First U.S. resident with swine flu dies; but officials not sure disease is the reason

This undated photo provided by the Rudy Garza Funeral Home and taken by Ultrashots studio shows Judy Trunnel. Texas health officials on Tuesday announced the first death of a U.S. resident with swine flu, and said Trunnel was a 33-year-old schoolteacher who had recently given birth to a healthy baby. Health officials stopped short of saying that swine flu caused the woman's death. State health department spokeswoman Carrie Williams said the woman had "chronic underlying health conditions" but wouldn't give any more details.

HARLINGEN, Texas – This week should have been a joyous time for Judy Trunnell, a 33-year-old schoolteacher who had just given birth to a healthy baby girl.

But the friends and relatives whose cars lined the quiet street in front of her home in a quiet subdivision Tuesday instead were mourning her, the first American with swine flu to die.

In Maryland, her cousin told WMAR-TV in Baltimore that Trunnell had died after spending two weeks in the hospital. She slipped into a coma, and her baby was delivered by Cesarean section, Mario Zamora said.

“She was just a beautiful person, warm at heart. She worked with disabled children as a teacher,” Zamora said. “Those that knew her will always remember her.”

Texas health officials stopped short of saying that swine flu caused Trunnell’s death. State health department spokeswoman Carrie Williams said the schoolteacher had “chronic underlying health conditions” but wouldn’t give any more details.

She died early Tuesday after being hospitalized since April 19, said Leonel Lopez, Cameron County epidemiologist.

Trunnell’s death came as life in the areas hardest hit by the outbreak began returning to normal. In Mexico, where the current strain is thought to have originated, stores, restaurants and factories were officially allowed to reopen Tuesday. And U.S. health officials withdrew their recommendation that schools with suspected swine flu cases shut down for two weeks.

The only other swine flu death in the U.S. was that of a Mexico City toddler who also had other health problems and had been visiting relatives in Brownsville, near Harlingen. He died last week at a Houston children’s hospital.

There have been 29 other confirmed swine flu deaths, all in Mexico. Hundreds of cases of the disease have been confirmed in several countries, but mostly in Mexico and the U.S.

Trunnell was from Harlingen, a city of about 63,000 near the U.S.-Mexico border, and taught in the Mercedes Independent School District about 15 miles west of her hometown.

She was first seen by a physician April 14 and was hospitalized on the April 19. Zamora said she had complained of difficulty breathing and was put on life support.

Doctors knew she had a flu when she came in, but did not know what kind, Lopez said. The area is undergoing a Type A influenza epidemic right now, and swine flu is one variety of that, he said. She was confirmed to have swine flu shortly before she died, he said.

Dr. Joseph McCormick, regional dean of the University of Texas School of Public Health’s Brownsville campus, said the woman was extremely ill when she was hospitalized.

Mercedes school district officials announced that it would close its schools for the rest of the week and reopen Monday.

Associated Press writers Alicia A. Caldwell in El Paso and Jamie Stengle in Dallas contributed to this report.

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LATEST DEVELOPMENTS

• Confirmed sickened worldwide: 1,884, including 942 in Mexico; 652 in U.S.; 165 in Canada.

• Mexico says epidemic has cost its economy at least $2.2 billion.

• Mexico cancels Cinco de Mayo celebrations but will allow most businesses to reopen Wednesday and universities to reopen Thursday.

The Associated Press

A lecture Tuesday about genetic and environmental causes of asthma and allergies at the University of Arizona has been postponed.

Fernando Martinez, a noted asthma expert and director of the university’s Arizona Respiratory Center, was to give a public lecture on the subject. Martinez’s research focuses on the natural history of childhood asthma and the genetic, physiological and environmental factors behind it.

The talk, to have taken place at 5:30 p.m. at the University Medical Center DuVal Auditorium, 1501 N. Campbell Ave., has not yet been rescheduled.

Workers wearing bio-hazard protection suits as a precaution against swine flu clean a hallway at National Autonomous University of Mexico in Mexico City on Monday. Mexican officials lowered their flu alert level in the capital on Monday, and plan to allow schools, businesses, museums and libraries to reopen this week.

The H1N1 virus, better known as swine flu, continues to infect people across the globe, but there is a growing sense among public health officials that the newly evolved influenza strain is mild, at least for now.

Though there is still much to be learned about the strain, Richard Besser, acting director of the Centers for Disease Control and Prevention, says he sees encouraging signs that it is a mild form.

In the U.S., the hospitalization rate is only 0.7 percent, says Jon Andrus of the Pan American Health Organization: “That’s comparable to most seasonal influenza.”

That appears to be the case in New York, which, with 73, has the highest number of confirmed cases in the nation.

“We have looked daily at every hospital and every intensive care unit in the city,” says Thomas Frieden, New York City Health Department commissioner, “and we have yet to find a single patient with severe illness from H1N1.”

But that could change quickly at any moment, Andrus warns. “Influenza viruses are predictable in their unpredictability.”

Officials worldwide are watching carefully to see how the virus evolves during the winter flu season in the Southern Hemisphere, which begins in June.

“That will tell us a lot about whether the virus is changing, whether it’s becoming more severe and what measures we might want to take in the fall,” Besser says.

The World Health Organization’s figures for Monday were 1,025 cases with 26 deaths in 20 countries, says WHO flu director Keiji Fukuda. The majority of cases continue to be reported in Mexico, the U.S. and Canada, Fukuda says, and most cases in the other 17 countries are related to travel from those three countries.

That means that raising the world pandemic phase to 6 is unlikely anytime soon, he says. WHO raised the alert level to Phase 4 on April 27 and to Phase 5 on April 29. Phase 6 would indicate “a global pandemic is under way,” according to WHO.

