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?

A Phoenix school has been ordered closed for a week by Maricopa County health officials due to an apparent flu outbreak.

County public health director Dr. Bob England says Lowell Elementary School has been “experiencing a much higher than normal rate of absenteeism due to illness that looks like flu.”

England ordered the school closed as a precaution until May 26.

He says with swine flu and seasonal flu behaving much the same way, it’s not recommended that students already home with mild illness be tested for swine flu. So, England says it’s likely that the strain of flu will remain unknown.

Lowell Elementary School spokeswoman Sara Bresnahan said officials saw a spike of absences on Monday among the school’s 700-student population. About 20 percent of the student body called in sick.

England ordered three schools closed April 29 after students contracted swine flu. A few days later, he announced he wouldn’t order new closures unless a particular school had a widespread outbreak.

PHOENIX – A woman in Arizona suffering from a lung condition has apparently become the fourth person in the nation to die with swine flu.

The Maricopa County Health Department reported Thursday that the woman, in her late 40s, died last week of what appears to be complications of the new strain of influenza.

Laboratory tests confirmed that the woman was infected with the flu strain. Health department spokeswoman Jeanene Fowler says the federal Centers for Disease Control and Prevention is expected to add her to the official national tally on Friday.

The case would bring the number of swine flu deaths in the nation to four and put the worldwide death toll at 70, with an estimated 6,672 cases in 33 countries.

Danielle McBurnett has had people compare her to the main character in the old television show “Doogie Howser, M.D.,” about a teenage doctor.

The first time she heard that comparison, however, someone had to explain to her who Doogie Howser was. The show was canceled in 1993, when she was just 1 year old.

On Wednesday, McBurnett, 17, became the youngest person ever to receive a bachelor of science degree from Arizona State University’s College of Nursing and Healthcare Innovation. She graduated summa cum laude from the program and plans to enroll in the school’s doctoral program in nursing practice in the fall.

McBurnett lives in Chandler with her parents, Ray and Lori, and three siblings. She was home-schooled, but at age 12 she started taking classes at Chandler-Gilbert Community College.

She received her associate degree (4.0 grade-point average) and high-school diploma at the age of 15 and enrolled at ASU.

She said she has never let her age stand in the way of accomplishments.

“Most people (when told her age) have just said, ‘Wow, that’s amazing.’ When I meet people, I don’t wear a big name tag that says, ‘Hi, I’m Danielle, I’m 17.’ I’ll tell some people when it’s pertinent information, but I don’t let my age dictate who I am.”

McBurnett has always carried herself in a mature fashion, said her mother, Lori McBurnett.

“She was born an adult, that’s the world she wanted to live in,” she said. “When she was very, very small, she wanted to talk with the adults and be with the adults. She didn’t want to play with toys. That was her nature.”

Danielle McBurnett has also been active in performing arts: She plays piano and has acted in a variety of plays. That training has helped boost her confidence and allowed her to project herself in a more dynamic fashion.

She said college just sharpened her focus on a goal she has held since she was 10 years old.

“I knew I wanted to be a nurse,” McBurnett said. “Now, I’m more focused on what I want to be on top of that and the next degrees I want to get. Now, I want to be a nurse practitioner. After that, I’m even considering going to law school, too.”

McBurnett said she didn’t want to become a doctor because she wanted a closer relationship with patients and the doctor’s career path didn’t offer as much flexibility.

“Nurses really get to interact with patients more than doctors, typically,” McBurnett said. “I really want that human, patient interaction. Also, I want to have the ability to do lots of things. I don’t want to be confined to just being a doctor, and I feel like I can do that better as a nurse practitioner. And I want to possibly spend more time with my own children, some day in the future, and I feel I’d be better able to do that as a pediatric-nurse practitioner.”

She wants to eventually be an advocate for children, both domestically and abroad, which is why law school may be part of her future.

She has opinions on subjects ranging from the health-care system to tort reform that may make her seem mature beyond her years, but she has also taken part in more typical activities for girls her age.

“I did go to prom,” she said with a laugh. “The home-school community has its own prom. I’ve been to a number of dances, and I feel like I participated in every high school opportunity out there.”

