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Anderson Cooper 360 Degrees

Swine Flu Threat

Aired April 27, 2009 - 22:00   ET


ANDERSON COOPER, CNN ANCHOR: Tonight, swine flu fears, flu facts, and breaking news: new probable cases being reported, this time in New Jersey, White House officials meeting this evening, scrambling to get out in front of a swine flu outbreak that is widespread and apparently growing.

As you look at the empty streets of Mexico City there behind me, the death toll there in Mexico is rising, and so is the number of cases in the United States and all around the world -- the World Health Organization now calling this a level four outbreak, with level six being an all-out pandemic.

President Obama calls it cause for concern, not alarm.

Tonight, we're going to give you the facts, not hype. We're not going to stoke unnecessary fear, tonight, the facts you need to know, so you can do something useful with your concern.

Let's get you up to speed on the big picture.


COOPER (voice-over): As world leaders scramble to prevent the pandemic, the threat spreads here at home. Eight states are now reporting suspected or confirmed cases of the swine flu.

South and North Carolina and New Jersey are the latest added to the list. But, by far, the greatest outbreak is at this Catholic high school in Queens, New York, where scores of teenagers have fallen ill.

MICHAEL BLOOMBERG (I), MAYOR OF NEW YORK: More than 100 students are sick. And we now have information that 28 of them have confirmed human swine flu, and another 17 have probable swine flu.

COOPER: The Obama administration has issued a public health emergency for the entire country, and the president urges calm.

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: This is obviously a cause for concern and requires a heightened state of alert. But it's not a cause for alarm.

COOPER: It is a much different situation in Mexico City, many venturing outside wearing masks. But the city is mostly shut down, countrywide, nearly 2,000 hospitalized as possible cases. And officials suspect the deadly new strain has claimed more than 149 lives.

A profile of the victims reveals why this airborne killer is so worrying.

GREGORY HARTL, SPOKESPERSON, WORLD HEALTH ORGANIZATION: The great majority of cases that we have seen so far have been in otherwise healthy young adults. This would tend to tell us that it is a virus which has the ability to cause a great deal of mortality and illness.

COOPER: Beyond Mexico and the U.S., around the world, new cases reported, Canada, Scotland, Spain, with several other nations awaiting test results.

At Tokyo's Narita Airport, they're using heat sensors to detect if arriving passengers have a fever, one of the symptoms of the swine flu. The CDC advises Americans to avoid nonessential travel to Mexico.

And, tonight, encouraging news from the CDC, saying lab testing reveals the virus is susceptible to two anti-flu drugs on the market, including Tamiflu. The White House has ordered doses sent to the affected states and the border.

And, in Washington, simple advice to stopping a catastrophe:

JANET NAPOLITANO, U.S. HOMELAND SECURITY SECRETARY: Washing hands, staying home from work or school if you feel sick, covering your mouth if you cough or sneeze. These are straightforward and simple measures, but they can materially improve our chances of avoiding a full-fledged pandemic.


COOPER: Well, if there is a front line in this fight, this virus, it is clearly Mexico right now.

360 M.D. Dr. Sanjay Gupta is there tonight.

Sanjay, how bad is it in Mexico?

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Well, so many of the early cases were treated at this hospital right over here.

They are catching up. They're trying to figure out just how bad this is. What we wanted to figure out is, where did this start? Where is it going?

Let's start at the beginning.


GUPTA (voice-over): It started off like any other flu, springtime in one of the world's largest cities. But, within a week, Mexico City would look like this.

(on camera): It's hard to believe this, but what you're looking at is a uniformed officer carrying a rifle outside a public hospital. We are here outside one of the largest public hospitals in Mexico City. We can't get inside.

They're very concerned about crowds gathering, in the wake of the swine flu. There are lots of patients inside, many of them waiting to see doctors. Many have been here for several hours. They have their masks on.

But this is what the situation has become here in Mexico City.

(voice-over): Chaos. And yet patients need care. They continue to flood in all day, all night. The question is, how do you treat what you don't understand?

(on camera): They came in. They were in their 20s, 30s and 40s. They weren't the elderly or the very young that you typically associate with the flu. But these were people in the prime of their lives. They were getting sick. They were dying. And the doctors here were mystified.

Over the next couple of weeks, they had a medical mystery to solve, and a lot of that solving took place right behind these gates.

We also spoke with Mexico City's mayor.

(on camera): How worried are you?


GUPTA: Very worried.

(voice-over): The hospitals are overwhelmed, not only with patients, but also with press. But we were able to get in.

(on camera): I will tell you what. It's been next to impossible to get into a hospital like this one. Finally, I told them I was a doctor. They let me in with a small camera, so that we could try and figure out how they are taking care of these patients with the swine flu. Let's take a look.

(voice-over): We now know, over the last two weeks, nearly 2,000 people came to hospitals like this one in Mexico, and around 150 died.

As (on camera): you can see, this is one of the hallways where they're taking care of a lot of the patients with the swine flu. As you notice here, there are no patients in the hallway. They're trying to keep all the patients sequestered in the room.

(voice-over): But the key to all of this is figuring out who exactly needs treatment.

(on camera): One of the things that's so critical in an outbreak like this is trying to identify patients early. There were patients at hospitals like this for two weeks before anyone can figure out what was going on. Finally, someone realized that there was probably a virus that the world had never seen before.

And they went to laboratories like this one to try and sort that out.