Besser suspects that the level probably will be raised to Phase 6 at some point “given that flu viruses spread easily from person to person,” but he says that wouldn’t change the work CDC already is doing.

In the U.S., the CDC’s report for Monday was 279 cases in 36 states and one death: a toddler visiting Texas from Mexico.

As of Monday, more than 330,000 children were out of school in the U.S. because of closures as the result of actual or suspected cases of H1N1. Taken together, the students would make up the nation’s sixth-largest school district, the U.S. Education Department says.

The CDC is considering revising its original advice that schools with active cases of H1N1 close for up to two weeks, Besser says. That’s because most schools have clusters of the flu, he says, and that means the virus is “already pretty well-established in those communities,” so closing schools won’t stop its spread.

Nearly 250,000 schoolkids home after closings

WASHINGTON – President Obama voiced hope Friday that the swine flu virus will run its course “like ordinary flus” as officials reported more than two dozen new cases and scores more schools shut down.

The government issued new guidance for schools with confirmed cases, saying they should close for at least 14 days because children can be contagious for seven to 10 days from when they get sick. That means parents can expect to have children at home for longer than previously thought.

The Education Department said that more than 400 schools had closed, affecting about 245,000 children in 18 states. That was about 100 more schools reported closed than reported on Thursday.

Major U.S. airlines, meanwhile, announced plans to curtail flights into flu-ravaged Mexico.

“I’m optimistic that we’re going to be able to manage this effectively,” Obama told reporters as he received an update from his Cabinet on the federal response to the health emergency. At the same time, he emphasized that the federal government is preparing as if the worst is still to come so that it won’t be caught flat-footed.

Obama’s fresh take on the flu scare — more intense in neighboring Mexico than in the United States but also present in some measure around the globe — came as the Centers for Disease Control and Prevention reported the virus has been confirmed in eight more U.S. states and seems to be spreading.

Confirmed cases have risen from 109 Thursday to 161 Friday, the CDC said, with the flu now reported in 23 states, up from 11. Separately, a few states reported slightly higher numbers, and the District of Columbia announced its first two probable cases. The U.S. death toll remained at one — the Mexican toddler who visited Texas with his family and died there.

The most recent onset of illness was Tuesday, CDC said, indicating a continuing spread, though no faster than the rate of the regular winter flu.

“We think the cases do continue to occur,” said CDC’s Dr. Anne Schuchat. But CDC also said the new swine flu virus lacks genes that made the 1918 pandemic strain so deadly.

Dieters, body builders taking supplement may suffer liver damage

WASHINGTON – Government health officials warned dieters and body builders Friday to immediately stop using Hydroxycut, a widely sold supplement linked to cases of serious liver damage and at least one death.

The Food and Drug Administration said the company that makes the dietary supplement has agreed to recall 14 Hydroxycut products. Available in grocery stores and pharmacies, Hydroxycut is advertised as made from natural ingredients. At least 9 million packages were sold last year, the FDA said.

Dr. Linda Katz of the FDA’s food and nutrition division said the agency has received 23 reports of liver problems, including the death of a 19-year-old boy living in the Southwest. The teenager died in 2007, and the death was reported to the FDA this March.

Other patients experienced symptoms ranging from jaundice, or yellowing of the skin, to liver failure. One received a transplant and another was placed on a list to await a new liver. The patients were otherwise healthy and their symptoms began after they started using Hydroxycut, regulators said.

Iovate Health Sciences, which makes the diet pills, said in a statement that the 2007 death of the teenager was not caused by Hydroxycut. The statement gave no details.

“The number of adverse event reports described by the FDA in its advisory is small relative to the many millions of people who have used Hydroxycut products over the past seven years,” said the company statement. “Iovate’s own assessment of the potential risk associated with the use of these products differs from that expressed by the FDA.”

On its Web site, the company said it agreed to the recall out of “an abundance of caution.” Iovate is based in Canada, with U.S. offices near Buffalo, N.Y. Consumers can get a refund by returning the pills to the store that sold them, the company said.

Dietary supplements aren’t as tightly regulated by the government as medications. Manufacturers don’t need to prove to the FDA that their products are safe and effective before they can sell them to consumers.

But regulators monitor aftermarket reports for signs of trouble, and in recent years companies have been put under stricter requirements to alert the FDA when they learn of problems. In 2004, the government banned ephedra, an ingredient in many supplements, linked to heart attacks and strokes.

Health officials said they have been unable to determine which Hydroxycut ingredients are potentially toxic, partially because the formulation has changed several times.

Public health researcher Ano Lobb, who has studied Hydroxycut and other dietary supplements for Consumer Reports, said the problem may be an ingredient called hydroxycitric acid. Derived from a tropical fruit, it’s been linked to liver problems in at least one medical journal study. Lobb said it’s likely that other supplements containing the same ingredient remain on the market.

“You really have to be careful about dietary supplements, especially weight-loss pills,” Lobb said. “People believe that the FDA has verified that these products are at least safe and effective, and that’s really not the case. When you see fantastic claims – that’s generally what they are.”

Flu crisis’ genesis in pig-breeding region of Mexico

Workers disinfect a classroom at Byron P. Steele High School in Cibolo, outside San Antonio, Texas, last month. Officials at Steele closed the campus and the district's other 13 campuses for at least a week, hoping to stop any more possible spread of swine flu.

A 5-year-old Mexican boy takes ill in his dusty village. He coughs, he sneezes, he gasps for breath.

Hundreds of Edgar Hernandez’s neighbors in La Gloria – villagers who live among smelly pig-breeding farms that attract swarms of flies – already have flu-like symptoms. After they complain repeatedly, government workers arrive to conduct medical tests.

Edgar recovers, but his illness remains a mystery to his family – at least for a while.

Fast forward about a month, to late April.

