As H1N1 ebbs for a second week in the United States, critics of the national vaccination campaign have gotten louder. The overall death rate from this pandemic strain, they point out, has so far been lower than that seen with seasonal flu.

What unadorned mortality numbers don't show, health officials counter, is this pandemic's tremendous toll in "life-years" lost. This is because H1N1 continues to strike hardest among children, young adults, and pregnant women, while largely sparing the elderly.

This is not to say an older person's life is not precious. But a death of a young person results in many decades of life lost. This contrasts with the months to years lost from the life of the frail, elderly patient who is the typical fatality from seasonal flu.

"Already there has been three times the number of deaths among children than we would see in a usual flu season," CDC director Thomas Frieden noted during this week's H1N1 media briefing. And the usual winter flu season has just begun.

Pregnant women remain of particular concern, with a 10 times higher risk of life-threatening complications when compared to the general population. Understandably, these complications (pneumonia, septic shock, organ failure) also threaten a woman's pregnancy.

Nonetheless, two weeks of declining H1N1 infections is good news indeed. Even if there are more waves of H1N1 infection in store, this lull comes at a time when communities are finally getting enough vaccine to begin expanding immunization beyond high-risk groups.

More good news comes with the CDC's announcement that monitoring for vaccine side effects is showing no spike in the incidence of Guillain-Barre Syndrome. This rare autoimmune condition became more common during the 1976 swine flu vaccination campaign.

Influenza experts continue to hold their breath over the possibility that H1N1 could yet grow more dangerous by either mutating or recombining with a more deadly cousin such as the H5N1avian flu circulating in Asia.

Even if H1N1 does change in ways that make it more deadly, those vaccinated should remain protected, Frieden says. The part of the virus used to make the H1N1 vaccine is distinct and independent of the portion that changes when influenza viruses become more lethal.

Science journalist Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World. Got a question or comment about swine flu? Post it here. Throughout the flu season, Jessica will be answering your questions on all things influenza.

Adjuvants are another class of vaccine ingredients that have proven controversial among people who remain uneasy about immunization.

In essence, adjuvants grab the immune system's attention to generate a stronger protective response. 

In gearing up for the H1N1 pandemic, World Health Officials asked developed nations to use adjuvants to stretch the vaccine supply to cover poorer countries. By generating a stronger immune response, adjuvants allows vaccine makers to use less "active" ingredient--in this case destroyed H1N1 flu virus--in each shot or squirt.

But while most European countries and Canada said "yes" to the WHO request, the United States said "sorry." Why?

U.S. flu vaccines have never included adjuvants. So using them would have warranted further safety testing, and that takes time. In other words, by making H1N1 flu shots in the exact same way as seasonal flu shots, U.S. suppliers were able to deliver a fully safety tested vaccine in under 9 months.

Alternately, the U.S. could have introduced adjuvant-containing flu vaccines on an "experimental" basis, based on their safety records in other countries. But U.S. polls showed that a majority of Americans wanted none of that.

Science journalist Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World. Got a question or comment about swine flu? Post it here. Throughout the flu season, Jessica will be answering your questions on all things influenza.

A new study comparing kids in the U.S. and the Phillipines has confirmed that growing up in a too-clean environment can boost inflammation levels, which in turn may increase the risk of heart disease and other chronic ills in adulthood. So is it still a good idea to get our kids to wash their hands all the time to prevent the spread of H1N1 and other cold and flu germs?

Coincidentally, this week two housemates familiar with my book Good Germs, Bad Germs emailed me with the hope of resolving just this debate over H1N1 and hand washing. Their household includes a 5-year-old as well as an adult with a donated kidney.

Housemate #1 had been urging the five-year-old to wash her hands frequently "to prevent the spread of too many germs," including H1N1. Housemate #2 countered that the germs that ended up on the child's hand were good for her--helping her build up resistance to disease.