PHOENIX – Enrollment in Arizona’s Medicaid program is surging because of the recession, with costly implications for the already troubled state budget.

The Arizona Health Care Cost Containment System reports that enrollment grew by nearly 102,000 from April 2008 to April 2009, an increase of 11 percent. The increase in April alone was 21,000.

AHCCCS’ budget administrator, Jeffery Tegen, said in a memo distributed this week to Gov. Jan Brewer’s budget staff and the Legislature that the increase is due mostly to “the economic downturn and subsequent job losses.”

Tegen’s memo says the increase will add $253 million of spending to the next state budget, which will cover the fiscal year starting July 1. That budget already faces a projected $3 billion shortfall.

PHOENIX – University of Arizona medical school professor Yvette Roubideaux is the new director of the Indian Health Service.

The White House says the U.S. Senate unanimously confirmed Roubideaux’s nomination Wednesday night.

Roubideaux, a member of the Rosebud Sioux Tribe, was an assistant professor in the Department of Family & Community Medicine at UA’s College of Medicine when she was picked by President Obama to head the IHS.

The White House says she has conducted extensive research on American Indian health issues, with a focus on diabetes and Indian health policy.

The IHS provides health care to American Indians.

Pima County health officials Thursday confirmed 12 more cases of swine flu, bringing the county’s total to 22.

Statewide, the number of confirmed diagnoses is 130.

Details about the new cases have not been released, Pima County Health Department spokeswoman Patti Woodcock said in a statement. “It is, however, my understanding that all have recovered or are in the process of recovering.”

Sunday, the first six cases of swine flu in the county were announced. Two involved middle school students in Tucson and Marana, the other four cases were on the Tohono O’odham Nation. By Tuesday, the number of cases had risen to 10.

“Keep in mind, we expected additional cases,” Woodcock said Thursday. “This does not change our approach to this virus.”-

Health officials recommend that people experiencing flu-like symptoms stay home and call a doctor before heading to a clinic or emergency room.

In line with recommendations by federal, state and local officials not to close schools because of the flu, Tucson and Marana schools have remained open. However, Tohono O’odham and Nogales schools have been closed as a precaution.

PHOENIX – The Arizona House has approved legislation to allow private health insurance policies for uninsured individuals that would omit some coverages normally mandated by the state.

The bill was sent to the Senate on a 48-12 vote Wednesday but its fate in the current legislative session is uncertain because the Senate has a months-old embargo on nonbudget bills.

Supporters said the business-backed bill (HB 2324) would help make health insurance less expensive for uninsured people.

One legislator who voted against the bill said Arizonans could be hurt by having insurance that doesn’t cover things such as treatment for alcoholism.

The state already has a law allowing “mandate light” policies for small groups of people, such as employees of businesses.

Health officials on Tuesday afternoon confirmed another four swine flu cases in Pima County, bringing the total to 10.

The newly confirmed cases include an infant, two teenagers and a young adult, according to Pima County Health Department spokeswoman Patti Woodcock. All four have recovered from the virus. Woodcock did not release any more information about the new cases.

Statewide, the number of confirmed swine flu cases rose to 49 Tuesday.

Pima County officials on Sunday confirmed the first six cases of the H1N1 influenza virus, including four on the Tohono O’odham Nation and one each in Marana and in Tucson.

County health officials continue investigating the most recent confirmed cases.

Although the swine flu turned out to be less serious than originally feared, Arizona officials learned vital lessons that will help the state if an epidemic hits in the future, Arizona’s interim public health director Will Humble said Tuesday.

Humble said he doesn’t believe state officials overreacted to the swine flu by shutting down schools. They were simply reacting to data coming from Mexico that indicated a possible pandemic.

He said the lessons officials learned during their response will help in the event of a truly serious virus.

Arizona has been relying on the federal Centers for Disease Control and Prevention to test its suspected cases, and an additional 150 to 200 possible cases are outstanding. But the state laboratory will take over those duties later this week now that new tests for the specific strain have been received from the federal lab.

Citizen staff Writer Ty Bowers contributed to this article.

PHOENIX – For a young Hopi medical student, the problem was overcoming her culture’s view of handling a dead body.

For a Navajo student, it was learning to believe that he could become a doctor when every other kid in his graduating class was going to a trade school.

