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Swine Flu Continues to Spread;
Aired May 02, 2009 - 16:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
FREDRICKA WHITFIELD, CNN ANCHOR: President Obama talked about the epidemic during his weekly radio and web address. He said the government is taking all necessary precautions.
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PRES. BARACK OBAMA, UNITED STATES: As our scientists and researchers learn more information about this virus every day, the guidance we offer will likely change. What will not change is the fact that we will be making every recommendation based on the best science possible. We will also continue investing in every resource necessary to treat this virus and prevent a wider outbreak.
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WHITFIELD: Americans are urged to take precautions but to avoid panic. Scientists at the Centers for Disease Control and Prevention say they are learning more about the H1N1 virus all the time.
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DR. ANNE SCHUCHAT, CDC, SCIENCE PUBLIC HEALTH PROG.: I think it's really challenging to find that right balance to stay alert and attentive and take those important steps personally or in your communities. What I want to say is that we have a new influenza virus. It's spreading.
We don't know as much as we would like about the way it's going to behave in our communities and we are learning a little bit more each day about the way it behaved in Mexico. But the picture is still very incomplete.
Here in the U.S., we are trying to act aggressively and quickly so that if it does turn out to be a moderate or severe influenza strain that we are prepared and we have the research to treat people that we can reduce the spread.
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WHITFIELD: So just how dangerous is this new flu strain. Joining us with some critical information is Dr. Carlos Del Rio, an infectious disease expert from Emory University. So initially before we heard this new report about Costa Rica, I was about to ask you, is this being over blown.
Because certainly a lot of viewers and readers are saying, wait a minute, now I feel like this is making me very nervous. When we talk about this virus now spreading, it's really is indeed very serious.
DR. CARLOS DEL RIO, EMORY UNIVERSITY: Yes, it is. And it is because this is a new virus to which the entire human population has never been exposed to and the possibility of a pandemic that causes significant disease and mortality exists. But as Dr. Anne Schuchat just said from CDC, we don't know how severe this virus is. It could be very severe. It could not be.
Some of the data coming in right now from Mexico for example where they experienced most of the deaths suggest that maybe the mortality is about one percent, maybe a little higher, but it's not what we initially suspected.
WHITFIELD: And we talk about pandemic that is imminent. And we are right now at phase five, according to the World Health Organization. And it is characterized, I'm just going to summarize it because this is what the W.H.O. put out on its website.
It's characterized by human to human spread of the virus into at least two countries in one W.H.O. region while most countries will not be affected at this stage, the declaration of phase five is a strong signal that a pandemic is imminent.
So what happens when we are in a pandemic. What do we see? What do we experience if indeed we go to that phase six?
DEL RIO: We would be experiencing a lot of what Mexico City is currently experiencing.
WHITFIELD: Almost shutting down.
DEL RIO: Mexico City is currently experiencing a lot of people sick. It's very hard for example for me to call anybody in Mexico and say do you know somebody with the flu, most people say yes. They know somebody and many people know people who have been hospitalized and have been fairly sick with the disease. So pandemic affects multiple individuals.
At phase six, we will have thousands of people affected. Our hospitals will be full. A friend, for example, said an emergency room over the last weekend did more than 3,000 tests.
WHITFIELD: OK. And this is phases of pandemic alert. We are looking at this stage right here. We're at this orange, five, evidence of significant human to human transmission. And Dr. Carlos del Rio, what we're going to be talking about a number of things in this hour.
Everything from travel. How do we contain this virus? What do we need to be doing on a day to day basis? A lot of drugstores across the country are now finding that they have zero stockpiles of face masks as well as hand sanitizers. We're going to address all of those things. You're going to be with us throughout the hour.
And Josh Levs is also there fielding a number of questions from our e- mailers, our viewers and sending us all kinds of questions and comments. Give us a taste, Josh, of what we're going to be hearing from people?
JOSH LEVS, CNN CORRESPONDENT: Fred, I really look forward getting some answers while you and I were talking. Just now, we heard from a woman that she and husband have canceled plans to go to a wedding tonight because they were just in Cancun. Is that the right call? Is it a bad call? We're going to get some answers to that.
Also this one, we got a question really interesting here from someone who has a job where he has to handle a lot of I.D. badges. Can he get the flu that way? Really interesting questions we're getting. On your Facebook page and my Facebook page, so many questions coming in.
One person saying you know what there is a conflict between what the CDC is saying and some other reports that I'm getting. We're going to dive into all of this throughout the hour via e-mail, Facebook and also twitter.com, joshlevscnn. You can reach us any which way, we're going to get as many answers as we can.
WHITFIELD: All right. Perfect. In fact you know, since we have a little bit of time, Dr. Del Rio, maybe you can answer the question of the person with the wedding, that e-mail coming in. Should they go to the wedding? It may have been nine days ago that they were in Mexico, but isn't there an incubation period of like seven days?
