The death of a 13-year-old Tucson middle school student brings Arizona’s swine flu death toll to three, according to the Pima County Health Department.

Nationwide, it’s up to seven.

The most recent Arizona deaths were the Tucson teen who died Friday and a 57-year-old Pinal County woman who died earlier this week, according to the Health Department and the Associated Press.

Arizona’s confirmed cases have risen to 476, which adds to the more than 1,650 confirmed cases in the four states that border Mexico, according to the U.S. Centers for Disease Control.

Texas leads the border states with 556; California clocks in second with 553; and New Mexico has 68.

A total of 5,100 cases are confirmed nationwide.

The state with the most?

Illinois with 696, followed by Wisconsin at 616, according to a report in BizJournals.com.

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How are your protecting against swine flu?

Does anyone you know have swine flu?

Ginger, long used as a folk remedy for soothing tummyaches, helped tame one of the most dreaded side effects of cancer treatment – nausea from chemotherapy, the first large study to test the herb for this has found.

People who started taking ginger capsules several days before a chemo infusion had fewer and less severe bouts of nausea afterward than others who were given dummy capsules, the federally funded study found.

“We were slightly beside ourselves” to see how much it helped, said study leader Julie Ryan of the University of Rochester in New York.

Results were released Thursday by the American Society of Clinical Oncology and will be presented at the group’s annual meeting later this month.

But don’t reach for the ginger ale. Many sodas and cookies contain only flavoring – not real ginger, Ryan said. Her study tested a druglike ginger root extract, and it’s not known if people could get the same benefits from ginger teas or the powdered ginger sold as a spice.

The study involved 644 patients from cancer centers around the nation who had suffered nausea in a previous round of chemotherapy. Two-thirds had breast cancer and the rest, other forms of the disease. They were placed in four groups and given one of three doses of ginger (the equivalent of one-half, 1 or 1 1/2 grams of ginger per day) or dummy capsules in addition to standard anti-sickness medicines.

Patients took the capsules for six days, beginning three days before chemo treatment. They rated their nausea symptoms on a seven-point scale.

Offer is good for a year, with restrictions

Sales of Lipitor hit $12.4 billion for Pfizer Inc. in 2008, making it the company's top-selling prescription drug.

TRENTON, N.J. – Pfizer Inc. says it will provide 70 of its most widely prescribed prescription drugs including Lipitor and Viagra for free to people who have lost their jobs and health insurance.

The world’s biggest drugmaker said Thursday it will give away the medicines for up to a year to Americans who lost jobs since Jan. 1 and have been on the Pfizer drug for three months or more.

The announcement comes amid massive job losses caused by the recession and a campaign in Washington to rein in health care costs and extend coverage. The move could earn Pfizer some goodwill in that debate after long being a target of critics of drug industry prices and sales practices.

The program also likely will help keep those patients loyal to Pfizer brands.

“Everybody knows now a neighbor, a relative who has lost their job and is losing their insurance. People are definitely hurting out there,” Dr. Jorge Puente, Pfizer’s head of pharmaceuticals outside the U.S. and Europe and a champion of the project, told The Associated Press in an exclusive interview Wednesday. “Our aim is to help people bridge this point.”

The idea for the program came just five weeks ago, at a leadership training meeting, as the workers discussed how many patients are struggling, Puente said.

He said he urged top management to approve the program, presenting a recent Associated Press article about how newly uninsured diabetics are suffering serious complications because they can no longer afford the medicines and testing supplies. Approval came quickly.

“It was my idea,” he said. “I floated it, and the reception it got was so dramatic that it very quickly became our idea.”

Colleagues suggested employees could donate to a fund to help support the effort, Puente said. He said some employees had tears in their eyes when discussing how they could help people who had lost jobs.

Officials for New York-based Pfizer said they don’t know how much the program will cost and haven’t put a cap on spending for it.

Applicants will have to sign a statement that they are suffering financial hardship and provide a “pink slip” or similar employer notice. Applications will be accepted through Dec. 31, with medication provided for up to 12 months after approval, or until the person becomes insured again.

Starting Thursday, patients can call a toll-free number, 866-706-2400, to sign up, and those whose drugs are not included in the program will be referred to other company aid programs. Starting July 1, patients can also apply through the Web site, www.PfizerHelpfulAnswers.com, which has information about the other Pfizer aid programs.

Pfizer and the rest of the drug industry are trying to have a voice in the debate over how to overhaul the U.S. health care system, partly by joining in a pledge this week to help hold down inflation of health costs.