A 9-year-old boy arrives at a medical clinic in Elyria, Ohio, an industrial city 20 miles southwest of Cleveland. He has a sore throat, body aches, fever and dizziness.

His mother consults a pediatric nurse practitioner, Sally Fenik; she thinks it’s strep throat or an allergy. She also mentions to the nurse they’ve just returned from visiting relatives in Mexico but doesn’t think it’s swine flu because no one else in the family is sick.

But on her way to work, Fenik has heard a radio news report about swine flu turning up in states bordering Mexico. She’s far away, in the industrial Midwest, but remembers thinking, “Boy, I hope that doesn’t start spreading and getting worse.”

After a rapid strep test on the boy comes back negative, Fenik does a nasal swab.

A half-hour later, the lab calls. It’s the type of influenza linked to swine flu virus.

This past Sunday, the Centers for Disease Control and Prevention confirmed the third-grader from Ohio had swine flu. Then on Monday, the Veracruz governor swooped in by helicopter to La Gloria to tell Edgar’s mother what medical experts already know – the kindergartner was Mexico’s first confirmed case of swine flu.

Two boys in communities 1,700 miles apart – two pieces of a vast epidemiological puzzle.

In this age of global trade and travel, the swine flu outbreak has proved itself a global illness – a strange new virus that respects no border as it hopscotches from the dirt roads of Mexican villages to the concrete canyons of big-city America to a glittering Hong Kong hotel.

The list of the nationalities of some of its victims, in the last week alone, reads like the index of an atlas: Austria, Britain, Canada, Germany, Israel, Mexico, the Netherlands, Spain, Switzerland, the United States.

Swine flu has been confirmed in 16 deaths, all from Mexico (one Mexican toddler died in Houston). It has sickened nearly 350 people in Mexico, and about 250 others from New York to New Zealand, including children, teens, adults, students and tourists. It has rattled the world’s financial markets, pushed oil prices down, caused a run on surgical masks and hand sanitizers, closed schools and churches, postponed sporting events, prompted travel bans and rerouted cruise ships.

It even stopped a superhero in his hairy tracks: Hugh Jackman canceled an appearance in Mexico City to promote “X-Men Origins: Wolverine.”

No one knows precisely where the swine flu virus will pop up next.

All they know is that it will.

“Influenzas are hard to predict,” Dr. Gregory Gray, director at the Center for Emerging Infectious Diseases at the University of Iowa College of Public Health, said at midweek. “I don’t think this will go away in a few days. The way it’s moving and the way air transportation goes . . . I think this thing is going to spread to every continent in the next week.”

In Veracruz, ominous signs

Where and how it all began is a medical mystery.

But one of the first hints of trouble surfaced toward the end of winter, just when the flu season should be wrapping up. It came from the Mexican state of Veracruz – a region that includes a high plain that supplies Mexico with much of its cured pork products and has many villages that are surrounded by pig-breeding farms.

Edgar Hernandez lives in one of them, La Gloria, a hillside hamlet (population 3,000) where people started complaining of bad colds at the end of February. On March 23, Veracruz health officials arrived to take saliva samples.

About a third of some 1,300 townspeople who sought medical attention – 450 or so – were diagnosed with acute respiratory infections and given surgical masks and antibiotics.

Edgar fell ill a bit later; the energetic 5-year-old retreated to his bed with a high fever. Other kids in his school already were sick.

People in his town have long complained that some of the pits that hold pig waste are not properly lined; they fear their groundwater is contaminated. They’re frustrated and angry, too, about the stench and the swarms of flies that invade their village.

Granjas Carroll de Mexico, half-owned by U.S.-based Smithfield Foods Inc., operates dozens of farms around La Gloria. Smithfield said in a statement this week that it has found no signs or symptoms of swine influenza in its herd or its workers.

Whether La Gloria is ground zero in this outbreak is not yet known.

Mexican health officials downplayed the possibility, pointing out Edgar had the only positive saliva sample among just 35 people tested for the new virus. It wasn’t until last week that authorities confirmed the little boy was infected with a new H1N1 strain – a strange hybrid of pig, bird and human flu virus.

Two children from La Gloria died before being tested; their parents refused to let them be exhumed.

Mexico’s chief epidemiologist, Dr. Miguel Angel Lezana, says officials haven’t ruled out Mexico, the United States, Asia or Europe as the origin of the swine flu virus.

The CDC has no firm answers either.

“We have no idea where it came from,” says Michael Shaw, the CDC’s associate director for laboratory science. “Everybody’s calling it swine flu, but the better term is swine-like. It’s like viruses we have seen in pigs – it’s not something we know was in pigs. It doesn’t really have any close relative.”

By early April, the Veracruz government notified Mexican authorities of a possible flu outbreak in La Gloria. This alert happened to come around Holy Week, a time when lots of people in this largely Catholic country travel to visit family.

On April 12, Mexican health authorities notified the CDC and the Pan American Health Organization of the unexplained cases of severe respiratory illness.

One day later, people started dying.

Gasping for air

Adela Maria Gutierrez was the first.

She arrived at a hospital in Oaxaca, in far southern Mexico, gasping for air, her oxygen-starved hands and legs a ghastly shade of blue. They gave her antibiotics, but she only got worse.

A lab technician conducted some tests. Surprisingly, the cause appeared to be a virus related to the highly contagious SARS, or severe acute respiratory syndrome. Gerardo Juarez, the chemist, immediately e-mailed a report to the hospital. “I was afraid for what it could do to the patient,” he recalls.

The hospital quickly put Gutierrez in isolation and began searching for any other possible people infected among her family and neighbors. A second round of tests showed it was not the SARS-related virus, leaving doctors puzzled.

By then, the 38-year-old mother of three was dead.

