now track the evolution of the virus in real time. HHS and CDC influenza experts have been working on influenza-related issues in 20 strategic locations across the globe for years, and continue to provide support to host countries to detect and respond to influenza-like illness during this challenging time.

The United States, like other countries, are mounting an aggressive response to this outbreak. CDC’s goals during this public health emergency are to reduce transmission, illness severity, and provide information to assist health care providers, public health officials, and the public in addressing the challenges posed by this newly identified influenza virus.

Findings in Mexico indicate that transmission in that country does occur person to person, and there are probably multiple episodes where the disease has been spread from person to person to person, and we refer to this as multiple generations of transmission.

The clinical spectrum of illness is not yet well characterized in Mexico, and this is a very important issue that we’re working closely with the Mexican Government and with the WHO to be able to define. As Admiral Galson indicated, here in the U.S., we’re taking steps to protect persons who are more vulnerable to serious illness and complications from virus. This is often people with underlying diseases – the elderly or the very young. We are pushing our recommendations through domestic and international partners to get the word out to these persons that they should take precautions, be aware of the warning signs, and seek medical care sooner rather than later.

Here in the U.S., new guidance is being issued continuously, and I urge you to visit our CDC website at www.cdc.gov. This is a rapidly evolving situation, and guidance should be considered interim and will be updated frequently. As we learn more about the virus, we are continuously sharing this information with our international partners. So I want to thank you for joining us today and we’ll now be happy to take your questions.

MODERATOR: Before we start questioning, please introduce yourself, your news organization, and your country of organization. And if you are directing a question to either gentleman, please, either Dr. Galson or Dr. Cohen. Go ahead. Let’s start with Nadia.

QUESTION: Thank you. Nadia Bilbassy with MBC Television, Middle East Broadcasting Center. Thank you both, Admirals, for this briefing. I have two questions, actually, and number one is WHO has cautions against travel towards the U.S. Do you think that’s warranted? Is this a good precautionary measure to take?

And second, knowing what we know about the virus so far that’s combined of four different viruses, it seems to be killing people in Mexico, but so far has not killed people in the U.S. except for the child who came from Mexico. Does the virus we know – do we know enough that the virus weaken as it leaves the origin where it came from? It’s for either of you.

RADM COHEN: We are currently at the stage where there is disease that’s occurring many places in the world. So it really is important, and we are trying to focus our efforts in addressing the disease which is occurring within our country. We continue to observe folks entering the country to try to identify if there are people who are acutely ill and to try to make sure that they’re able to get into appropriate healthcare. But I think it’s really important to each country to focus on the preparedness that they need to do for the arrival of this virus.

The second question --

QUESTION: The weakening of the virus.

RADM COHEN: Yes. One of the reasons why we have been very interested in looking at the disease in Mexico has been the reports of severe illness and death. And we are continuing to investigate that. As you know, in the United States, we’ve only had the one death that you relate to. And in the rest of the world, most of the illness has not been as severe. So we’re trying to understand that by working with our colleagues to see if it might be explained by a much broader occurrence of disease, of which the deaths are only a tip of the iceberg, where there might be other potential explanations for that.

MODERATOR: We’ll go to the back and --

QUESTION: Dorothy Baranis (ph) of DB Media (ph). How does this H1N1 strain compare to the SARS virus? And what can you do with the information you gathered already years ago?

RADM COHEN: It’s a very different virus. It has a different ability to be spread. It has different sources. It has a different clinical illness. It has different epidemiologic characteristics. So it’s very different from influenza. For example, people who have SARS usually only are infectious to other people after a number of days of being ill, whereas people with influenza can be actually able to transmit the disease before they actually have symptoms.

So the real important part of that is that the world community learned so much from addressing the event with SARS that we are much better prepared now, both in international collaboration and individually in the separate countries, to address the emergence of these kinds of diseases.

QUESTION: Is this one more danger – excuse me, is this one more dangerous or how does it compare?

RADM COHEN: Well, they’re different illnesses. The illness with SARS was a very severe illness for the individual, and we had a number of outbreaks that were associated with the hospital care of ill individuals with SARS. This illness, although there have been reports of severe illness, most of what’s being recognized at this point is less severe. But it’s important to remember, as both of us have cautioned, that influenza can change and be unpredictable.

There were reports in some of the previous pandemics that occurred that the early disease that occurred in a pandemic was less severe, and that the virus somehow changed to cause more severe disease. This was very commonly reported in the 1918 pandemic. So there’s a very great difference between the diseases. Right now, we’re seeing less severe disease, but we have to maintain our very high level of caution to be prepared for something that the virus may do that might not be predictable.