Pfizer’s program comes at a time when many drugmakers, including Pfizer, have been raising prices on their drugs, partly to offset declines in revenue as the global recession reduces the number of prescriptions people can afford to fill.

The 70-plus drugs covered in the program include several diabetes drugs and some of Pfizer’s top money makers, from cholesterol fighter Lipitor and painkiller Celebrex to fibromyalgia treatment Lyrica and Viagra for impotence. Drugs from several other popular classes such as antibiotics, antidepressants, antifungal treatments, heart mediations, contraceptives and smoking cessation products also are included. Cheaper generic versions are available for quite a few of the drugs.

Pfizer said that from 2004 through 2008, its patient assistance programs helped 5.1 million people get 51 million Pfizer prescriptions for free or at reduced cost, with a total value of $4.8 billion.

Misinformation serves as placebo rather than actually curing our health care system

The Senate Finance Committee held a hearing Tuesday on overhauling the heath care system. Among those testifying was Steven Wojcik (left), vice president of public policy for National Business Group Health.

The country is about to have a very frustrating debate over health care, characterized more by misdirection than an honest discussion of the alternatives.

A good illustration was provided by the Monday confab at the White House, in which health care executives committed to reduce expenditures by $2 trillion over the next decade.

Or did they?

President Obama, in his remarks, said that they did: “They are pledging to cut the rate of growth of national health care spending by 1.5 percentage points each year – an amount that’s equal to over $2 trillion.”

The actual letter signed by the executives, however, says something importantly different:

“We will do our part to achieve your administration’s goal of decreasing by 1.5 percentage points the annual health care spending growth rate – saving $2 trillion or more.”

“Our part” is much different, and far more ambiguous, than “we will do the whole thing.”

This is best seen as collusion by the health care industry and the Obama administration to misdirect the American people.

In the first place, what health care expenditures will be over the next 10 years is unknowable. So, the “pledge” is written on water.

More importantly, the commitment was made by trade associations that don’t actually deliver health care. What happens on the ground with health care costs is unaffected by press events held by politicians and lobbyists.

Most important, what happens on the ground already provides incentives for true economies. There are serious distortions in the health care marketplace, but market share can still be gained by reducing costs and prices.

The real significance of the press event wasn’t the phony pledge of cost savings. The event signaled the political capitulation of the health care industry. They will now accept whatever role in the health care system the politicians assign them.

The more substantive event that happened that day was the release of an “options” paper for health care reform by Senate Finance Chairman Max Baucus and Ranking Member Chuck Grassley.

But, again, “options” is a misnomer. This paper doesn’t really spell out fundamentally different approaches. Instead, the choices are all a variation on a single theme: a government-managed system of private health insurance.

Existing plans would be grandfathered in. But all future health insurance would have to be purchased through a government exchange.

The government would decide the benefit options insurers could offer, and insurers would have to offer all options. Pricing would be strictly circumscribed. Medical underwriting would be prohibited.

The fight over whether there would be a “public option,” a health plan actually administered by the government, is misplaced. If government controls the benefits and pricing of private plans, politicians and bureaucrats are in charge irrespective of whether there is a formal public plan.

The political need for action is driven by the uncertainty over coverage in the American system. The gaps in coverage are hugely worrisome even for those who currently have good insurance.

This uncertainty, however, is easily eliminated at no cost to the taxpayers. There already is a national health care plan, Medicaid for the low income. Universal access could be provided simply by allowing any legal resident to buy into Medicaid at the government’s cost.

The system as a whole, however, makes no sense. Obtaining health insurance through your employer is an artifact of World War II wage and price controls.

Some Republicans want to eliminate this dependence and stimulate a market for individual health insurance. That makes more sense, but the public is unlikely to be comfortable with such a radical restructuring without a government backstop, such as the ability to buy into Medicaid.

This debate will be sad and frustrating.

And the end result will probably be neither fish nor fowl – a system that provides neither the certainty and security of a European-style national health care system, nor the choice and freedom of a vigorous individual health insurance market.

Robert Robb, an Arizona Republic columnist, writes about public policy and politics in Arizona. E-mail: robert.robb@arizonarepublic.com

LONDON – As swine flu cases hit 6,500 worldwide, World Health Organization officials were meeting with vaccine manufacturers and other experts in Geneva on Thursday to discuss making a vaccine to fight the virus.

The meeting focused on the major questions surrounding a possible swine flu vaccine, such as how much should be produced, how it will be distributed and who should get it.

The expert group’s recommendations will be passed to WHO Director-General Margaret Chan, who will issue advice to vaccine manufacturers and the World Health Assembly next week.

But some experts feel the main decision has already been made.