Her death was not just tragic, but alarming: Gutierrez had worked door-to-door for Mexico’s tax collection agency, interviewing scores of people. As it turns out, one of her co-workers, a temporary employee, was from Veracruz, the state on the Gulf of Mexico where the first swine case was confirmed. Family members said that woman had a bad cough.

On April 17, the Mexican government issued a national health alert requiring all hospitals to report cases of severe respiratory illnesses.

By then, there were indications the outbreak’s tentacles had reached beyond Mexico.

CDC test results showed a swine-like flu had infected two American children, 9 and 10, in neighboring California counties.

Soon, health departments elsewhere report more swine flu cases. They fit no particular geographic pattern: Arizona and Indiana. Massachusetts and Kansas. Texas and Michigan.

And no distinct profile: toddlers, high schoolers, college students. A baggage handler, a businessman, a doctor. Some had traveled to Mexico, others hadn’t ventured outside their communities.

That isn’t surprising, says Gray, the Iowa infectious disease expert.

“People can be carrying the virus and have no symptoms at all and be passing it on to others,” he says. “The virus can live on surfaces and on inanimate objects – such as door handles or dirty tissues. It doesn’t live that long. It’s also transmitted through coughing and sneezing. The bottom line is there are lots of ways this virus can go from human to human. It’s difficult to defeat all of them.”

But, Gray says, “it’s not a cause for panic. . . . It does not seem to be inordinately lethal. Time will tell. It’s certainly not anything like SARS. What we’re seeing is a good demonstration of how respiratory viruses move quickly over a vast geographic area. . . . These events probably happen all the time.”

Full-blown crisis

On the afternoon of April 24, Mexico’s top epidemiologist got word from a lab in Canada. The respiratory infections that Mexican health officials had downplayed as common flu was a new swine flu.

The CDC said the strains matched the new virus popping up in the United States.

Mexico was gripped by a full-blown health crisis.

Striking images flashed on TV screens and splashed across front pages around the globe. There were Mexican soldiers handing out surgical masks to people in the subway, doctors in full-body white protective suits, a couple kissing through surgical masks outside the Palacio de Bellas Artes in Mexico City.

As swine flu moved across the world’s time zones, one fact became glaringly apparent: The only deaths were in Mexico, with the exception of a 23-month-old from Mexico City who died in Houston.

Why?

“That is the $64,000 question,” says Dr. Ronald Hershow, associate professor of epidemiology at the University of Illinois-Chicago School of Public Health.

Hershow notes a few possibilities: That there may not be enough cases to draw any conclusion. That the virus changed outside of Mexico, though that appears unlikely. And that, unlike Mexico, the U.S. health system had the advantage of knowing from the onset that it was dealing with a swine flu virus.

“We really don’t know enough details to have an explanation,” he says.

Even without deaths, the illness caused fear, anxiety and discomfort in the United States.

That became clear in New York City on April 23, when students at St. Francis Preparatory School in Queens formed a long line in the nurse’s office. It soon snaked out the door. The teens complained of fever, nausea, sore throats and achy bones. Several had recently returned from a spring break trip to Cancun.

That night, Rachel Mele’s parents rushed her to the hospital.

“I could barely even catch my breath,” the 16-year-old recalled. “I’ve never felt a pain like that before. My throat, it was burning, like, it was the worst burning sensation I ever got before. I couldn’t even swallow. I couldn’t even let up air. I could barely breathe through my mouth.”

She recovered but, as some people improved, others got sick.

No one knows for certain how many people have been sickened. Labs in the United States and Mexico are moving away from testing all suspected cases and focusing on spotting new outbreak hot spots or ways to limit its spread.

But as more cases are reported, schools are closing across the United States and sporting events are being canceled. So, too, was the annual Mayfest in Fort Worth, Texas, which usually attracts 200,000 people over four days.

Mexico City, which already had closed its schools and museums, took a larger step: It ordered a five-day national shutdown, starting Friday, of all but “essential” businesses and urged people to stay inside.

The bustling capital of about 20 million is eerily quiet.

The few people still outside are wearing masks.

Arizona has earned a bronze rating as a bicycle friendly state from the League of American Bicyclists, according to a news release from a local cycling committee.

Just six states applied for the designation, which is based on factors related to the states’ commitment to improved cycling conditions, and four made the grade, the Tucson-Pima County Bicycle Advisory Committee news release said.

The league rates states based on legislation, programs, places to ride and education of the public on bicycle recreation and transportation, according to the league’s Web site.

The program, which was launched last year, has four levels of recognition: platinum, gold, silver and bronze. No state earned the platinum or gold award. Only Washington and Wisconsin earned silver.

Tucson is Arizona’s only gold level bicycle-friendly community. Tempe and Scottsdale earned silver awards and Chandler, Flagstaff, Mesa and Gilbert earned bronze.

GRAND CANYON NATIONAL PARK – Search crews on Friday found the body of one of three people who were swept away after they jumped into the Colorado River on a visit to the Grand Canyon.

Canyon officials are waiting to identify him until they can tell his family.

The search continued for the other two. Searchers used a helicopter, a dog and other efforts to try to find them.

Garrick Taylor, a spokesman for the Tri-City Baptist Church, said the men were part of a 30-member group that went on a planned three-day hiking trip on Wednesday that the church organizes each year.

Grand Canyon National Park spokeswoman Maureen Oltrogge identified the three as 15-year-old Saif Savaya, and two brothers, 16-year-old Mark Merrill and 22-year-old Joey Merrill. None were wearing life vests.

The group was in the canyon bottom just upriver from the main park headquarters on the South Rim. The river is cold at this time of year, with water temperatures of about 50 degrees. Currents are swift in the area.

“All those factors work against them,” Oltrogge said.

Taylor said the rest of the group returned to Tempe and is praying for the missing to return home safely.