DEL RIO: Yes but as you said, if it's nine days ago, there is no risk. Now they just came back yesterday. They could still be incubating the virus. But most people are not entirely infectious until they actually have symptoms. We think people start transmitting may start a few hours or maybe up to a day before they actually get sick, but most of the transmission occurs when people develop the symptoms. So they - my suggestion is if you are not having a cough, if you're not having a fever and you feel perfectly fine, go to the wedding.
WHITFIELD: Wow. She might like to hear that. OK. I'm sure she is very glad to hear that. Thanks so much. We'll be hearing from you again throughout the hour. So washing your hands, is that enough to try to contain any spread of this virus?
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WHITFIELD: All right. Some schools are closing to prevent the spread of the H1N1 flu virus. Right now, more than 400 schools in 19 states have actually shut down. Among them, a school district in Madison County, Alabama which is. Huntsville.
Joining us by phone, the superintendent of that district, Terry Davis. All right, Mr. Davis, give me an idea what kind of guidelines are you getting from the CDC or perhaps from the Alabama Health Department about the criteria used in in which to make the decision to close down a school district.
VOICE OF TERRY DAVIS, SUPERINTENDENT MADISON COUNTY: Well, I'm actually in an adjacent district to the district that actually closed schools down. But obviously all three superintendents have been in close contact with the county medical personnel and with the state personnel.
They are doing a beautiful job of advising us. As a matter of fact, we just got off of a conference call with Dr. Williams from Montgomery. So there is no one person making all the decisions. They are constantly in contact with the CDC to help us make the right decisions.
WHITFIELD: So you have not closed your schools? You're saying the school system in the adjacent county have?
DAVIS: Well, we all, all three. This happened on Wednesday afternoon when we were notified we had some cases within our county. We had three school districts within our county. Almost 50,000 plus kids here. The smaller district is the one that actually had the children in their schools. But the decision was made for all the three systems at that point to go ahead and close for the remainder of the week.
Now with the exception, this is kind of a fluid situation right now in my district. I do not have any confirmed cases. We are planning to open back up on Monday morning unless there is something compelling that comes out of our study over the weekend. We have another meeting with the MA and all the city and county officials tomorrow at 12:00. And I guess -
WHITFIELD: What kind of sanitation measures are being taken in your school district in order to welcome kids back come Monday and feel comfortable and know that parents are going to feel comfortable that their kids necessary are in a safe environment?
DAVIS: Well we actually as soon as we got the decision that we were going to close on Wednesday night, we pulled in all of our directors and met until about 11:00 that night. We came in the next morning and met with all of the principals and we had a listing there and our director in charge of custodial services already had a document prepared for them to make sure that they could take these back to their custodians to do the cleaning and all types of things.
Now there are all sorts of things we did and basic cleaning is just -- they told us it was not anything really. They say that it's something we would deter it other than having hygiene just good hygiene across the schools.
WHITFIELD: Washing hands, trying to -
DAVIS: They did tell us to focus in on the lower grades and on special needs areas where kids were more likely to exchange bodily fluids and those types of things. We focused on a lot of those.
WHITFIELD: So you are feeling pretty confident as you move into the next school week?
DAVIS: We feel that we are very well prepared. We have asked our principals to spend about an hour with our teaching staff and some called them in yesterday and some are doing it early Monday morning and we are having our nursing staff meet with them and talk them through the actual virus itself. WHITFIELD: OK.
DAVIS: We will have them as employees and -
WHITFIELD: All right. Madison County, Alabama superintendent Terry Davis, thanks so much. All the best.
All right. Colleges and universities also taking action to limit the spread of the H1N1. Some are actually postponing and even canceling graduation ceremonies. Northeastern University in Boston held its graduation ceremony yesterday, as planned. But school officials did do away with the traditional hand shake between deans and students.
Graduates wiped their hands with hand sanitizer before the ceremony began and you saw kind of a motion was taking place. Bottles of sanitizers were placed under faculty chairs.
All right. If you are heading to church tomorrow, watch for some precautions there as well. Concern over the flu virus had many churches changing the way they actually conduct services. Rituals where you may notice changes, well sharing wine from a common chalice. Receiving communion on the tongue, sharing a loaf of bread and shaking hands. Instead of communion on the tongue, mostly in the palm of the hand now.
All right. Cutting back on human to human contact and stop this flu from actually spreading, we turn again to our infectious disease expert, Dr. Carlos del Rio. All right. We are getting instructions about hand washing, hand sanitizers and we're talking about trying to combat any potential spread of this virus. How helpful and is this really the only measure that we should be taking?
DEL RIO: Well, the most important measure once you have cases, is obviously to isolate the cases, to make sure that those people that are infected are not in contact with other people and they can potentially spread it. So the technique that of what you have described as social isolation.
WHITFIELD: People not shaking hands.
DEL RIO: And somebody - the most important measure is that if somebody is sick, they should go to the doctor. They shouldn't go to school. They shouldn't go to work. Because that's where the highest risk is.