(voice-over): The hospital management did not want us to see these hospital workers, upset because they weren't given masks or meds. They came out anyway and told us.

Under all the pressure, Mexico City in springtime is starting to show cracks. And everyone is hoping the swine flu can be controlled, and soon.


COOPER: Sanjay, I -- and I guess the bottom-line question is, how dangerous is this, and -- and are most -- you know, how risky is it for people watching right now at home?

GUPTA: I think, statistically, for any of your viewers, Anderson, it's very unlikely they're ever going to get the swine flu. So, now, that -- that should be a -- a sort of -- sort of calming, a little bit, to them.

But I think what's sort of more important is that we're having a hard time figuring out just how deadly this is. You have around 150 deaths in Mexico, as you have heard, but we don't know how many that's out of total.

Thirteen hundred people went to the hospital, but there could have been a lot more people who had mild illness as well. So, the fatality rate is really sort out hard to sort out here. You know, we do hear about some of these cases in the United States now. There have been no deaths. There's been one hospitalization.

It could be that it's sort of early in the natural history of this. But, so far, it seems like the fatality rate might be lower than we -- than we thought.

COOPER: Do we know why, in -- in Mexico, it seems -- you know, with flu, often, it's the very young, the very old who -- who -- who die. That doesn't seem to be the case here. I have heard the median age for -- for this, the average age of victims has been teenagers, 16, 17, 18.

A, is that true, and why would that -- why it be striking, killing people who aren't normally the ones who would die from a flu?

GUPTA: It is true. And this is a bit counterintuitive.

When you think about the flu, the seasonal flu, the flu that we're accustomed to, it typically tends to have the worst ramifications in people who don't have as -- as well-developed immune systems, so the very elderly and the very young. They just can't fight it off.

What's sort of counterintuitive is, with this particular virus, it's in the people who have robust immune systems. As their body starts to respond to try and fight off that virus, they produce tons of inflammatory cells. And those inflammatory cells can sort of flood the lungs.

So, in essence, it's not the virus itself that's so problematic, but the body's reaction to it. And we have seen that before. That's the same sort of situation with SARS. And it's been the same situation with some of the pandemics of years past. And that's one of the red flags that got public health officials concerned about this -- Anderson.

COOPER: There's a lot more questions I'm going to ask Sanjay, including why there have been so many deaths in Mexico, and the cases here in the United States are so mild. Could it possibly be a different virus? That's just one of the questions we will ask Sanjay and several other doctors right after this next break.

But we do have more breaking news back in Washington -- late word tonight that the Senate's going to hold emergency hearings tomorrow on the outbreak -- expected to testify, officials from the CDC, as well as Dr. Anthony Fauci, who runs the National Institute for Allergy and Infectious Diseases.

They have got a lot on their plate, certainly, working with public health authorities in all 50 states. Eight states now have now confirmed or suspected cases, from one in Kansas, to 28 here in New York City.

Erica Hill is actually tracking the spread right now in America.


ERICA HILL, CNN CORRESPONDENT (voice-over): On this beautiful spring day, a dark cloud hangs over New York. With 28 confirmed cases of swine flu and plenty of close quarters in this city of more than eight million, some New Yorkers are worried.

UNIDENTIFIED MALE: I am so scared, because I actually live in Queens.

UNIDENTIFIED MALE: It was shocking to hear that it was in a high school in Queens.

HILL: That high school in Queens is St. Francis Prep.

DR. THOMAS FRIEDEN, NEW YORK CITY HEALTH COMMISSIONER: These confirmed cases of human swine flu were, in all likelihood, contracted in New York City at the school community at St. Francis.

HILL: A group of students at the private school recently returned from a trip to Cancun. But not all those infected went to Mexico.

Fourteen-year-old Frederick Jolin father tells CNN his son isn't even friends with any of the kids who went, yet, he tested positive.

Frederick spoke to WCBS.



JOLIN: It was like any -- it's at a point, like, anybody could get it. Like, you could die from it.

HILL: In South Carolina, Newberry Academy's hallways and classrooms are empty today. Thirteen students recently returned from Cancun. Twelve came back sick. So did one adult. The school is now waiting on test results to confirm whether their symptoms were actually swine flu.

ROBERT DAWKINS, HEADMASTER, NEWBERRY ACADEMY: It's real easy to see how it got so many of them. They were a self-contained group for five days and four nights on buses, airplanes, and in resort rooms together.

HILL: The school is closed until at least Wednesday, on the advice of health officials.

A Kansas man, who also infected his wife, was in Mexico City on business. And one of the most recently confirmed cases, a 9-year-old Ohio boy, is also just back from Mexico. But, in Texas and California, there are cases that don't involve recent travel to or from Mexico, something health officials at every level are taking into account as they follow the developments across the U.S.

And, back in New York, even the heartiest commuters are taking the warnings seriously.

UNIDENTIFIED MALE: I'm going to wash my hands after I take my hand off this pole, for sure.

UNIDENTIFIED MALE: Every time I get off the subway, when I get to work, when I get home, I wash my hands.

HILL: A small gesture that could make the difference.


HILL: And one thing to point out, there's been a lot of attention. And I know, Anderson you said this off the top of the show. The goal here is not to -- to further cause any panic.

One thing that was great to see is, even in hearing from that headmaster in South Carolina today, he was very calm about the entire situation, and said that he hadn't really heard from parents who were all that upset, that everybody seemed to be taking the news well, taking it in stride...