Joey Merrill is a student at the International Baptist College that the church runs in Tempe, Taylor said. His brother, Mark, lives in the eastern Arizona town of Sanders and went along for the trip.

Savaya is a member of the Phoenix Arabic Bible Church, Taylor said.

WASHINGTON – Government health officials warned dieters and body builders Friday to immediately stop using Hydroxycut, a widely sold supplement linked to cases of serious liver damage and at least one death.

The Food and Drug Administration said the company that makes the dietary supplement has agreed to recall 14 Hydroxycut products. Available in grocery stores and pharmacies, Hydroxycut is advertised as made from natural ingredients. At least 9 million packages were sold last year, the FDA said.

Dr. Linda Katz of the FDA’s food and nutrition division said the agency has received 23 reports of liver problems, including the death of a 19-year-old boy living in the Southwest. The teenager died in 2007, and the death was reported to the FDA this March.

Other patients experienced symptoms ranging from jaundice, or yellowing of the skin, to liver failure. One received a transplant and another was placed on a list to await a new liver. The patients were otherwise healthy and their symptoms began after they started using Hydroxycut.

Iovate Health Sciences, which makes the diet pills, said it agreed to the recall out of “an abundance of caution.” The company is based in Canada and its U.S. distributor is headquartered near Buffalo, N.Y.

“While this is a small number of reports relative to the many millions of people who have used Hydroxycut products over the years, out of an abundance of caution and because consumer safety is our top priority, we are voluntarily recalling these Hydroxycut-branded products,” the company said in a statement on its Web site. Consumers can get a refund by returning the pills to the store they purchased them from, the company said.

Dietary supplements aren’t as tightly regulated by the government as medications. Manufacturers don’t need to prove to the FDA that their products are safe and effective before they can sell them to consumers.

But regulators monitor aftermarket reports for signs of trouble, and in recent years companies have been put under stricter requirements to alert the FDA when they learn of problems. In 2004, the government banned ephedra, an ingredient in many supplements, linked to heart attacks and strokes.

Katz said it has taken so long to get a handle on the Hydroxycut problem because the cases of liver damage were rare and the FDA has no authority to review supplements before they’re marketed. “Part of the problem is that the FDA looks at dietary supplements from a post-market perspective, and an isolated incident is often difficult to follow,” she said.

The FDA relies on voluntary reports to detect such problems, and many cases are never reported, officials acknowledge.

Health officials said they have been unable to determine which Hydroxycut ingredients are potentially toxic, partially because the formulation has changed several times.

Public health researcher Ano Lobb, who has studied Hydroxycut and other dietary supplements for Consumer Reports, said the problem may be an ingredient called hydroxycitric acid. Derived from a tropical fruit, it’s been linked to liver problems in at least one medical journal study. Lobb said it’s likely that other supplements containing the same ingredient remain on the market.

“You really have to be careful about dietary supplements, especially weight-loss pills,” said Lobb. “People believe that the FDA has verified that these products are at least safe and effective, and that’s really not the case. When you see fantastic claims — that’s generally what they are.”

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ON THE WEB

FDA press release: tinyurl.com/cfxjbe

President Barack Obama voiced hope Friday that the swine flu virus will run its course “like ordinary flus” as the government reported more than two dozen new cases and Continental Airlines curtailed flights into more heavily ravaged Mexico.

“I’m optimistic that we’re going to be able to manage this effectively,” Obama told reporters as got an update from his Cabinet on the federal response to the health emergency. At the same time, he emphasized that the federal establishment is preparing as if the worst is still to come so it won’t get caught flat-footed.

Obama’s fresh take on the flu scare — more intense in neighboring Mexico than in the United States but also present in some measure around the globe — as the Centers for Disease Control and Prevention said the virus has been confirmed in eight more states.

Confirmed cases have risen from 109 to 141, the CDC said, and it said the flu now is in 19 states, up from 11. Separately a few states reported slightly higher numbers.

Obama said it wasn’t clear whether the flu would be more severe than others before it, and he said the swine flu is a cause for special concern because it is new strain and people have not developed an immunity to it.

Government agencies are preparing in case the flu comes back in a more virulent form during the traditional flu season, the president said, talking of an overarching effort to help schools and businesses while also responding to pleas for help from other countries.

Meanwhile, Houston-based Continental became the first U.S. carrier to curtail service. Many travelers have become increasingly concerned about going to Mexico, though authorities there said new cases and the death rate was leveling off. Continental has over 500 flights a week between the United States and Mexico.

Mexico City Mayor Marcelo Ebrard said Friday that no new deaths from swine flu were reported overnight for the first time since the emergency was declared a week ago. Mexico has confirmed 300 swine flu cases but stopped reporting suspected infections when the number approached 2,500. There have been a dozen confirmed deaths there from the flu, although reports have indicated that roughly 120 may have died from it.

Of the curtailment of airline flights, Continental’s chairman and chief executive, Larry Kellner, said that “we were already experiencing soft market conditions due to the economy, and now our Mexico routes in particular have extra weakness.”

No other U.S. carriers had announced capacity cuts. “We are hearing that there is a softening of demand to and from Mexico,” said David Castelveter, a spokesman for the Air Transportation Association, which represents airlines.

Clinics and hospital emergency rooms in New York, California and some other states are seeing a surge in patients with coughs and sneezes that might have been ignored before the outbreak.

The outbreak even touched the White House, which disclosed that an aide to Energy Secretary Steven Chu apparently got sick helping arrange Obama’s recent trip to Mexico but that the aide did not fly on Air Force One and never posed a risk to the president.

The aide, Marc Griswold, a former Secret Service agent who was doing advance work for Chu, told The Associated Press when reached at his Department of Energy office Friday that he was feeling better.

He declined to elaborate beyond comments in the Washington Post Friday.