How many of us when we had a bad cold have said you know I will get over this. I still have a very important appointment today. I need to go to the doctor, I need to go to the grocery store. If you are like that, either stay home or go to the doctor.
WHITFIELD: But isn't that what make this is as odd? Just like a typical or type A influenza, initially you seem like you have a bad cold. You have a sore throat. There are some sniffling, maybe some body aches. But what's difficult is for a patient to discern OK, when do I need to go to a doctor, how do I know it's serious? DEL RIO: Again, this is not the time of year to have influenza. If you're starting to have a cough, chest discomfort, sniffles, high fever, headache, muscle aches, like you're having a bad flu, go to the doctor. Don't go to work. Don't go to school. Go to the doctor.
WHITFIELD: OK. Lots of questions coming in from people via e-mail, i-reports and all sorts of measures. Josh Levs is fielding many of them, what questions do we have for the doctor right now?
LEVS: You know what Fred, I'm going to start with one here, someone asking would it be a good thing to get the swine flu right now. And it's interesting because -
WHITFIELD: Would it be a good thing?
LEVS: Yes. And I will tell you why. She says she was hearing about the 1918 pandemic and what happened at the time is it got some people and it went dormant for the summer and came back in the fall and killed a lot of people. So her question right here, are the people who have already been sick going to have a natural immunity if it comes back in the fall?
Basically, I'm asking, should we try to get the H1N1 virus now so that we won't get sick if the virus mutates and gets stronger in the fall. I'm sorry Liz, not Lisa. So, doctor, I have a feeling I know the answer. What is the answer to that?
DEL RIO: The answer is no. You don't want to get any infectious disease because there is always a risk. Now we need to say that what she is trying to also tell us is a, yes, we don't have a vaccine yet and we may or may not have a vaccine for the wintertime.
We don't know if this virus is going to come back in the winter time, but obviously health authorities and everybody is very conscious and there are going to be a lot of surveillance looking, making sure there no cases. But at the end of the day, the protection is the same whether it's right now or in the fall. You need to wash your hands, you need to be careful of respiratory secretions and you need to go to the doctor if you are sick.
LEVS: But for the record, you mentioned to me earlier that she is right about the history. It did go dormant for a while and it came back that fall and it was a lot worse at that point.
DEL RIO: Yes, indeed.
LEVS: It doesn't mean it will happen now.
DEL RIO: That's what exactly happened in 1918.
LEVS: Right.
DEL RIO: We don't know if that's going to happen this time around.
WHITFIELD: OK. What else? LEVS: Fred, let's take a look at your Facebook page. This is really interesting here. Someone says he has heard a lot about the masks. What about regular old hankies?
I'm a big fan of a handkerchief, changed daily and laundered with my shirts, looks nifty in the pocket too. Will the handkerchief keep my germs for me. Doctor, is that a good idea?
DEL RIO: Anything you do to cover your sneeze, to cover your cough is important. If you use your elbow, that's good. If you use your hand that is not good because then you shake hands or touch something else or put it on a doorknob. But if you have a handkerchief, you can use it but just wash it every day.
LEVS: All right. I think I have a few seconds left, let me bang out one more really quickly. John Sullivan over on my Facebook page, question, to this story that we did, that Randi Kaye did called the "Anatomy of a Sneeze," where she saw people on the subway. If you sneeze, your germs get on a lot of people. He says I saw that report but then I heard the CDC say you know what, if not so bad, you can go on the subway now. Doctor, is it safe to ride in the subway now?
DEL RIO: I think it's absolutely safe to ride in the subway, you know, it can be sneezed on, it could happen. But if you really think, think about Mexico City. Mexico City is a city of 20 million. Five million everyday ride in the subway of Mexico City. With the number of cases they have, they would have had several thousand cases if this was still transmissible in the subway.
LEVS: OK.
WHITFIELD: I think they are concerned. A lot of people think about the spores, you know, that kind of airborne and enter into your body in different you're your mouth, your nose, your ears. And I guess the feeling is from a lot of people that boy it sure is easy to get something from a sneeze.
DEL RIO: Yes, but again -
WHITFIELD: From even someone who is just two persons away from you.
DEL RIO: Again, we don't know how transmissible this virus is.
WHITFIELD: Yes, just don't know how bad.
DEL RIO: And we don't know enough to say everybody gets infected or just a few people.
WHITFIELD: OK. Well one of the things we do know about this virus, at least, particularly with the confirmed case in the U.S., most people have been able to recover without any antiviral. However, there is Tamiflu and there is Relenza available, but then what's potentially next, a vaccine. How close are we to a vaccine?
(COMMERCIAL BREAK) WHITFIELD: All right. More now on government efforts to deal with swine flu. the H1N1 virus. While anti-viral drugs like Tamiflu and Relenza won't prevent H1N1, they can be used to actually treat it. As mentioned, at least in the United States, most people have recovered on their own.
