Click photo to enlarge
Dr. Marty Fenstersheib, Health Officer of the Santa Clara County Public Health Department, gives a swine flu briefing at Valley Medical Center in San Jose on April 29, 2009. He specifically spoke about the closure of Branham High School in San Jose this morning to address possible exposure at the school. Branham will be closed for a week. (Gary Reyes/Mercury News)

Santa Clara County recorded its second, third and fourth probable cases of swine flu Wednesday, as public health officials considered unprecedented steps to dampen the spread of the new virus that has hit at least 10 states and 10 California counties.

With the World Health Organization for the first time warning all countries to immediately activate their pandemic preparedness plans, the U.S. announced its first death from swine flu. Around the country, the total number of confirmed cases approached 100 as public health doctors tried to better understand how the virus is being transmitted.

In the valley, a prohibition on large public gatherings, such as the immigration march scheduled for Friday in San Jose, or Bay Area-wide closing of schools are among potential steps that might need to be taken, health officials said, to slow the transmission of the Type A H1N1 influenza virus. Officials cautioned that they are not ready to take any such "social distancing" steps at this point.

But even in one of the world's great hubs of digital information, the virus still seems steps ahead of local health officials' ability to communicate accurate information about its spread. State officials incorrectly reported the number of likely cases in Santa Clara County as seven, while the county's public health department Web site was overwhelmed by the number of hits and was rendered unresponsive for most of the day. Officials set up a hot line specifically for swine flu questions: 408-885-3980.


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Worried that they might be infected with swine flu, county residents have been flooding area emergency rooms. Valley Medical Center reported the number of visitors to its emergency room has increased by more than a third this week. Behind the scenes, public health nurses and investigators worked the phones and visited with family members and other close contacts of known cases, trying to gather information about how the virus spreads.

'Novel virus'

"This is a novel virus, a virus that to our knowledge a human being has never been exposed to before," said Dr. Mark Horton, California's chief public health officer. "That's why we're paying much more attention to this than any annual seasonal flu."

Dr. Sara Cody, Santa Clara County's communicable disease control officer, has watched as the WHO has raised its influenza pandemic alert two levels since Monday. Santa Clara County declared a local state of emergency Wednesday to marshal state and federal resources.

"There is some adrenaline; this is what we've been training all our lives to do," Cody said. "It's a little bit of a surreal feeling. We are not quite certain whether or not this is for real."

Indeed, health officials said that while the virus has killed more than 150 people in Mexico, and the U.S. Centers for Disease Control and Prevention announced Wednesday the death of a 23-month-old Mexican child who was in Texas, no one yet knows the full threat the new flu strain presents. Health officials note that the seasonal flu kills 36,000 Americans a year.

Still, with schools proving such a potent source of transmission, Marty Fenstersheib, Santa Clara County's top public health officer, said Bay Area public health officials have discussed under what circumstances they may need to close all schools in the Bay Area, should the virus continue to spread or increase its virulence.

"All of us in the Bay Area have been looking at this and talking about the question," he told reporters Wednesday. "We have not made any decision. We have decided that at this point, it is not appropriate to close the entire school system, and we would certainly want to do something regionally."

Fenstersheib said public health officials were also "monitoring" the situation with large public gatherings such as the march for immigration reform, prompting organizers to affirm Wednesday that the march is on. The march will begin at 4 p.m. Friday at Story and King roads in San Jose and proceed to San Jose City Hall. Many of the 10,000 expected marchers will be Mexican citizens and Mexican-Americans.

Salvador Bustamante, co-chair of the Silicon Valley Alliance for Immigration Reform, said he was upset that health officials were even considering canceling the march.

"I doubt the county has the authority to prevent people from making use of their constitutional rights," he said. "I don't think we should treat people like children. People are very aware of what's going on."

While all four of the presumed Santa Clara cases have been relatively mild — none requiring hospitalization — health officials say they must remain vigilant because the virus could turn more virulent as it spreads through the U.S. population.

New cases

Among the three probable swine flu cases announced Wednesday — a 30-year-old man and a 32-year-old woman, both of whom had recently been in Mexico, and a 53-year-old woman — health officials said two live in San Jose and one in Santa Clara. A "probable" case means health officials have identified an infection as belonging to the "A" family of influenza viruses, but have not completed subtyping the virus to absolutely confirm the H1N1 strain.

For at least the next few days, local health workers will be hustling to interview close contacts of those affected in an effort to learn more about the spread of the virus. Fenstersheib said the county is dispatching teams of four to five nurses to interview the immediate family members and "close contacts" of those who have contracted the virus. But the teams have no intention of interviewing, for example, all the classmates of the 16-year-old girl from Branham High School in San Jose, who has Santa Clara County's first probable case of swine flu.

Local health officials suggested that people with a fever of over 100 degrees go to their own doctors or a health clinic to seek medical care — not the already overburdened emergency rooms.

Fenstersheib said the county should have plenty of antiviral drugs once it gets its allotment from the state, and that it is important that valley residents "not panic."

"We have no intention of quarantining anybody," he said. "The cases here have been very mild. "... This is not like the cases we've been seeing in Mexico."

Contact Ken McLaughlin at 408-920-5552 or kmclaughlin@mercurynews.com.