COOPER: Right.

HILL: ... and taking the necessary precautions.


Erica, appreciate it. Thanks very much.

By the way, a -- a lot of people have flights that are booked and paid for to and from Mexico. And we thought you should know that, even before the State Department today warned against nonessential travel, airlines began waiving change fees for travelers going to or through Mexico. So, basically, you can most likely reschedule or change your connections without paying extra. You should check your airline for details tonight.

As always, a lot more on the -- the blogs, the live chat,, including a piece by one of our guests tonight, Dr. Nathan Wolfe, director of the Global Viral Forecasting Initiative. He will also be on the live chat throughout this hour, answering your questions. So, check it out at, the live chat. It's happening now. I'm about to log on myself.

Erica Hill also has her live Webcasts during our breaks tonight.

There's a lot more on this throughout the air. Dr. Nathan Wolfe joins us next, along with a global health specialist just back from Mexico, Dr. Carlos del Rio, as well as Dr. Sanjay Gupta in Mexico City.

Also, you will hear from one of the girls at this New York high school. The school is closed. It's being disinfected today. She was rushed to the hospital this weekend with a 103 fever. Find out what it feels like to be infected.

And, later, new revelations in the craigslist case -- this thing just gets stranger and stranger -- about how deep in debt the suspect is. And now authorities say the med school student was also going after men online. We will explain that.

And, only on 360, Suze Orman opens up about life before the fame and fortune -- part of a look at the world's most influential people.

We will be right back.


COOPER: Updating our breaking news, another state apparently touched by swine flu, New Jersey, with five probable cases among people who traveled to California or Mexico, all said to be mild, like the rest of the known infections here in the United States.

Beefed-up surveillance at American airports right now, though nothing yet like this. Take a look. This is airports in Japan and China using infrared scanners. Anyone running a fever is stopped, questioned, and, in some cases, quarantined.

There's a lot we do yet know about this swine flu, a lot of questions to be asked, like why the American cases have been so mild so far, but so many have already died in Mexico.

Let's dig deeper with Dr. Sanjay Gupta in Mexico City, Dr. Carlos del Rio, professor of global health at Emory University, just back from Mexico, also Dr. Nathan Wolfe, director of the Global Viral Forecasting Initiative. And, if you watched "Planet in Peril," you will remember Dr. Wolfe spent time with us in the forests of Central Africa, where he tracks the spread of viruses from animals.

Sanjay, do they have -- I mean, here people are being treated with Tamiflu. Do they have enough Tamiflu in Mexico and enough masks to go around?

GUPTA: Well, they don't, simply put, although they have been trying to distribute as many masks as possible.

This is a very large city, as you know, Anderson, population of around 20 million. They had about four million of these masks, and they were passing them out. They ran out at some point. In fact, there were protesters outside the hospital, as you saw earlier, mainly complaining about the lack of masks, even though they were -- they were treating patients who were infected.

Also, with regard to the Tamiflu, about a million treatments, we hear -- again, you know, not enough, if this started to get bigger within Mexico City alone.

Dr. del Rio, you just returned from Mexico. What's your assessment of how the government there is -- is handling this stuff?

DR. CARLOS DEL RIO, PROFESSOR OF GLOBAL HEALTH, EMORY UNIVERSITY: I think, Anderson, that the government response has been swift. I think it has been good.

The key strategy they have followed is that of social isolation, of making sure people are not gathered together. As Sanjay said, this is a city of 20 million. It's the ideal city to have an outbreak like this.

The subway itself transports more than five million people a day. So, the number of people that are in contact with each other is very, very large. The possibility of transmission is very large. So, closing schools, closing sports events, closing social events, closing churches on Sundays, all those things, hopefully, will have some impact in trying to decrease transmission.

That has been the strategy being followed. And, hopefully, we will see over the next several days that that is beginning to take effect.

COOPER: Dr. Wolfe, what do we know about swine flu? I mean, how -- how does it spread from a pig to a -- a person? And, also, you told me right before you came out that this actually started in birds long ago.


So, the way that the virus is transmitted among pigs is quite similar to the way that it's transmitted among humans. So, it's -- these are sort of respiratory droplets, aerosol, spread from pig to pig. And, presumably, the transmission from pig to human would be much the same.

Now, the interesting thing about influenza viruses in general, these are -- are primarily, originally, wild bird viruses. But they have a tremendous amount of capacity to jump around. So, viruses from humans can go to pigs. Viruses from pigs can go to humans. Bird viruses can go directly to humans and to pigs. And then these viruses can mix. And...

COOPER: And what makes it so scary, so -- so spreadable right now is that it doesn't -- you don't have to have affiliation -- you don't have to be -- interact with a pig. You -- basically, it's person-to-person.

WOLFE: That's right.

So, presumably, at some point, this virus was a pig virus. It jumped into a human. At that point, it was capable of going from human to human. And that's really when these outbreaks spark and begin. And that's obviously what happened here.

COOPER: Sanjay, at -- at this point, do we know why -- we talked before the break about why there have been so many deaths in Mexico, why the cases here are so mild. Is it possible it's not the same virus?

GUPTA: Well, there could be a variant of the virus. And that is certainly one hypothesis out there.

The answer to your question, after talking to lots of doctors on the ground here, we don't know. It could be that it's just earlier in the whole natural history of the disease here in Mexico. So, we're seeing -- we're seeing those deaths here, haven't seen deaths yet in the United States.