The title of Good Germs, Bad Germs goes right to the heart of their question. So I'm glad to offer my two cents, based on the research of immunologists and infectious disease specialists.It's true that exposure to "germs" (i.e. viruses and bacteria) is necessary to strengthen and balance the developing immune system. This appears to be most important in early childhood.

Fortunately, this exposure doesn't have to involve the kind of germs that make you sick. In fact, the vast majority of germs in our environment are harmless. They're in our water, on our pets, in good, old fashioned dirt, everywhere. And that turns out to be a very good thing. Our world and our bodies could not functional normally without them.

By contrast, only a tiny minority of the viruses and bacteria we encounter each day make their "living" by causing disease. That said, this rogue's gallery includes some nasty characters, with the H1N1 influenza virus now among them. Such "bad germs" are definitely worth avoiding.

Bottom line: With H1N1 circulating widely in our communities, the experts agree that it's definitely a good idea for everyone to wash hands frequently or use an alcohol-gel sanitizer.

This is most important after being around other people who might be infected. Someone carrying H1N1 touches something (school desk, office keyboard, doorknob, etc.) and deposits the virus. You touch that something and then touch your eyes, nose, or mouth and, bingo, that virus has found a new home.  

Frequent hand washing is even more important if you live with anyone with an immune-compromising condition. This includes organ recipients, who must take powerful immune-suppressing drugs to prevent their bodies from rejecting the donated organ. 

Science journalist Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World. Got a question or comment about swine flu? Post it here. Throughout the flu season, Jessica will be answering your questions on all things influenza.

Headline writers are spinning away with the news of a dip in H1N1 influenza, or swine flu, outbreaks.

But any suggestion that H1N1 has peaked is premature, CDC officials say. In fact, the CDC has long predicted that H1N1, like most flu strains, will hit our communities in waves. And some of the states coming late to the H1N1 party remain on their first upsurge.

Even in places experiencing a lull, flu infection rates remain higher than usual for this time of year, cautions Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases. In the best case scenario, vaccination efforts--now in full swing--will blunt any future waves.

What's more, as H1N1 ebbs, seasonal flu could come roaring in, Schuchat says. Now at minimal levels, season flu typically peaks in late December and January.

Of course, there's nothing typical about this year's flu season. With H1N1 infections continuing through the summer, the previous flu season simply merged into the present one.

Of one thing we can be sure: With millions of families getting together for Thanksgiving this week, there's sure to be some viruses exchanged along with the kisses and good food.

To help counter holiday flu spread, the CDC has launched a Traveler Health Campaign.  

It's four-step strategy is pretty basic:

• Travel only if well

• Wash hands often

• Cover coughs and sneezes with tissue or sleeve

• Get vaccinated 

Happy Thanksgiving, everyone!

Related links:

7 Common Myths about Swine Flu

A History of Flu Pandemics 

Swine Flu Survival Guide

Science journalist Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World. Got a question or comment about swine flu? Post it here. Throughout the flu season, Jessica will be answering your questions on all things influenza.

Yesterday I breathed a sigh of relief as I watched my teenage daughter get her H1N1 shot at a local public health clinic. Though she grumbled as I dragged her across town during her lunch period, she couldn't help smiling when she saw it was a girlfriend's mom, a volunteer nurse, administering the shots.

In fact, there was such an upbeat community spirit around the event--organized in the meeting room of a local arts center--that I half expected someone to break out doughnuts.

We'd arrived early after getting a heads-up from the town health officer that within 24 hours of his announcing the four-hour clinic, he had received hundreds of calls from as far as two states away. Yet it was so well organized that my daughter was in and out and back to high school with 15 minutes of her lunch period to spare.

Meanwhile, on Nov. 3, CDC officials announced the availability of another 31.8 million doses of H1N1 vaccine, bringing the total doses available for distribution to 10 million. This remains short of the national need, but should make headway in vaccinating high-priority groups such as pregnant women, children and young adults, and those with underlying health problems such as asthma or heart disease.