MODERATOR: All right. We’ll go here to Kuwait.

QUESTION: Heather Yamore (ph) with the Kuwait News Agency. I have two questions. One, there are reports coming out that Mexican health officials are reevaluating some of the casualties believed to be from the H1N1 virus. How does that impact – and suggesting that perhaps the virus may be leveling off. How does that impact how the U.S. gauges the threat of the H1N1 virus? And that question’s open to both of you.

But another question for Dr. Cohen: You said that the health officials are advising the elderly and people who may have underlying diseases, but it seems that the casualties, for the most part, from reports, have been the young and relatively healthy individuals. Can you comment on that?

RADM GALSON: Let me handle the first one and I’ll have him handle the – Dr. Cohen handle the second one. Every single country that has cases of this flu is going to be evaluating those cases and investigating these cases. And, of course, we are communicating between countries. We are sending people around the world and have people around the world, so we’ll be working together.

But the assessment that Mexico is doing of their cases is very important, but we’re really basing our response in the United States on the severity of the epidemic in the United States. It helps to understand what happened in Mexico to help us understand the behavior of this virus. But on a day-to-day basis, the decisions that we’re making are based on the severity here in the U.S.

I’ll let you go to the next one.

RADM COHEN: The report that this disease was affecting otherwise healthy young people was one of the reasons why the public health officials were concerned about its severity. And so we really need to be able to look at all of those cases and try to determine if they did have any underlying risk factors.

Of the cases that have been hospitalized in the United States, a large percentage of those now are people who do have underlying conditions, which would be the same individuals or the same kind of conditions that would predispose hospitalization for people who had seasonal flu. So we’re trying to sort out the difference in what we’re seeing here and what’s been reported in Mexico.

MODERATOR: We’ll go – New York.

QUESTION: Hi, my name is Andrea Musa (ph). I’m from (inaudible) Sao Paulo newspaper in Brazil. I have two questions. The first: There have been questions about the capacity of the U.S. public health system to accommodate an epidemic situation, especially considering the economic crisis. I have heard that other priorities in health have had personnel shifted to take care of the H1N1 spread – outbreak. I would like to hear either of you to comment a little bit on that. And the second question is also about the capacity but for testing the cases. I would like to know if the CDC is still the only place where there can be a final confirmation of contamination cases and if there are plans for that to change and how will that progress.

RADM GALSON: Okay. I’ll handle the first one and have Dr. Cohen handle the second one. In 2005, we finalized a pandemic influenza plan in the United States. And since that plan was put in place, we have been rehearsing that plan. We have been getting ready for that plan. We have been stocking the national stockpile and we are very, very ready to handle this type of emergency. That said, as we’ve both emphasized, there’s no predicting what can happen and, you know, we will – we are doing our best and we have rehearsed the possible scenarios, but we just don’t know what’s in front of us.

I am a strong advocate for strengthening the U.S. public health service and the public health system. And it is very important to have a strong system, but in the area of pandemic flu preparedness, we believe we are ready.

RADM COHEN: We have begun distributing the diagnostic kits to state and some local health departments. Seventy-two various health department laboratories have began today receiving the kits. And so the states and the large cities will have the ability to confirm cases on their own. In addition, we have put into sort of the public access all of the information that would be necessary for other laboratories around the world to prepare diagnostic reagents so that they can confirm their own cases as well.

MODERATOR: We’ll go here.

QUESTION: (Inaudible) from – am I on – from (inaudible) magazine. I have three questions. First, when will you say – recommend people to wear masks? What are the indicators you are looking at or watching? The second is about the vaccine. How soon will you develop a – say, a good vaccine for these diseases? And the third is about the antivirus courses. You said that maybe in total you could have 63 million courses of that, right? Is there a chance that this is not enough? And what about the – say, the courses? When did you develop that and how effective are they?

RADM COHEN: Okay. Well, let me take these out of order, since I have them written. I can remember which ones.

Let me talk about the antiviral drugs. We originally had 50 million drugs in the national stockpile. In addition to that, the states had purchased another 23 million. So this 13 million is essentially going to replace the 11 million that we sent out to all the states. So with the replacement of these antivirals, our stockpile will pretty much be reconstructed as it was. The early evidence, which is mostly anecdotal, suggests that there is efficacy, and particularly when people are treated early in their illness. So one of our recommendations is that people who have this infection be treated with a antiviral drug that it’s susceptible to within the first 24 to 48 hours.