“We’re not the Typhoid Mary family, for goodness sake,” he told the Post. “We’ve been told that we’re not contagious. We’re already past the seven-day mark for that.”

So far U.S. cases are mostly fairly mild and, officials said, most so far haven’t required a doctor’s care.

Still, the U.S. is taking extraordinary precautions — including shipping millions of doses of anti-flu drugs to states in case they’re needed.

Late Thursday the Department of Health and Human Services announced it was buying 13 million new treatment courses of antiviral drugs to replenish and grow the U.S. strategic stockpile. Eleven million treatment courses have been sent to states — 25 percent of each state’s allotment — and the U.S. also announced plans Thursday to send 400,000 treatment courses to Mexico.

The World Health Organization is warning of an imminent pandemic because scientists cannot predict what a brand-new virus might do. A key concern is whether this spring outbreak will surge again in the fall.

The CDC added the following states Friday to its list of confirmed cases: New Jersey with five cases, Delaware with four, Illinois with three, Colorado and Virginia with two, and Minnesota and Nebraska each with one. The CDC reported one case in Kentucky and none in Georgia, while Georgia officials report one case there — that of a sickened Kentucky resident who traveled to Georgia.

CDC previously had confirmed cases in New York, Texas, California, South Carolina, Kansas, Massachusetts, Indiana, Ohio, Arizona, Michigan and Nevada.

CHICAGO – The nation’s first swine flu death, a toddler in Texas, is tragic but health experts say not unexpected, and they advise parents to just take ordinary precautions.

Every year dozens of U.S. children die from seasonal flu; that’s one reason annual flu shots are recommended for children 6 months and older. So far this season, 55 children have died from regular flu, federal health authorities report.

While children, especially those younger than 5, are known to be most vulnerable to severe and fatal complications from seasonal flu, most children who get even the most aggressive strains of flu don’t die.

So far, flu experts say there’s no reason to think the new strain will be much different.

“Nobody should be unduly worried; everybody should be aware of what’s going on and doing things they should be doing in flu season anyway,” said Dr. Mark Dworkin, an infectious disease specialist at University of Illinois at Chicago.

That includes covering your cough, washing your hands often — and telling children to do the same.

Dr. Carlos Perez-Velez, an infectious disease specialist with National Jewish Health system in Denver, says a good trick to get kids to wash their hands long enough to kill germs is to tell them to recite the alphabet A to Z before they quit washing.

Parents should also avoid sending children with fevers or other signs of illness to school, and should skip work if they have those symptoms — usual precautions when they or their kids are sick.

Some wonder about keeping children home from preschool or day care — often called “germ factories” — even when their kids aren’t sick and no flu has been reported.

Dr. Kathryn Edwards, a Vanderbilt University flu specialist, said there’s no reason to keep healthy children home or restrict their activities.

“We need to respond to the swine flu just the way that we respond to seasonal flu,” Edwards said.

The death in Texas, of a 23-month-old boy visiting from Mexico City, “is very, very sad, but we do not have any evidence to say that the swine flu is more severe and will cause more deaths than other flu,” she said.

While there’s no vaccine to protect against the new swine flu strain, some are in development. Experts say parents should still be sure to get annual vaccines to protect children against seasonal flu.

According to the CDC, more than 20,000 children younger than age 5 are hospitalized every year because of seasonal flu. In the 2007-08 flu season, the CDC received reports that 86 children nationwide died from flu complications.

In the 2003-04 season, one of the worst in recent years, at least 153 children died. Even so, the highest death rate was among infants younger than 6 months, and that was just 0.88 per 100,000 babies.

In that season, one-third of children who died had an underlying illness that put them at particularly high risk for severe flu complications and death. Illnesses known to increase children’s susceptibility include asthma and heart and lung problems.

Authorities say the boy who died in Texas had an underlying illness.

Young children are vulnerable to flu complications because their immature immune systems aren’t efficient at fighting off germs, said Dr. Kenneth Alexander, pediatric infectious diseases director at the University of Chicago.

Also, young children have small airways that can swell when flu hits, predisposing them to pneumonia and fluid accumulating in the lungs, he said.

Alexander said parents should watch for classic flu symptoms, including fever of at least 100.5, cough and runny nose. Children old enough to talk might complain of sore throats and body aches. Young children sometimes just have a runny nose and a fever with the flu, and they’re more likely than adults to have vomiting, too, he said.

Parents should contact their physicians if children have these symptoms, but experts said most cases won’t even be flu, let alone swine flu.

Young children with these symptoms who also are having trouble breathing, or who seem less alert or unable to drink liquid should see a doctor right away because these could be signs of dangerous complications, said Dr. Andrew Bonwit, a pediatrician at Loyola University Medical Center in Maywood, Ill.

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ON THE WEB

CDC: www.cdc.gov/flu/protect/children.htm

PHOENIX – Four flu samples have been sent to the federal Centers for Disease Control and Prevention for tests that will determine if they are the swine flu strain first identified last week in Mexico, an Arizona Department of Health Services spokeswoman said Tuesday.

State health workers expected to find out Wednesday if at least one of the samples is positive for the strain that has raced around the world in recent days, spokeswoman Laura Oxley said. The other three tests were sent only Tuesday morning, and the CDC estimated it could take as long as 24 hours to determine the results of a sample.

Oxley did not know details about the patients, and said sending unidentified samples to the CDC throughout the flu season is a routine practice. Officials are urging doctors and health care providers to conduct a nasal swab test in suspected flu cases.

The tests could confirm if the swine flu strain is already in Arizona. CDC officials in Atlanta said Tuesday that the number of confirmed cases in the U.S. has jumped to 64 and states said there are at least four more. So far, the cases are still in the five states where they previously were reported, with 45 in New York City, 10 in California, six in Texas, two in Kansas and one in Ohio.

