Rumors of a swine flu outbreak in Florida reached a fever pitch today, as health officials from Orlando to Tallahassee stressed that a suspected case in Orange County remained unconfirmed, even though a sample was sent to a state lab for further testing.
And Carnival Cruise Lines, Norwegian Cruise Line and Royal Caribbean Cruises have suspended stops at Mexican ports over concerns about swine flu.
Carnival canceled Mexico port calls for three ships scheduled to visit the country today. It hasn't yet announced a decision on future stops there.
Royal Caribbean had said it was monitoring the situation but telling passengers not to worry because the outbreaks are inland, not in the Mexican coastal cities popular with cruise tourists. But later Tuesday the company said it is suspending port calls indefinitely in Mexico until more is known about the swine flu outbreak.
The move affects its Royal Caribbean International and Celebrity Cruises ships.
Norwegian is canceling Norwegian Pearl's final two calls in Mexico this week after saying earlier in the day that it was monitoring the situation and asking passengers about their health before cruises start but keeping the trips.
Royal Caribbean has four ships that regularly stop in Mexico and two more that were scheduled to begin port calls there. Celebrity Cruises has one ship that was scheduled to make stops in Mexico. The company says the ships will stop in other ports or spend extra time at sea.
Royal Caribbean's chief medical officer, Dr. Art Diskin, said authorities had not raised specific concerns about the ports the ships visit in Mexico, but the company was taking a cautious approach to the situation.
The company is screening embarking guests and crew members about recent visits to Mexico or contact with ill people, increasing sanitization measures on ships and giving passengers swine flu information from the Centers for Disease Control and Prevention.
In Orlando over the weekend, a hospital treated a patient with flulike symptoms and because that patient either was from Mexico or had some contact with Mexico, where the swine flu is running rampant, the sample was sent to federal health officials for more testing, which could take up to 48 hours.
That was enough to get the rumor mill churning, resulting in two hastily called news conferences to say no confirmed cases had been documented, leaving Florida so far untouched by the swine flu. At least for now.
Florida stands a good chance of being infected, according to the Florida Department of Health, which has an action plan for pandemic influenza.
"Florida's geographic and demographic characteristics make it particularly vulnerable to importation and spread of infectious diseases, including influenza," the plan states. "Nearly one-third of Florida's population resides in urban/suburban areas of three southeastern counties, including large populations of immigrants.
"Florida's two interstate road systems bring in thousands of tourists each year. The two largest of the 13 international airports are in Orlando and Miami; 38,000,000 visitors used air travel in year 2000."
The state health department estimates a flu outbreak could infect up to 10 million people, with 5 million chronically ill. The department said a full-blown outbreak could kill 18,000 people in the Sunshine State.
Florida Hospital in Orlando reported a case of a patient who came in with flulike symptoms and had some contact with Mexico, and that fell in the criteria for further testing, officials said.
Florida Surgeon General Ana Viamonte Ros reiterated today in an early afternoon news conference in Tallahassee that there were no confirmed cases of swine flu in Florida, but she admitted a sample from the Orlando case was sent to the lab for further testing.
"We have no confirmed cases in the state, in Orlando or anywhere else," she said.
"We are prepared as a state, our laboratories are prepared. We all are working in concert to make sure we are doing whatever needs to be done to keep our residents as safe as possible and as informed as possible."
Roger Sanderson, one of three regional epidemiologists with the state's health department and stationed at the Tampa lab, said calls from county health departments are flooding in.
"We don't want specimens on everybody who has a little sore throat or a cough," he said. "We want to make sure we prioritize to those that are at the highest risk for actually having swine flu."
Only the CDC can confirm a swine flu case, he said.
"We can do a lot of the work here to rule out seasonal influenza," Sanderson said, "but it has to go through CDC."
He said local hospitals do not have the testing ability to confirm a case.
Federal health officials said the number of confirmed swine flu cases in the United States has jumped to 64.
The CDC said there were 17 new cases in New York City, four more in Texas and three additional cases in California, and that there were "a number of hospitalizations." That brings the total numbers of cases confirmed by federal officials to 45 in New York City, 10 in California, six in Texas, two in Kansas and one in Ohio. Five cases _ three in California and two in Texas _ have left people hospitalized.
Acting director of the CDC Richard Besser said in a telephone conference call this afternoon that the situation is "rapidly changing and we will continue to respond aggressively."