But, even as Dr. Besser from the CDC has mentioned, we may see some deaths in the United States. It could also be that, you know, we were not talking about swine flu that much even at this time last week. So, patients who had the flu who decided to sort of ride it out at home may be going in now instead and getting it checked out. So, I think the level of concern may be higher. And that could be helping people.

You know, let me just point out, Anderson, the hospital behind me continues to be busy, even -- even so many weeks now afternoon that first swine flu death. An 11-year-old was taken to the hospital earlier, admitted. Ambulances continue to go in and out -- armed guards outside there, because they worry about the crowds gathering and -- and whether or not families might gather out here and be -- be somewhat concerned about things.

So, that's sort of the scene here as well -- Anderson.

COOPER: Dr. del Rio, you know, Dr. Wolfe was pointing out to me that -- that some 35,000 people in the United States die every year just from regular flu. So, is this just hype about this? I mean, why should people be paying, you know, so much attention to it? Why should they be concerned? Or should they be?

DEL RIO: I think the reason to be concerned is, 35,000 people die in the U.S. from regular flu, but we had a vaccine for regular flu. This is a totally new virus. The population has not been exposed to it. There's no previous immunity to this virus.

And, therefore, that's the scary component of it. You have a virus to which there's no pre-vaccination, there's no prior immunity, and, therefore, the lethality rate may be a lot higher than of other influenza viruses.

The -- in -- in bird flu, for example, the estimated mortality is about 50 percent, 40 percent to 50 percent. In these cases, what we're seeing in Mexico, it's a -- it's a mortality of rate of about 6 percent to 10 percent, which is about what was seen in the 1918 Spanish flu outbreak.

COOPER: Dr. Wolfe, you -- you track these viruses all the time. And you have been doing it for many years. You say people shouldn't be surprised by this. Why?

WOLFE: Well, essentially, we live in an incredibly interconnected world. And in -- a virus that previously might have gone extinct in some rural village has the potential to really get to Tokyo or Paris or the United States.

COOPER: Because of air travel, roads.

WOLFE: Air travel -- planes, trains and automobiles.

In addition, this contact with animals continues, OK? And that's really the source of all of these outbreaks. What's happening with swine flu is by no means unique. It was the same sort of phenomena that led to H5N1, the bird flu. The same thing leads to Ebola outbreaks. They're often localized. Even HIV is a virus of animals that entered into humans.

So, this represents a very sort of similar phenomena, something that we have been seeing for ages and we will continue to see far into the future.

COOPER: We are going to continue to talk about it tonight.

Dr. Wolfe is actually going to be online on the live chat as soon as we go to a commercial break and throughout this hour. He will also be back on the program later on, answering your questions. But, if you have questions for him, go to the live chat at He will answer your questions there.

I also want to thank Dr. Carlos del Rio for taking the time to be with us tonight.

And we will also talk to Dr. Sanjay Gupta later in the program, as well, from Mexico City.

Thank you, all.

As we said, Dr. Wolfe will be online at

Coming up, though, next, you are going to meet a -- a young girl, a teenager, who was rushed to the hospital this weekend, a 103 fever. She didn't even go to Mexico, though, but a lot of folks in her school also came down with this virus. We will talk about what she has been going through. You will actually hear from her what it feels like to have this thing.

Later, you have seen the steps taken. The question is, are they enough? President Obama today suggesting today that we're falling behind in research. We're taking a closer look at research and readiness for a major outbreak, whether it's this swine flu or the next possible virus that could create a pandemic. We're "Keeping Them Honest."

And it's not a bull in a china shop, but it's close. How did it get in a grocery store? And what happened when it did? All of it caught on tape -- that toward the end of the program tonight.

We will be right back.


COOPER: U.S. medical officials have no idea how many Americans may be sick with swine flu or incubating the virus. The biggest outbreak here so far, of course, has been in New York, where more than 100 students at a Queens high school have fallen ill. You see them right there sanitizing the school. It was closed today, so that the cleanup crews could basically scrub it top to bottom.

Some of the students who got sick recently traveled to Cancun, Mexico, but not all of them. Sixteen-year-old Arianna Anastos wasn't on that trip, but her friends were. And she got sick, sick enough to send her to the hospital this past weekend.

I talked to Arianna and her father, Chris, earlier in an exclusive interview.


COOPER: Arianna, how are you feeling right now?

ARIANNA ANASTOS, LIKELY HAD SWINE FLU: I'm feeling a lot better now.

COOPER: When did you first start to feel sick, and -- and what did you feel like?

A. ANASTOS: I felt sick on Thursday. I was really dizzy. And I started having a fever and a cough. And I -- I had trouble breathing.

COOPER: How -- how bad did the fever get? A. ANASTOS: About 103 by Saturday.

COOPER: So, then, what did you do about it?

A. ANASTOS: I went to the hospital with my mom. And we waited for about an hour. And I got tested by the strep throat test and the nose swab.

COOPER: You -- you haven't been to Mexico. How do you think you got it?

A. ANASTOS: Probably from someone else. I mean, like, you know, people touch the railing on the school, like, and then I touch them, so any possible way.

COOPER: Chris, you must have been incredibly concerned. How -- how -- how did you deal with this?


On Saturday morning, she looked like she was run over by a truck, really. It really scared us. But...


COOPER: What do you mean by that? Like, how did -- how did she look?