The availability of vaccine will depend on many, many issues. We are right now developing what’s called a seed stock, which is a vaccine candidate that’ll be distributed to the manufacturing companies that they’ll use for making their vaccines. But there’ll be a number of other factors that will have to be considered that are regulatory, that are scientific, that deal with the production processes, that we hope would give us a vaccine in the fall in time for having an immunization campaign that could address a potential another episode of this virus that might occur during the fall and winter of the years, as often happens with pandemics that we get waves of disease.

So we’re hopeful, but as those of you have followed any vaccine issues with influenza know, that in recent years, there have been production problems or other types of problems that have occurred, so there are many things that potentially could be stumbling blocks that we’ll have to face in getting a vaccine as soon as possible, but we’re making every effort to do that.

Oh, there was one other question. The particular focus of masks are for the individuals, particularly those that are in healthcare that are dealing with high-risk patients. Now, we also suggest that individuals who are ill can wear a surgical mask to try to prevent the spread of disease because it’s spread by droplets generally, so it’s by coughing or sneezing. So a surgical mask can help reduce that.

There is permissive guidance about others, particularly people that may be high risk to complications or people who may have positions where they come into a great deal of contact with people in crowded circumstances. But one of the primary areas is the type of isolation and infection control practices that occur in hospitals that take care of sick individuals, and there masks are a very important part of protecting the workers.

MODERATOR: We’ll go here. There. It’s coming there.

QUESTION: Thanks. Robert Reynolds (ph) from Al Jazeera English. A question for Admiral Galson about the origins of this illness. We don’t know exactly where it came from, although we know that swine and birds were involved. There’s been a lot of speculation that factory farms in Vera Cruz state or elsewhere in Mexico might have been the point of origin – very large hog production operations.

As the senior public health official in the United States, you’re no doubt concerned about other instances of where factory farming and modern agricultural practices have led to outbreaks of disease. Is there a cause now to look more closely at these types of farming techniques, agricultural techniques, and regulate them more carefully, or are we simply at the mercy of what the virus might do in this sort of massive farming operation?

RADM GALSON: We have a very intensive effort underway in the U.S. through WHO with Mexico to look at the origins. We don’t know the answer yet. We have not linked this to factory farming. We’ll have to see if we can identify the origin. And so there is really too little information to make policy jumps between what’s happened here and what we might do in terms of farm policy.

QUESTION: It is a source of concern for you?

RADM GALSON: We don’t have the facts to be concerned right now.

MODERATOR: Right here. Wait for the mike, please.

QUESTION: I’m (inaudible) from China, the Xinhua News Agency. I have three questions. The first one is, as I know, a total of 141 H1N1 flu cases have been confirmed in the United States and the number increase remarkably every day. So does that mean that the virus cannot spread rapidly between humans?

And the second one is, as a new (inaudible) of the virus is a mixture of swine flu, avian flu, and human flu virus. So does that mean the flu virus in the world can, you know, be more virulent than we thought?

And the third one is, can you give some advice on the international cooperation on fighting the virus? So do you think there’s a reason that – why is it in this region, the USA, so many virus attacks the human beings, like the avian flu and the human flu and the SARS? You know, so that’s all. Thank you.

RADM COHEN: Let me start with the last question again. If I’m understanding properly, we have seen a number of viral diseases in recent years, and a number of these viral diseases have crossed over from animal species into humans.

In 1992, the Institute of Medicine published a report on emerging infectious diseases, and they identified a number of factors that was leading to disease emergence. As you can well imagine, changes such as the ability to travel internationally, the increasing development in many parts of the world that bring people in contact with potential animal species, the population centers that are growing in many parts of the world – all of these things increase the possibility of transmission. And then when you have the opportunity of coming in contact with animals or other types of vectors that has been uncommon for humans, if you get that transmission occurring and then you can rapidly move from one part of the world to another part in 24 to 48 hours, it becomes an opportunity for the spread of these agents. And viruses are a group of these agents that have that kind of potential.

So this is something that we have seen. It’s likely something that we will continue to see. And this is one of the reasons why people have become so interested in this concept of one health, where people in animal health and in human health and who are interested in the environment are able to work together to understand diseases that are occurring in all of those areas for the benefit of all of those areas. So I suspect that viruses will continue to pose us a problem, but we’ve also had problems with bacterial diseases and other potential emerging pathogens.

