2009 southeast Queensland oil spill
The Queensland government declared a state of emergency. Premier Anna Bligh described the spill as the "worst environmental disaster Queensland has ever seen." It took over 1,425 people 16 months to clean up the affected areas.


2009 southeast Queensland oil spill, Cause and initial responses
MV Pacific Adventurer was sailing from Newcastle to the Port of Brisbane in Moreton Bay. Cyclone Hamish had formed off the coast of Queensland. Subsequently, the improperly stowed cargo dislodged from the deck damaging other cargo and containers, causing various substances to spill into the ocean. The ship was damaged at and below the waterline and began to leak fuel and lubricant oil.


2009 southeast Queensland oil spill, Cause and initial responses
Over the following days the spill washed ashore over a 60 km stretch of coastline. In an interview, crew members stated that the captain, Bernardino Santos, was to blame for the incident. The captain decided to stay on course, directly through the storm. As the ship encountered heavy swells, the 20 crew members went below deck, fearing for their lives. At 3:12 a.m., a wave broke the restraints for the cargo and sent 31 containers of ammonium nitrate overboard.


2009 southeast Queensland oil spill, Cause and initial responses
The Queensland maritime safety authorities estimated that the ship was at a 25-degree angle at the time the containers were knocked off. When the ship came back down, one of the containers damaged the hull. After rolling to the opposite side, it crashed onto another container, creating a large hole underneath the ship, which was not noticed until it docked in Brisbane.


2009 southeast Queensland oil spill, Cause and initial responses
Swire Shipping initially reported that only 20 tonnes had been spilled. This was later revised to 30 tonnes, 100 tonnes, 230 tonnes and 250 tonnes. The Queensland Government reacted to the situation based on the initial information of 20 tonnes, which was later discovered to be inaccurate, leading to claims of an inadequate initial clean-up response. After divers inspected the ship for the source of the spill, two holes were found. One, located just above the waterline, was 10 mm (0.4 in) long 15 mm (0.6 in) wide. The second and larger hole was underneath the ship and measured about 1 m (3.3 ft) long and 300 mm (12 in) wide.


2009 southeast Queensland oil spill, Affected areas
In the days following the spill, substances washed ashore along a 60 km (37 mi) stretch of coastline. Oil covered beaches, rocky reefs, coastal wetlands and mangrove wetlands. Most of these areas were declared restricted zones and public access was limited. Radar satellite images acquired in preparation for cyclone damage captured the extent of the spill before it hit the coastline.


2009 southeast Queensland oil spill, Clean-up
Following the oil spill Queensland Premier Anna Bligh declared two islands and parts of the Sunshine Coast disaster areas. Clean-up efforts were reportedly going to cost at least A$100,000 a day and last more than a week as the oil continued to spread. Several search parties have been sent to the spill area to attempt to find the potentially explosive materials that were in the 31 containers. Press reports stated that if the ammonium nitrate were to mix with the heavy fuel, the mixture could ignite and cause a large explosion.


2009 southeast Queensland oil spill, Clean-up
If the chemical did not react with the fuel but still leaked out, marine life could be threatened by large blooms of algae. By 15 March, the cost of the spill jumped to $A10 million (US$6.6 million). A team of 88 people were sent out to begin the clean-up process and a further 58 were expected to join within the following days. On 16 March, the Royal Australian Navy began searching for the 31 containers of ammonium nitrate that were knocked off the ship. A navy minehunter was sent to look for the containers to reduce the amount of impact the chemical could cause.


2009 southeast Queensland oil spill, Clean-up
The clean-up was a delicate operation, because high tides had already eroded beaches after ex-tropical cyclone Hamish battered the coast over the previous week. At the same time, high tides carried off some of the fuel oil initially deposited along shorelines and dispersed it back into the sea. By 15 March, the federal government reported that 50% of the oil had been contained and that the slick had been removed from about 95% of Bribie Island, 85% of the Sunshine Coast and 25% of the waters around Moreton Island.


2009 southeast Queensland oil spill, Clean-up
On Moreton Island, 290 people worked to clean up the oil, with most focusing on Middle Creek and Cape Moreton. Even though hundreds of people had worked on cleaning the spill, the average amount of oil cleaned each day was 1 km (0.6 mi) per day. At that rate, it would have taken more than a month to clean all the affected areas. The Federal Government promised to provide $A2 million (US$1.3 million) to help with the clean-up.


2009 southeast Queensland oil spill, Clean-up, Clean-up in process
In late July 2010, the clean-up effort was declared "complete". Federal Environment Minister Peter Garrett attended clean-up sites to celebrate the end of clean-up efforts. 1,425 personnel took 16 months to clean up 155 hectares of coastal area and included installation of 21,220 plants and 2.6 km of fencing to protect recovering vegetation.


2009 southeast Queensland oil spill, Effects and consequences, Disaster declaration
Shortly after the slick washed ashore the Queensland government declared a state of emergency. The disaster declaration will restrict public access to beaches affected by the oil slick and allow clean-up teams unobstructed access. The declaration covers:


2009 southeast Queensland oil spill, Effects and consequences, Local economy
Several of the local restaurants which receive shipments of fish from the waters off the Queensland coast refused to stock any more fish due to the spill. The cost of the clean-up also hurt the economy, costing at least A$10 million. In July 2009 the total bill was estimated to be A$34 million. The Australian Government provided A$750,000 to help jump-start the tourist industry. Fourteen of the 19 beaches affected along the Sunshine Coast that had been cleaned were reopened in March 2009.


2009 southeast Queensland oil spill, Effects and consequences, Fines and legal implications
Once the ship was at port, Captain Santos was forced to surrender his passport to Australian officials and he was to remain in Brisbane for at least two weeks to help with the investigation. On 14 October 2011, Swire Navigation and Bluewind Shipping were fined $A600,000 each and ordered to publish a public apology after earlier pleading guilty to causing the spill. The court heard the two companies have already paid $A17.5 million under a limitation order in the Federal Court, as well as an additional $A7.5 million to help cover the $A31 million cost of cleaning up the damage. Charges against Santos were dropped earlier in the week.


2009 southeast Queensland oil spill, Effects and consequences, Wildlife
The Environmental Protection Agency reports that the full extent of wildlife affected by the spill has yet to be realised. "The flow-on effects of oil spills can be substantive," according to a spokesperson for the agency. "The longer-term impacts are yet to be realised." Several birds have been found covered with oil. By 17 March, about 30 animals had been recovered after being covered with oil. All of the animals were immediately treated and cleaned. Oiled animals included pelicans, ghost crabs and sea snakes.


2009 southeastern Australia heat wave
The 2009 southeastern Australia heat wave was a heat wave that commenced in late January and led to record-breaking prolonged high temperatures in the region. The heat wave is considered one of the, if not the, most extreme in the region's history. During the heat wave, fifty separate locations set various records for consecutive, highest daytime and overnight temperatures. The highest temperature recorded during the heat wave was 48.8 °C (119.8 °F) in Hopetoun, Victoria, a record for the state.


2009 southeastern Australia heat wave
Many locations through the region recorded all-time high temperatures including capital cities Adelaide, which reached its third-highest temperature, 45.7 °C (114.3 °F), and Melbourne, which recorded its highest-ever temperature on record, 46.4 °C (115.5 °F). Both cities broke records for the most consecutive days over 40 °C (104 °F), while Mildura, Victoria recorded an all-time record twelve consecutive days over 43 °C (109 °F).