The need for American Indians in the health-care professions has never been greater, but the obstacles standing between them and medical degrees are often daunting, if not overwhelming. George Blue Spruce knows those obstacles firsthand and has spent a lifetime helping others overcome them.

Blue Spruce, the nation’s first American Indian dentist, is an assistant dean at A.T. Still University in Mesa, where he is helping tribal members enter the world of medicine.

At 78, Blue Spruce has a long and distinguished résumé. He founded the Society of American Indian Dentists and was assistant U.S. surgeon general from 1981 to 1986. He also wrote the original draft of the Indian Health Care Improvement Act in Title 1 of federal statutes.

Now “retired,” he is pursuing what he calls his true life’s work: traveling the nation to tell young American Indian men and women that the medical professions need them, and perhaps more importantly, that their people need them to be in the medical professions.

Largely through his efforts, A.T. Still claims more American Indian dentists in training than any other school in the country. In addition, American Indians are being educated in osteopathic medicine and as physician’s assistants and athletic trainers.

Since Still’s dental college opened in 2002, eight American Indians have graduated with dental degrees, and 12 are “in the pipeline,” according to Carol Grant, Still’s director of American Indian Health Professions.

The numbers tell the story of the need.

With fewer than 150 American Indian dentists in the country, that means there is roughly one for every 32,000 American Indians, Grant said. The rate among the rest of the population is about one to every 1,200 people.

According to Frank Ayers, dean of student affairs at Creighton University’s School of Dentistry in Omaha, Neb., the need for American Indian dentists is desperate, particularly in remote reservation areas where there are few health-care resources.

“A report on oral health issued in 2000 by the American Dental Association showed that among Native American children, tooth-decay rates are four times higher than the general population,” Ayers said. “Native American communities have very great needs for dental and medical services and little access to those services.”

Ayers said that every year, the nation’s 56 dental schools “average only about 30 Native American students enrolling in dental schools, and that’s not anywhere near enough to meet the needs of Native American communities.”

Ayers said the key to delivering dental care to American Indian communities is recruiting dental students from those communities.

“If a student has a strong tribal affiliation when you bring them into the profession, they are much more likely to return to the reservation and help their people,” he said.

The problem of dental care on reservations is so acute that a bipartisan bill, the Native American Full Access to Dental Care Act, was introduced in Congress in 2007 to address the situation, but it eventually died in committee.

But what Congress couldn’t get done, Blue Spruce hopes to do, even if it is only one student at a time. Grant credits Blue Spruce with persuading hundreds of American Indians to seek careers in the health professions.

“He goes everywhere, to conferences, to schools, and his message to young people is that ‘you can do this, and you are needed,’ ” Grant said. “Dr. Blue Spruce is a very humble, quiet man, but when he speaks, he does so with authority and people listen.”

Blue Spruce does exude a quiet, even humble demeanor, but he is matter-of-fact about his own story. He attended the Santa Fe Indian School in New Mexico and got his dental degree from Creighton.

“It all begins with the family, and it was the encouragement of my mother and father who grew up not reading, writing or speaking English,” Blue Spruce said. “Yet they saw that for me to be successful in the dominant society, I needed that piece of paper, that piece of character, called a college degree.”

When Blue Spruce got his DDS in 1956, he began a practice, but he also began talking to other American Indians about why they should go into medicine.

“I knew that for so many American Indians there is a lack of parental support and often no support from the extended family or from the tribe. And counselors in our Indian communities too often talk to students about a marketable skill right out of high school and not enough about going to college.”

Rowin Begay, 30, a first-year osteopathic medicine student at A.T. Still who is from Rough Rock on the Navajo Reservation in northern Arizona, says his friends didn’t really think of college.

He says he was fortunate to have a family that pressed him to better himself, but even with that support, there have been challenges in medical school that others don’t face.

“There are cultural things . . . I’ve had to work hard to learn to be assertive, to speak publicly, to put myself forward,” he said.

Grant credits Blue Spruce with helping find – and keep – students like Begay.

“He creates a sense of family when they come here, and he mentors them and advises them. He takes them under his wing and walks them through the whole system,” Grant said.