He said the strain that is appearing in the United States is not as strong as the strain that is spreading across Mexico.
He said stockpiles of vaccine and medical equipment are being shipped to the states, even those that have not reported any suspected cases.
"This is a forward leaning step," he said. "Every state has requested their portion of national stockpile. If the drugs are needed, they have them in hand and they won't have to wait."
The level of concern is high, he said.
"People are concerned and we are concerned," he said. "Concern is a good thing if it drives planning and it drives action."
He said the worst is anticipated.
"As this moves forward," he said, "I fully expect to see deaths."
Florida's vulnerability to outbreaks can be attributed to shipping ports and airports, and Tampa boasts two of the larger ones in the state. Cruise ships come in and out of the Channel District every week, and airplanes fly in and out of Tampa International Airport every day.
All three major cruise lines that sail out of Tampa make stops in Cozumel or Cancun in Mexico. Some customers are fidgety about boarding a vessel that will take them to swine flu ground zero.
"My hand is kind of forced at this point," said Crystal Gary of Brooksville, who is set to embark Thursday on a four-day Carnival cruise bound for Cozumel. "I called Carnival yesterday, and they said I was about their millionth caller."
She said Carnival officials had told her the ship returned Sunday from Cozumel, and there were no reports of flu. They told her she was locked into the cruise and could not change it without losing much of the $842 she plunked down in January to reserve a cabin.
"My husband said he's not going over there," Gary said, even though the couple could stand to lose more than 90 percent of their reservation fee.
"They were not nasty," she said of the cruise line officials. "But they told me I would lose all my money at this point."
Late in the day, she heard that her voyage would bypass Cozumel.
"That's wonderful news," she said. "I wanted to cry because I was so looking forward to my cruise."
Denise Palmer of Tampa is overseeing a group of 12 embarking on the same cruise. She, her husband and three children, her parents and a group of five friends from Kentucky are in her party.
"I'm cautiously optimistic that there are not going to be any problems," she said. "I don't think that Carnival will put anybody in danger."
She was relieved to hear the cruise line has decided not to stop in Mexico.
"So basically, we're going to go," she said.
A spokeswoman for Carnival Cruise Lines said his morning that the cancellation penalties still apply but that the situation is being monitored each day.
An e-mailed statement from Carnival today said: "We are aware that the CDC has recently issued a travel health warning which recommends the postponement of nonessential travel to Mexico." Updates were to be posted on the cruise line's Web site, www.carnival.com.
"There are currently no reported cases of swine influenza on Carnival ships or in any of the ports that we visit in Mexico," the statement said. "We are consulting closely with public health officials and government agencies such as the CDC, the World Health Organization and the Department of Homeland Security to monitor the situation.
"Carnival enforces the highest of standards for cleaning and sanitation on all of our ships to prevent the spread of infectious diseases. We have well trained medical staff and expansive reporting capabilities on board. We do not anticipate that our guests' cruise experience will be impacted by this type of illness."
With Tampa being an international cruise line and airport hub, local health officials are wary. Already this week, Hillsborough health officials laid out their plan to track and contain any swine flu outbreak in the Tampa Bay area.
The county health department, like health departments across the state, has asked local emergency rooms, doctors and nurses to look for patients with flulike symptoms and to ask those patients about their recent travel history.
This morning, health officials say the outbreak has spread to the Middle East and Asian-Pacific region. Most of those infected there are believed to have contracted the flu in Mexico, where about 150 people have died. Six countries besides Mexico have reported outbreaks.
Tampa International Airport has one regular connection to Mexico, a daily JetBlue flight to Cancun. Travelers also can make connections on flights to Mexico through the Houston and Dallas-Fort Worth airports in Texas.
Published reports vary on whether Cancun - a favorite among U.S. springbreaking students - has been affected by cases of swine flu, but British tour operators have canceled flights to Cancun through May 5.
Tampa International Airport has not enacted special protocols to contend with prospective swine flu developments but is working with Homeland Security officers to determine what steps, if any, should be taken, airport director Louis Miller said this morning.
Matt Chandler, Homeland Security spokesperson, said that both federal and state security officers have been told to keep an eye out for sick people at the airport.
"We've been telling people on the ground to be on the lookout for individuals at all ports of entry," Chandler said. "They'll ask, 'Are you sick?' If they are, then they're put through a screening process, isolated from passengers as a precaution."