2009 southeastern Australia heat wave
The exceptional heat wave was caused by a slow-moving high-pressure system that settled over the Tasman Sea, with a combination of an intense tropical low located off the North West Australian coast and a monsoon trough over Northern Australia, which produced ideal conditions for hot tropical air to be directed down over southeastern Australia. The heat began in South Australia on 25 January but became more widespread over southeast Australia by 27 January.


2009 southeastern Australia heat wave
A weak cool change moved over the southern coastal areas bringing some relief on 30 January, including Melbourne, where the change arrived that evening, dropping temperatures to an average of 30.8 °C (87.4 °F). Higher temperatures returned on the following weekend with Melbourne recording its hottest day since records began in 1855, 46.4 °C (115.5 °F).


2009 southeastern Australia heat wave
The heat wave generated extreme fire conditions during the peak of the 2008–09 Australian bushfire season, causing many bushfires in the affected region, contributing to the extreme bushfire conditions on 7 February, also known as the Black Saturday bushfires, which claimed 173 lives in Victoria.


2009 southeastern Australia heat wave, Cause
The heat wave was caused by a slow-moving high-pressure system that settled over the Tasman Sea. Coupled with an intense tropical low and a monsoon trough over Northern Australia, this produced hot, tropical air to be directed over southeastern Australia, raising temperatures significantly. The CSIRO stated that "The warm lower tropospheric anticyclone is the key synoptic weather system responsible for the heat-waves." The heat wave was the worst in Australia's history.


2009 southeastern Australia heat wave, Records and statistics
During the heat wave, several records were broken; Tasmania recorded its highest-ever temperature; 42.2 °C (108 °F) in Scamander, and the long-standing Tasmanian record of 40.8 °C (105.4 °F) (recorded in Hobart on 4 January 1976) was broken five times within two days at Flinders Island, Fingal (twice), St Helens and Scamander, while Hopetoun in Victoria recorded the state's highest temperature and the highest temperature of the heat wave, with a reading of 48.8 °C (119.8 °F).


2009 southeastern Australia heat wave, Temperatures (Daily Maximum), Adelaide, South Australia
A record-high minimum temperature was recorded at around midnight on 29 January, when the temperature dropped to only 33.9 °C (93.0 °F) at the Bureau of Meteorology weather station in Kent Town, near the Adelaide city centre. Temperatures recorded in other parts of the city and other towns throughout South Australia were even higher.


2009 southeastern Australia heat wave, Temperatures (Daily Maximum), Wagga Wagga, New South Wales
On 31 January 2009 Wagga Wagga broke the all-time January record for the most days above 40.0 °C (104.0 °F) with six days recorded (the record previously being five days, which was set in 1952 and equalled in 1979 and 2001). The January record set in 1979 was equalled for number of days above 35.0 °C (95.0 °F) or more which is 19 days.


2009 southeastern Australia heat wave, Temperatures (Daily Maximum), Wagga Wagga, New South Wales
Wagga Wagga broke the all-time record and the February record for the highest recorded maximum on 7 February 2009, 2:50pm AEDT the city recorded 45.2 °C (113.4 °F) with the previous February record being 44.6 °C (112.3 °F) set on 1 February 1968 and the all time previously being 44.8 °C (112.6 °F) set on 23 January 2001.


2009 southeastern Australia heat wave, Temperatures (Daily Maximum), Wagga Wagga, New South Wales
On 8 February 2009 the record for the consecutive days over 37.8 °C (100.0 °F) was to be broken with thirteen consecutive days recorded (the previous record being six days, which was set in 1946 and equalled in 1979, 1980 and 2004). Wagga Wagga also recorded fourteen consecutive days of over 35.0 °C (95.0 °F).


2009 southeastern Australia heat wave, Accompanying bushfires
After a slow start to the 2008–09 Australian bushfire season, the high temperatures and wind precipitated several bushfires across Victoria and South Australia. The conditions were very similar to the heat wave experienced in early January 1939, which killed 438 people and precipitated the Black Friday bushfires of 1939.


2009 southeastern Australia heat wave, Accompanying bushfires
Fires were also started in the Australian Alps by lightning strikes from dry thunderstorms in north-east Victoria and south-east New South Wales.


2009 southeastern Australia heat wave, Accompanying bushfires
The tail end of the heat wave also precipitated the Black Saturday bushfires, in which 173 people died, 414 injured and 2,029 houses destroyed at various locations across the state. Several locations around the state recorded their highest temperatures since records began in 1859 and winds gusted up to 110 km/h.


2009 southeastern Australia heat wave, Comparison to normal climate for the area
Many areas in central South Australia, northern Victoria and inland New South Wales regularly experience temperatures over 40 °C (104 °F) for one, two or three consecutive days, sometimes more, during the summer months. During the heat wave, however, many of these regions experienced temperatures over 40 °C (104 °F) for twice as long or more, on average, than is normal for that time of year. Coastal regions and the ACT experienced slightly lower temperatures; however, these were still above average and lasted for a prolonged period.


2009 southeastern Australia heat wave, Comparison to normal climate for the area
While coastal regions may have experienced shorter periods of heat wave, for the time that they did experience temperatures over 35 °C (95 °F), they mostly reached the top 3, top 5 or top 10 all-time temperature records for a number of days. An excellent example of this is Melbourne, which had only 3 consecutive days over 43 °C (109 °F), yet when combined with the record set on 7 February, now has recorded three of its five (being 1st, 3rd and 5th) all-time record-high temperatures.


2009 southeastern Australia heat wave, Comparison to normal climate for the area
The heat wave was perhaps most extreme in northern and eastern Tasmania, where 7 of the 8 highest temperatures recorded in Tasmania up to that time occurred during the heat wave.


2009 southeastern Australia heat wave, Comparison to normal climate for the area
A chart of the variation of maximum and minimum daily temperatures, through the year, for Melbourne was prepared from observations between May 1855 and August 2006. For early February, this shows a mean daily maximum temperature of 26 °C (79 °F) with the 75th-percentile temperature being about 31 °C (88 °F).


2009 southeastern Australia heat wave, Effects, Energy
Localised power outages occurred throughout both cities during the week at varying times for various lengths. It is estimated that over 500,000 residents in Melbourne were without power for the evening of 30 January 2009. The outage affected much of central Melbourne with train and tram services cancelled, the evacuation of Crown Casino, traffic light failures, people being rescued from lifts and patrons of the Victorian Arts Centre evacuated and shows cancelled. The outage occurred only an hour after the National Electricity Market Management Company (NEMMCO) issued a statement saying load shedding was ending and power had been restored.


2009 southeastern Australia heat wave, Effects, Energy
Blackouts also occurred in the city's west, caused by the three-day heat wave. It is believed an explosion at South Morang contributed to the power problems along three transmission lines supplying Victoria's west and Victorian power supplier SP AusNet shed 1,000 megawatts. On the 30th, Energy Minister Peter Batchelor announced consumers who lose power for more than 20 hours would be eligible for compensation.


2009 southeastern Australia heat wave, Effects, Energy
Areas that didn't experience blackouts still had problems with abnormally low voltage (probably due to increased air-conditioner usage).


2009 southeastern Australia heat wave, Effects, Energy
As of 1 February, the heat wave is estimated to have cost the Victorian economy $100m during the week.


2009 southeastern Australia heat wave, Effects, Transport
Over the course of the week, thousands of train and tram services were cancelled in both cities, with more than 1,300 individual train services cancelled in metropolitan Melbourne alone. The cancellations were due to buckling rail lines, air conditioner failures and power outages. On the 30th, all public transport in the city was free as the government admitted responsibility for failing to provide adequate infrastructure elements to cope with the heat, as well as long-standing issues with underfunding. On the 30th, 730 (40%) of rail services were cancelled, the worst day of operation since Connex took control in 2004.