When we said that influenza was unpredictable, part of the reason it’s unpredictable is because it has this really phenomenal ability to change genetically. And it’s not just that it can have individual mutations, but if you have an animal who becomes infected with two different viruses – let’s say you have a pig that gets infected with a virus from another pig and a virus from a human – that can result in the making of a virus that contains genetic parts of the virus that came from the pig and the virus that came from the humans. And so then you can add a bird virus to that, so there is almost a limitless potential for these viruses to recombine, and you often cannot predict what will be the outcome of those kinds of recombinations. Will you have something that infects humans or animals? Will it cause severe disease?

So the ability of genetic recombination is one of the major important aspects. And so the fact that we’ve found different genes that come from different swine origins or come from avian origins or human origins is not that surprising, or that the origins of these may have been in various parts of the world at different points in time. So this is consistent with the difficulties that we face in dealing with this agent.

The fact that we have 141 cases and how it’s changed, I think that we’ve expressed the view all along that we think that there will be spread based on what we have seen in Mexico, what we have seen in other countries around the world where travelers from Mexico have gone to those countries. There is evidence in Mexico that there are multiple generations of transmission. So are the conditions the same that might provide this in the United States? That’s one of the things that we’re studying. But we are trying to determine how easily this spreads. And if the cases in Mexico are really the tip of the iceberg, where there may be thousands and thousands of cases, it’s very likely that this particular virus can transmit fairly easily from person to person.

MODERATOR: We’ll go to the back of the room.

QUESTION: Thank you very much. Dorothy Baranis (ph) of DB Media (ph) again. So you talked about the origin of the swine flu and farm policy and too little information, but that’s exactly the problem we have. We need all the information we can get, not – right now, not the tomorrow or the day after tomorrow. So I’m wondering, first of all, are the Mexican authorities or scientists over there perhaps delaying information or not releasing information you need or would like to have right now? And secondly, if that is the case, what measurements are you taking in order to get those information? I mean, what is the status right now?

RADM GALSON: We’re working very successfully with the Mexican Government. We have a team of – we have a team of disease detectives that are down there. It’s an international team. We’re working to try to identify the origins and understand how the virus spread at the beginning, and we need to get all that information together. It’s not usually a black-and-white answer. It requires analysis, discussion, and if there are policy implications of that, we’re going to consider that. But obviously, we don’t want to do something precipitous before we understand all the data.

MODERATOR: Right here.

RADM COHEN: The highest priority is understanding the issue, is there a difference in severity. And that, for, the world community, is, job one. There are a lot of other questions that one has to try to answer. What are the other aspects of the clinical illness? What are successful treatments? What are not successful treatments? So there are the clinical questions. There are the epidemiologic questions such as how do you describe the people who are ill. What are their demographic characteristics, what is their age, their occupations, all of these things that may help you understand where the person acquired the infection.

So there is a great deal of information that has to be sifted through, and there is great collaboration that’s going on both internationally and bilaterally in this investigation.

MODERATOR: Laura.

QUESTION: Hi, Laura Beatty, Al Arabiya. I wanted to talk about what you just touched on, and that is all of these different clinical ways and epidemiological ways of evaluating the virus. In terms of the mutations, the cases that you’ve seen so far, also relating back to time, how long does it take for you to evaluate the different strains, whether or not they are mutations or whether those mutations are significant? And also, how many days does it take you to confirm a case? Thank you.

RADM COHEN: Well, one of the major issues in confirming the case is getting the specimen to the laboratory. Within hours, one can confirm the case. Similarly, now, with the advances in technology, one can actually sequence the entire virus in hours and actually have that available for comparisons between other viruses and for researchers around the world to look at it and to think if there’s some aspects of it they think that might be related to other viruses or be helpful in understanding what’s happening. So the technology has advanced very rapidly, and so we have very powerful tools in being able to study this virus.

MODERATOR: Wait for the mike, please, if you have a follow-up.

QUESTION: Sorry, quick follow-up. But that kind of technology doesn’t exist everywhere, and so that’s kind – you know, you must have seen big chasms in the response time in other places.

RADM COHEN: Well, there actually are a number of centers around the world that have been developed in preparation for dealing with influenza that have either similar or the – exactly the same capacity. So the isolate that’s acquired in one part of the world may be sent to a different collaborating center and have similar studies. And since they share their data, a study that’s done in Australia can be compared to a study that’s done in Atlanta.

So there obviously are all of the transportation issues that exist depending on where the case originates from in getting a specimen to the laboratory, but there are laboratories around the world that have this capacity, in part, that have developed in preparation for dealing with the next influenza threat.