As the ranks of the vaccinated expand well into the millions this week, health officials also expect the inevitable. After being immunized, some people will suffer health problems for reasons that have nothing to do with the vaccine. For decades, the tendency to link such events to immunization has plagued childhood vaccination programs.

As a proactive measure, an international team of epidemiologists, immunologists, and infectious-disease specialists has published a report in the medical journal Lancet, cataloging the background rates of disorders that they suspect could be erroneously linked with vaccination. Their statistics include the following:

• Miscarriage occurs in around 400 in a million pregnant women in any given day.

• Guillain-Barré paralysis occurs in around 4 in 10 million persons in any given week.  

• Sudden unexplained death occurs in 5 or 6 per 10 million persons in any six-week period.

Only if rates spike above these numbers, the researchers say, should any potential link to vaccination be proposed.

And now that I have my daughter's H1N1 shot checked off, I'm resuming my hunt for seasonal flu vaccine in our area. So far, no luck.

Science journalist Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World. Got a question or comment about swine flu? Post it here. Throughout the flu season, Jessica will be answering your questions on all things influenza.

Like many science journalists this year, I find myself troubled by an underlying tone of advocacy in my reporting on H1N1 influenza. In particular, this uneasiness concerns my coverage of public concerns about the H1N1 vaccine.

The online conversation here on iVillage.com reflects what pollsters say they're seeing: A significant minority of Americans have misgivings about getting immunized. Within this group is a small but vocal core of individuals who see an underlying conspiracy between public health officials and the pharmaceutical industry--a conspiracy bent on delivering dangerous vaccines in the name of profit.

So here is my quandary:

As a journalist, I strive to give voice to both sides of controversial issues.

As a science writer, I must weigh and convey the scientific evidence.

The quandary? Study after study and decades of use show flu vaccines to be safe and effective. In the United States, the H1N1 vaccine is prepared no differently than other flu vaccines. Indeed, if the H1N1 strain had been detected earlier, it would have been included in this year's seasonal flu shot.

Admittedly, this is of little assurance to those who see vaccines as generally dangerous. But here, too, the science is overwhelming.

In extremely rare cases, vaccines may trigger problems. But when it comes to the vaccines currently approved for use, studies show that serious reactions are so rare that they do not rise above chance occurrence. Vaccinated children do not suffer neurological or other problems at higher rates than do unvaccinated children. But unvaccinated children do suffer higher rates of infection and related complications, including death.

In the last two months, over 22,000 Americans have been hospitalized for influenza-related pneumonia, and over 2,400 have died. All of this is presumed to be due to H1N1 influenza because seasonal flu has yet to begin its upswing. This rate of flu-related hospitalization and death has reached the level typically seen at the peak of a flu season, in late December. So health officials worry that far worse may be in store.

And so I circle back to my difficulty: How do I, as a journalist and a science writer address "both sides of a story" when the scientific evidence is on one side and the potential consequence of ignoring the science is so great? I pose this question with the sincere hope of a respectful dialogue. Please, continue to send your questions and comments.

Meanwhile, the writers and editors at iVillage.com remain committed to addressing your questions and concerns, both in this column and in Q&As such as Dr. Tanya Berenson's Questions about Swine Flu? iVillagers Asked and Dr. Tanya Benenson Answered and Swine Flu: Shots, Germy Kids and Other Questions.

Science journalist Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World. Got a question or comment about swine flu? Post it here. Throughout the flu season, Jessica will be answering your questions on all things influenza.

Swine flu parties are still in the news. And on the Internet, the topic has gone viral (sorry). A search on the phrase produces over 3.3 million hits.

Still, I have to wonder whether this buzz reflects media frenzy rather than any real indication that people are deliberately exposing their children and themselves. As a reality check, I'd love to hear from any reader who has actually participated in such a party or knows people who did--and why.