2009 southeastern Australia heat wave, Effects, 2009 Australian Open
Several outdoor matches during the 2009 Australian Open on the 29th and the 30th were cancelled due to the heat. A number of players, including number 3 seed Novak Djokovic, cited the temperature as reason for withdrawing from matches. Serena Williams was quoted as saying it was so hot on court she felt like she was having an "out-of-body experience". After these retirements and an intensification in the heat, the organisers responded by closing the roof and allowing players longer breaks and icepacks.


2009 southeastern Australia heat wave, Effects, Human health
There is dispute between sources as to how many people were affected by the heat wave. Hundreds were treated for heat-related illness and 6 fatalities were confirmed, and a number of "sudden deaths" were suspected to be caused by the heat. Authorities worked through each case to determine exactly how many fatalities were directly attributable to the heat wave.


2009 southeastern Australia heat wave, Effects, Human health
Commercial news sources vary widely at the number of fatalities, some report only 2 deaths, while others speculate that the toll may ultimately be higher. Fifty-seven deaths were suspected to have occurred in South Australia and 33 in Victoria, however authorities preferred to wait for coronial reports before confirming how many were directly attributable to the heat wave.


2009 southeastern Australia heat wave, Effects, Human health
The Victorian state coroner announced a tripling of dead bodies being placed in the state mortuary during the heat wave, filling the morgue to capacity. Hospitals and funeral homes were relied upon to provide temporary storage of corpses, even before the deaths associated with the Black Saturday bushfires created additional demand for mortuary space.


2009 southeastern Australia heat wave, Effects, Human health
Throughout the heat wave, thousands of people, many of them elderly, were confirmed to have been treated by ambulance officers and placed in hospitals for heat-related illnesses in Victoria and South Australia. Ambulance Victoria reported a 70% increase in emergency calls during the week. It is estimated that around 2,000 people across Victoria and South Australia were treated for heat stroke and other effects of the heat wave.


2009 southeastern Australia heat wave, Effects, Human health
According to a Monash University study of funeral notices, more than 200 people died as a result of the heat wave. A 45% increase in the death rate was noted during the time. A subsequent report by Victoria's chief health officer, Dr John Carnie, put the final figure at 374.


2009 southeastern Australia heat wave, Effects, Fauna and flora
Baby birds, possums and bats were among the wildlife not coping in the extreme heat. The RSPCA received five times the usual number of admissions to its shelters in Melbourne, with 50 possums admitted to the Burwood East shelter alone.


2009 southeastern Australia heat wave, Effects, Fauna and flora
There were many reports of koalas wandering into urban yards and houses to drink water offered by residents. This behaviour is highly unusual as the animals do not normally drink water and are naturally shy of people.


2009 southeastern Australia heat wave, Effects, Fauna and flora
In Melbourne, a city where most trees are non-native, notably the plane trees that line many inner and middle suburban streets, deciduous trees began shedding their leaves by early February, creating the appearance of an early autumn. Water restrictions meant many trees and plants were already stressed, and some street trees and trees in parks where councils had not arranged special watering, died, or suffered die back, as did trees and plants in private gardens.


2009 structural changes to local government in England
Structural changes to local government in England were effected on 1 April 2009, whereby a number of new unitary authorities were created in parts of the country which previously operated a 'two-tier' system of counties and districts. In five shire counties the functions of the county and district councils were combined into a single authority; and in two counties the powers of the county council were absorbed into a significantly reduced number of districts.


2009 structural changes to local government in England
Elections to the new authorities took place on 1 May 2008 for some of the new authorities, which took up their powers on 1 April 2009. The other new authorities retained the existing county council as the "continuing authority" as of 1 April 2009 with elections taking place two months later on 4 June 2009.


2009 structural changes to local government in England, Background
Following the passing of the Local Government Act 1992, the Local Government Commission for England recommended a number of unitary authorities to be created in England during the 1990s. The changes that were implemented meant that much of the country continued to have a two-tier arrangement of local government. Further proposals for unitary authorities in northern England, tied to the option of regional devolution, were put to a referendum in 2004 and were rejected.


2009 structural changes to local government in England, Background
In 2006, the white paper Strong and Prosperous Communities invited local authorities in England to submit their own consensus-based proposals for unitary authority arrangements, to be submitted before 25 January 2007. Selected submissions went to a public consultation from March until June, with successful proposals announced in July. Legislative requirements for implementation were in place following the enactment of the Local Government and Public Involvement in Health Act 2007.


2009 structural changes to local government in England, Proposed changes, Early responses
Various local councils indicated their wish to seek unitary authority status. Four medium-sized towns and historic county boroughs, overlooked by the 1990s review: Ipswich, Oxford, Norwich and Exeter proposed unitary status on their present boundaries, and commissioned a report jointly to press their case. Norwich announced its intention to respond to the invitation, as did Ipswich and Exeter. In Lancashire, Preston and South Ribble desired to form a single unitary authority although Preston bid for it alone.


2009 structural changes to local government in England, Proposed changes, Early responses
The City of Lancaster considered seeking unitary status on its present boundaries (having supported a merger with South Lakeland and Barrow-in-Furness to form a Morecambe Bay unitary authority during the referendums review). Blackpool advocated a merger with the Fylde and Wyre districts, which they did not support. Pendle and Burnley also tried to form a unitary authority with Rossendale; however Rossendale rejected this.


2009 structural changes to local government in England, Proposed changes, Early responses
The Local Government Chronicle suggested that the non-metropolitan counties of Cornwall, Shropshire, Durham, Cumbria and Northumberland would fit the government's criteria, and that the government would be unlikely to favour carving out unitary authorities from existing two-tier counties. Shropshire County Council, as well as two of the five districts of Shropshire, stated their wish for a move to unitary status. The issue was considered in Durham and Cumbria and the idea of a North Cumbria authority covering the Eden, Copeland, Carlisle and Allerdale districts had some support.


2009 structural changes to local government in England, Proposed changes, Early responses
The issue was also considered in Northumberland, with the county council in favour of one Northumberland unitary authority. Alan Beith, the MP for Berwick at the far north of Northumberland, suggested instead a three unitary solution, with authorities for the largely rural north and south-west, and an authority for the urban south-east (Wansbeck and Blyth Valley).


2009 structural changes to local government in England, Proposed changes, Consultation period
On 26 January 2007, the government confirmed that 26 proposals for unitary authorities had been received. Various county councils proposed they should become unitary authorities: Bedfordshire, Cheshire, Cornwall, Cumbria, Durham, North Yorkshire, Northumberland, Shropshire, Somerset and Wiltshire. Districts seeking to become unitary authorities on their own were Bedford, Exeter, Ipswich, Lancaster, Oxford, Preston. Pendle and Burnley proposed merging as a unitary authority.


2009 structural changes to local government in England, Proposed changes, Consultation period
On 27 March 2007, the government announced that the proposals by Bedfordshire, Bedford, Cornwall, Cheshire, Cumbria, Durham, Exeter, Ipswich, North Yorkshire, Norwich, Shropshire, Somerset and Wiltshire to become unitary authorities would go into the next phase, as would the proposal of Chester for a two-unitary authority Cheshire and by the districts of Northumberland for a two-unitary Northumberland.