PHOENIX – Social-networking sites such as Facebook and Twitter are being considered for inclusion in a system that would warn people with asthma when particulate pollution in their neighborhoods reaches levels that could trigger an attack.

Researchers and officials from Arizona state agencies, the U.S. Environmental Protection Agency and from universities met recently to discuss ways of notifying asthmatic children and the elderly about high-pollution advisories.

Preliminary plans call for warnings to go to schools and individuals through telephone networks and e-mail, but for the first time, social networking is also being considered.

“For some time, we’ve looked beyond traditional notification systems,” said Patrick Cunningham, interim director of the state Department of Environmental Quality. “For instance, we now send text messages about a high-pollution day to landscapers who might be using leaf blowers.”

Cunningham said officials could use sites like MySpace and Facebook to reach young people. “What we want is to be effective,” he said.

Under the system, people with asthma could register under their ZIP code with health officials, who would alert them via text or on Facebook, Twitter or other social media when neighborhood sensors detect high levels in their area.

Current pollution alerts, given through traditional media, generally cover all the Phoenix metro area even though high readings might be only in a small area.

The idea of the alert system grew out of a December study conducted at Arizona State University.

ASU engineering Professor Harindra Fernando said the network he hopes to develop in the Phoenix area will “tell you if tomorrow will be a good day or a bad day for asthmatics, and it will issue warnings from ZIP code to ZIP code.”

Fernando said he hopes that modifying an existing network that measures air pollution in Milan, Italy, and issues air-quality alerts specific to areas and developing an alert system can be done in the next two years, with a notification system in place by 2012.

Cunningham said he is going to ask the EPA for $300,000 to $500,000 to fund the project.

U.S. Border Patrol agents along the southwestern border with Mexico are on alert for illegal immigrants who may have swine flu, but being on the lookout for contagious diseases is really an everyday part of their jobs.

It’s not unusual for agents who capture illegal immigrants to discover someone with a suspicious cough or illness, and migrants have been found with diseases such as tuberculosis.

But the swine flu outbreak first reported in Mexico did heighten awareness for agents in the field.

“First of all we take the situation with H1N1 (swine flu) very seriously. We share the view that people should be aware but not alarmed or in a state of panic,” said Doug Mosier, spokesman for the patrol’s El Paso, Texas, sector. “We have been the first line of defense between the ports of entry since 1924, so being exposed to various communicable diseases historically is something we’ve always been vulnerable to and been a part of.”

The Border Patrol follows a standard procedure in which immigrants who have been arrested and who show obvious symptoms are given a breathing mask to keep others from continued direct exposure. Border Patrol vehicles used to transport illegal immigrants to processing centers are equipped with separate ventilation systems to protect agents, said Lloyd Easterling, a Border Patrol spokesman in Washington.

The Border Patrol on Friday couldn’t immediately provide any reports on how many illegal immigrants with communicable diseases they encounter or other specific diseases they’ve seen.

The flu outbreak has brought a reaction from some federal workers who regularly screen migrants. A labor union representing Customs and Border Protection officers who man border crossings asked this week that its officers be allowed to wear masks and other protective gear while checking travelers who might have been exposed to swine flu.

But the union for Border Patrol agents, who look for those who have crossed illegally, didn’t follow suit. Agents already have such equipment available and use it at their discretion.

“Name the disease, and since we catch people from all over the globe, there is the risk of encountering someone with a communicable disease,” said T.J. Bonner, a Border Patrol agent and president of the National Border Patrol Council, the union representing agents.

Pima County health officials could learn as early as Saturday whether any of about 20 patient samples sent to the federal Centers for Disease Control and Prevention test positive for swine flu.

Samples from around the country have flooded the CDC lab in Atlanta, delaying results, according to health department spokeswoman Patti Woodcock.

Arizona has sent 56 samples to the CDC for testing. So far, only four Phoenix-area children tested positive for the virus. Three Phoenix-area schools have been closed for seven days because of the results.

Public health officials say Arizona has enough courses of antiviral medicines to respond to swine flu cases, even though the state’s stockpile of flu-treatment doses are lower than the recommended level.

The U.S. Department of Health and Human Services recommends that each state have enough antiviral medicine on hand to treat 25 percent of its population. But a survey by The Associated Press of all 50 states and the District of Columbia found that 29 states, including Arizona, were below that mark.

