Plenty of flu caution as Mexico returns to work

In gleaming office towers and gritty markets, Mexicans returned to work Wednesday after a five-day swine flu shutdown, and dozens returned to a heroes' welcome from "humiliating" quarantines in China. But Mexico's death toll rose, feeding fears of more infections now that crowds are gathering again.

SWINE FLU MAP

The World Health Organization urged countries not to quarantine visitors or impose trade restrictions without scientific reasons. But China defiantly justified its quarantines as protection for its densely populated cities. And even impoverished Haiti turned away a Mexican ship carrying desperately needed food aid because of flu fears.

In Mexico City, friends and co-workers greeted each other with back slaps, firm handshakes - and dollops of hand sanitizer. Some high-rises stationed doctors in their lobbies who questioned returning employees and required visitors to fill out forms stating they had no flu symptoms. Maitre d's in surgical masks stood at attention amid rows of sidewalk tables that were pulled out and washed down for the first time in days.

The city's health secretary late Wednesday announced that all businesses - including sports arenas, dance halls, movie theaters and all restaurants - will be allowed to operate Thursday. But Armando Ahued said businesses must screen for ill people and make surgical masks mandatory for employees and customers.

"We're returning to normal," said Eugenio Velis, 57, a graphic artist sipping coffee with friends in the trendy Condesa neighborhood.

But Ernesto Viloria, 40, worried about his children using public transit and returning to school.

"Nothing can be the same," insisted Viloria, who works in finance. "The virus continues, even though it's declining, and we have to pay attention."

Mexico's government said the shutdown reduced the spread of the virus at its epicenter. Deaths have slowed as the country mobilized an aggressive public health response to the epidemic that has sickened thousands in 24 countries.

Sweden and Poland were the latest countries to confirm swine flu cases, both in women who had recently visited the U.S.

In Mexico, the confirmed death toll reached 42 Wednesday - mostly as backlogged cases got tested, but also two new deaths on Tuesday. It also confirmed more than 1,100 nonfatal cases. Eighty percent of Mexico's swine flu infections have been in and around the capital, and a majority of the dead were between 20 and 39 years old.

There was some concern that Mexico was relaxing too quickly, especially with high schools and universities reopening Thursday, and primary schools reopening next week. While "filter teams" prepared to screen out sick students and teachers, epidemiologists warn that the virus has spread throughout Mexico, and could bounce back.

"We have seen a tendency (of the outbreak) to diminish but not disappear," Health Secretary Jose Angel Cordova acknowledged.

Indeed, this swine flu seems to have a long incubation period - 5-7 days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. And that means the virus can keep being spread by people who won't know to stay home.

But from gritty taco stands to the Cartier store on Mexico City's version of Rodeo Drive, people were glad to be back at work.

Jesus Cortez, 43, manned El Taquito Veloz, "The Speedy Little Taco," in the rough Tepito neighborhood, offering roasted pork on a spit as its specialty - tacos al pastor. Nearby, workers sliced chunks of meat from a boiled steer's skull, flanked by cilantro branches.

Swine flu creates anxiety at some small businesses

Small business swine flu news. Swine flu dilemma? Some small businesses are stocking up on disinfectant wipes and spray. Others are asking employees returning from vacations to Mexico to stay home for a few days.

While the swine flu cases diagnosed in this country appear to be mild, they are causing anxiety at some small companies. Human resources consultants say they've gotten more inquiries from employers who want to prevent an outbreak or need information about sick time policies.

Staffers at Patricia Thorp's Coral Gables, Fla.-based public relations firm are concerned about flu germs in the workplace. Swine flu school closure

"I had a couple of staffers saying, 'what are we doing?'" said Thorp, president of Thorp & Co. So she's been buying disinfectant wipes and hand sanitizers, and the office kitchen is being cleaned each day by the firm's employees, not just the landlord's cleaning crew.

Thorp also had to deal with a flu-related issue when one of the vice presidents was sick. The message from the boss was, don't come to work.

"You have to stay home all week. None of this being a hero," Thorp said she told the staffer, who turned out not to have the swine flu. "It's for yourself but also for everyone else."

Human resources consultants say many owners are wondering if it's legal to force sick staffers to leave work.