2009 structural changes to local government in England, Proposed changes, Consultation period
On 25 July 2007 it was announced that the unitary proposals by Cumbria, North Yorkshire and Somerset had been rejected. On 5 December 2007 it was explained that the unitary proposals by Exeter, and Ipswich, like those of Norwich (which were referred for review on 25 July 2007) did not meet the requirements to proceed; but may be reconsidered after the Boundary Committee has conducted a review of local government structures across the whole of the two-tier counties they are currently a part of.


2009 structural changes to local government in England, Proposed changes, Consultation period
A legal challenge was made by Shrewsbury and Atcham Borough Council and by Congleton Borough Council to the government's decisions, on the basis (amongst other things) that the reviews were made without statutory authority. The High Court and then on 4 March 2008 the Court of Appeal rejected the challenge, finding that the review had been legalized retrospectively.


2009 structural changes to local government in England, Proposed changes, Consultation period
† - in the context of examining options for unitary arrangements in the wider county area.


2009 structural changes to local government in England, Proposed changes, Consultation period
‡ - the Boundary Committee is asked to advise whether an alternative unitary proposal for Norwich based on revised council boundaries could deliver the required improvements.


2009 structural changes to local government in England, Successful proposals
On 27 March 2007 Local Government Minister Phil Woolas announced that 16 councils bidding for unitary status had been shortlisted to go forward for public consultation. On 25 July 2007 Woolas' successor John Healey announced that nine proposals would proceed, subject to the approval of Parliament in the Local Government and Public Involvement in Health Act 2007. A further announcement on 5 December indicated that only the five county level proposals (Cornwall, Durham, Northumberland, Shropshire, and Wiltshire) would proceed, while further consideration was to be given to the various proposals submitted for two more county areas (Bedfordshire and Cheshire).


2009 structural changes to local government in England, Successful proposals
On 18 December it was confirmed that the two-authority plan for Cheshire would proceed. On 6 March 2008 it was confirmed that proposals for Bedford Borough Council to become a unitary authority on its existing boundaries, and for Mid Bedfordshire District Council and South Bedfordshire District Council to merge to create a new Central Bedfordshire authority would be implemented.


2009 structural changes to local government in England, Successful proposals, Single authorities
In the following areas, the existing non-metropolitan county has now also become a non-metropolitan district (i.e. a "unitary county") and the existing non-metropolitan districts have been abolished.


2009 structural changes to local government in England, Successful proposals, Multiple authorities
In the following areas, the existing non-metropolitan counties have been abolished. Each of the two new non-metropolitan districts in Cheshire (resulting from amalgamations of the existing districts) is now also a non-metropolitan county. In Bedfordshire, the new Central Bedfordshire non-metropolitan district (resulting from the amalgamation of two existing districts) is now also a non-metropolitan county, and the previous Bedford non-metropolitan district is now a unitary council.


2009 structural changes to local government in England, Further changes
The Boundary Committee for England has completed its structural reviews for Norfolk, Suffolk and Devon.


2009 structural changes to local government in England, Further changes
Initial draft proposals were published in July 2008. The committee was expected to make final recommendations by 31 December 2008, but these were delayed, due to legal challenges; and because they didn't assess the potential new authorities in proposals which would have split up the counties between two or more unitaries in aggregate. As a result, a further set of draft proposals were published in March 2009:


2009 structural changes to local government in England, Further changes, Final recommendations
Final recommendations were then due in July 2009.; but a successful legal challenge from three District Councils in Suffolk wanting a three unitary model for Suffolk to be considered by the committee resulted in a further delay. The Boundary Committee appealed this decision in favour of Forest Heath, St Edmundsbury & Waveney Councils in October 2009; in December (2009) they found out their appeal had been successful.


2009 structural changes to local government in England, Further changes, Final recommendations
The Boundary Committee has now submitted its final recommendations to the Secretary of State. In all three counties the committee has stated that its preferred option is for a countywide unitary covering the whole of the existing two-tier area to be implemented. In addition in relation to Suffolk they have stated they have no major reservations about the two unitary pattern of North Haven & Rural Suffolk being adopted. Interested parties had until 19 January 2010 to make their representations to the Secretary of State.


2009 structural changes to local government in England, Further changes, Decision on reform
On 10 February 2010, Rosie Winterton, Minister of State for Local Government, announced the proposed final decisions on the unitary proposals:


2009 structural changes to local government in England, Further changes, Decision on reform
The changes in Devon/Exeter and Norfolk/Norwich were to come into effect in April 2011, subject to judicial review. Draft structural changes orders were approved by the House of Lords on 22 March 2010, though the Lords took the unusual step of formally noting its regret. The amendments did not alter the draft orders or affect the legal validity of the Lords approval. The House of Commons approved the draft orders on 23 March. The final Exeter and Norwich orders were made on 24 March following a Government statement responding to the Lords vote. However, the orders were quashed in a judicial review causing elections to be held in Exeter and Norwich in September 2010.


2009 structural changes to local government in England, Further changes, Cancellation of further structural changes
The Queen's Speech at the May 2010 State Opening of Parliament included a Local Government Bill to revoke structural change orders that would have established Exeter and Norwich as unitary authorities and prevent the implementation of the Suffolk unitary proposals. The bill was introduced in the House of Lords on 27 May 2010.


2009 student protests in Austria
In the wake of student protests in Austria since the end of October 2009 against restrictions on the access to higher education, many Austrian universities' lecture halls and rooms were occupied, including the two largest auditoriums in Austria at the University of Vienna.


2009 student protests in Austria
The protests represent the largest Austrian education protests in recent years and led to a broad discussion about education policy. Personalities from the worlds of education, politics, civil society, trade unions, the arts and culture, and the media have commented on the protests and showed solidarity to some extent. The protesters represent grass-roots-efforts and are democratically organized; the internet plays a central role in communication. In addition to the demonstrations, various working groups were formed and started further actions. In the occupied rooms, plenaries were held to come to decisions, and cultural and educational events took place.


2009 student protests in Austria
The demands of the protesters include funding for and democratization of the universities, as well as the abolition or non-introduction of tuition fees. A central slogan of the protests is "education instead of vocational education" (Bildung statt Ausbildung). The protests often run under the joint symbolic motto "university on fire" (Uni brennt) or "our university" (Unsere Uni).


2009 student protests in Austria, Occupations
The protests started with the occupation of the assembly hall of the Academy of Fine Arts Vienna by a group of students and teaching staff on 20 October 2009. They protested against the rector's office's introduction of the Bologna process. After declaring solidarity, the Audimax of the University of Vienna was spontaneously occupied on 22 October 2009. Henceforward, plenums, where grass-roots discussions and votings were held, took place in occupied lecture halls. Numerous work groups were formed, which were the main organisers of the occupation besides the plenums.


2009 student protests in Austria, Occupations
After 22 October, the protests extended to other universities. On 23 October, the pre-clinic of the University of Graz was occupied by approximately 50 students. On 27 October, facilities at the University of Vienna and the TU Wien, as well as the assembly hall at the University of Klagenfurt and lecture hall 1 at the Johannes Kepler University Linz, were occupied. 28 October saw the occupation of lecture hall 381 at the University of Salzburg by 300 people after a protest rally. Facilities of the University of Innsbruck and the Graz University of Technology were occupied on 29 October 2009.


2009 student protests in Austria, Occupations
Further, parts of the University of Arts Linz were occupied on 3 November. In consultation with the rector's office, several vacant rooms at the Türkenwirt-building of the University of Natural Resources and Life Sciences, Vienna, were occupied on 28 October. The occupiers’ demands included a transformation of the vacant building into a long called for “students’ house” (“Haus der Studierenden”).