C. ANASTOS: Well, she was on the couch lying down with her eyes closed, could not move, could not even open her eyes. I had a wet towel over her eyes to keep her temperature down.

COOPER: So -- so, you went...

C. ANASTOS: And that would be...

COOPER: Arianna, you went to the hospital on Saturday. Did they -- what did -- did they give you Tamiflu?


COOPER: So, how soon after taking the Tamiflu did you start to feel better?

A. ANASTOS: After two pills, I started feeling better.

COOPER: How do you deal with the fear about spreading it? I mean, Arianna, were you worried that you might give it to other family members?


I mean, my parents would, like, come into the room, but they would wear masks and gloves. And they wouldn't allow anyone into the room. And they wouldn't allow me, like, to touch anything in the house, or else my mom would, like, spray it with Lysol. So, you know, no one got sick.


C. ANASTOS: We took every precaution we could to prevent the spreading. And, obviously, we were -- my wife and I and my other daughter did not get it. So, it worked for us.

COOPER: So -- so, they gave you masks at the hospital, and you made sure to wear those around the house?

C. ANASTOS: Yes. Yes. They -- they really did a good job. They explained to us what we needed to do. They gave us the equipment. And we just followed direction, and nothing happened to us. And Arianna is almost 100 percent.

COOPER: Well, I'm -- I'm glad, Arianna, that you're feeling better. It's amazing what a difference two pills can make. And I'm glad you were able to get the Tamiflu.


COOPER: And I'm glad you're feeling better, and I'm glad no one else in your family caught this.

A. ANASTOS: Thank you.

COOPER: Arianna and Chris, thanks so much for being with us.


COOPER: Well, swine flu -- swine flu is a microscopic threat that crosses borders easily and invisibly, making every U.S. airport a potential entry point.

So, what is being done to stop it from coming into the United States? We will have the latest on that ahead.

And we will bring our doctors back to answer your questions.

Also ahead, some stunning developments in the craigslist killer case -- why police may soon expand their search for victims to include men -- plus, the latest on the suspect's summer wedding plans.

And New Yorkers looked up today and saw this, an airliner flying low, and an F-16 chasing it -- tonight, what it was, my New York's mayor is furious, and so, apparently, is President Obama.

We will be right back.


COOPER: Well, health officials around the world are facing a huge unknown. They have no way of knowing if the swine flu outbreak that's causing so much worry will escalate into a full-fledged pandemic. As we said, the U.S. government has declared a public health emergency, a move that President Obama qualified today as a precaution. Take a look.


BARACK OBAMA, PRESIDENT OF THE UNITED STATES: The Department of Health and Human Services has declared a public health emergency as a precautionary tool to ensure that we have the resources we need at our disposal to respond quickly and effectively.


COOPER: But as we just pointed out, in a world where people travel far and often, containing any flu outbreak is a major challenge.

Thelma Gutierrez has the latest on efforts to stop swine flu from spreading from Mexico to America.


THELMA GUTIERREZ, CNN CORRESPONDENT (voice-over): The San Isidro port of entry south of San Diego is the world's busiest land border crossing. More than 100,000 people cross here each day.

Customs officials say they're on heightened alert. But, despite news alerts and evidence of growing numbers of those infected with swine flu virus, traffic here is still heavy as usual.

Customs and Border Patrol agents are closely watching people crossing into the United States, and those who appear sick get a secondary screening.

As for air travel, flights are still arriving in the United States from Mexico, though federal officers are watching passengers for signs of illness. And some travelers are wearing masks.

But travel headed toward Mexico is about to plunge. Travel advisories issued this afternoon now warn Americans not to go to Mexico if they don't have to.

JANET NAPOLITANO, HOMELAND SECURITY SECRETARY: They encourage individuals to avoid any nonessential travel to Mexico for the time being. You may ask how long will the alerts be operative? And the answer is, we don't know.

GUTIERREZ: With their frequent briefings and decision to distribute antiviral medications to states, experts say the government generally gets good marks for its swine flu response.

There is concern, however, that if the outbreak explodes into a pandemic, public health laboratories will be overwhelmed. A recent report says budget cuts have resulted in the loss of 11,000 state and local public-health jobs.

JEFF LEVI, TRUST FOR AMERICA'S HEALTH: That could really be a threat because it would delay our ability to identify what's going on. And that's critical to a rapid response. GUTIERREZ: Experts say hospitals don't have enough beds, masks, gloves or ventilators.

IRWIN REDLENER, COLUMBIA UNIVERSITY: I think the country needs on the order of a couple of 100,000 additional ventilators over what we have now.

GUTIERREZ: At the Old-Town Mexican cafe in San Diego, family members like Herb Lizalde worry about loved ones in Mexico who are required to wear masks and take extreme precautions in their daily lives.

HERB LIZALDE, RESTAURANT OWNER: The military's handing them all out. So it's kind of a thing that they have to do.

GUTIERREZ: Required measures that give so many Americans with family in Mexico a little peace of mind.


COOPER: Thelma, if tens of thousands of people are going through, what exactly are customs agents doing during this -- what they call the heightened alert?

GUTIERREZ: Anderson, right now they're calling it passive observation. They're not out asking each and every one of the cars that are going through whether or not they're sick.

Instead they're looking for very obvious signs of the flu. They say if they spot someone who appears to be very sick, they can pull that person over, question them. And then if need be, they have a guardian tee quarantine area where they can actually place these people and then turn them over to health officials. So far say they haven't even found one of those cases, so that's good news at this point.