SWINE FLU MAP

The answer: "You can ask people to go home if you think there's a reasonable suspicion that they have the flu," said Alecia Latimer, HR services manager for AlphaStaff, a Fort Lauderdale, Fla.-based company that provides human resources outsourcing. Latimer said her company has a large number of worried clients in Orange County, Fla., where tourism is the dominant industry, and in Texas, where there is concern because of its proximity to Mexico. The swine flu is believed to have originated in Mexico.

Labor lawyer Martin Gringer with the firm Franklin Gringer & Cohen in Garden City, N.Y., is also fielding more inquiries. One company asked about two workers who had gone to Mexico but weren't sick.

"They didn't want the couple to come back to work," Gringer said. And, just as with sick staffers, employers do have the right to tell workers they shouldn't come in - as long as the companies aren't discriminating in some way. Gringer warned that employers who tell staffers of Mexican descent that they shouldn't come in might be seen as creating the hostile environment that could the basis of a discrimination lawsuit.

What isn't clear is whether a staffer sent home or told not to come to work must under the law be paid. HR and legal experts have differing opinions. But many advise owners to pay the staffers so they won't be tempted to come to work just to be paid.

"If people are really sick you want to encourage them to stay home," Gringer said.

Latimer's company is also getting questions about sick time policies, and what they need to do if an employee is sick for an extended period of time.

Owners are not required under federal or most state laws to grant employees paid time off when they're sick, but the federal Family and Medical Leave Act of 1993, known as the FMLA, might require that companies give workers unpaid sick leave.

Owners should also keep in mind that granting sick time is a benefit that makes them more competitive employers. A draconian sick time policy is likely to make good employees leave, and make your best prospects think twice about working for you.

A more difficult question is what to do if workers have used up all their sick time. Should an owner give them some more time or dock their pay?

Latimer and Gringer say that's something each owner needs to decide, but if they do opt to give staffers more time off, they have to do the same for all staffers. Which means the slack you're cutting your best employees you also have to cut the worst ones.

Many owners are likely to be flexible. Thorp, who has already been pondering the question, said, "I would just give people the extra day off."

Depending on the type of work a small business does, an owner can get around the issue of more sick time if an employee could telecommute, working on a PC at home. That's not so easy if the company is a manufacturing operation, and the worker has to be physically present to get the work done.

Gringer said employees can in some cases be fired if they're too sick to work, but that step should only be taken in consultation with a labor lawyer or HR specialist. The Americans with Disabilities Act covers some workers who have medical problems, and firing them could mean a lawsuit.

Gringer said employees frequently calling in sick need to be handled case-by-case. While some are legitimately sick, there are some who always seem to out sick on a Friday.

But, Gringer said, "most employers know who's abusing the system and who's not." And the abusers can indeed be dismissed.

Owners who want to learn more about the laws that deal with employee illnesses, including the FMLA and the ADA, should look online.

Was this a swine flue death or not?

Swine flue death or not? This week should have been a joyous time for Judy Trunnell, a 33-year-old teacher who had just given birth to a healthy baby girl. But the friends and relatives whose cars lined the quiet street in front of her home in a quiet subdivision Tuesday instead were mourning her, the first American citizen with swine flu to die.

Swine flu school closure

Trunnell died after being hospitalized for two weeks. She slipped into a coma, and her baby was delivered by Cesarean section, said a cousin, Mario Zamora.

"She was just a beautiful person, warm at heart. She worked with disabled children as a teacher," Zamora told WMAR-TV in Baltimore. "Those that knew her will always remember her."

Texas health officials stopped short of saying that swine flu caused Trunnell's death. State health department spokeswoman Carrie Williams said the teacher had "chronic underlying health conditions" but wouldn't give any details.

Pregnant women should not be alarmed, state health department spokesman Doug McBride said Wednesday.

"There are a number of health conditions that put people in a higher risk group where they are more likely to develop serious complications should they get any type of influenza," McBride said. "Pregnancy is not a chronic condition."

Trunnell died early Tuesday after being hospitalized since April 19, said Leonel Lopez, Cameron County epidemiologist. She was extremely ill when she was hospitalized, said Dr. Joseph McCormick, regional dean of the University of Texas School of Public Health's Brownsville campus. Swine flu school closure

Trunnell taught in the Mercedes Independent School District about 15 miles west of her hometown of Harlingen, a city of about 63,000 near the U.S.-Mexico border.