“It’s a foregone conclusion,” said David Fedson, a vaccines expert and former professor of medicine at the University of Virginia. “If we don’t invest in an H1N1 (swine flu) vaccine, then possibly we could have a reappearance of this virus in a mild, moderate, or catastrophic form and we would have absolutely nothing.”

Flu vaccine companies can only make one vaccine at a time: seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake.

Vaccine makers can make limited amounts of both seasonal flu vaccine and pandemic vaccine — though not at the same time — but they cannot make massive quantities of both because that exceeds manufacturing capacity.

Seasonal flu kills up to 500,000 people a year. At the moment, health officials aren’t sure how deadly swine flu is, and whether they will need more seasonal flu vaccine or swine flu vaccine. And if the swine flu mutates, scientists aren’t sure how effective a vaccine made now from the current strain will remain.

WHO estimates that 1 to 2 billion doses of swine flu vaccine could be produced every year, though the first batches wouldn’t be available for 4 to 6 months.

The U.S. Centers for Disease Control and Prevention is currently working on a “seed stock” to make the vaccine, which should be ready in the next couple of weeks. That will be distributed to manufacturers worldwide so they can start producing the vaccine.

WHO is also negotiating with vaccine producers to save some of their swine flu vaccine for poorer nations. Many rich nations like Britain, Canada, Denmark, France, Switzerland and the United States signed deals with vaccine makers years ago to guarantee them pandemic vaccines as soon as they’re available.

As of Thursday, at least 33 countries reported nearly 6,500 cases of swine flu worldwide, with 65 deaths. According to WHO’s pandemic alert level, the world is at phase 5 — out of a possible 6 — meaning that a global outbreak is “imminent.”

“It’s a no-brainer,” Fedson said of the decision to make swine flu vaccine. “All that’s being discussed now is the details of how to make sure you have enough seasonal flu vaccine and the logistics of making the switch to H1N1 vaccine production.”

North America has been the hardest-hit continent. The United States has reported 3,352 laboratory-confirmed cases of swine flu, including three deaths. Mexico has 2,446 cases and 60 deaths, while Canada has 389 cases with one death, according to WHO figures.

Spain and Britain have the most cases in Europe, at 100 and 71 respectively.

In Central America, Costa Rica has eight cases and one death and Panama has 29 cases.

President Obama leaves the State Dining Room of the White House after speaking about health care reform Monday.

The White House trumpeted the news: health care providers taking a $2 trillion scalpel to their costs and pushing the U.S. toward Barack Obama’s vision of health coverage for all. But don’t line up yet for those insurance cards.

First, a reality check for the nation’s 50 million uninsured.

Medical providers have a long track record of avoiding fiscal constraints, as witnessed by the government’s efforts to tamp down Medicare costs.

And none of the groups that went to the White House can actually dictate prices to their members. Doctors in New York or hospitals in Los Angeles are free to charge what the market can bear.

There’s one more catch: Even if every penny of the promised savings shows up, not all of it would be used to help cover uninsured Americans. Actual savings to the government are all that can be counted as Congress tries to pay for subsidies that will be needed to help make health insurance affordable for everyone.

The medical groups’ pledge is “a very hopeful sign,” said economist Robert Reischauer, head of the Urban Institute. “But when we get down to hammering out the details, health care reform remains both complex and philosophically and politically difficult to accomplish.”

Costs could still turn out to be the greatest obstacle to Obama’s health care plan.

Outside experts estimate the taxpayers’ tab could total between $1.2 trillion and $1.5 trillion over 10 years. Some go as high as $1.7 trillion. Obama’s budget proposal includes a down payment that may cover less than half the bill.

Pledging restraint on costs Monday at the White House were groups representing hospitals, doctors, drug makers, medical device manufacturers and a major health care labor union – a who’s who of health care interests. The president posed proudly with them and called it “a watershed event.”

Obama wants to build on the current system in which most people get coverage through private insurers. But he wants to change the rules so the sick can’t be turned down. And he wants to provide subsidies to help low-wage workers and even some in the middle class afford their premiums.

House Republican leader John Boehner of Ohio isn’t impressed. “Today’s announcement promises savings with no concrete plan to achieve them and no enforcement mechanism if they don’t,” he said Monday.

Indeed, it’s too early to tell whether the White House meeting will be remembered as a turning point or as a political mirage. The administration is projecting an image of a new coalition for health care, with Obama and most of the health care industry and consumer interest groups claiming the political center.