COOPER: All right. Thelma Gutierrez, thanks.

As we said, there's no way to know if this latest swine flu outbreak will escalate. Certainly hope it doesn't. The last thing we want to do is fuel any alarm.

That said, public health experts have long been worried that we won't be prepared when the next flu pandemic hits. And there's good reason for their concern.

Tom Foreman tonight is "Keeping Them Honest."


TOM FOREMAN, CNN CORRESPONDENT (voice-over): Back in 1976, a swine flu scare spurred announcements on TV and calls for nationwide vaccinations.

UNIDENTIFIED MALE: Get a shot of protection, the swine flu shot.

FOREMAN: But a congressional report last fall says more than 30 years later, we're still not ready.

The government wants enough vaccine developed and available to inoculate all 300 million citizens in six months for any kind of flu. But at best, current American production might protect one in five.

At the Center for Infectious Disease Research and Policy, Dr. Michael Osterholm.

DR. MICHAEL OSTERHOLM, CENTER FOR INFECTIOUS DISEASE RESEARCH AND POLICY: We have made investments in this country. In fact, the United States has made more investments in influenza vaccine work than any other country in the world. But at the same time, it's still a long ways from having a modern, efficient, really a very effective influenza manufacturing infrastructure available.

FOREMAN: The report finds multiple problems. Vaccine production techniques are old and slow. With little profit in developing new ones, American industry shows little interest. And while foreign producers could help, in a pandemic, they'd likely keep their vaccine at home.

The U.S. government could spend more money developing drugs called adjutants (ph) that stretch vaccine supplies. Europe is ahead of us on that. And in times like this, everyone likes such ideas.

UNIDENTIFIED MALE: We want to be aggressive.

FOREMAN (on camera): But when the crisis passes, governments, industry and the public lose interest quickly.

In 2006, an avian flu scare had governments worldwide vowing to stockpile enough Tamiflu, a drug that treats flu symptoms. Not even a vaccine. And yet shortages remain.

UNIDENTIFIED MALE: If this virus does result in a human pandemic in the next weeks and months, we are going to be in a world that is going to need a lot of vaccine that it's not going to have.

FOREMAN: "Keeping Them Honest," we were warned.

UNIDENTIFIED MALE: Swine flue? I'm too fast for that to catch me.

FOREMAN: Tom Foreman, CNN, Washington.


COOPER: Well, answering your questions online right now is Dr. Nathan Wolfe, epidemiologist. You can log onto the live chat at, talk with him.

Also Erica Hill's live Web cast is on from the flue outbreak, during the break.

Scores have been killed, hundreds sickened, and the danger continues. We'll talk to Dr. Sanjay Gupta and Dr. Nathan Wolfe, answering your questions, ahead.

And also tonight, the alleged Craigslist killer. Surprising new developments, bizarre new developments. A report that may change the investigation. Police say the suspect may have also been targeting men online.

And later, fighter jets, what looked like Air Force One flying over New York, New Jersey, rattled a lot of nerves in this city. Led to evacuations. What was behind this flight? The story ahead.


COOPER: Tonight, police may have found a possible motive fort the Craigslist killer. Reports out today revealed that med student Phil Markoff was in serious debt. We'll tell you how much in a moment.

At the same time, some new developments on the investigation, including a woman who says she was his first victim.

The biggest surprise, perhaps the strangest, is an allegation that Markoff may have been targeting men on Craigslist, as well.

Randi Kaye has the latest in tonight's "Crime & Punishment" report.


RANDI KAYE, CNN CORRESPONDENT (voice-over): The victim profile in the Craigslist killer case may be on the verge of a makeover. A spokesman for the Suffolk County D.A.'s office tells me the hunt for victims could include men if evidence warranted.

(on camera) Investigators may want to talk to this man who told NBC he fears he could have become another of Philip Markoff's alleged victims. He says Markoff contacted him twice on Craigslist, once last spring and again in January.

UNIDENTIFIED MALE: I posted an ad on Craigslist under "male for T," which stands for "males for transsexuals."

KAYE (voice-over): The man says Markoff answered an ad in the "casual encounters" section of Craigslist, the same place investigators say Markoff found his other alleged victims. His lawyer says he's not guilty. The man told NBC Markoff e-mailed explicit pictures of himself from the Yahoo! address sexaddict5385.

DON CLARK, FORMER FBI SPECIAL AGENT-IN-CHARGE: If this person is truthful, then the likelihood is, is that he's not the only one male that's out there. There are probably many others.

KAYE: Markoff's lawyer did not return calls about this allegation or about this court document, obtained by CNN, that shows Markoff is broke.

This paperwork, signed by a probation officer, shows Markoff has been unemployed for some time and that the 23-year-old medical student is $130,000 in debt from student loans. That qualifies him for a court-appointed, taxpayer-funded lawyer.

Could that be why he allegedly robbed a woman of $800 in this Westin Hotel? The stripper, who says she met Markoff here, told CBS's "48 Hours" he erased his number from her cell phone, cut the hotel phone line, and this.

UNIDENTIFIED FEMALE: He picked up a pair of my underwear that were on the floor and put them in his pocket.

KAYE: And Markoff's upcoming summer wedding? Seems it's been canceled. The band hired to perform now says on its Web site, "Due to circumstances beyond our control, August 14 is now available to book."