2009 student protests in Austria, Occupations
Therefore, facilities at 11 university locations across Austria, mostly large lecture halls and assembly halls, were under occupation, often with the rector's office's acceptance and active support. With the exception of the Vienna University of Economics and Business, lecture halls at 4 of the 5 biggest universities in Austria were occupied, among which is the biggest university in German-speaking countries, the University of Vienna. On the morning of 21 December 2009, the 61st day of the protests, the Audimax of the University of Vienna was evicted in the presence of the police after a resolution of the rector's office. At the time of the eviction, approximately 15 students and 80 homeless people were present in the room. Lecture hall C1 stayed occupied until its eviction on 6 January 2010.


2009 student protests in Austria, Occupations
On May 10, short-term occupations occurred in reaction to the closing of the last space which was provided for the movement. Approximately 50 people occupied the rector's office of the University of Vienna for almost two hours and subsequently, the Audimax was also occupied for the same period by up to 300 people. In both cases, the students left the rooms after the police read out the eviction order. On May 14, a small group occupied the Department of Commerce for half an hour. Prior to this, the exit from the university dialogue was announced during a joint press conference of the ÖH and "unibrennt".


2009 student protests in Austria, Reactions, Media
The protests were perceived differently throughout the media. The Austrian left-liberal newspaper "Der Standard", which sent staff members to the auditorium on the first day of the protest to report live on derstandard.at's website, reported the most extensively about the protest movement. Furthermore, the second, more conservative German quality newspaper "Die Presse" initially observed the movement rather cautiously and mainly criticized the nature and goals of the protest. "Der Kurier", a daily newspaper with the widest-circulation in Austria also hit a similar mark, emphasizing on the necessity of restricting the access to higher education.


2009 student protests in Austria, Reactions, Media
The newspaper claims that the nightly concerts, parties and the therewith associated consumption of luxury foods outweighed the protest activities. The country's highest-circulation newspaper called "Kronen Zeitung" did not seem to sympathize with neither the student's approach nor the reactions of the politicians.


2009 student protests in Austria, Reactions, Media
One the one hand, misleading short messages were launched, such as those about a supposedly "hooded demonstrator", who in fact wore respiratory protection while spraying an easel, and on the day of the demonstration on November 5, the commentator Michael Jeannée displayed his dislike against the Audimax occupants by publishing a letter called "University rebels cause chaos in Vienna". On the other hand, "Krone" editorial writer Claus Pandí criticized the "misjudgments" of the politicians, who, according to him, collectively ignore and deny the university injustices. Internationally, German-speaking countries in particular showed interest in the protests.


2009 student protests in Austria, Reactions, Media
On November 5, 2009, the widely-known German newspaper "Die Zeit" dedicated its title page to the student protests in Austria with a red-white-red background. Additionally, the French daily newspaper "Le Monde" gave a detailed report on the protests in Austria during the first week of the occupation. But even outside of Europe, many media outlets dealt with the student protests. The Russian state television for instance showed a report devoted exclusively to the situation in Austria in a news program. In 2010, the documentary #unibrennt - Bildungsprotest 2.0 was published by the "AG Doku" and produced by coop99. The documentary captures the movement of university occupations in Germany and Austria and the exemplary significance of the occupation of the University of Vienna.


2009 student protests in Austria, Aftermaths and consequences
Small financial successes were achieved by the students of the BOKU. A "students' house" ("Haus der Studierenden") that had been claimed for years was made available in the up-to-then vacant second floor of the property “Türkenwirt” (Tüwi) by the rector's office of the ÖH. At the University of Salzburg, commitments were made by the rector's office to fulfil part of the receivables such as in the case of regular listener's congregations or greater participation in the faculty councils.


2009 student protests in Austria, Aftermaths and consequences
Similarly, work groups consisting of both members of the university and students were formed, dealing with study law, with the improved flow of information and greater transparency, as well as the creation of free space for students. In contrast, the occupied lecture hall will be released over the Christmas holidays. In Vienna, the university management announced a competition focusing on the presentation of the foyer of the second largest lecture hall, the C1 on Campus. After the eviction of the occupations, various furniture and tables were placed for utilization but finally removed after a few months.


2009 student protests in Austria, Aftermaths and consequences
On the basis of a list of requirements or rather the long-standing requirement of an Institute of International Developments of the University of Vienna, as a result of the protests, the provisional establishment of the research platform International Development could be achieved along with the means and the premises for the students. At Ars Electronica, #unibrennt was awarded with the prize for his 2.0 link to Ars Electronica's in the Digital Communities category. Taken as a whole, the protests were resulting in no immediate crucial changes in the Austrian Higher Education policy.


2009 student protests in Croatia
Student protests in Croatia 2009 began at the Faculty of Humanities and Social Sciences at the University of Zagreb. On Monday, 20 April 2009, the independent students' initiative for the right to free education started an occupation of the Faculty of Philosophy in Zagreb, Croatia. The occupation lasted for 35 days, until 24 May, when the students voted to suspend the occupation. The students were protesting the Croatian government's plans to reduce public funding for higher education.


2009 student protests in Croatia
The occupation in Zagreb spread next day to the University of Zadar (where the entire university was blocked) and then to other cities in the country, including Split, Pula, Rijeka and Osijek. During those 35 days, around 20 faculties and universities in eight Croatian cities were occupied at some point.


2009 student protests in Croatia
The students who organized the occupation demanded the right to free education for all and the elimination of all tuition fees, at all levels of higher education: undergraduate, graduate and postgraduate. During the occupation, everyone was free to enter and leave the faculty buildings, but regular classes were not held. Instead, students organized an alternative educational program, which consisted of lectures, public discussions, workshops, movie screenings and other events. Everyone was free to attend these happenings, whether they were students or not. Only the regular classes were blocked – the administration, the library, the bookshop and other facilities within the faculty building were allowed to function as usual.


2009 student protests in Croatia
The central organ of student decision making at the occupied faculty called plenum was set up. All decisions were made in a direct democratic manner, including whether the student occupation of the faculty should be continued or ended. The plenum was an assembly of all interested students and other citizens and everyone had the right to speak and vote. All decisions were made by the majority of all present participants.


2009 student protests in Croatia
The initial occupation in Zagreb ended soon after the university administration announced that sanctions would be imposed if the action were not ended.


2009 student protests in Croatia
On 23 November the students again occupied the Faculty of Humanities and Social Sciences in Zagreb. After nearly two weeks, the plenum, voted to end the occupation on 4 December.


2009 student protests in Croatia
They have received letters of support from individuals and organizations, both from Croatia and from abroad. Among those who have expressed support for their cause were Noam Chomsky, Judith Butler and Slavoj Žižek.


2009 student protests in Croatia
The students of Faculty of Humanities and Social Sciences in Zagreb wrote a manual called The Occupation Cookbook in which they described the functioning of their faculty during the occupation.


2009 suicide air raid on Colombo
On February 20, 2009, the air wing of the Tamil Tigers separatist militia launched a suicide attack against military locations in and around Colombo, Sri Lanka, using two weaponized light aircraft. It is speculated that the raids were intended to mimic the September 11 attacks, where aircraft were used as flying bombs and crashed directly into their targets. The attackers failed to reach their presumed targets and crashed to the ground after being shot down by the Sri Lanka Air Force, although one of the aircraft struck a government building in Colombo, killing two people, and over 50 people in total were injured in both crashes.


2009 suicide air raid on Colombo, Background
The Liberation Tigers of Tamil Eelam, also known as the LTTE or the Tamil Tigers, was a separatist militant organization that was fighting to create an independent Tamil state in the north and east of Sri Lanka. Between 1983 and 2009, they engaged in a violent conflict with the military of Sri Lanka, which resulted in the deaths of an estimated 70,000 people. During their campaign, the Tamil Tigers used a variety of controversial tactics, including the extensive use of suicide bombers. The Tamil Tigers are designated as a terrorist organization by 32 countries, including the United States, Canada, and the member nations of the European Union.