State Superintendent of Public Instruction Tom Horne recommended Tuesday that individual schools be closed if a teacher or student is diagnosed with the flu strain. He said in a memo to school officials that the policy could help stop the spread of the virus.

Horne also urged educators to, first, encourage students and staff with symptoms to stay home and, second, continue to promote proper hygiene, including frequent hand washing and covering coughs and sneezes.

Gov. Jan Brewer convened a team of administrators late Monday to review preparedness plans in the event cases pop up in Arizona.

State officials have about 36,000 doses of the antiviral drug Tamiflu on hand, not including doses that are commercially available. Additional supplies from federal stockpiles are expected to arrive in the state, Oxley said.

Hospitals throughout the state have been reviewing preparedness plans for a flu pandemic.

As of late Tuesday afternoon, the emergency rooms at Tucson Medical Center and University Medical Center had not experienced increases in the number of patients coming in with flu-like symptoms, officials said.

At least three area drug stores on Tuesday had sold out of surgical masks.

The Pima County Health Department continues monitoring cases of swine flu nationwide, spokeswoman Patti Woodcock said in a statement Tuesday afternoon. Health officials rely on hospitals and clinics to report instances of patients complaining of flulike symptoms who also have traveled to areas with confirmed swine flu cases.

The swine flu outbreak is a serious matter, having killed about 150 people in Mexico and infected about 50 in the United States.

But while the virus has potential to morph into a pandemic – one of the most terrifying words in the English language – it isn’t even an epidemic at this point.

Caution and concern are merited, but full-bore hysteria is not.

Our government declared a national health emergency so it could release about 12 million doses of flu medications to states.

That’s a wise precaution, not cause for alarm. We wish similar efforts were under way in Mexico, where the onslaught of swine flu has not been handled as well as it should be.

As The Associated Press reported Tuesday, two weeks after the first known swine-flu death of the current outbreak, Mexico still hasn’t given medicine to families of the dead.

Our neighboring nation hasn’t determined where the outbreak started, how it spread or how to get frightened ambulance drivers to take sick people to hospitals.

“A portrait is emerging of a slow and confused response by Mexico to the gathering swine flu epidemic,” the AP reports. “And that could mean the world is flying blind into a global health storm.”

Let’s hope not. People need to be careful and follow the instructions issued by health experts: Wash your hands thoroughly and often. Avoid exposure to people who are sick. Stay out of Mexico. And if you get sick, stay home and call a doctor. Don’t share your germs with the masses.

Troops can’t stop virus

Border enforcement activists’ response to the flu outbreak has been unrealistic and counterproductive, however.

Many are calling for troops on the Mexican border, for example, as if a virus can be stopped by brute force.

It can’t. And even if it could, we would need to also shut down several of our own states as well as Canada, Europe, the Middle East and the Asia-Pacific regions, all of which now have documented cases of swine flu.

U.S. officials are responding appropriately by screening people at the Mexican border, looking for those who are ill and barring them from entry.

But commerce between Mexico and the U.S. is conducted with thousands of trucks heading in both directions.

Even if all cross-border traffic were stopped, results would be marginal at best in preventing spread of the disease, noted Homeland Security Secretary Janet Napolitano.

We hope that Napolitano and President Obama will make some recommendations to the Mexican government about its handling of this outbreak.

HHS secretary is needed

We also urge the Senate to confirm Kansas Gov. Kathleen Sebelius as the new secretary of Health and Human Services.

That department has been functioning efficiently and professionally, but leadership will be essential as this swine flu outbreak runs its course.

Likewise, we reiterate our request to Arizona Gov. Jan Brewer to quickly find a replacement for Leesa Berens Morrison, who stepped down as director of the Arizona Department of Homeland Security.

There is much to be done to safeguard the public health, and so far our government has responded swiftly and logically to try to quell this threat.

The American people must do likewise.

Let’s save the hysteria for a pandemic or at least an epidemic, and let’s shelve the tendency toward xenophobia, recognizing that the U.S. and many other countries are battling the same threat as Mexico.

Our focus should be on staying healthy.

The humpback chub, a closely watched indicator of the Grand Canyon’s ecological health, has grown steadily in number since 2001 as changing conditions on the Colorado River have created a more hospitable habitat.

The population of the endangered fish grew by 50 percent over the past eight years, the U.S. Geological Survey reported Monday. By the end of last year, there were an estimated 7,650 adult chub, fish at least 4 years old, near the confluence of the Colorado and Little Colorado rivers. That’s up from about 4,000 fish as recently as 2000.

Scientists offered several possible factors for the higher numbers, including drought-related spikes in water temperature, the removal of non-native fish from the river and a series of experimental water releases from Glen Canyon Dam.

Put together, those factors essentially re-created some of the conditions that once supported larger populations of the chub.

“It may be that the synergy, the combined impacts of all of those, is the thing that helps humpback chub survive best,” said Matthew Andersen, a USGS biologist. “We have great confidence in the population trend. We’re still investigating the reasons behind it.”

The chub, found in just six locations on the Colorado River and its tributaries, has become a measure of the Grand Canyon’s overall condition in recent years. The chub’s numbers in the lower Colorado dwindled after the 1963 completion of Glen Canyon Dam shut off the river’s natural flow, altering the habitat.

Finding more fish in the river is encouraging, environmental advocates said Monday, but work remains to ensure the species’ long-term survival.

“This is not a result that should have us sitting back comfortably in our chairs,” said Nikolai Lash, Colorado River program director for the Flagstaff-based Grand Canyon Trust. “It should have us leaning forward, trying to figure out how to take advantage of whatever it was that led to a small improvement.”

A decision is expected in the next few weeks in a case the trust and others filed in U.S. District Court in Phoenix, challenging the government’s management of the river and the chub habitat.