Randi Kaye, CNN, New York.


COOPER: I guess that's no surprise there.

More breaking news on the swine flu outbreak. Where is it? How bad is it? And what you can do? We're taking your questions with Dr. Nathan Wolfe and Dr. Sanjay Gupta. You can e-mail, tweet or Facebook us.

Also tonight how a 747 ended up flying low over Manhattan not far from Ground Zero. A photo op, believe it or not. Who thought that one up? We'll tell you and tell you why President Obama is fighting mad about it.

Later, take a look at this. A bull in a grocery store sent customers running. It is our "Shot" tonight, coming up.


COOPER: Well, when Suze Orman talks, people listen. A lot of people. The personal finance expert's advice is followed by millions. Her tips on money, stocks and savings have made the best-selling author a business icon and one that's earned the respect of many Americans. Her achievements are being honored by "time" magazine who has named her one of the world's 100 most influential people. The issue comes out Friday.

You'll also be able to see a "360" special on Friday, the world's most influential people. The issue comes out Friday. You'll also be able to see a "360 special on Friday.

Tonight a little preview with business journalist Suzy Welch interviewing Suze Orman. Take a look.


SUZY WELCH, BUSINESS JOURNALIST: Somebody tweeted me, "I love Suze Orman. I don't know if she's ever walked in my shoes." SUZE ORMAN, PERSONAL FINANCE EXPERT: Are you kidding? I absolutely -- this is why Suze Orman is Suze Orman, because I have walked in those shoes. I've walked in the shoes of credit-card debt. I've walked in the shoes of being ashamed that my parents didn't have any money. And I wanted to be like all the other kids, and I wasn't.

Why do you think I was a waitress till I was almost 30 years of age, having been one for seven years, making $400 a month? I've walked in those shoes. I've lived in my car for months. I've done all of that.


COOPER: For more of Suze Orman, for more of that interview, you can go to And don't miss the "TIME" 100, 360 special, "The World's Most Influential People" this Friday night. See who else made the list. Should be a fun night.

Right now Erica Hill is back with a "360 News and Business Bulletin" -- Erica.

ERICA HILL, CNN CORRESPONDENT: Anderson, swine flu fear hitting Wall Street, coupled with concerns ahead of a very busy week of quarterly reports, and that combination led to a sell-off today. The Dow off 51. Both the S&P and the NASDAQ also fell.

Saying "I do" in Iowa. Same-sex marriages officially began today in the state. The first couple to exchange vows, Melissa Keaton and Shelly Wolfe. Iowa's highest court legalized same-sex marriages there on April 3.

And in New York and New Jersey, a photo op causing a panic. A backup of Air Force One and two F-16s flew over Lower Manhattan and Jersey City this morning. The catch here: no warning to residents. Even the mayor says he didn't know.

The White House says it was a photo op and insists that city officials were notified.

The mayor actually said he was furious, Anderson. And if the reasoning behind any of this was to keep it classified, he thinks it is ridiculous and very poor planning. A lot of New Yorkers would probably agree.

COOPER: Yes. It's unbelievable that this thing happened -- that somebody thought that was a good idea.

HILL: And the mayor says if he would have known, he would have said, "Don't do it, especially not in Lower Manhattan."

COOPER: Yes. Seriously. Erica, thanks.

Join the live chat happening now at Virus hunter Nathan Wolfe taking part. He and Dr. Sanjay Gupta also answering your swine flu questions next on this program. We'll tell you what you need to know. And a bull in a grocery store. The invasion caught on tape. See what employees did to try to stop him. It's our "Shot of the Day," something to make you smile with all of this heavy news before going to bed. We'll be right back.


COOPER: Earlier, we asked you to send us your questions about swine flu. There are so many unknowns in this story. We're going to get some of those questions now answered.

360 MD Sanjay Gupta joins us again from Mexico City and Nathan Wolfe was here in New York. He's an epidemiologist and director of the Global Viral Forecast Initiative, which is basically an early warning system for pandemics. He's essentially a virus hunter.

Sanjay, our first question comes from a CNN iReporter. Take a look.


UNIDENTIFIED MALE: I have a question. You see people wearing face masks in an attempt to protect themselves from the influenza virus. But isn't it true that the virus is so small that they can make it through the pores of the mask? So why wear a mask in the first place?


COOPER: Sanjay?

DR. SANJAY GUPTA, CNN CORRESPONDENT: Yes, the mask is not foolproof. I think that's for sure. Although it can prevent large doses, if you will, of the virus from entering our nose or mouth and getting into our lungs. That's sort of the idea of it. It can't be used in isolation.

One of the things we're really learning down here in Mexico City is there's a lot of concern about the virus sort of hanging out on inanimate objects like keyboards, ATM machines. One of the things the minister of health pointed out to me, it can get on money, as well. It can get on your hands.

There's less handshaking. There's not the customary greeting of kissing on one cheek. And there's a lot of hand washing. Anderson, we talk about hand washing all the time, but it's probably never been more important than it is now.

COOPER: Dr. Wolfe, we have a question from Emily, who posted this on the AC 360" Facebook page. She says, "Would getting a flu shot reduce our chances of catching swine flu?"

NATHAN WOLFE, EPIDEMIOLOGIST: It's a good question. Not much is really known about this. This is early stages of the outbreak.

Certainly, it's the case that, if our initial reports are correct and that this virus is mosaic, including parts of human viruses, there may be elements of some protective immunity, but I think the current wisdom is that probably these vaccines are not going to afford much, if any, in the way of protection against this particular virus.

