Subject: Swine Flu
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STAFF: Good afternoon. Thanks for being here.
In a minute, Secretary Napolitano is going to make some remarks and then open it up for questions. She is joined with her today by the Undersecretary of State for Management Pat Kennedy and the president's counterterrorism and homeland security adviser, Mr. John Brennan.
SEC. NAPOLITANO: Thank you. Good afternoon.
This is the second daily briefing, and we will do these on a regular basis as we work our way through these -- this swine flu issue, what is happening at the governmental level and what is happening around the world.
First, I would like to inform you that today both the CDC and the State Department will be issuing travel alerts related to swine flu and related to travel to Mexico. What those alerts mean is that they encourage individuals to avoid any nonessential travel to Mexico for the time being.
You may ask, how long will the alerts be operative? And the answer is we don't know because, obviously, it's related to how much swine flu is being detected. But those alerts are in the process. I think CDC has already posted theirs and State Department is in the process of posting those travel alerts.
Secondly as President Obama said this morning, swine flu is a cause for concern but not a cause for alarm. We are simply in preparation mode. We do not yet know how widespread this flu will be within the United States. So we continue to move aggressively to prepare.
I spoke this afternoon with Mexico's ambassador to the United States, so that our governments are moving in tandem. And I will be speaking later on with my counterpart in Canada. We really have a trinational approach to the flu issues.
As I said yesterday, I issued a public health emergency declaration. That permitted today the -- an emergency authorization that allows the FDA to proceed, to permit things like Tamiflu to be used for populations that they otherwise wouldn't be used for, in this case, for example, very, very young children.
The Department of Homeland Security is conducting conference calls with state public health and homeland security officials, on a daily basis, to discuss developments related to swine flu. And I've reached out to the governors of each of the states where a confirmed case has arisen.
As I said yesterday, we're in the process of activating our national stockpile of antiviral drugs. The priority is placed on states that have been affected, as well as states along the border. And antivirals already are on the way to some of these states.
All states will have access to the national stockpile. And full deployment is expected by the 3rd of May. The Department of Homeland Security, excuse me, continues to direct people entering the United States, from Mexico, who appear to be sick, to the CDC or to local health officials, to be evaluated.
In addition, travelers' health alert notices are being posted at ticket counters and gates, within the airports. And at the land ports, there's a tear sheet that is being handed out to travelers.
We are reaching out to the private sector, to make sure that they are preparing and to inform them of the latest actions we are taking. It's important that they be thinking ahead about what they would do, should this erupt into a full-fledged pandemic, which it has not yet, by the way.
And finally we are taking precautionary measures, with respect to the health of our own workforce. We have prepositioned antivirals, for all the nine Border Patrol sectors and for our Coast Guard sectors, to assure that they remain at full strength.
We provided guidance to all employees on how to use antivirals.
We continue to stress, the CDC continues to stress, the Department of Health and Human Services continues to stress, that common sense will go a long way here to mitigate the impact of any flu. And common sense means washing hands; staying home from work or school if you feel sick; covering your mouth if you cough or sneeze. These are straightforward and simple measures, but they can materially improve our chances of avoiding a full-fledged pandemic.
Everybody has a role to play here. It's our function to make sure that what the government is doing is coordinated, that we are thinking in advance of the problem. But again, government cannot do this alone. We all have an important part to play.
So with that, alerts are posted -- information is available, by the way, for people who are interested. The CDC website is a very, very good website; cdc.gov/swineflu is the exact address. In addition, www.state.gov and www.travelstate.gov -- travel.state.gov, the two State Department websites, also have information. And of course, the Department of Homeland Security's website has information and will click you over into other department websites as well.
With that --
Q Can --
SEC. NAPOLITANO: John, Pat, we'll be happy to take some questions.
STAFF: (Tom ?)?
Q Can you give us any information about how many people coming into the U.S., either by land port or by airports, have been referred to -- (you know, to see ?) health authorities?
SEC. NAPOLITANO: Don't know yet. We're -- we're just in the beginning process of trying to collect that kind of information. But again, what I've been saying is we'll provide you with information on a daily basis as we work our way through this.
Q How does that work? Someone comes to the border inspection person and is coughing or displays some sort of symptom; is there a health professional right there to seem them? Who -- and who are those folks?