MODERATOR: Right here.

QUESTION: Thank you. I’m (inaudible) with ITAR-TASS news agency, Russian news agency. I wanted to ask you to talk more about the international cooperation and sharing of information, because it is expected, like these next days, that this strain, like an example of the virus, would be sent to Russia. Has our government asked for it? Do you know anything about that? And I also wanted to ask if the U.S. could actually give any help to Mexico right now, something like medicines? Or do you think the international community could give any help to Mexico right now? Thank you.

RADM GALSON: Yeah. First of all, as I mentioned, we have provided antiviral drug doses, courses to Mexico. So that sort of collaboration is taking place. When there is a request that comes in to the U.S. Government for assistance, we will consider it and we consider them based on the strength of the particular request and the circumstances.

There is a high level of collaboration on influenza preparedness coordinated through the World Health Organization. Of course, Russia is part of that, and I don’t have any particular information about Russian activity. I don’t know if you do, but I do know they’re an active part of the World Health Organization, and that’s where the coordination is taking place.

Anything you want to add to that?

RADM COHEN: Well, we are – we have begun sending the virus to other laboratories, and I just don’t know whether that one in particular has been one that it’s been sent to.

QUESTION: My name is Satoshi Ukai, Shimbun, Japanese newspaper. I have two questions. One is: We – in what kind of situation does the U.S. Government consider closing the southern border with Mexico? The second question is: Do you expect more patients in Southern Hemisphere as it enters the flu season in winter? Thank you.

RADM GALSON: The question on the borders – a lot of the U.S. officials who have been speaking to the press this week have talked about this. The bottom line is that the virus, the infection is around the world already, and we just don’t see the value of closing borders. In terms of all the different types of steps, we don’t think that that is an effective step to be prioritized.

The issue about the southern, you’re probably more expert on that, the Southern Hemisphere.

RADM COHEN: Well, yes, we would be getting into the southern season, and there is a potential for the strain to spread as if it was during that particular season. At this point in time, we don’t know exactly what’ll happen. We do know that it already is in countries that are in the Southern Hemisphere. So we will have to follow it closely to see whether the pattern of disease follows a pattern that’s similar to the seasonal disease, both in the southern and in the Northern Hemisphere. For the Northern Hemisphere, it’s a very important issue because this is not our typical influenza season.

So there are factors which make it unlikely for influenza to be spread during this time of year, not all of which we know and understand. We would anticipate that we will have a influenza season starting in the fall. And as you pointed out, it’s sort of the opposite for the Southern Hemisphere, and there are factors there. So we will be, again ,working closely with our colleagues in the Southern Hemisphere and observing what they experience potentially as an indicator for what we might experience this fall in the United States.

MODERATOR: We’ll go to the back right there.

QUESTION: My name is (inaudible) of Al Hayat TV of Egypt. My question is related to a subject I am not sure if you have touched on it before. I came a little bit late in your – into your presentation. The Government of Egypt has decided to slaughter all the stock of the country of pigs, which is a controversial decision, but that has been taken as a preventive measure. To what extent do you consider that at least not the effective way, but at least one of the ways that could be considered? Or do you think it’s useless and you don’t advise it? Thank you.

RADM GALSON: We don’t want to comment on policy decisions that other countries have made, but there’s no evidence that contact with pigs and with pork that’s well-cooked is a factor in the spread of this disease. Every country has to assess the information, decide what to do, and, you know, we aren’t going in that direction here.

QUESTION: Oliver Janney, CNN International. I’d like to ask the Attorney General, do you agree with the World Health Organization’s director’s characterization that H1N1 threatens humanity?

RADM GALSON: You meant Surgeon General.

QUESTION: Sorry. Surgeon General. Apologize. (Laughter.)

RADM GALSON: You’re not the first one. Again, the way that you describe this threat, different people decide to use different words. We are very concerned in the United States and that’s the word that we like to use. We – there’s no reason to panic. I think people around the world need to be concerned as well.

MODERATOR: We’ll come here.

QUESTION: Hi. I – today, President Barack Obama said that the U.S. is now looking towards long-term options of solutions with this virus. So I’d like to know if you guys can sort of illuminate what that would look like in terms of U.S. cooperation internationally, with the spread of this virus and other potential strains?