Arizona’s estimated 258,000 treatment courses of antivirals would cover about 4 percent of the state’s population.

State health department spokeswoman Laura Oxley pointed out that the treatment courses are for people who are extremely ill and aren’t intended as a way to prevent an infection.

The state was supplementing its 58,000 treatment courses with an estimated 200,000 from the federal government’s strategic reserve. The 200,000 figure represents a quarter of Arizona’s full allocation from the reserve.

State and local health officials believe they will not need to request more from the national stockpile. They anticipate a drop in illnesses as regular flu season ends and summer approaches.

Public health officials in Arizona say it appears the swine flu that has spread across the nation in the past week isn’t any more severe than normal influenza.

April McMahon kept her 14-year-old daughter, Shealan Lester, home from Tucson’s Gridley Middle School on Friday because she had 102-degree fever.

A doctor diagnosed the eighth-grader with the flu, but said the family would have to wait until next week to learn if Shealan had swine flu.

Until the results get back, “the doctor said she needs to be quarantined to her room,” McMahon said in a telephone interview.

Aside from the fever, Shealan seems fine, her mother added. “I’m not worried at all.”

In letters and in e-mail and Web site updates, education officials throughout the region have told parents that a school might close for up to seven days if a student or employee contracts swine flu.

Despite concerns of a local outbreak, most here seem calm.

Catholic churches in the area will employ a little “common sense” during Mass, according to Fred Allison, a spokesman for the Roman Catholic Diocese of Tucson. During flu season, the U.S. Conference of Catholic Bishops typically advises its ministers of Holy Communion to wash their hands before Mass begins.

As of Friday afternoon, diocese officials had not urged churches to forgo communion, Allison said.

On the Web

Arizona Department of Health Services:

http://www.azdhs.gov/

Citizen staff writer Ty Bowers contributed to this article.

BALTIMORE – With a swine flu outbreak spreading across the nation, more than half the states have yet to stockpile the number of flu-treatment doses recommended by the federal government, an Associated Press survey found.

States that are falling short cite budget constraints, or say it’s better to spend health-care funds on preventing the spread of disease than on antiviral medicines that may or may not work on a particular flu strain.

“You don’t have any guarantee that if you purchase a large amount of drugs that they would be effective in the future,” said Gwenda Bond, a spokeswoman for the Kentucky Cabinet for Health and Family Services. “Drugs do have a shelf life, and so you don’t want to spend a lot of money on drugs that may expire before you need them.”

The strain of swine flu that began appearing in Mexico and has since spread to 11 U.S. states is treatable — but not preventable — using Tamiflu and Relenza, each of which has a shelf life of about five years.

The U.S. Department of Health and Human Services recommends that each state have enough antiviral medicine on hand to treat 25 percent of its population. But an AP survey of all 50 states and the District of Columbia found that 29 were below that threshold.

Several were just under it, but 15 states had enough medicine on hand to treat fewer than 20 percent of residents. Seven states — Arizona, Colorado, Connecticut, Florida, Idaho, Massachusetts and Montana — could treat about 15 percent.

Despite that, the acting head of the U.S. Centers for Disease Control and Prevention said no state is expected to experience shortages because the federal government is racing to fill states’ stockpiles with millions of additional doses from its own strategic reserves.

Dr. Richard Besser said Thursday that the CDC had deployed drugs to nine states so far, and that all 50 states would receive allocations from the national reserve by Sunday.

Besser said the deployment is being done “as a forward-leaning move … in case this becomes something much bigger than it currently is.”

Federal officials also said there was no shortage of the medicine in regular pharmacies.

A course of antiviral medicine contains enough doses to treat one person. In 2006, as part of its own pandemic flu preparations, the federal government created a stockpile of 44 million courses, which would cover about 15 percent of the U.S. population.

It then recommended that states purchase additional courses so the combined stockpiles would cover one quarter of each state’s population, and offered subsidies covering 25 percent of the cost. Because some states passed on the subsidies, other states were able to use the federal aid to go beyond 25 percent coverage.

The AP’s tally includes both drugs currently on hand in the states and those expected over the next week or so from the Centers for Disease Control and the drugs’ manufacturers.