2009 suicide air raid on Colombo, Background
By 2002, the Tamil Tigers controlled an area of approximately 15,000 km2 in north and east Sri Lanka. At the time, facing increasing losses on the battlefield and international pressure to stop the fighting, both sides were persuaded to engage in internationally mediated peace talks. The much-hyped peace process carried on until July 2006, when the Tamil Tigers blocked a canal supplying water to an area under the control of the Sri Lankan government. The Sri Lanka Army initially launched an offensive to reopen the canal, and captured it two weeks later. After this success, the Sri Lankan military expanded their offensive, gaining control of the entire Eastern Province in mid-2007, and confining the LTTE to an area of approximately 100 km2 by February 2009.


2009 suicide air raid on Colombo, Background
The first reports of aircraft being in the possession of the LTTE came in 1998, when the pro-LTTE website TamilNet reported that a Tiger aircraft sprinkled flowers over a cemetery in Mullaithivu. However the LTTE did not use aircraft as offensive weapons until March 2007, when they launched a surprise attack against Colombo using a light aircraft to drop a bomb on the main base of the Sri Lanka Air Force.


2009 suicide air raid on Colombo, Background
The LTTE are believed to have smuggled a number of light aircraft into Sri Lanka during the 2002–06 ceasefire period, and these were first detected by UAVs of the Sri Lanka Air Force in 2005. Up to February 2009, the LTTE carried out seven other air attacks against government targets, with the Air Force claiming to have shot down a Tamil Tiger aircraft on one occasion.


2009 suicide air raid on Colombo, Background
The aircraft used for the Colombo attack are believed to be Zlín Z 143. The Z 143 is a single engine, low-winged monoplane manufactured in Czechoslovakia, mainly used for training purposes. Originally a four-seater, it was modified by the LTTE to carry four bombs fitted to its undercarriage. The Tamil Tigers are the only group known to use Z-143s for military purposes.


2009 suicide air raid on Colombo, Attacks
With the Sri Lankan military on the verge of winning the war, the Tamil Tigers launched their first suicide air attack on the night of February 20, 2009. Two aircraft took off from a narrow road in Puthukkudiyirippu in the Mullaithivu District, and were sighted by Sri Lanka Army personnel operating along the front lines around 8:30 pm. The aircraft were soon detected by a Sri Lanka Air Force radar installation at Vavuniya. The aircraft, which had switched off their lights to avoid detection, proceeded towards Mannar and then southwards towards Colombo.


2009 suicide air raid on Colombo, Attacks
Twenty minutes after the detection of the aircraft, an F-7 interceptor of the Sri Lanka Air Force was scrambled to intercept the planes, but was unable to do so due to the low altitude of the Tamil Tiger aircraft. The two Tamil Tiger aircraft then flew past Bandaranaike International Airport, and three international flights were subsequently canceled. At 9:47 pm the aircraft entered airspace above the city of Colombo, and air defense systems were activated. As a precaution, the power supply to the city of Colombo was cut, plunging the city into darkness.


2009 suicide air raid on Colombo, Attacks
As one of the aircraft circled over Colombo Harbor and took a turn over Galle Face Green, it was hit by anti-aircraft gunfire. At 9:51 pm it crashed into the 12th floor of the 15-story Inland Revenue Department (IRD) building, which is located on Sir Chittampalam Gardiner Mawatha. The impact triggered the explosives packed into the plane, setting part of the building on fire. Two people were killed and over 50 injured in the crash, and a military statement said "parts of strewn pieces of flesh said to be that of the Tiger pilot" were found inside the building. The engine of the plane was found on the 12th floor of the building.


2009 suicide air raid on Colombo, Attacks
Unable to proceed due to heavy anti-aircraft gunfire, the second aircraft headed back towards the Air Force base located next to Bandaranaike International Airport. However the aircraft was shot down before it reached the base, crashing at 9:59 pm. Six civilians were injured in the crash. The wreckage of the aircraft, along with the body of the pilot, was found by the military. The pilot had two cyanide capsules and a powerful bomb attached to him.


2009 suicide air raid on Colombo, Attacks
Investigations conducted at the crash sites indicated that for the first time, the Tamil Tiger aircraft were packed with explosives, rather than carrying bombs as they had previously done. It was estimated that there were 215 kg of C-4 plastic explosives inside each plane.


2009 suicide air raid on Colombo, Reaction
The Ministry of Defence released footage taken from an infrared Sri Lanka Navy surveillance camera of the aircraft crashing into the IRD building. Meanwhile, the LTTE released pictures of who they claimed were the two cadres who flew the two aircraft, posing with the leader of the LTTE Velupillai Prabhakaran. They also released a letter allegedly written by one of the cadres urging other Tamils to join the LTTE and fight Sri Lanka.


2009 suicide air raid on Colombo, Reaction
" This incident is not a hit and run one. It is a fully fledged suicide mission, whereby both aircraft had explosives and ammunition attached to the underside. It was in the end however a failed mission."


2009 suicide air raid on Colombo, Reaction
There was concern among Sri Lankan media as to why the aircraft were not intercepted before reaching the capital. An Air Force spokesman said that, since the Tamil Tiger craft were flying at extremely low height of around 300 feet (91 m), it was impossible for the fighter aircraft of the Air Force to engage them. He said that instead the Air Force was intending to shoot down the planes using anti-aircraft guns when they reached Colombo.


2009 suicide air raid on Colombo, Reaction
The military believes that the target of the first plane was either the Sri Lanka Air Force Headquarters, which was adjacent to the Inland Revenue Department building, or the President's House or Army Headquarters, which were also in the area. However, after the aircraft was hit, the pilot lost control and crashed into the IRD building. The second aircraft is believed to have targeted aircraft hangars at the Air Force base at Katunayake. Given the amount of explosives packed inside the aircraft, there could have been devastation if they had hit their targets.


2009 suicide air raid on Colombo, Reaction
Although the Tamil Tigers claimed in a statement that they had launched successful air raids against Sri Lanka Air Force installations, the attacks are largely seen as failures. However they did send out a message that the Tamil Tigers were still capable of launching attacks. The Sri Lankan government called the attacks a "desperate attempt by the LTTE to bring it into the limelight at a time when it was facing a disgraceful defeat" on the battlefield, and a spokesman said terrorist organizations typically would not waste such valuable resources in this manner unless there was no hope in winning.


2009 swine flu pandemic
The 2009–2010 pandemic of swine influenza, caused by H1N1 influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, is the most recent flu pandemic involving the virus (the first being the 1918–1920 Spanish flu pandemic and the second being the 1977 Russian flu). The first two discoveries were independently made in the United States in April 2009. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses and that further combined with a Eurasian pig flu virus, leading to the term "swine flu".


2009 swine flu pandemic
Some studies estimated that the real number of cases including asymptomatic and mild cases could be 700 million to 1.4 billion people—or 11 to 21 percent of the global population of 6.8 billion at the time. The lower value of 700 million is more than the 500 million people estimated to have been infected by the Spanish flu pandemic. However, the Spanish flu infected a much higher proportion of the world population at the time, with the Spanish flu infecting an estimated 500 million people, which was roughly equivalent to a third of the world population at the time of the pandemic.