Mercedes school Superintendent Walter Watson said he was told early Tuesday that Trunnell died after being taken off life support.

"It brings tears to my eyes to my eyes to know she won't be with our children or hers," he said.

"You just don't replace people like that," Watson said.

When students were told Tuesday that Trunnell would not be coming back, some of the older students had questions, said Travis Elementary Principal Pearl Guerrero. Some wanted to know about her baby. Others wanted to know about her 4-year-old daughter whom some had met.

"She was a young lady who had everything to live for," Guerrero said. "She was excited to have a new baby. She had so many things to look forward to and now she's gone."

Trunnell was first seen by a physician April 14. Doctors knew she had flu but did not know what kind, Lopez said. The area is undergoing a Type A influenza epidemic and swine flu is one variety of that, he said. She was confirmed to have swine flu shortly before she died, he said.

U.S. health officials on Tuesday withdrew their recommendation that schools with suspected swine flu cases shut down for two weeks. Mercedes school district officials said the district would close its schools until Monday.

The only other swine flu death in the U.S. was that of a Mexico City toddler who also had other health problems and had been visiting relatives in Brownsville, near Harlingen. He died last week at a Houston children's hospital.

There have been 29 other confirmed swine flu deaths, all in Mexico. Hundreds of cases of the disease have been confirmed in several countries, but mostly in Mexico and the U.S.

Don't try 'pox party' for swine flu

It seems logical: Why not try to get sick with swine flu now, and get some immunity in case it comes roaring back this fall in a deadlier form? Sort of like those "pox parties" to get your kids exposed to a childhood disease.

Bad idea, flu experts say. It's too risky.

It's true that once your body has encountered a particular virus strain, it is generally better able to fight it off later on. Vaccines work by masquerading as germs, priming the immune system to attack particular bugs.

The current swine flu appears no deadlier than ordinary flu, but scientists worry that it could return in a more lethal form during the regular flu season in fall and winter. That's what happened in the deadly pandemic of 1918, and there's evidence that people who got sick earlier that year had protection when the lethal wave came.

So wouldn't it be a good idea to get sick now?

"I understand the logic (but it) leads you astray," said Dr. William Schaffner, a flu expert at Vanderbilt University.

He said there's no way to predict how bad a case of flu will be in a particular person. Given the risk of life-threatening complications, "this is not something where you want to do a biological experiment," he said.

"You can't control the infection that you're going to get, and you may be the one, or your child may be the one, that gets a severe infection."

What's more, a person who decides to get sick can accidentally pass it along to other, more vulnerable people, even before any symptoms show up, he said.

Dr. Robert Atmar, a flu researcher at the Baylor College of Medicine in Houston, agreed. He said he would "strongly recommend against" purposely trying to catch the new flu.

For one thing, it's not yet clear that swine flu will return in deadlier form this fall. "Why roll the dice when you may not need to?" he asked.

He also said flu medicines should be available to ease symptoms of patients during the winter flu season, and that scientists hope a vaccine will be ready by then.

15 is median age of US swine flu hospital cases

What is the swine flue age? People hospitalized in the United States for swine flu are turning out to be younger than is typical for regular flu. U.S. health officials said the median age for confirmed hospital cases in the United States is 15. And in Mexico, new figures showed that almost half of the 42 confirmed swine flu deaths were of people 29 and younger.

Some experts have speculated that older people exposed to more flu strains in the past have built up greater immunity.

At a briefing on Wednesday, Dr. Richard Besser, acting director of the Centers for Disease Control, said older people's immunity might be one possible explanation. Or he said it might just be that younger people have tended to get sick first in the outbreak.

During the regular winter flu season, elderly people and those with chronic health conditions are the most likely to be sent to a hospital.

The age range of those in U.S. hospitals with swine flu is eight months to 53 years. There are 35 people hospitalized with confirmed cases of the new flu in 14 states, the CDC says.

Besser said the CDC has little information on other medical conditions of hospitalized patients that might have made them more vulnerable. So far, no single health problem has emerged as a dominant factor, he said.

On Tuesday, Mexico's Health Department released figures showing Mexicans 19 and younger accounted for more than half of those confirmed ill from the virus.