The federal government said it has indeed enough anti-viral medicine stockpiled to treat 50 million people if necessary. It says individual states have enough medicine stockpiled to treat another 23 million people. The Defense Department has a stockpile of antiviral medicine as well.
So researchers around the world are trying to find a vaccine for this deadly flu virus. Dr. Peter Hotez is the president of Sabin Vaccine Institute. He is in Washington. Before we talk about the vaccine, let me ask you about this stockpile of the Relenza and the Tamiflu. Because I also heard we all did from the W.H.O. that they actually thank the U.S. for helping to share some of the stockpile with some countries. So given that, do we still have enough of the stockpile to treat American citizens if need be?
DR. PETER HOTEZ, SABIN VACCINE INSTITUTE: Well, I think it's important to point out, first of all, thank you for having me this afternoon.
I think it's important to point out that what we are seeing now may look very different a few months from now. We know that influenza exhibits a very seasonal pattern. What we classically see as a large rise in influenza. It's one of the most seasonal viruses that we know, that rises in October, December, and January. And so the big crunch is going to come six months from now.
WHITFIELD: So you do think it will be - we'll have more cases again?
HOTEZ: Look, clearly the most important preventive measure we can do right now is ensuring that we have a safe and effective vaccine by November or December.
WHITFIELD: OK. So we are talking about what between four and six months before a vaccine could be developed.
HOTEZ: That's right. It's a very tight window.
WHITFIELD: Good. We're talking about the fall and the winter, then we're saying that just in time, there just might be a vaccine. How confident about that are you?
HOTEZ: Well, the three major vaccine manufacturers have done an excellent job in responding to needs to make vaccines in a timely manner. Remember influenza is unlike many other viral infections such as measles and that it undergoes a big change each year. So every year, the vaccine industry has to make a new round of influenza vaccine. So they are fairly adept at turning around vaccines in a fairly quick period.
There are a lot of problems though in making influenza vaccine. It assumes that the virus can grow an egg. So right now, all of the vaccine that is going to be available in December will have to be producing eggs, we are not yet ready for newer cell culture-based techniques which will probably come online a year or two from now.
WHITFIELD: So, Dr. Hotez we are also joined by Infectious Disease specialist Dr. Carlos Del Rio, just back from Mexico, you also have family in Mexico. Talk about how concerned you are about them and at the same time you were there on business as an infectious disease specialist. What did you discover or what did you learn, if anything, in your travels to Mexico?
DEL RIO: Well, number one I think the most important thing I learn is how quickly and how effective the measure that the Mexican government established where the decision there rapidly last a week ago Friday to close all schools in Mexico City and by that weekend to close all social events. For example, the soccer matches last Sunday were played but they were played at empty stadiums. All churches closed.
All those measures that were implemented very rapidly by the government and very decisively are beginning to take effect. We're beginning to see stabilization of cases there and decrease mortality. But the other thing I saw is the social response. The population responded an incredible way. There were no riots. There were no people going to the grocery store and just getting everything. They were really very responsible and doing the right things and people are being very careful not shaking hands, covering their cough -
WHITFIELD: And it has been impressed there with the washing of the hands and I also understand there many regions in Mexico where an abundance of water is not just there for the hand washing. So then what?
DEL RIO: Many regions in Mexico City, shanty towns, simply don't have clean water, but others spend a lot of distribution of alcohol-based gels for people to have.
WHITFIELD: OK.
DEL RIO: But you know, a very critical issue has been for example, face masks. Masks are distributed over city there. Last weekend, the government distributed over five million masks.
WHITFIELD: Wow.
DEL RIO: But you have a city of 20 million.
WHITFIELD: Yes.
DEL RIO: There is still 15 million people that haven't gotten - exactly.
WHITFIELD: Lots of e-mail questions coming our way. Josh Levs has been fielding all of them. So you got questions for Dr. Hotez as well as Dr. Del Rio.
LEVS: Absolutely. Yes. I tell you Fred, a lot of people are writing us are suspicious or confused when it comes to these statements that it takes a long time to create and took a long time to create the potential vaccines. So what I want to do is toss this to Peter.
Let me just show you an example, Tara is saying that. Tabibi wrote this, for example, I mean don't you just need to get someone with the virus and take the virus out and weaken it? Obviously, it's far more complicated than that. But Peter, perhaps you could give us really simple terms, why does it take that long? What has to be done? The simplest term as possible.
HOTEZ: So there a number of very clear cut steps that have to be taken. First of all, you need to modify the swine flu virus. So that it grows well in egg. So there are some genetic modification that the virus has to undergo. That takes some time. Then you have to start inoculating the virus into eggs and you have to be assured that there's enough eggs around.
I remember these are special eggs. These are embryonated hen's eggs that have to be sure that's there and then you start inoculating the eggs, you recover the virus from the egg and put into a fluid -
LEVS: Complicated than a lot of people realize.
HOTEZ: That's right.
WHITFIELD: Dr. Del Rio agreeing with you, Dr. Hotez, about the whole eggs and making sure you have a great supply of that. Josh, do you have any other e-mail questions for us, for everyone?