2009 swine flu pandemic
The number of lab-confirmed deaths reported to the WHO is 18,449, though the 2009 H1N1 flu pandemic is estimated to have actually caused about 284,000 (range from 150,000 to 575,000) deaths. A follow-up study done in September 2010 showed that the risk of serious illness resulting from the 2009 H1N1 flu was no higher than that of the yearly seasonal flu. For comparison, the WHO estimates that 250,000 to 500,000 people die of seasonal flu annually.


2009 swine flu pandemic
Unlike most strains of influenza, the pandemic H1N1/09 virus did not disproportionately infect adults older than 60 years; this was an unusual and characteristic feature of the H1N1 pandemic. Even in the case of previously healthy people, a small percentage develop pneumonia or acute respiratory distress syndrome (ARDS). This manifests itself as increased breathing difficulty and typically occurs three to six days after initial onset of flu symptoms. The pneumonia caused by flu can be either direct viral pneumonia or a secondary bacterial pneumonia.


2009 swine flu pandemic
A November 2009 New England Journal of Medicine article recommended that flu patients whose chest X-ray indicates pneumonia receive both antivirals and antibiotics. In particular, it is a warning sign if a child seems to be getting better and then relapses with high fever, as this relapse may be bacterial pneumonia.


2009 swine flu pandemic, Name
The World Health Organization uses the term "(H1N1) 2009 pandemic" when referring to the event, and officially adopted the name "A(H1N1)pdm09" for the virus in 2010, after the conclusion of the pandemic.


2009 swine flu pandemic, Name
Controversy arose early on regarding the wide assortment of terms used by journalists, academics,and officials. Labels like "H1N1 flu", "Swine flu", "Mexican flu", and variations thereof were typical. Criticism centered on how these names may confuse or mislead the public. It was argued that the names were overly technical (e.g. "H1N1"), incorrectly implying that the disease is caused by contact with pigs or pig products, or provoking stigmatization against certain communities (e.g. "Mexican"). Some academics of the time asserted there is nothing wrong with such names, while research published years later (in 2013) concluded that Mexican Americans and Latino Americans had indeed been stigmatized due to the frequent use of term "Mexican flu" in the news media.


2009 swine flu pandemic, Name
Official entities adopted terms with varying consistency over the course of the pandemic. The CDC used names like "novel influenza A (H1N1)" or "2009 H1N1 flu". The Netherlands National Institute for Public Health and the Environment used the term "Pig Flu" early on. Officials in Taiwan suggested use of the names "H1N1 flu" or "new flu". The World Organization for Animal Health, an IGO based in Europe, proposed the name "North American influenza". The European Commission adopted the term "novel flu virus".


2009 swine flu pandemic, Name
Officials in Israel and South Korea briefly considered adoption of the name "Mexican virus" due to concern about the use of the word "swine". In Israel, objections stemmed from sensitivity to religious restrictions on eating pork in the Jewish and Muslim populations, in South Korea, concerns were influenced by the importance of pork and domestic pigs.


2009 swine flu pandemic, Name
As terminology changed to deal with these and other such issues, further criticism was made that the situation was unnecessarily confusing. For example, the news department at the journal Science produced an article with the humorous title "Swine Flu Names Evolving Faster Than Swine Flu Itself".


2009 swine flu pandemic, History
Analysis of the genetic divergence of the virus in samples from different cases indicated that the virus jumped to humans in 2008, probably after June, and not later than the end of November, likely around September 2008. The research also indicated the virus had been latent in pigs for several months prior to the outbreak, suggesting a need to increase agricultural surveillance to prevent future outbreaks.


2009 swine flu pandemic, History
In 2009, U.S. agricultural officials speculated, although emphasizing that there was no way to prove their hypothesis, that "contrary to the popular assumption that the new swine flu pandemic arose on factory farms in Mexico, [the virus] most likely emerged in pigs in Asia, but then traveled to North America in a human." However, a subsequent report by researchers at the Mount Sinai School of Medicine in 2016 found that the 2009 H1N1 virus likely originated from pigs in a very small region of central Mexico.


2009 swine flu pandemic, History
Initially called an "outbreak", widespread H1N1 infection was first recognized in the state of Veracruz, Mexico, with evidence that the virus had been present for months before it was officially called an "epidemic". The Mexican government closed most of Mexico City's public and private facilities in an attempt to contain the spread of the virus; however, it continued to spread globally, and clinics in some areas were overwhelmed by infected people. The new virus was first isolated in late April by American and Canadian laboratories from samples taken from people with flu in Mexico, Southern California, and Texas.


2009 swine flu pandemic, History
Soon the earliest known human case was traced to a case from 9 March 2009 in a 5-year-old boy in La Gloria, Mexico, a rural town in Veracruz. In late April, the World Health Organization (WHO) declared its first ever "public health emergency of international concern," or PHEIC, and in June, the WHO and the U.S. CDC stopped counting cases and declared the outbreak a pandemic.


2009 swine flu pandemic, History
Despite being informally called "swine flu", the H1N1 flu virus cannot be spread by eating pork products; similar to other influenza viruses, it is typically contracted by person to person transmission through respiratory droplets. Symptoms usually last 4–6 days. Antivirals (oseltamivir or zanamivir) were recommended for those with more severe symptoms or those in an at-risk group.


2009 swine flu pandemic, History
The pandemic began to taper off in November 2009, and by May 2010, the number of cases was in steep decline. On 10 August 2010, the Director-General of the WHO, Margaret Chan, announced the end of the H1N1 pandemic and announced that the H1N1 influenza event had moved into the post-pandemic period. According to WHO statistics (as of July 2010), the virus had killed more than 18,000 people since it appeared in April 2009; however, they state that the total mortality (including deaths unconfirmed or unreported) from the H1N1 strain is "unquestionably higher".


2009 swine flu pandemic, History
Critics claimed the WHO had exaggerated the danger, spreading "fear and confusion" rather than "immediate information". The WHO began an investigation to determine whether it had "frightened people unnecessarily". A flu follow-up study done in September 2010, found that "the risk of most serious complications was not elevated in adults or children." In a 5 August 2011 PLOS ONE article, researchers estimated that the 2009 H1N1 global infection rate was 11% to 21%, lower than what was previously expected.


2009 swine flu pandemic, History
However, by 2012, research showed that as many as 579,000 people could have been killed by the disease, as only those fatalities confirmed by laboratory testing were included in the original number, and meant that many without access to health facilities went uncounted. The majority of these deaths occurred in Africa and Southeast Asia. Experts, including the WHO, have agreed that an estimated 284,500 people were killed by the disease, much higher than the initial death toll.


2009 swine flu pandemic, Signs and symptoms
The symptoms of H1N1 flu are similar to those of other influenzas, and may include fever, cough (typically a "dry cough"), headache, muscle or joint pain, sore throat, chills, fatigue, and runny nose. Diarrhea, vomiting, and neurological problems have also been reported in some cases. People at higher risk of serious complications include people over 65, children younger than 5, children with neurodevelopmental conditions, pregnant women (especially during the third trimester), and people of any age with underlying medical conditions, such as asthma, diabetes, obesity, heart disease, or a weakened immune system (e.g., taking immunosuppressive medications or infected with HIV). More than 70% of hospitalizations in the U.S. have been people with such underlying conditions, according to the CDC.