At the least, a number of surveys this month indicate that many people are feeling complacent. At this point, only a minority of respondents say they will definitely get the H1N1, or "swine flu," vaccine. Admittedly, the majority of those who get sick do recover with nothing worse than a miserable week in bed.

But a new Canadian study backs up those early, scary reports out of Mexico--the ones indicating that this flu was proving deadliest among otherwise healthy adolescents and young adults--especially young women.

The researchers focused on 168 critically ill H1N1 victims in Canadian intensive care units between April and August. Septic shock and organ failure were common. Over 80 percent ended up on mechanical ventilators, or breathing machines. And 29, or 1 in 6, died. Their average age? 32. Nearly a third were previously healthy children.

"Our data suggest that severe disease and mortality is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years," the researchers conclude in a report released in advance of its November publication in the Journal of the American Medical Association.

The twist here is that these patients started out with what seemed like "ordinary" flu symptoms--the kind that public health officials tell us to treat at home. The difference was that their symptoms took a sudden and terrible turn for the worse.

This inability to tell who will or won't develop life-threatening complications seems to underscore the paramount importance of prevention. Vaccine party, anyone?

Science journalist Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World. Got a question or comment about swine flu? Post it here. Throughout the flu season, Jessica will be answering your questions on all things influenza.

Swine flu has struck pregnant women especially hard, raising concerns about the health of mother and child. The latest numbers show 28 pregnant women with swine flu have died, with 100 hospitalized in intensive care.

Even as pandemic fears continue at full steam, parents don't seem to be on board with the new H1N1 (swine flu) vaccine.

A new survey finds that only 40% of parents are planning to have their kids vaccinated. Of those who responded that they would not, almost half (46%) said they didn't believe their children would contract the virus; 20% said they didn't believe swine flu was a serious concern. Meanwhile, 54% of respondents said that they will get their children vaccinated for the seasonal flu.

The survey also shows clear differentiation along racial lines -- more than half of Hispanic parents will vaccinate their children against swine flu, compared to 38% of white parents and 30% of black parents.

Confusion over potential risk seems to play a large part in the low numbers -- according to the survey, many parents believe swine flu and seasonal flu pose the same threat to their children.

That confusion can only be expected, with information about the swine flu coming in daily and often changing. However, while the serious complications of seasonal flu tends to spare young kids, Centers for Disease Control and Prevention stresses that the swine flu strain is new and different -- it tends to strike hardest in children, young adults and pregnant women.

For more information to help you make your own decision, check out iVillage's Swine Flu Survival Guide.

Related Links

Should I be worried about getting the swine flu vaccine for my kids?
What you need to know about H1N1 and seasonal flu vaccines
Swine Flu information from the Centers for Disease Control and Prevention

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Data from the first clinical trials of the H1N1 (swine flu) vaccine in Australia and Britain show that one dose of the vaccine could be just as effective as two, protecting a recipient from the virus within about 10 days . The results are a potential boon, considering concerns that the anticipated supply of vaccine may not be enough to cover all those considered "high-risk", including pregnant women, children and health care workers.

If the results hold true, the number of people who can be vaccinated could be doubled, though two doses may still be needed for young children.

120 of the adults in the trial were given one 15-microgram shot and their blood tested 21 days later. 97 percent of this group responded well, showing enough antibodies for protection from the H1N1 virus. Another group of adults was given double the dose, 30-micrograms, resulting in the same amount of protection.

The Australian vaccine manufacturers, CSL Limited, is contracted to supply the United States with millions of doses of the vaccine; the president of the American branch expects the vaccine to do just as well in trials here. In fact, Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, agrees, saying that trials sponsored by the National Institutes of Health corroborate the Australian trials.

More good news - side effects experienced by approximately half the trial's participants were limited to the normal and mild side effects of the seasonal flu vaccine, including soreness at the injection site and headaches.