LEVS: Yes. One more from VK who says the U.S. had swine flu before. Why was a vaccine not developed already? Why is it all so new suddenly? Who do you think, Fred?
WHITFIELD: Dr. Del Rio, why don't you tackle it -
DEL RIO: In 1976 there was an outbreak in Ft. Dix about swine flu. A vaccine was produced and we know exactly what happened. The vaccine unfortunately caused significant neurological complications and in fact more people died out of the vaccine than they did with the swine flu epidemic back then. So again, not only does a new vaccine needs to be developed but it needs to be tested. It needs to sure, safe and effective vaccine. That is going to take some time. the vaccine industry and the vaccine researches are working overtime to make sure we have that.
WHITFIELD: So Dr. Hotez, it sounds like what's key now is the time to do this and approach this vaccine because we got so many more confirmed cases now that of course you didn't have prior to so how could you develop a vaccine?
HOTEZ: Well, that's right. And so, it's worth pointing out that the swine flu vaccine of today is different from the swine flu vaccine of 1976. In fact, many the human influenza viruses, maybe many people are not aware of this, comes from pigs. Pigs are the great reassortment vessel by which bird influenza virus strains and human virus strains come together. And then people become expose. So it requires each time to develop an entirely new vaccine from an entirely new strain.
WHITFIELD: All right. Dr. Peter Hotez, thanks so much. Dr. Carlos Del Rio, we got more e-mails coming our way as well. Josh, I know. Our own Dr. Sanjay Gupta, he too, was in Mexico recently. He is now back, but before he has decided to kind of kick back his heels a little bit and recover from his trip while he stopped by the CDC for a rare inside view of what's taking place at the heart of the investigation of this flu.
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FREDRICKA WHITFIELD, CNN ANCHOR: We're going to get back to our swine flu H1N1 update over the next hour but first we want to keep you up to date on what else is happening in the news.
Three top republicans met with voters in Arlington, Virginia today. Former Florida Governor Jeb Bush, house minority whip Eric Kantor and former Massachusetts Governor Mitt Romney say they want to listen and learn. It's the first of a series of town hall meetings aimed at rebuilding the GOP after last year's losses.
President Obama is looking for a replacement for Supreme Court Justice David Souter. Souter plans to retire after the end of the current session. The White House hopes to have a replacement confirmed by the time the court reconvenes in the fall.
Hispanic groups are outraged after a trial in Pottsville, Pennsylvania. Two teenagers accused of beating an illegal immigrant to death were found guilty of simple assault. An all white jury found them not guilty of the more serious charges including murder.
We are continuing our special hour spreading outbreak. Spreading fears in the swine flu epidemic or H1N1. By the way, as we have been on the air now, we understand that President Obama and Mexico's President Calderon actually spoke for about 20 minutes this afternoon to share information about each country's efforts to limit the spread of the flu strain and the importance of close U.S.-Mexican cooperation.
Now we are continuing our discussion here with a panel of guests standing by to answer some of your questions. We have Dr. Peter Hortez who is with us, we've got John Barry who is the author of "The Great Influenza." Dr. Carlos Del Rio as well and Josh Levs who is also filtering through so many of your e-mails that you're sending us because people have questions about this H1N1 swine flu. What is it? Where did it come from? What are we going to do? Josh let's begin with you and the first question that folks may have to our experts here.
JOSH LEVS: Fred, I actually want to pick up on something that you were just talking about there. President Obama and the president of Mexico, I don't know if our guests want to answer, but I'm going to talk to that just in case because a lot of people are saying similar things. Look what Roger is saying. "It's outrageous after being politically correct the administration did not close the border with Mexico immediately after the flu was announced." I think I saw about 50 emails, Facebook postings saying close the border, do something to the border. Would this in the end have solved anything though? That's for our doctor, since you can still fly as a tourist either way.
WHITFIELD: All right, I'd let Dr. Del Rio?
DR. CARLOS DEL RIO, EMORY UNIVERSITY: Clearly cases were first reported actually here in the United States in San Diego. They were already happening here before they were reported in Mexico, not that it wasn't happening in Mexico. But this is a huge border, lots of people going back and forth, lots of things going back and forth. It is virtually impossible to shut down the border. I think that's been tried for the drug trade, I don't think this has worked at all, so we need to be careful about saying that.
There is such an intertwined community and economy. I wrote an editorial for CNN recently in which I made it very clear that for example, if we were to have a huge, large flu outbreak in this country we need ventilators for the hospitals for people who are sick with the lung disease. The ventilators, the national stock pile has plenty of ventilators but something that is needed in the ventilator which are called the circuits, they're not produced here, they're produced in Mexico. If you shut down the border, you wouldn't be able to function in the United States with those equipments. So I think our economies are so intertwined that thinking about shutting the border is done by people that just don't understand how our economies work.