Left out, for now, are conservative Republicans, who oppose Obama’s direction but have yet to articulate their own vision, and liberal Democrats who have been hoping to move toward a nationalized system like Medicare for all. As the debate heats up, the voices from both ends of the political divide will get louder – and the pressure on the center will increase.

Still, the sight of health care industry leaders volunteering to hold back spending is pretty unusual.

By joining Obama, providers are acknowledging at least some responsibility for a bloated and dysfunctional system that economists say is unaffordable.

In the 1990s, when President Bill Clinton attempted to overhaul health care, the battle lines quickly hardened. Obama, who has gone out of his way to woo the interest groups, praised their willingness to sacrifice on Monday.

The groups don’t just have the national interest in mind. Industry is worried that Congress will create a government health plan to compete with private insurers.

Such a plan would quickly become the biggest in the country and could use its power to set lower payment rates, driving costs down on the backs of medical providers.

“I think the reason all these groups want to actively participate in the process is they don’t want to see a blunt instrument used to get spending down,” said Mark McClellan, who ran Medicare for President George W. Bush. “This is an opportunity to get everyone behind a better approach to improve the way health care works.”

That’s just what the groups say they want to do. Their proposals include coordinating care for people with chronic illnesses, rewarding quality not quantity, and using technology to root out waste and prevent errors that get patients sicker.

But it’s hard to put numbers next to any of those ideas. For example, what if better care for chronically ill patients turns out to increase costs? None of the groups has set a target for how much its members should have to pony up.

Congress is going to need hard numbers to pass Obama’s plan this year.

Robert Laszewski, a former health insurance executive turned policy consultant, said he’s betting the consensus won’t last.

“When Congress comes up with mechanisms to reduce costs that actually take money out of the hands of doctors, hospitals and insurance companies,” he said, “that’s when we’re going to find out if things are really different this time.”

Ricardo Alonso-Zaldivar reports on health care policy for The Associated Press.

WASHINGTON – President Obama’s plan to provide medical insurance for all Americans took a big step toward becoming reality Sunday after leaders of the health care industry offered $2 trillion in spending reductions over 10 years to help pay for the program.

Hospitals, insurance companies, drug makers and doctors planned to tell Obama on Monday they’ll voluntarily slow their rate increases in coming years in a move that government economists say would create breathing room to help provide health insurance to an estimated 50 million Americans who now go without it.

With this move, Obama picks up key private-sector allies that fought former President Bill Clinton’s effort to overhaul health care. Although the offer from the industry groups doesn’t resolve thorny details of a new health care system, it does offer the prospect of freeing a large chunk of money to help pay for coverage. And it puts the private-sector groups in a good position to influence the bill Congress is writing.

Six major groups plan to deliver a letter to Obama and pledge to cut the growth rate for health care by 1.5 percentage points each year, senior administration officials said Sunday. They spoke on the condition of anonymity in order to sketch the offer before full details are revealed at a White House event scheduled for Monday.

Obama has offered an outline for overhauling the health care system, and he wants Congress to work out the details and pass legislation this year. His plan would build on the current system in which employers, government and individuals share responsibility for paying the cost and care is delivered privately. The government would play a stronger role by subsidizing coverage for many more people and spelling out stronger consumer protections.

“We cannot continue down the same dangerous road we’ve been traveling for so many years, with costs that are out of control, because reform is not a luxury that can be postponed, but a necessity that cannot wait,” Obama said in prepared remarks the White House released Sunday. “That is why these groups are voluntarily coming together to make an unprecedented commitment.”

The industry groups are trying to get on the administration bandwagon for expanded coverage now in the hope they can steer Congress away from legislation that would restrict their profitability in future years.

Insurers, for example, want to avoid the creation of a government health plan that would directly compete with them to enroll middle-class workers and their families.

Drug makers worry that in the future, new medications might have to pass a cost-benefit test before they can win approval. And hospitals and doctors are concerned the government could dictate what they get paid to care for any patient, not only the elderly and the poor.

Hats on to the Arizona Cancer Center’s Skin Cancer Institute for putting a 12-minute video online to help people detect cancers.

(“Hats off” won’t prevent skin cancer, but “hats on” surely can.)

Early detection saves lives, and the quick spotting of skin cancers just became a whole lot easier thanks to the video that can be watched at www.azskincancerinstitute.org.

We denizens of the desert get plenty of sun exposure, so we need to indulge in sunblock, hats and other protection.

But spotting cancers promptly also is vitally important in the battle against skin cancer. Melanoma survival rates are 98 percent with early detection.

So check out the video now online, and follow the guidelines and instructions. The 12 minutes you spend now may provide you with many more years of life.

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.

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.

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.