Updated, 10:50 p.m. | Two more New York City residents — a 41-year-old woman from Queens and a 34-year-old man from Brooklyn — have died after contracting swine flu, bringing the total number of city fatalities related to the disease to four, the city’s health commissioner, Dr. Thomas R. Frieden, announced on Tuesday afternoon. (See related article.)
The two people both had underlying medical conditions that raised their vulnerability to the swine flu virus, Dr. Frieden said. The two other city residents who died from swine flu this month — Mitchell Wiener, an assistant principal at a Queens middle school, and a Queens woman in her 50s — also had underlying medical conditions.
Speaking at a news conference in Lower Manhattan, Dr. Frieden also announced that one more school — 811Q, a 42-student special-education program for students who are medically fragile, at Public School 822 in St. Albans, Queens — would be closed. More than 40 schools have been closed since swine flu broke out in New York City in late April.
(Later on Tuesday evening, the authorities announced the closings of four more schools: Public School 128, a 786-student school in the Washington Heights section of Manhattan; 231K, a 123-student special education program for students with disabilities, located at Public School/Intermediate School 180 in Bensonhurst, Brooklyn; Public School 68, with 791 students in the Wakefield section of the Bronx; and a 150-student program for students with disabilities at Public School 369 in Boerum Hill, Brooklyn.)
Dr. Frieden said that autopsies in the two new deaths were pending, but said that laboratory testing had confirmed swine flu in both victims. “In these two cases, the deaths were not medically attended, and so the full history is not yet known,” he said. “They either died at home or could not be resuscitated when they were brought in.”
He added, “To our knowledge, neither of these individuals worked in the school system.”
As of Monday morning, the federal Centers for Disease Control and Prevention had confirmed 6,764 swine flu cases, including 10 deaths, in 47 states and the District of Columbia. The three most recent New York City deaths were not included in those figures.
Dr. Frieden, who has been selected by President Obama to lead the C.D.C. and is to leave the New York City job, said there have been 131 hospitalizations related to swine flu as of Tuesday.
In the past month, the city has closed 42 schools or school programs in 31 school buildings; 25 schools or school programs have reopened, including 20 on Tuesday.
Over the past week, about 20 to 25 patients have been newly hospitalized each day because of flulike symptoms.
Normally, a typical city emergency room records “not more than a couple of hundred visits a day,” but now, some have been reporting “more than 2,000 per day,” Dr. Frieden said.
At the same news conference, Kathleen Grimm, a deputy schools chancellor, said that a letter from Schools Chancellor Joel I. Klein was being sent home with all students, explaining the swine flu situation.
While officials have said that shutting schools will do little or nothing to halt the overall march of the flu virus, but have said that in certain cases the decision to close schools might help protect medically vulnerable people at risk of contracting the flu virus from students or staff at affected schools.
Dr. Frieden emphasized that although swine flu appears to be more contagious than seasonal flu, so far, it does not appear to be more deadly.
Between 400,000 and 1.5 million New Yorkers get seasonal flu every year, and about 1,000 city residents each year die from complications of seasonal flu, he said.
Speaking before signing two bills at City Hall on Tuesday afternoon, Mr. Bloomberg said: “As the virus spreads through the city, and through this country and around the world, these deaths sadden us but I don’t think they take us by surprise. It doesn’t, however, lessen the loss of loved ones and our thoughts and prayers are with their families.”
With reports of new flu cases tapering off around the country — with the exception of New York, New Jersey and New England — federal health officials said Tuesday that they would concentrate on tracking the swine flu’s progress in the southern hemisphere and on preparing for a surge of new cases in the fall.
Outside of the Northeast, reports of people with flu symptoms visiting doctors and hospitals have dropped down to normal late-May levels, “which is extraordinary,” said Dr. Anne Schuchat, director of immunization and respiratory disease for the Centers for Disease Control and Prevention.
Although Dr. Schuchat would not say say flu had peaked for the season, she said the country was “at a transition point” and would look ahead to the next season, which usually begins in November.
The agency will help the World Health Organization monitor the Southern Hemisphere’s flu season, which is set to begin soon. The chief worry is that the virus could swap genes with the H1N1 human seasonal flu now circulating and pick up its resistance to Tamiflu. In a much less likely but much more serious scenario, it could pick up genetic material from the H5N1 avian flu and become far more lethal.
While Kathleen Siebelius, the secretary of health and human services said last week that the government would allocate $1 billion to the search for a swine flu vaccine, Dr. Schuchat said federal officials would make their decision “as late as possible” about whether to recommend that Americans get that vaccine.
Mindful that in 1976, 40 million Americans got a vaccine against a swine flu that never re-emerged, and many suffered side effects that may have been caused by it, health officials want to make sure the makers have as much time as possible to test the vaccine’s safety and to make sure the returning virus looks dangerous enough to justify the risks — usually slight — that any vaccine entails.
The W.H.O. said Tuesday that 46 countries have reported almost 13,000 cases of lab-confirmed H1N1 and 92 deaths, most of them in Mexico.
More than half the confirmed cases have been in the United States, where more than 300 people have been hospitalized with flu complications and where at least 10 people have died, Dr. Schuchat said.
However, since the United States, Mexico and Canada are testing only a tiny fraction of the flus seen by doctors, the real number of global cases is likely to be in the hundreds of thousands. Most flu pandemics ultimately infect about one-third of the world, but take about two years to do so, officials said.
David W. Chen and Donald G. McNeil Jr. contributed reporting.
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