WHITFIELD: And we have so many more questions for you our experts, Dr. Hortez, Dr. Del Rio as well as John Barry. But first the nonstop work to develop a vaccine. It is happening at the Centers for Disease Control and Prevention. CNN chief medical correspondent Dr. Sanjay Gupta had just recently returned from Mexico and you know how I mentioned before he gets a chance to kick back, he made a stop at the CDC. Well Dr. Sanjay Gupta he never kicks back.
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DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT (voice-over): After five days in Mexico, hunting down one of the first cases of the swine flu virus, I'm back in Atlanta. Now, if there's a place where every bit of news about swine flu is converging, it's here, the Centers for Disease Control and Prevention. Before they would let me into the main control center, a checkup, here in the medical clinic to make sure I wasn't sick. They tell me, I'm fine.
(On camera): So, now we're ready to take a look at the nerve center of the CDC, something known as emergency operations control. Take a look over here. Hundreds of people have been in here working day and night for over the last week. Take a look at those screens up there. Those screens monitoring cases as they come in, trying to put it all together. Trying to piece it all together, trying to get control on this outbreak.
UNIDENTIFIED MALE: Everybody you see in here is here because of the outbreak.
GUPTA: What else do we have over here? TOBY CRAFTON, MANAGER, CDC COMMAND CENTER: Each one of those regions that you see on that map right there has a team of epidemiologists and folks that are working on making sure that they track each one of the cases in that region. So, they are literally down there getting calls from all those states. Talking to the state health officials. Talking to the epidemiologists in each state and tracking the numbers.
GUPTA (voice-over): Tracking cases, looking for clues, sending out investigators. The guidelines on those Ft. Worth school closings, they came from here. But today, the focus seems to be shifting. What if this spirals into a full-fledged global outbreak? And what if we need a vaccine.
(On camera): I want to show you something that very few people get a chance to see. We're in the back hallways here in the CDC in the laboratory area, and look through this window over here. That woman is working on the swine flu virus. While those samples come here, what she is doing underneath the hood, she's obviously protecting herself, is to try to check to see if the swine flu virus is sensitive to antivirals. But I can tell you the early testing shows that it's quite sensitive to tamiflu.
DR. MICHAEL SHAW, ASSOC. LAB DIR., CDC INFLUENZA DIVISION: This particular virus with this particular combination of genes we've never seen before in humans or animals. It was totally new.
GUPTA: Michael Shaw runs the lab. Are we making a vaccine?
SHAW: Yeah. We're all learning right now. We're doing the best we can, as fast as we can. Which is the message I guess we really want to get out, you know, we're working day and night trying to get this done.
GUPTA (voice-over): Here's how it works -- the scientists here at the CDC provide the virus for the vaccine. After that, it's in the hands of the manufacturers. The big drug companies. Has a vaccine been recommended now?
DR. ANNE SCHUCHAT, CDC SCIENCE AND PUBLIC HEALTH PROGRAM: No. We're at the stage where we're trying to understand the situation. We're trying to characterize the severity, and the epidemiologic characters.
GUPTA: If history is any guide, over the next few weeks, H1N1 is likely to fizzle down, but come fall and winter, it could come back. Making a vaccine that much more important and keeping the hundreds of people in this room just as busy. Dr. Sanjay Gupta, CNN, Atlanta.
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WHITFIELD: All right, so one more time let's reintroduce our panel, we've got an incredible panel here answering all of your questions. We've got John Barry the author of "The Great Influenza." Dr. Peter Hortez president of the Vaccine Institute, Dr. Carlos Del Rio an infectious disease specialist and Josh Levs taking your questions from all of you who are watching, sending in your iReports, your e-mail questions and you're visiting us in so many different ways with great inquiry. So John let me begin with you because you studied the flu epidemic of 1918 and you would hope or we would all hope that we kind of learned from the past. Give me an idea of what lessons may have been learned from 1918 that are applicable today with this pandemic.
JOHN BARRY, AUTHOR, "THE GREAT INFLUENZA": There are two different sets of lessons. One is communication, the government needs to tell the truth. In 1918 it did not. It tried to reassure people falsely and ultimately that led to real out right panic in some cases. Influenza victims actually starving to death because people were too scared to bring them food. And as bad as it was it wasn't that bad.
The other lesson is a lot of the social distancing measures, school closing and things like that that are being recommended now are a result of studies of what cities did in 1918 and trying to over lay some modern statistical analysis and correlate what actions may have had some impact on slowing down the disease.
WHITFIELD: There are other questions from our viewers, Josh has one.
LEVS: Yeah John I will tell you, the most popular thing we're hearing today is people saying everyone's making too big of a deal of this swine flu. Look at history, it's not that big of a deal. Here's one example that we have on Facebook from Tim O'Connor. "To me Josh the swine flu has never been an issue. Don't folks realize a thousand people die each day from common flus all over the world." John, you know history well. Are people making too big of a deal of this swine flu so far?