SEC. NAPOLITANO: It depends on which port you're entering at. And -- you know, because there are different sizes, different locales and all the rest. Generally speaking, they're referred to -- or put in another room. I don't want to use the word quarantine, because technically it's not a quarantine. But they're put in a separate room, and they're either questioned by a Customs Border Protection (sic) officer who has some training in this, or, in the bigger ports, a -- either a public-health official who is on site or they call the local public-health authority to have some people brought over.
And they'll question them, and then, if it's ascertained that they may indeed have the flu, they'll make a decision about whether they can go ahead and enter the country and go to a place to get taken care of, or whether they need to go back home.
Q But it doesn't appear to be that the -- that just large numbers of people are being diverted to this secondary inspection?
SEC. NAPOLITANO: Not that I've heard of today. And again, this is a changing scene, and so that may change. But as of today, I've not heard of that.
Q How has Mexico done in responding to this?
SEC. NAPOLITANO: Well, Mexico's had a much more acute problem to solve. And you know the steps that have been taken in Mexico City, for example, with respect to closing down the schools, shutting off places where people would gather, issuing masks and the like. So they are taking every public health precaution one can identify with respect to this kind of an outbreak.
We have people down there now, teams from the CDC. One of the things that we are assisting on is laboratory capacity for running diagnostic samples, but also collecting good data, because it will help us for our planning if we -- if we can see how widespread this really is in Mexico.
Q Can you tell us, Madame Secretary and perhaps Mr. Brennan as well, a little bit about when the United States government first became sort of fully aware of, you know, these events in Mexico and how you began to come up with your response, one? And then what about today brought on the travel alert? What changed today to -- (off mike) -- a travel alert?
SEC. NAPOLITANO: Sure. John, you want to -- okay.
MR. BRENNAN: The first instances of the influenza down in Mexico were the end of last week. In terms of confirmation, it was like Thursday or Friday of last week. So the Mexican health authorities knew they had a health issue, and therefore they sent the samples to both the Canadian labs as well as to CDC. And so the confirmation that it was swine flu was last week.
But to date, at least from my perspective, the Mexican authorities have been exceptionally cooperative and forthcoming. Both Secretary Napolitano and I have spoken to the Mexican ambassador. I think there's been very strong cooperation.
SEC. NAPOLITANO: Yes. And Ginger (sp), by Friday we were beginning to assemble the information and form the interagency team that would need to work this issue over the weekend. And under HSPD- 5, you know, I was designated as the principal federal official. And we began -- that whole process was well under way as we worked throughout the weekend.
Q Since Friday. And it was Mexican authorities who first notified the United States?
MR. BRENNAN: (Off mike) -- it was through the health -- through the health --
SEC. NAPOLITANO: No, there were health issues.
MR. BRENNAN: -- professionals that were cooperating, both U.S. and Mexican health officials.
Q And the State Department question about why today the travel alert?
SEC. NAPOLITANO: I think that is just in part because the data -- as the data becomes more robust, then better decisions can be made about what actually needs to happen.
Q What kind of guidance are you giving state and local governments in terms of what they should do if they have cases of the flu now?
For instance, are you suggesting, if it's in a school, they close down the schools?
SEC. NAPOLITANO: The CDC has issued community mitigation guidance to communities, and we can give you an actual copy of that.
Q Madame Secretary, have you issued any notes or information for local law enforcement -- (off mike)?
SEC. NAPOLITANO: We are in touch with local law enforcement, and we're in touch with diffusion centers in the various states. And they have access to all the material, for example, that's posted on the CDC website, our website and the like, for whatever use they care to make.
Q Would the administration be making any kind of additional budget request of Congress, other actions taken, actions that may be taken, or are you deferring to other -- (off mike) -- considerations?
SEC. NAPOLITANO: I don't think any decision has been made on that yet.
Q Can you talk about the lack of personnel across both HHS and DHS? I think the figures for DHS is two confirmed in place; six announced, nominated; 13 unnamed, including the assistant secretary for health, TSA and some new directors. These have not been confirmed and, you know, principal federal officers and chief coordinating officers -- (off mike) -- would it be helpful -- (off mike) -- on the pandemic plan? Has it been triggered? How closely are you following this -- (off mike)?