The vaccine most likely will not be available until late October. This estimated arrival date may miss the mark, according to a new study. "If the H1N1 flu follows the pattern we are expecting we should see a sizable outbreak in the U.S. starting in early September and probably peaking in mid- to late- October," says Ira Longini, a professor of biostatistics at the University of Washington in Seattle and lead researcher.

However, Longini still recommends getting vaccinated, as swine flu is expected to linger in the population for around 20 years, with more outbreaks predicted this winter and spring and in the years to come.

Have swine flu questions and looking for answers? Explore iVillage's Swine Flu Survival Guide.

More swine flu news:

Get your vaccine for seasonal flu, experts urge
Swine flu shots may come too late to stem fall outbreak
Get your vaccine for seasonal flu, experts urge

Fall is around the corner, schools are re-opening and fresh concerns about the H1N1 flu are
popping up. BeWell's Dr. Saralyn Mark has been working with NASA on preparing for the swine flu this fall; here's what she thinks is in store and some new HINI advice for pregnant women and children.


Saralyn Mark, MD
BeWell Expert

Associate Professor of Medicine adjunct
Yale and Georgetown University Schools of Medicine

Affiliate Professor
George Mason University School of Public Policy

Senior Medical Advisor
NASA
*The opinions expressed are the views of the author and not of NASA.

Photo: Getty Images

The World Health Organization is on the brink of declaring the swine flu outbreak a true pandemic. That means it's on every continent (Australia tipped the balance) but it's still a fairly mild strain everywhere on Earth. For now.

Sleepaway camp concerns: One odd aspect of the H1N1 virus (the official name for what everyone still calls swine flu) is that it appears to be spreading even though the weather is balmy. No winter recluse is this. Now that kids are either out of school or eagerly counting the days, many parents are starting to worry about summer camp. Will swine flu outbreaks close summer camps just as they have closed schools? The answer is...it just happened. A Boy Scout camp in Utah closed on Tuesday, June 9. Expect more camps to close. Unlike schools, though, kids at sleepaway camp can't just take the school bus home immediately; it could be a logistical nightmare, and a big concern for parents hundreds of miles away from their kids.

It's easy to worry. Influenza experts are watching carefully for signs the virus may become more virulent now that it's in the southern hemisphere, and come back as not only a pandemic but a potentially dangerous one in the fall. For now, there are concerns for pregnant women and parents.

The best advice? Stay calm but stay informed.

Bookmark Health Beat and follow us on Twitter  

The death of a 20-year-old woman from swine flu in Chicago one day after giving birth has made pregnant women nervous--and full of questions. To answer them, we asked pediatrician Claire McCarthy, MD, who answered iVillage moms' top questions about swine flu in May. Dr. McCarthy is an assistant professor of pediatrics at Harvard Medical School, a senior editor for Harvard Health Publications, and a contributing editor for Parenting Magazine.

Q: I'm pregnant, and worried.  Are there any special precautions I should take?

A: We are still learning about H1N1 (formerly known as swine flu), so we don't know for sure how it might affect pregnant women and their babies.  What we do know is that pregnant women can be more likely to get sick than other people, and when they get sick it can be dangerous both for them and their baby.  So it's important to take precautions:

• Wash your hands with soap and water, or alcohol-based gel (carry it with you), every chance you get
• To the extent that it is possible, stay away from sick people.
• If you have been exposed to someone with H1N1 (or with a flu-like illness that might be H1N1), talk to your doctor about whether taking medication to prevent illness (or at least make it milder) makes sense
• if you have flu symptoms (fever, congestion, cough, sore throat, muscle aches, vomiting, or diarrhea) call your doctor immediately.
• For more information, here is the link to the CDC's recommendations for pregnant women
  

 Bookmark Health Beat or follow us on Twitter

Over the weekend, H1N1, aka swine flu, reminded us that it can still pack a deadly wallop. A beloved assistant principal at a public school in New York City died, becoming the sixth American citizen to succumb. Dozens of schools, especially in New York and Texas, remain closed due to the outbreak. Meanwhile, the CDC estimated that as many as 100,000 Americans may have gotten swine flu, even though only a little over 5,000 cases are confirmed. "It's not going away, despite what you may have heard," says CDC spokesperson Anne Schuchat, M.D. on Monday, May 18. "People are continuing to get sick, to get hospitalized, and to die, and we expect more. This virus is the ultimate moving target."