BARRY: Most of last week I was actually trying to get down people's concerns. But now there seems to be a lot of the attitude you just expressed. This is still very serious. 1918 between 50 and 100 million people died in that outbreak, that's somewhere between 3 and 5 percent of the entire population of the world. That is pretty severe. Now even though we are not facing probably anything like that, even a very mild flu epidemic, you know the annual regular flu as I'm sure your viewers have heard by now many times kills 36,000 Americans a year.
But a new virus is going to infect many more people than the regular seasonal flu because they won't have any immune protection against it. Even if it's no more deadly than ordinary influenza, it will still kill many more people the first time people's immune systems see it. In fact, the CDC did a study in 1999 of what a mild 1968 type pandemic virus would do and it believed that it would kill a minimum of 89,000 Americans. It got worse from there. This is still something that needs to be taken seriously.
WHITFIELD: All right John and Josh and doctors, we're going to have much more. We have more questions coming your way and of course we are coming upon a time of the year, spring and summer people want to travel. But now new worries.
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WHITFIELD: Welcome back. Vice President Joe Biden raised a few eyebrows with something he said this week regarding traveling and the flu outbreak.
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JOE BIDEN: I would tell members of my family and I have, I wouldn't go anywhere in confined places now. It's not that it's going to Mexico, it's you're in a confined aircraft when one person sneezes it goes all the way through the aircraft. That's me. If you are out in the middle of a field and someone sneezes, that's one thing. If you're in a closed aircraft or closed container or closed car or a closed classroom, it's a different thing.
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WHITFIELD: Well oops! The CDC's acting director says there is no increased risk with flying or subway travel, but he says people who have flu like symptoms should be responsible and not put others at risk. As you might expect, the vice president's comment is not going- over very well with the travel industry. The U.S. travel association president Roger Dow issued this statement saying, "Elected officials must strike a delicate balance of accurately and adequately informing citizens of health concerns without unduly discouraging travel and other important economic activity." He added that, "According to President Obama, swine flu is a cause for concern, but not panic."
So let's talk to somebody who knows the travel industry very well. Amy Ziff is with Travelocity and she knows how easy and hard and frustrating it's going to be to change any travel plans right now. Amy, the operative word is patience and our Josh Levs has been getting a whole lot of questions from people who want to know, if you can answer their questions about travel. So, Josh?
LEVS: Fred, I will tell you something. Travel has become the number one topic of discussion right now on your Facebook page and on mine too with respect to the swine flu. Amy, I will tell you, this is interesting. Gina has posted about this, she said, she understands some of these rules about what you can bring on a plane and not bring on a plane. You can't bring on certain sizes of hand sanitizer. Is there any suggestion that maybe the airlines will change that rule to help protect people's health?
AMY ZIFF, TRAVELOCITY: I don't see them changing the rule, but I do see them potentially handing out sanitizers that are permissible in that case. Even in Mexico City, they are actually handing out masks for people. So that might become something that they would do if it's necessary. But at this point it hasn't been ruled as necessary.
WHITFIELD: And remember I guess for travelers usually like three ounces or less so that's still a pretty good little size there.
ZIFF: That's right. And the other thing is just remember that personal hygiene habits are really good. They're saying you should wash your hands frequently and you can do that from an aircraft. So just go to the bathroom and do that. I personally travel with those little wipes and I always wipe down the seats and the arms and the tray table when I'm on an airplane. LEVS: Good point, the wipes don't count as liquid. You can bring on those wipe things. I wouldn't have thought of that. Sorry. Part two of this over here. "Should I contact my doctor to get a preventive prescription of some sort?" I know one thing you look at Travelocity when you're flying to certain parts of the world, you need sometimes to get certain shots. In this case, are there certain medicines or things that people should take on their trips?
ZIFF: Well in fact it's always prudent to have a bit of a first aid kit when you travel, but that doesn't include necessarily the kind of anti-virals that doctors are recommending in the case of this H1N1 flu.
WHITFIELD: Tamiflu, relenza, I mean you have to get a prescription for that.
ZIFF: Right, but they're saying wait, let that go to the people who really need it. Don't do a run on the pharmacies for that. Until it's recommended, I would say good to have a basic first aid kit with you but not necessary.
WHITFIELD: Ok, we have about one minute to squeeze in a couple more questions from people.
LEVS: I will summarize this for you. Amy I will tell you a lot of people are writing out their specific itineraries, I'm planning to fly to California, I'm going to Florida, and blah, blah, blah. You can't answer every single one. Is there anywhere that people can figure out a good place to travel, a place not to travel at all. Does Travelocity answer that? What should people do with their itineraries?
ZIFF: Well essentially we are following the CDC and the World Health Organization and their recommendations and there are absolutely no recommendations against closing borders or not traveling. So people should feel comfortable where there aren't travel advisories or warnings in effect to get on the road, whether it's air travel, train travel or car travel and go.
WHITFIELD: All right, so say I have a plane ticket to Mexico or on a cruise line and one of my ports of call happens to be an affected place. What do I do because it's likely some of those carriers are not going to honor my ticket any more.