SEC. NAPOLITANO: Yes, with respect to presidential appointments, confirmees, those roles are all being filled by career civil servants who have a great deal of experience. And as far as I'm concerned, the process -- the work has been moving very smoothly and with great efficiency. So I think we're moving right along in that sense.
With respect to the pandemic play book, you know, the World Health Organization has us at Level Three, which is basically preparatory to pandemic. Today they are meeting with respect to whether that level should be raised. Level Six is actual pandemic. And so we're keying off of that. And even if they raise the level today, our preparations now are as if it had already been raised. So we are proceeding as if we are preparatory to a full pandemic.
We don't know that a pandemic actually will occur, but because we want to make sure that we have equipment where it needs to be, people where they need to be and, most important, information shared at all levels, we've already organized as if -- as if this were.
Q I think at the next level, at Level Four, that there are possible, in the frame of a pandemic plan, it's possible that the border could be -- parts of the border could be closed down, or increased border surveillance of people coming across. Is that something that's been discussed at this point?
SEC. NAPOLITANO: Well, as I said yesterday, we're already doing passive surveillance at the border. And with respect to closing the border, again, you would close the border if you thought you could contain disease, the spread of disease. But the disease already is in a number of states within the United States, so the containment issue doesn't really play out.
And this particular flu; you can actually have it for a couple of days before you show any symptoms.
And so even if you -- I mean, people could be coming through now, even under passive surveillance, who actually have the flu. So that's a very difficult judgment to make.
Q Other than -- (inaudible) -- at gates at the airport, specifically, what else is TSA doing? Are passengers being questioned? (Inaudible.)
SEC. NAPOLITANO: Well, again, if they're coming from international travel, they have to go through CBP. And CBP is doing the passive surveillance, if passengers appear sick. And they are also asking or able to ask questions, particularly on flights that originate in Mexico.
And we're giving -- on the land ports, as I said before, they're giving out what's called a tear sheet, which is -- we can give you a copy of that. It tells you what to look for and what to do, if you think you're getting ill. And that information is being posted, in the airports and at the gates.
Q Are there any quarantine centers at airports? (Inaudible.)
SEC. NAPOLITANO: My understanding is that we have 19 airports that have quarantine available. That would cover about 85 percent of air travelers. But we haven't activated that need yet. And we may not need to. We don't know. But we have identified where they are, what we would need to do, in case the facts warrant it later on.
Q You say that it takes about three to four days for the symptoms to show up. So people could come in by air, not know that they have it, because the symptoms haven't shown up. And they'll be able to walk right in, right?
I mean, is there any contingency plans for dealing with that? You know, how would you deal with something like that?
SEC. NAPOLITANO: Well, if people are sick, and if you have the flu -- you believe you have the flu; you have a fever; you have a heavy cough -- we're asking people -- I'm asking -- we're asking people, don't go to school; don't go to work. Don't go to a place where you can infect other people.
I mean, the normal tendency is, you know, we have a lot of Type A personalities, and people want to go, keep working. And we're saying, don't do that if you believe realistically that you have the flu. If you don't know but you show some of the symptoms, contact your doctor.
And going to, I think, your question, what you're saying is, people could still be coming in the country; because of a symptomatic may have the flu. And that is true. But again given the number of cases and what's actually appearing and the like, we believe, at this level, the appropriate precautions have been taken.
Q That's about it.
SEC. NAPOLITANO: Thank you all.
STAFF (?): Thanks, guys.
Q Thank you.
Q Your trip abroad?
SEC. NAPOLITANO: I didn't get to go. (Laughter.)
Q It's postponed? Or canceled?
SEC. NAPOLITANO: The deputy secretary went in my place.
Q Secretary, why would -- why -- (off mike) -- very young children?
SEC. NAPOLITANO: Pardon me?
Q Why did -- give authorization for very, very young children to get Tamiflu? Is there a reason for that?
SEC. NAPOLITANO: Well, Tamiflu normally is not prescribed for children under the age of 1.
Q Well, why -- why was the authorization given to authorize that? You mentioned -- I just want you --
SEC. NAPOLITANO: That question you should address to the CDC.
STAFF: Thank you, everyone.