Hawaii has enough for nearly 29 percent of its population. It bought more than the recommended amount because of the year-round stream of tourists who boost its population.

Bill Hall, a spokesman for the Department of Health and Human Services, said the federal government based the 25 percent figure on past pandemic outbreaks in which about a quarter of the population became infected and “made it clear this is shared responsibility with the states.”

The swine flu outbreak is a road test of sorts for battling an outbreak with antiviral medicine, said Trish Perl, an infectious disease expert at the Johns Hopkins University School of Public Health.

“None of us have ever really done this practically,” she said. “Right now is the first time that we’ve been able to really test it with some of the prevention strategies that have been used in states where they have had some of these cases. So, I think the good news is that we’re going to know relatively soon.”

However, the drugs’ effectiveness is limited. Tamiflu, the more commonly stocked of the drugs, needs to be taken within in first 48 hours of the onset of symptoms, according to its manufacturer, The Roche Group. It generally only reduces the duration of symptoms.

Georgia Gov. Sonny Perdue had originally proposed spending $15.7 million for about 2.2 million courses in 2007, but the spending was cut to $7 million by state lawmakers and the state ended up purchasing 460,000 courses instead. Combined with the 1.3 million currently allocated by the federal government to Georgia, that’s enough to cover about 18 percent of the state’s population of 9.7 million.

Kentucky health officials’ decision to get half the amount recommended under the federal guidelines came down to both a policy and financial decision, Bond said. Health officials did not want to buy too much medication that may not be able to treat a pandemic or could eventually expire and go to waste.

“But at the same time, we did feel that it was prudent to … have some on hand, because they are effective against many flu strains,” she said.

So Kentucky spent about $3.6 million on antiviral courses, which is “no small expense” for a state that’s facing massive budget woes, Bond said. Kentucky has enough to cover just over 20 percent of its population.

Colorado and Maine are among the states that chose not to stockpile treatments, deciding the money would be better spent on hygiene education, canceling large gatherings and other precautions against a pandemic flu.

“Since this is the biggest gain for the dollar, this is where we have put our efforts,” said Chris Lindley, division director for the Colorado Department of Public Health and Environment.

In Massachusetts, where the state has enough antivirals to treat slightly more than 15 percent of the population, health department spokeswoman Jennifer Manley said the state’s decision not to buy the recommended amount was based in part on the fact the state had to pay out of pocket for the drugs and if a virus becomes resistant, the antiviral courses would be wasted.

“It’s not a silver bullet,” Manley said. “If we ordered a million doses, and it becomes resistant, that is a lot.”

Hall, the HHS spokesman, said the federal government left it up to the states to decide whether they needed to purchase the full amount available to them, and some opted against it.

Jeff Levi of the Trust for America’s Health, which compiled a recent state-by-state report on the stockpiling of antiviral medicine, criticized that decision and said the federal government should have purchased the full amount itself.

“I think what we’re seeing with swine flu, with the virus being susceptible to the drugs in the stockpile, I think it demonstrates the importance of doing this,” Levi said.

Dr. Michelle McDonald speaks during the H1N1 influenza press conference on the flu cases in Pima County.

Six cases of swine flu have been confirmed in Pima County – four on the Tohono O’odham nation, one in Tucson and one in Marana, according to the Pima County Health Department.

Another 11 cases are suspected, but have not been confirmed.

The number of confirmed swine flu cases in Arizona rose to 17 over the weekend, according to the Arizona Department of Health Services Web site.

Last week four cases of swine flu were confirmed in Arizona, all school-age children in Maricopa County who have either recovered or are recovering, officials said. The state sent samples in at least 52 more suspected cases to the federal Centers for Disease Control and Prevention in Atlanta, about half of which were from Pima County, said Patti Woodcock, spokeswoman for the Pima County Health Department.

If cases of the virus are found in the county, then local officials will begin “active surveillance” of hospitals and clinics, Woodcock said. That means health workers will track patients’ contacts and retrace their steps, much as they did during a spring 2008 outbreak of measles.

As they did with the measles outbreak, county health officials are urging people experiencing flulike symptoms to call their doctors instead of going to doctors’ offices or hospital emergency rooms, potentially exposing more people, Woodcock said in a statement Thursday.