Claire McCarthy, MD, is an assistant professor of pediatrics at Harvard Medical School, a senior editor for Harvard Health Publications, and a contributing editor for Parenting Magazine. We asked her to answer questions iVIllage moms have been posting on our message boards.

1)    How can I stay calm?
The best way to stay calm, I think, is to realize that even if the worst happens--i.e. that you or someone in your family get the H1N1 virus--you will most likely be completely fine.  While people do get sick with it, in the vast majority of cases there is a full recovery.  The virus is also sensitive to antiviral medication, and there are thousands of stockpiled doses.

For a little perspective, every year during regular flu season there are more than 30,000 cases of flu--and up to 10% of the people who get it die (usually the very young, the very old, and people with other health problems).  Yet we all go about our daily lives each year during flu season without panicking.  

Another way to stay calm is to get the real information behind the sensational (and frightening) headlines.   The best, most comprehensive source of information is the CDC's H1N1 website; turn off the TV and visit the website regularly, and check in with your local department of health.

Swine flu is all that anyone with electricity is talking about. I have to admit, the unsettling images of  people wearing masks and printed "we're closed" signs in front of schools and businesses combine to create low-level anxiety. On top of that, reports of deaths from the flu (go figure) really can make that sinking feeling in your stomach feel like the Grand Canyon. The news reports and snatches of random conversation, make you ask yourself, "Should I be worried?"

Let's look at the facts. Influenza kills 36,000 Americans every year. Last year over 200,000 people were hospitalized for complications from the flu. Approximately 5-20% of the population gets the "flu" every year. Swine flu is thought to come from a mutation of a pig virus and human virus. It's spread through respiratory droplets -- like coughing and sneezing -- and is passed along hand to hand or by coming into contact with an infected person. There has been one recent death in the U.S., and possibly more to come. The virus is Swine Influenza A (H1N1) and can be treated with antiviral drugs like osetamivir and zanamivir (started within 48 hours of symptom onset).

Use common sense by washing your hands frequently, cough into your elbow (not your hands), and stay home if you feel ill. If you find yourself overly concerned or making yourself sick with worry (and, frankly, paranoia) yet you have absolutely no symptoms, try these tips:

1.  Limit your network or newspaper coverage about the pandemic. Update yourself once or twice daily by going to a reliable source like www.cdc.gov.

2.  Focus on what's under your control.

3.  Maintain healthy habits. Exercise regularly and be mindful of  what you eat. Try to eat whole grains and fresh fruits.

4.  Breathe. Take ten deep breaths regularly through your nose with your mouth closed. Find a deep center of calm within.

5.  Avoid feeling panicky by having a plan. Educate yourself on the symptoms of swine flu, keep your doctor's number handy, and remember that this is a treatable illness. However, if you are have a young child,  are pregnant, or have an existing condition that makes you immunocompromised, you should check in with your doctor at the first sign of flu symptoms because your risk is higher.

-- Dr. Janet Taylor (read Dr. Taylor's blog on BeWell.com)
Psychiatrist in private practice and former clinical instructor of psychiatry at Columbia University, Harlem Hospital 

After the alert level was raised late yesterday afternoon, the news got (and stayed) busy of course. Health and Human Services Secretary Kathleen Sebelius, quick get started in her new position, joined Homeland Security Secretary Janet Napolitano in a live webcast with Dr. Richard Besser, acting director of the CDC. You can check out the video here. Keiji Fukuda, assistant director-general of Health Security and Environment at WHO, also spoke with reporters.

