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By NICK CUMMING-BRUCE and ANDREW JACOBS
Published: June 11, 2009

GENEVA — The World Health Organization raised its alert on swine flu to the highest level on Thursday, in its first designation of a global pandemic in 41 years.
Calling further spread of the virus “inevitable,” the organization’s director general, Margaret Chan, said, “We are at the earliest days of a global pandemic.” The new H1N1 strain, she said, is “spreading easily from one person to another, and from one country to another” in more than one region of the world.
But the pandemic is “moderate” in severity, she noted, with the overwhelming majority of patients experiencing only mild symptoms and a full recovery, often in the absence of any medical treatment. And scientists are painstakingly tracking its every movement.
“The virus is spreading under a close and careful watch,” Dr. Chan said. “No previous pandemic has been detected so early or watched so closely.”
The heightened alert came after an emergency meeting with flu experts here that was convened after a sharp rise in cases in Australia, which reported 1,263 cases on Thursday, and rising numbers in Britain, Japan, Chile and elsewhere. The declaration will trigger drug makers to speed up production of a swine flu vaccine — expected to take a minimum of 4 to 6 months — and prompt governments to devote more money to containing the virus.
As the disease moves into the developing world, where rates of chronic disease are high and health systems typically poor, Dr. Chan said, “it is prudent to anticipate a bleaker picture.”
The virus itself can also change quickly, she said, and even those nations that have already experienced a rash of cases “should prepare for a second wave.”
“The virus writes the rules, and this one, like all influenza viruses, can change the rules without any rhyme or reason,” Dr. Chan said.
Unlike seasonal flus, which have taken their highest toll on the very young and the very old, Dr. Chan said, most severe cases of the new H1N1 virus have involved people between the ages of 30 and 50, while overall, the majority of all infections have occurred in people under 25.
Some 2 percent of infections, Dr. Chan said, have resulted in severe illness, with rapid progression to pneumonia. Based on preliminary data, asthma, cardiovascular disease, autoimmune disorders and obesity are the underlying conditions that most put people at greater risk. Around a third to a half of the severe cases occurred in previously healthy young people, she said.
Pregnant woman are also at heightened risk, a particular concern for the developing world, Dr. Chan said, which already reports 99 percent of maternal childbirth deaths worldwide.
Typically, pandemics take six to nine months to move throughout the world. This one has been detected early, giving health officials what Dr. Chan called a “head start.” And as the disease continues, it will be important to add to the health resources of poorer countries, Dr. Chan said. Vigilance must be maintained, she said, “for the next year or two — and beyond.”
“Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection,” Dr. Chan said. “We are all in this together and we will all get through this together.”
The W.H.O. released a report on Wednesday saying that 74 countries had reported 27,737 cases of the disease and 141 deaths since April. Those cases had been heavily concentrated in the Americas, but the rise in cases in Australia and elsewhere indicate communitywide spread in other world regions. According to W.H.O. rules, the organization should declare a pandemic once it finds evidence of widespread “community transmission” — meaning beyond travelers, schools and immediate contacts — on two continents.
The last pandemic, the Hong Kong flu of 1968, killed about 700,000 people worldwide. Ordinary flu kills 250,000 to 500,000 people each year, international health officials have said.
Meanwhile, around the world, efforts to limit the spread of the flu continue. In Hong Kong, which is especially skittish about the flu after its experience with a lethal SARS outbreak in 2003, authorities ordered all kindergartens, primary schools and day care centers to close after an outbreak of swine flu was reported at a local secondary school. The order, effective Friday, will last at least two weeks and affect about a half million students.
Fifty cases of the H1N1 flu have been reported in Hong Kong, but health officials said the 12 infected students at St. Paul’s Convent School were the first cluster. The students are being quarantined at a hospital while officials try to determine the source of the infections.
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Hong Kong health officials said Wednesday that a 55-year-old man was the first person to contract the disease locally. So far, the city has had no fatalities.
Hong Kong’s Health Department says it will order five million doses of flu vaccine and open eight flu clinics. “The government is well prepared,” Donald Tsang, the city’s chief executive, said at a news conference announcing the school closings on Thursday. “There’s no need to panic.”
China confirmed 10 new flu cases, bringing the total number of infections on the mainland to 111. Health officials say all of the country’s flu cases have involved people returning from abroad. According to the Health Ministry, the new cases include a Canadian-Chinese teenager who just returned from Toronto and two children in Shanghai who had been in the United States. There have been no deaths, and more than half of those infected have been discharged from the hospital, the ministry said.
Chinese officials released Mayor C. Ray Nagin of New Orleans from three days of quarantine in Shanghai on Wednesday. Mr. Nagin and his wife had been placed in isolation after a passenger who sat one row ahead of them on a flight from the United States came down with a fever.
Mr. Nagin, who had been set to attend a series of economic development meetings, described the experience as “surreal” and said he and his wife had their temperatures taken every three to four hours. “When you see people coming toward you with full hazmat gear on, it’s pretty interesting,” he told The Associated Press after his release, referring to hazardous material protection.
In New York City, health officials said Thursday that three more people had died from the H1N1 virus, bringing the city’s total to 15, The A.P. reported. One victim was a child under the age of 5, one was a person between 5 to 24 years old, and another was between 30 to 39 years old.
The deaths came one day after health officials announcedthat in a telephone poll of New Yorkers, 6.9 percent of the 1,006 surveyed reported having flulike illness, like fever and cough or a sore throat, between May 1 and May 20, that may or may not have been swine flu.
Extrapolated to the general population, that would mean that about 550,000 people could have become sick with the virus. The 530 citywide who have been hospitalized make up a tiny proportion — about one-tenth of 1 percent — of those who became ill, an indication of how mild the virus generally has been, officials said.
The total number of swine flu cases reported to the nation’s Centers for Disease Control and Prevention and other national, state, and city health authorities worldwide likely do not account for hundreds of thousands of cases which were not tested by doctors because of their mildness, flu experts have said.
“The findings don’t tell us exactly how many New Yorkers have had H1N1 influenza,” Dr. Thomas A. Farley, the city’s new health commissioner, said in a statement. “But they suggest it has been widespread and mild in most people.”