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Fears of flu rebound as Mexico seeks 'normalcy'

Mexico announced a return to "normalcy" yesterday, preparing to reopen businesses and schools even as the virus sickened more than 1,400 people in 20 countries.

World health officials said the global epidemic is still in its early stages, and that a pandemic could be declared in the days to come. But Mexico's president said it was waning at its epicenter, justifying Wednesday's end to a five-day nationwide shutdown he credits for reducing the spread of the new virus.

Already, streets in the capital seemed more lively, with more vehicles and fewer people wearing face masks. Some cafes even reopened ahead of time. President Felipe Calderon said universities and high schools will reopen on Thursday, and younger schoolchildren should report back to school on May 11.

"The school schedule will resume with the guarantee that our educational institutions are in adequate hygienic condition," promised Calderon, who called on parents to join educators in a "collective" cleansing and inspection of schools nationwide.

"This is about going back to normalcy but with everyone taking better care," Calderon said.

Parents and teachers will turn away children who appear sick. The government is spending US$15 million for detergent, bleach and soap to clean buildings, in a country where 12 percent of the nearly 250,000 schools - about 30,000 - lack running water or bathrooms.

Mexico canceled its biggest celebration of the Cinco de Mayo holiday today, a re-enactment of the May 5, 1862 victory over French forces in the central state of Puebla. Other holiday events also were canceled.

And experts inside Mexico's swine flu crisis center warned that the virus remains active throughout Mexico and could bounce back once millions return to work and school. It also may get worse north of the border.

"The bottom line is that there hasn't been time for the severe illnesses to perhaps show up in the US yet," Marc-Alain Widdowson, a medical epidemiologist from the US Centers for Disease Control and Prevention, told The Associated Press.

Experts in the US also urged caution, even as a New York City school reopened Monday after a spring break trip to Mexico led to as many as 1,000 people being sickened.

"We are by no means out of the woods," said Dr. Richard Besser, acting director of the CDC.

Health Secretary Jose Cordova insisted that swine flu infections are trending downward after 27 deaths at the center of the epidemic, including a toddler from Mexico who died in Texas. He said those infected appear to pass it on to an average 1.4 other people, near the normal flu rate of around 1.3.

Cordova said soccer stadiums and concert halls could reopen - if fans are kept 2 meters apart.

But other experts said the known cases are almost certainly only a fraction of what's out there, meaning more illnesses could surface once crowds gather again in Mexico.

"It's clear that it's just about everywhere in Mexico. I think now there is considerable person-to-person transmission," Widdowson said. And now that the virus is taking off in the US, chances of severe cases could rise as well.

"We've seen in many of the cases in Mexico, there's been sometimes five to seven days of being mildly ill with increasing respiratory distress and then being hospitalized, and then spending five days or a week in hospital, so that's a timeline of two weeks," he said.

As of Monday, Mexico had 802 confirmed cases, and US case grew to at least 383 in 36 states. Globally, the virus has reached more than 1,447 people in 20 countries - still in its early stages, to the World Health Organization.

The WHO was studying whether to raise the pandemic alert to 6, its highest level, which would mean a global outbreak has begun. WHO uses the term pandemic to refer to geographic spread rather than severity. Pandemics aren't necessarily deadly. The past two pandemics - in 1957 and 1968 - were relatively mild.

"We do not know how long we will have until we move to Phase 6," WHO Director-General Margaret Chan said. "We are not there yet. The criteria will be met when we see in another region outside North America, showing very clear evidence of community-level transmission."

The Southern Hemisphere is particularly at risk. While Africa still hasn't reported any swine flu infections and New Zealand is the only country south of the equator with confirmed cases, winter is only weeks away. Experts worry that typical winter flus could combine with swine flu, creating a new strain that is more contagious or dangerous.

Still, the UN health agency urged governments to avoid unproven actions to contain the disease, including group quarantines of travelers from Mexico and bans on pork imports.

"Let me make a strong plea to countries to refrain from introducing measures that are economically and socially disruptive, yet have no scientific justification and bring no clear public health benefit," Chan said in a video message to the UN General Assembly in New York.

Calderon said other governments have treated his citizens unfairly, and that punishing nations that report outbreaks sets a bad precedent for future flu control efforts. "If they weaken us economically or in other ways, Mexico will be able to focus much less attention and funds on this problem," Calderon said.

Mexico's Economy Secretary, Gerardo Ruiz, said Mexico will bring the issue to the World Trade Organization if other countries don't drop restrictive measures.

In Tokyo, 37 passengers and two flight attendants on a flight from Los Angeles were detained in a hotel after Japanese officials suspected one traveler of having swine flu.

They were released about 10 hours later when the passenger, a Japanese woman coming back from Las Vegas, tested negative for swine flu, American Airlines spokesman Tim Smith said.

The latest figures from Mexico suggest the virus may be less lethal and infectious than originally feared. Only 38 percent of suspected cases have turned out to be swine flu, and no new deaths have been reported since April 29. But Cordova acknowledged that about 100 early deaths in which swine flu was suspected may never be confirmed because mucous or tissue samples were not collected.

Widdowson, of the CDC, said it's too early to say the outbreak is waning in Mexico, but the signs of progress are clear.

"What we have not seen in Mexico City is a huge, runaway epidemic, and I think that's totally clear. The hospital capacity has not been exceeded. So there hasn't been anything like the kind of picture that people might expect from a severe flu," he said. "I think that gives us optimism."

Good hygiene can be a challenge in Mexico's crowded schools - a problem illustrated by 10-year-old Carolina Arteaga, who wandered with a plastic cup in downtown Mexico City yesterday, begging money from people outside gleaming office towers. She had no surgical mask and no gloves as she eagerly rubbed a few coins together with grubby fingers.

"I forgot it at home," the fourth-grader said when asked why she didn't have her mask.

Carolina will soon be returning to school and says she knows to wash her hands frequently. But because she needs to collect money to help her mother buy food, such instructions probably won't be carried out.


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