The number of cases in the United States went above 250, and South Carolina and Georgia became the eleventh and twelfth states with confirmed cases. Schools continue to close across the nation, and Mexico's government shut down all non-essential activity.

In Floral Park, a New York City suburb, the story got quite personal, when one family had five children contract the swine flu. Jacqueline Civitano lent a very realistic perspective in MSNBC's coverage, examining our preparedness. Startlingly, researchers have been able to learn very little from Mexico's first swine flu death, and the search for a vaccine still continues.

Of course it was hard to miss coverage of Vice President Joe Biden's comments about avoiding travel. You can catch up on the story with video of Biden's comments about swine flu if you missed it.

While it's a semantic story on the surface, the question of what we really call this disease is still out there. WHO is officially referring to swine flu as "H151," hoping to avoid confusion about the risk of eating pig products. It's worth noting that whatever we call the disease, experts say it isn't spread by eating pork. The important precautions to take are covering your mouth when you cough or sneeze, wash you hands and avoid touching your face. If you are sick, don't play tough; stay home from work and see a doctor. There's a great, simple breakdown of key points on at The Huffington Post, with five things you need to know.

Janet Napolitano with Tamron Hall on MSNBC

Visit msnbc.com for Breaking News, World News, and News about the Economy

Get more updates by following us on Twitter.

Today at 1 pm Eastern, Health and Human Services Secretary Kathleen Sebelius and HHS Secretary Sebelius and Homeland Security Secretary Janet Napolitano will host a live webcast and answer questions from the public. Also joining them in this discussion about swine flu will be Dr. Richard Besser, acting director of the Centers for Disease Control. You can view the webcast at hhs.gov or cdc.gov. Want to submit a question? Email hhsstudio@hhs.gov.

Get more updates by following us on Twitter.

Today's news had a very sad beginning, as the report came of the nation's first swine flu death, a 23-month-old in Texas. While the currently-known cases are still called "mild," experts still expect some more severe cases.

In the afternoon, we learned that the World Health Organization raised the alert to "pandemic level 5". And the announcement came that Germany and Austria also have confirmed cases.

Schools are, appropriately, among the most concerned institutions, and in some cities, widespread closings are still likely.

Governments and companies are already turning thoughts to preparedness and the search for a vaccine.Pig farmers are explaining the precautions they take to maintain healthy conditions.

Pork companies, meanwhile, are trying to remind us that people don't get swine flu from eating pork. In fact the Wall Street Journal Health Blog delved into the topic of why many people, including President Obama, just want to call it H1N1 flu virus, its more scientific name.

In the midst of the crisis, the nation finally got a new leader at the department of health and human services, Kathleen Sebelius. The former governor of Kansas of course went straight to the situation room after being sworn in as secretary.

While swine flu may have us thinking a little more about health and a little less about wealth, we still can't ignore the economy. And the markets are reflecting some of the fears surrounding swine flu. Oil is down, since people may be traveling less.

Take a look inside WHO, with NBC Nightly News

Visit msnbc.com for Breaking News, World News, and News about the Economy

Get more updates by following us on Twitter.

"After one death, there is no other," wrote Dylan Thomas. And now we have the first confirmed death on American soil from swine flu, a 23-month old child in Texas who traveled from Mexico with his parents to Brownsville. It's not the first death, of course. In Mexico, there are 159 suspected dead, with seven confirmed. If parents in the U.S. are scared, those in Mexico City must be terrified.

This morning's news saw a little bit of conflict on the swine flu front, since we were concerned to see the number of estimated cases in the country get up to fifty, but at the same time the government's efforts seemed focus on calming our fears. Those two messages weren't too surprising. The truth is, those numbers will keep going up (later in the morning the CDC updated the total to 64), and until we have a better understanding of this particular strain, the mantra "everybody stay calm" may be the best advice.

Schools are among the most vulnerable locations, and many communities have resorted to closing down schools and major public gathering areas, like local parks.