RADM COHEN: We talk about two major strategies for trying to prevent influenza. One is to interfere with transmission, so all of the things that the Surgeon General has talked about, about personal hygiene. There are also things that can be done in communities to try to prevent transmission. If you increase the distance between people, you increase the likelihood that you can prevent transmission. So there are these activities that we refer to as social distancing. They may involve activities such as closing schools or other activities that may discourage mass gatherings and such. All of these activities will be evaluated as we look towards the future into the long term to get a better idea of what the severity of this is and what are appropriate based on that severity. But the longer-term approach is having an effective vaccine. That is a very powerful strategy.

Each year in the United States, we have almost 200,000 hospitalizations and 36,000 deaths from seasonal influenza. Now those diseases and those deaths are, to a large part, preventable through vaccines and other strategies. So it’s really important that we look long term, as the President said, both in the things that we can do short term and long term about reducing transmission, but also in the types of protection that we can provide through effective vaccines.

MODERATOR: Wait for the mike, please.

QUESTION: Sorry. I just have a clarification. From – correct me if I’m wrong, but from my limited medical knowledge, I believe that –

RADM COHEN: She’s good.

QUESTION: Well, she’s not that good. (Laughter.) But I believe that antibiotics are used to treat bacterial infections, not viral infection. So when you talk about the Tamiflu, is it an antibiotic and is it mainly used to treat the symptoms and the complication as a result of the virus, rather than destroy the virus?

RADM GALSON: These are antiviral drugs. They’re not antibiotics. So they’re targeted, designed and they kill viruses, not bacteria. They are called antivirals. There are different ways of classifying those, but these are not antibacterial drugs; they’re antiviral drugs. And they are effective at reducing the symptoms of the influenza. When you get sick, they also have some activity, if taken after people have been exposed, prevent them from getting sick. So they have activity in both areas.

Do you want to add?

RADM COHEN: Let me – one of the things that sometimes is confusing is that people who get influenza die of bacterial pneumonia. And what happens is that when the damage is caused to the respiratory tract, it provides the right conditions for bacteria that may be present to multiply and cause a bacterial pneumonia. So it’s often that people who have a complication of influenza will be treated with an antibiotic to kill the bacteria that are now causing a complication of the influenza. So there are – it’s a lot of confusion that sometimes occur around this.

So that actually is one of the important questions that we need to answer, when we look at severe disease – are people dying of a viral infection alone or are they dying of a complication of that that might be a bacterial infection?

MODERATOR: We’ll go here.

QUESTION: I’m (inaudible) from Japan (inaudible). In Japan, the government – government can order or force the patient to be hospitalized or be isolated from public by law. And I’m wondering if you – federal government or state or county or city authorities can also have those kind of power in terms of law, I mean, legally speaking.

RADM COHEN: In the United States, there are federal laws about quarantine, and, you know, there is an important difference between isolation and quarantine. Isolation is a sick person that you want to try to put in a circumstance where they can’t transmit the disease. A quarantine, you often will put someone who has been exposed to a disease, that you’re afraid they might develop a disease and spread.

The law in the United States – there are federal authorities, but most of the authorities reside at the state and local level, and they vary from state and local level as to what is the nature of the authority that the public health officials have and how do they go about doing isolation or quarantine.

MODERATOR: Time --

RADM GALSON: You know, I don’t think we know enough about the Japanese law to compare them for you and say which is stronger or not.

MODERATOR: We’ll go there to the back, and then we will have time for only one more question.

QUESTION: My name is Hajib Motabi (ph) with Kyodo News. On the severity, a Japanese expert who is a member of WHO committee, which is (inaudible) studying the phase, he says this virus is mild, weak, toxic type. I don’t know how I put it in English, but it’s weak, toxic type, like seasonable influenza. And it’s not likely to evolve into the high toxic type like H1N1 avian influenza. It means it’s not dangerous than – it’s not more dangerous than seasonal influenza. So what do you make of these remarks?

RADM COHEN: Well, I think that we would like to have more information to really understand the actual severity that’s occurring. We still have this large question mark in Mexico as what’s happening. And there is the potential for strains to evolve and become more severe. So I think we have to exercise caution.

In the United States and in most of the other parts of the world that have seen the disease, the disease has not been as severe as has been reported in Mexico. But in most areas, this is still early. We have a few cases of disease. And even with that, if our seasonal influenza causes 36,000 deaths and 200,000 hospitalizations, if we have an opportunity to impact that, I think that we would like to be able to do that.

MODERATOR: Time for one more. Okay. If there are no more questions, I thank you all for coming, and I thank our distinguished guests. Thank you, sir.

RADM COHEN: Thank you.

MODERATOR: All right, sir.

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