The chub, named for a protruding hump on its back, can grow as long as 20 inches and can live for 30 years or more. It uses its prominent fins to glide through the water and find insects to eat. Over 4 million years, the chub evolved to survive in warm sediment-laden water.

The construction of Glen Canyon Dam to store water and generate electricity changed the fish’s environment on the lower Colorado. The river’s flow was controlled artificially and, because water was released from the lower depths of Lake Powell, its temperature cooled.

As a result, native-fish populations plummeted. Responding to lawsuits from environmental groups, Congress passed legislation in 1992 that ordered federal agencies to manage the dam in ways that would help restore habitat, but until about 2000, fish numbers remained low.

In 2001, the population started to grow, Andersen said. Scientists began looking at three factors:

• A long drought lowered water levels at Lake Powell, which allowed the sun to reach deeper into the lake and warm the water.

• Non-native fish have been removed from parts of the river where the chub live. Non-native fish compete for food and eat young chub. From 2003 to 2006, the non-native rainbow trout population near the Little Colorado confluence dropped 80 percent.

• The U.S. Bureau of Reclamation has conducted a series of experimental test releases from Glen Canyon Dam. Andersen said it’s possible some of those tests have helped improve conditions.

County, state officials prepared if outbreak spreads to Arizona

Oscar Perez, a barber in Meny's barbershop in Nogales, Mexico, cuts a customer's hair while he wears a mask to protect himself from the swine flu. The Mexican government broadened its efforts to control the outbreak of swine flu on Monday by closing schools throughout the country.

Swine flu has hit 19 of Mexico’s 32 states, but one southern Arizona health official said the deadly virus strain has yet to reach Sonora.

“The official communication we have with Sonora is that they don’t have any (cases),” said Myrna Seiter, a border surveillance epidemiologist with the Tucson-based Arizona Office of Border Health.

Arizona has no documented cases of swine flu during this outbreak, according to state and local officials. But that could change.

“We expect cases to show up here, because we’re looking for it,” Pima County Health Department spokeswoman Patti Woodcock said Monday. “It would not be a surprise.”

County health officials have begun a program of “enhanced surveillance,” Woodcock said. That means officials have sent word to area hospitals and clinics to watch for patients exhibiting flulike symptoms who have traveled from areas where cases of swine flu have occurred.

If a suspected case turns up locally, then the Health Department would begin “active surveillance,” Woodcock said. That would initiate a full-scale investigation, during which officials would pore over patient charts and other medical records to determine if there is an outbreak here.

The Arizona Department of Health Services is prepared, should there be cases in this state, said Will Humble, the department’s acting director.

“We’ve got our ducks in a row already,” Humble said. “We’re pretty confident that we have the resources, people and infrastructure in place to do the right thing, to either stop this thing or slow it down as much as we can.”

Much of the emphasis right now is on enhanced surveillance, he said, with the goal of identifying cases quickly, and then, if needed, isolating the ill so they can’t spread the disease.

The state is also beefing up its stockpile of antivirals in case they are needed.

The swine flu virus appears to respond to Tamiflu and Relenza – both lessen the severity of symptoms – if the medications are administered shortly after the onset of symptoms.

The state has 56,000 doses of Tamiflu, Humble said, and plans to get more from the federal government’s stockpile.

U.S. Customs and Border Protection planned to distribute leaflets and warnings about the outbreak at all U.S. ports of entry, including Phoenix Sky Harbor International Airport.

Leaflets are also being distributed along the Mexican border, the agency said.

Teresa Small, supervisory public affairs officer for Customs and Border protection, said inspectors have not detained any travelers at the Arizona border thus far, but they are authorized to hold anyone entering the country who appears to have the virus.

She said inspectors follow a list of protocols when they encounter a person who may be sick, including the use of protective masks and gloves.

Inspectors then contact the federal Centers for Disease Control and Prevention and advise them of the symptoms and circumstances. In some cases, travelers may be released based on the phone conversation. The CDC could also send a health official to the border to determine whether the traveler may be a carrier of the virus.

She said travelers who are sick may be held against their will until the matter is resolved.

“They don’t have a choice,” she said. “It’s something we have to be able to do to enforce the law. . . If we have to go to the quarantine level, we’ll work with them (CDC) to make that happen.”

Frank Sayne, a Tucson-area contractor who also works on properties in San Carlos, Sonora, said he travels to Mexico 40 to 50 times per year for work.

The flu outbreak is “concentrated in Mexico City, but I’m not going to let that dictate whether I go down there,” Sayne said.

He plans to travel to Mexico on May 5. He usually goes down with friends and business associates, but he said a few have had reservations about going.

Sabri Germain-Gomuc, a University of Arizona junior majoring in biochemistry and molecular biophysics, said his parents, who live in Phoenix, went to Mexico this weekend despite the recent outbreaks.

“They go there like once a month, but just (to) Rocky Point,” Germain-Gomuc said. “They were careful and did not eat at sketchy restaurants.”

Julian Etienne, a spokesman for the Mexican Consulate in Tucson, said that he has not heard of people canceling trips to Mexico.

Etienne said there was more of a concern over drug-related violence than there has been over the swine flu.

According to the World Health Organization, there have been 152 deaths, all in Mexico, with 20 confirmed as swine flue. 1,995 suspected cases of swine flu in Mexico. Fifty 50 cases in U.S. have been confirmed

Elsewhere, six confirmed in Canada; two confirmed in Scotland and seven suspected; 11 confirmed and 43 suspected in New Zealand; two confirmed and 25 suspected in Spain; one suspected in France; one confirmed in Israel, one suspected in South Korea.

Matt Lewis, the Citizen’s NASA intern, and The Arizona Republic contributed to this article.