While these precautions are necessary, especially in schools where kids have been infected, many media outlets have devoted space today to reducing panic. Newsweek has good insight to the straightforward but not-so-simple question "Should We Panic," and the "5 Reasons Not to Panic" from ABCNews gives good tips and calming advice.

The CDC is continuously updating its site's swine flu page, which has the five best pieces of advice summarized conveniently and concisely. Speaking of the CDC, the Health Blog on the Wall Street Journal site has been live blogging a lot, including today's CDC media update.

Meanwhile, is Twitter helping or hurting as everyone is spreading not just information, but fear as well?

What's next? Of course we don't know how bad it's going to get. But we do know that the government wants to commit more funds and resources to controlling the spread. For now, the CDC has recommended avoiding any non-essential travel to Mexico. Keep checking for updates, and stay vigilant. Follow some common practices for good hygiene: Cover your mouth and nose with a tissue when you cough and sneeze (and throw the tissue away), wash with soap and water often and don't touch, rub or scratch your nose, eyes or mouth.

Robert Bazell answers your questions, from NBC Nightly News

Visit msnbc.com for Breaking News, World News, and News about the Economy

Get more updates by following us on Twitter.

From Dr. Tanya Benenson, NBCUniversal Medical Director

What is swine flu?
It is a lot like our seasonal flu but it usually only affects pigs. This one, swine influenza A (H1N1), is affecting humans who have not been exposed to pigs. This suggests there might be human-to-human transmission. The mode of transmission is presumably respiratory droplets.

If I had the flu shot, am I protected?
No. The swine H1N1 is very different from the human H1N1 that is in the flu vaccine. Currently there is no human vaccine available for swine flu.

How can I prevent getting the flu?
Similar recommendations as the seasonal flu. You are trying to avoid being exposed to respiratory droplets.

• Hand washing or use of alcohol-based hand sanitizers (minimum concentration of 60 percent to 95 percent ethanol or isopropanol).
• Avoid touching your eyes, nose and mouth as those are direct entry points for viruses. Viruses can get on your hands when you touch infected objects.
• Avoid close contact (6ft) with a sick person.

What are the symptoms?
Symptoms are very similar to the human flu:

• Cough
• Fever/Chills
• Sore throat
• Fatigue/Body aches
• Decreased appetite
• Less commonly: runny nose, nausea, vomiting, diarrhea

Is there treatment for swine flu?
YES, Tamiflu and Relenza (both prescription medications) work on this virus but it needs to be started in the first 48 hours of symptoms. So it is important to contact your doctor right away if you have symptoms.

If I think I have the flu, what should I do?
STAY HOME and contact your physician right away. This is not the time to be "tough" and go into work or school nor is it the time to travel. If you see your doctor, they might do a swab of your nose or mouth to confirm the virus with the CDC. Your doctor would start you on treatment based on your symptoms and likelihood of having the illness. Don't be alarmed if your doctor's office has a sign posted, like in the SARS days, that tells you to put on a mask if you have flu-like symptoms. This is a routine precaution during an outbreak to protect health care workers as well as other patients in the office. We are all just being extra careful.

COVER YOUR COUGH and avoid close contact with others. You should maintain a distance of 6 ft between you and other people, even family members. If you need to COUGH or SNEEZE, cover it with a tissue and throw the tissue away. Alternatively if you have no tissue available, you can cough or sneeze into the elbow of your sleeve. You are trying to avoid spreading infected respiratory droplets around that others could pick up.

Is there reason to panic?
No. The CDC and WHO have a good handle on the situation and are establishing a state of preparedness. If you follow the guidelines above and keep updated on the Homepage and links below, you will be in top of it.

Questions?
If you have any further questions, call your physician. You can also call the CDC directly at (800) CDC-INFO (232-4636) or go online for more detailed information on swine flu:

• Key facts from the CDC
• Swine flu and you
• En español

And for updates on the current state of swine flu from the CDC and ISOS:

• CDC investigation
• International SOS

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