ZIFF: Let's separate them out. For the airlines, basically you are going to be allowed to change the dates of travel if you have a current ticket through generally the end of May. Now every carrier is doing something slightly different, for example Jet Blue, Delta, US Air, they're allowing you to take the amount of money that went to an unused portion of your ticket and apply that to future travel elsewhere. But American and Continental they want you to do the same itinerary that you were originally booked on just at a later date. With the cruises they are skipping Mexican ports of call but you can rebook on a different itinerary later if you're on Carnival, Royal Carib, Celebrity they are just not going to those Mexican ports of call for now. Some ships will go to other places in the Caribbean or the Bahamas instead while others will just simply have a day at sea instead.
WHITFIELD: All right, I think we're out of time on our e-mail questions to you Amy, but you were great in zipping through all of this. Amy Ziff, zipping through it.
ZIFF: Sure thing.
WHITIFELD: All right appreciate it. Much more straight ahead. We have more e-mail questions coming your way for the doctors and Josh Levs is delivering some of those questions as well as to our author John Barry.
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SEAN CALLEBS, CNN CORRESPONDENT (voice-over): Wireless technology is everywhere and soon it could even be inside us. Sound hard to swallow, well peep the i-pill.
JEFF SHIMZU, PALPS RESEARCH: What we're doing is we're putting smarts on board of a drug delivery pillar.
CALLEBS: Part medicine, part machine. The i-pill is equipped with micro sensors and GPS like medication so it knows exactly where it is in the body, when it's time to deliver the dose it goes to where your body needs it most. According to researchers this makes the medication work better and limits potential side effects.
SHIMZU: Medications today are basically designed for the average person. Some people it helps, some people there's no effect and some people it makes sick. But if you can change that for the person, then you can widen that range of people who are going to be effectively treated by your medication.
CALLEBS: The i-Pill is still being tested on animals, but it could be instrumental in fighting crone's disease, colitis and even intestinal cancer. Down the road, the small mechanics on this revolutionary pill could have an even larger effect.
SHIMZU: (INAUDIBLE) along the line with the future and personalization of health care. We are programming that pill for you and we are seeing if you are responding and changing as time goes on. Rather than just sending you off with a bottle of pills and call me back in two months.
CALLEBS: Sean Callebs, CNN.
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WHITFIELD: We're finalizing our hour now on H1N1 swine flu and last opportunity for questions to our experts Dr. Carlos Del Rio infectious disease specialist at Emory, Dr. Peter Hortez president of the Sabin Vaccine Institute. And John Barry author of "The Great Influenza" and Josh Levs who has some of your e-mails. All right so Dr. Hortez, let me just ask you first. We are encroaching upon the winter months in terms of a possible return of this flu. So, does this mean that everyone really should be getting a flu vaccine even though we're talking about type A that usually combats?
DR. PETER HORTEZ, SABIN VACCINE INSTITUTE: We have to see how severe the outbreak is. I think it's worth pointing out that many people don't realize that a lot of the vaccine that's going to be consumed in the United States is actually produced offshore. While some vaccines made in the U.S. we're going to have to depend on the UK, on Germany and Belgium for good cooperation to ensure that we have enough vaccine available come the winter.
WHITFIELD: All right, the final question for Dr. Del Rio from you Josh from our viewers as well as to John.
LEVS: Yeah absolutely I was just taking a look at some of the final questions we've been getting. Let's take a look at this one, it's kind of mysterious, I got this on Twitter from Autumn Meadows. What do you do if your kids have recurring flu symptoms and their pediatrician refuses to give them the swine flu test. I'll tell you she's not the only one that said that.
WHITFIELD: Dr. Del Rio what do you do?
DEL RIO: I think refusing is such a strong word. I think a doctor needs to make a decision whether a test is indicated or not so you need to trust your doctor if the doctor thinks the symptoms are not consistent with influenza, but more of like a common cold. They're not going to do a test because a test that is done on a patient that doesn't have a disease actually has a high probability of giving a false positive. A doctor will know when to order a test and when not to order a test.
WHITFIELD: All right and real quickly in about 10 seconds or less, John Barry, international cooperation, how important it is based on what we've learned from 1918, now looking forward, how important it is for the world to cooperate together on this?
BARRY: That is extraordinarily important and so far we've done a pretty good job. I think Mexico was a little bit slow in getting information out there.
WHITFIELD: Ok, John Barry, Dr. Carlos Del Rio, Dr. Peter Hortez, Josh Levs and Amy Ziff who was with us a bit earlier too. Thanks to all of and thanks to you viewers for sending in your very riveting and probing questions so that we all have a better understanding of H1N1. This is getting crazy. Also referred to as swine flu. All right thanks so much, I'm Fredricka Whitfield, see you again tomorrow. At the top of the hour Don Lemon examines the Chrysler bankruptcy and asks what it means for consumers in the next hour of the CNN NEWSROOM.