In the event of an outbreak here, the county’s allotment of antiviral medication would be used only to treat patients, not to vaccinate others, Woodcock said.

Maricopa County’s health director, Dr. Bob England, said none of the patients who had the swine flu there has been hospitalized or suffered severe symptoms.

“It isn’t going to stop there,” England said. “We have lots of testing to be done, and in the coming days we’re going to have more (confirmed cases).”

England and state Health Services Department Interim Director Will Humble said it appears the swine flu that has spread across the nation in the past week isn’t any more severe than a normal influenza. If evidence mounts that that is the case, school closures could end quickly.

About 36,000 people die each year in the United States from the regular flu. The U.S. has reported only one death outside Mexico from the swine flu – a Mexican toddler who visited Texas with his family.

As a precaution, Tucson Unified School District leaders have canceled school field trips Friday to the Tucson Convention Center for the Tucson Symphony Orchestra’s “Young People’s Concert.”

Fifth-grade visits to TUSD middle schools Friday have also been cancelled.

Tarwater Elementary and Hartford Sylvia Encinas Elementary schools in the Chandler Unified School District were ordered closed for seven days. Moon Mountain Elementary School in northwest Phoenix was ordered closed on Wednesday.

Health officials said there was no known relationship between the two Chandler-area students. In the third new case reported on Thursday, the student had been home during the infectious period and could not have infected any classmates.

State Department of Health Services officials also learned Thursday that a 19-year-old Northern Arizona University student had a “probable” case of swine flu.

NAU and the Coconino County Health Department were awaiting confirmation from the CDC, but a school spokesman said it will continue to operate under normal business conditions.

“We have a residential campus here, we’re right at the tail end of the semester, finals start next week,” said Tom Bauer, a NAU spokesman. “We don’t feel this would be in the best interest of anyone at the moment to be thinking about closing because of one ‘probable’ (case). We’re not being blasé about this. We are very concerned with all of our students.”

The first case was confirmed Wednesday in an 8-year-old northwest Phoenix boy. Although he had returned to school, health officials ordered his elementary school closed for a week to prevent the disease from spreading.

England said in that case, the child had not traveled to Mexico, where the flu strain was first identified.

“There was no travel history, which, again, underscores my thought – that it’s here. It’s in the community. There are probably many more people infected than we realized,” England said. “Nobody’s cared about it because it hasn’t made people all that sick.”

The student whose illness prompted the closure of the second school also had recovered. The third student hadn’t attended school while contagious, and the fourth case is being investigated, England said.

The CDC and officials in several states have confirmed at least 120 cases of the swine flu as of Thursday. They are in New York, Texas, California, South Carolina, Delaware and scattered cases in Arizona, Indiana, Kansas, Massachusetts, Michigan, Nevada, Ohio, Minnesota, Colorado, Georgia and Maine.

Health officials said people should treat the swine flu strain like any other flu – contact your personal doctor, and avoid spreading the virus by staying home and covering sneezes and coughs. Patients should seek additional medical help if fever persists or spikes, breathing is difficult or other severe symptoms develop.

Officials were worried that people unnecessarily visiting hospitals or clinics could make it hard to tend to trauma patients. Dr. Jeffrey Schultz, pre-hospital director at John C. Lincoln Hospital in Phoenix, said an increase in patients could affect the ability to care for them. Furthermore, people have been coming to the hospital to request they be tested for the flu, even if they don’t show symptoms.

“If you’re not having any of those symptoms, it’s unlikely, even if you request that test . . . you’d be getting that test. That wouldn’t be good health care,” Schultz said.

Arizona health officials have tested more than 400 samples since Monday in a state lab and determined that about 60 percent of them were seasonal flu.

“We’re chugging them in and out,” state health department spokeswoman Laura Oxley said. “We’re prepared to go around the clock, (but) we haven’t had to do that yet.”

Oxley said the state could receive test kits by the end of the week from the CDC that will enable health officials to confirm the virus themselves.

“We are working on it,” she said. “We want to do it, and life will be a lot easier when that comes.”

Citizen Staff Writer Ty Bowers and the Arizona Republic contributed to this article.

By Citizen Staff Report, Wire Report