COOPER: Sanjay, you agree with that?

GUPTA: Yes. I think that, you know, this is sort of made up of several different components. So could the flu shot provide protection against one of the components? Perhaps.

But I think to Nathan's point, it's not going to be enough. It's not a vaccine for swine flu overall.

COOPER: We've got another one. This is coming to us via Twitter. Natasha wants to know -- oh good, this Dr. Wolfe -- what makes swine flu different from any other flu that kills 30,000-plus a year? Why the worry?

GUPTA: Well, I mean, one primary reason for concern is the lack of immunity, the likely lack of efficacy of the current vaccines against this particular strain. Part of it is it's just unknown. Any time that a novel virus enters into the human population, particularly if it's in a family like influenza that has the potential to cause massive pandemic, this is a reason for concern. Something we need to watch very carefully, which is, obviously, what's being done now.

COOPER: And the strange thing is in Mexico, it's killing people in their late teens, 20s. Who are not normally the victims of the flu. It's usually the very young and the very old.

GUPTA: Yes, that's right. And I think one of the things that happens sometimes is that actually the body's own immune system responds in a very particular way that can cause illness. So in these cases, it's the actually healthy immune system which causes harm to these individuals. Whereas in particular strains that cause more harm to the young and old, it's actually a weakened immune system which is causing harm.

COOPER: Sanjay, this questions to you. We have a question from the AC360 blog. Juanita asks if this means she should cancel her trip to Puerto Vallarta in July? Should people be canceling travel that far down the road?

GUPTA: Boy, Puerto Vallarta sounds nice. I think we're going to have to wait and see on that one, you know, see how this outbreak sort of develops over time. There are no specific travel advisories. They're saying nonessential travel should be sort of thought about before coming to Mexico. So it's April now. You've got a couple of months, I still think, to decide on that one.

COOPER: Sanjay, bottom line for people in the United States watching this right now, I mean, is what, just, you know, be aware of it? Don't freak out. Wash your hands. You know, be aware of people around you?

GUPTA: I think so. You know, we don't exactly know where this thing is going to head right now. The numbers are small right now. We're paying attention to it because this is a new virus, one that we haven't seen before. And we don't have natural immunity to it.

It may fizzle out. It may be something that we talk about in years from now as something that just happened but has never really amounted to anything.

But if it turns out to be something more than that, then people need to have as many knowledge as possible about this. And a lot of how we deal with this is going to be on an individual basis, sort of containment even at the family level.

COOPER: Do you agree with that?

WOLFE: I do. I mean, the other thing that I would just add to that is we don't know what's going to happen with this particular virus. But what we do know is that it's part of a pattern that we're seeing. Viruses are going to continue to enter into human populations from animals. And they're going to continue to affect us.

Part of what we're doing right now, it's very important. I mean, this is sort of like response to a heart attack. And you definitely need to respond to heart attacks.

But I think an important point is that these things are going to continue to happen. So we need to try to move a little bit earlier in this process and to try to be able to predict and possibly even prevent much earlier in this process by, for example, doing some of the work that we do, which is to actually monitor individuals who have close contact with animals. Potentially then we could catch these things before they hit Mexico City.

COOPER: You're actually tracking viruses as they cross over from -- you're tracking what viruses cross over from animals to humans all around the world with global viral forecasting initiative.

WOLFE: That's right. I mean, what we know is that's the commonality to all these things, whether it's Sars, Ebola, HIV. They all come from animals. And so what that gives us is the potential to create a monitoring system which can catch these things at the moment that they're entering. So they're constantly pinging us.

And so if we do catch them at that point, we may be able to really make a difference.

COOPER: Dr. Wolfe, great work. And appreciate what you doing.

WOLFE: Thank you very much.

COOPER: Appreciate you being on the program tonight. Sanjay as well. Stay safe there, Sanjay.

"The Shot" coming up next. It's going to kind of make you smile or at least be glad you weren't in the supermarket. Wait until you see how the employees tried to stop a bull running around in this supermarket. Crazy. And at the top of the hour, we'll have more on the breaking news of the swine flu threat. All the facts you need to know. Not the hype, just the facts. We'll be right back.


COOPER: All right, Erica. For tonight's "Shot," something you do not see every day, thankfully, and really something you never really want to see unless it's on YouTube, of course. It comes to us from Ireland, where as you can see, a bull trots right into a local supermarket. The bull meanders down the aisle, checks out the storage room.

HILL: Looks for the specials.

COOPER: Some of the people just flat out run. Others put up barricades to try to stop the bull. One used a shopping cart to barricade the fellow in. That did not work.

The bull escaped, apparently, from a livestock market.

HILL: Can you blame him?

COOPER: I know. The farmer is actually running down the aisle after the bull. Then does an about-face as the bull kind of charged after him.

HILL: Poor bull.

COOPER: I know.

HILL: He just didn't want to be eaten.

COOPER: He was later caught. No one was hurt, apparently. We have no idea what's now happened to the bull. To said bull.

And there the bull leaves.

HILL: I hope he got to go live in a nice pasture somewhere.

COOPER: That's what we'll say happened.

HILL: He could roam the aisles of the pasture.

COOPER: Exactly.

Coming up at the top of the hour, serious stuff, the swine flu outbreak spreading and the new efforts to stop it. We'll be right back.