2009 swine flu pandemic, Signs and symptoms
In September 2009, the CDC reported that the H1N1 flu "seems to be taking a heavier toll among chronically ill children than the seasonal flu usually does". Through 8 August 2009, the CDC had received 36 reports of pediatric deaths with associated influenza symptoms and laboratory-confirmed pandemic H1N1 from state and local health authorities within the United States, with 22 of these children having neurodevelopmental conditions such as cerebral palsy, muscular dystrophy, or developmental delays. "Children with nerve and muscle problems may be at especially high risk for complications because they cannot cough hard enough to clear their airways". From 26 April 2009, to 13 February 2010, the CDC had received reports of the deaths of 277 children with laboratory-confirmed 2009 influenza A (H1N1) within the United States.


2009 swine flu pandemic, Signs and symptoms, Severe cases
The World Health Organization reports that the clinical picture in severe cases is strikingly different from the disease pattern seen during epidemics of seasonal influenza. While people with certain underlying medical conditions are known to be at increased risk, many severe cases occur in previously healthy people. In severe cases, patients generally begin to deteriorate around three to five days after symptom onset. Deterioration is rapid, with many patients progressing to respiratory failure within 24 hours, requiring immediate admission to an intensive care unit. Upon admission, most patients need immediate respiratory support with mechanical ventilation.


2009 swine flu pandemic, Signs and symptoms, Complications
Most complications have occurred among previously unhealthy individuals, with obesity and respiratory disease as the strongest risk factors. Pulmonary complications are common. Primary influenza pneumonia occurs most commonly in adults and may progress rapidly to acute lung injury requiring mechanical ventilation. Secondary bacterial infection is more common in children. Staphylococcus aureus, including methicillin-resistant strains, is an important cause of secondary bacterial pneumonia with a high mortality rate; Streptococcus pneumoniae is the second most important cause of secondary bacterial pneumonia for children and primary for adults. Neuromuscular and cardiac complications are unusual but may occur.


2009 swine flu pandemic, Signs and symptoms, Complications
A United Kingdom investigation of risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza looked at 631 patients from 55 hospitals admitted with confirmed infection from May through September 2009. 13% were admitted to a high dependency or intensive care unit and 5% died; 36% were aged <16 years and 5% were aged ≥65 years. Non -white and pregnant patients were over-represented. 45% of patients had at least one underlying condition, mainly asthma, and 13% received antiviral drugs before admission. Of 349 with documented chest x-rays on admission, 29% had evidence of pneumonia, but bacterial co-infection was uncommon. Multivariate analyses showed that physician-recorded obesity on admission and pulmonary conditions other than asthma or chronic obstructive pulmonary disease (COPD) were associated with a severe outcome, as were radiologically confirmed pneumonia and a raised C-reactive protein (CRP) level (≥100 mg/l). 59% of all in-hospital deaths occurred in previously healthy people.


2009 swine flu pandemic, Signs and symptoms, Complications
Fulminant (sudden-onset) myocarditis has been linked to infection with H1N1, with at least four cases of myocarditis confirmed in patients also infected with A/H1N1. Three out of the four cases of H1N1-associated myocarditis were classified as fulminant, and one of the patients died. Also, there appears to be a link between severe A/H1N1 influenza infection and pulmonary embolism. In one report, five out of 14 patients admitted to the intensive care unit with severe A/H1N1 infection were found to have pulmonary emboli.


2009 swine flu pandemic, Signs and symptoms, Complications
An article published in JAMA in September 2010 challenged previous reports and stated that children infected in the 2009 flu pandemic were no more likely to be hospitalised with complications or get pneumonia than those who catch seasonal strains. Researchers found that about 1.5% of children with the H1N1 swine flu strain were hospitalised within 30 days, compared with 3.7% of those sick with a seasonal strain of H1N1 and 3.1% with an H3N2 virus.


2009 swine flu pandemic, Diagnosis
Confirmed diagnosis of pandemic H1N1 flu requires testing of a nasopharyngeal, nasal, or oropharyngeal tissue swab from the patient. Real-time RT-PCR is the recommended test as others are unable to differentiate between pandemic H1N1 and regular seasonal flu. However, most people with flu symptoms do not need a test for pandemic H1N1 flu specifically, because the test results usually do not affect the recommended course of treatment. The U.S. CDC recommend testing only for people who are hospitalized with suspected flu, pregnant women, and people with weakened immune systems.


2009 swine flu pandemic, Diagnosis
For the mere diagnosis of influenza and not pandemic H1N1 flu specifically, more widely available tests include rapid influenza diagnostic tests (RIDT), which yield results in about 30 minutes, and direct and indirect immunofluorescence assays (DFA and IFA), which take 2–4 hours.


2009 swine flu pandemic, Diagnosis
Due to the high rate of RIDT false negatives, the CDC advises that patients with illnesses compatible with novel influenza A (H1N1) virus infection but with negative RIDT results should be treated empirically based on the level of clinical suspicion, underlying medical conditions, severity of illness, and risk for complications, and if a more definitive determination of infection with influenza virus is required, testing with rRT-PCR or virus isolation should be performed.


2009 swine flu pandemic, Diagnosis
The use of RIDTs has been questioned by researcher Paul Schreckenberger of the Loyola University Health System, who suggests that rapid tests may actually pose a dangerous public health risk. Nikki Shindo of the WHO has expressed regret at reports of treatment being delayed by waiting for H1N1 test results and suggests, "[D]octors should not wait for the laboratory confirmation but make diagnosis based on clinical and epidemiological backgrounds and start treatment early."


2009 swine flu pandemic, Diagnosis
On 22 June 2010, the CDC announced a new test called the "CDC Influenza 2009 A (H1N1)pdm Real-Time RT-PCR Panel (IVD)". It uses a molecular biology technique to detect influenza A viruses and specifically the 2009 H1N1 virus. The new test will replace the previous real-time RT-PCR diagnostic test used during the 2009 H1N1 pandemic, which received an emergency use authorization from the U.S. Food and Drug Administration in April 2009. Tests results are available in four hours and are 96% accurate.


2009 swine flu pandemic, Cause
The virus was found to be a novel strain of influenza for which existing vaccines against seasonal flu provided little protection. A study at the U.S. Centers for Disease Control and Prevention published in May 2009 found that children had no preexisting immunity to the new strain but that adults, particularly those older than 60, had some degree of immunity. Children showed no cross-reactive antibody reaction to the new strain, adults aged 18 to 60 had 6–9%, and older adults 33%.


2009 swine flu pandemic, Cause
While it has been thought that these findings suggest the partial immunity in older adults may be due to previous exposure to similar seasonal influenza viruses, a November 2009 study of a rural unvaccinated population in China found only a 0.3% cross-reactive antibody reaction to the H1N1 strain, suggesting that previous vaccinations for seasonal flu and not exposure may have resulted in the immunity found in the older U.S. population.


2009 swine flu pandemic, Cause
Analyses of the genetic sequences of the first isolates, promptly shared on the GISAID database according to Nature and WHO, soon determined that the strain contains genes from five different flu viruses: North American swine influenza, North American avian influenza, human influenza, and two swine influenza viruses typically found in Asia and Europe. Further analysis has shown that several proteins of the virus are most similar to strains that cause mild symptoms in humans, leading virologist Wendy Barclay to suggest on 1 May 2009, that the initial indications are that the virus was unlikely to cause severe symptoms for most people.


2009 swine flu pandemic, Cause
The virus was less lethal than previous pandemic strains and killed about 0.01–0.03% of those infected; the 1918 influenza was about one hundred times more lethal and had a case fatality rate of 2–3%. By November 14, 2009, the virus had infected one in six Americans with 200,000 hospitalisations and 10,000 deaths—as many hospitalizations and fewer deaths than in an average flu season overall, but with much higher risk for those under 50. With deaths of 1,100 children and 7,500 adults 18 to 64, these figures were deemed "much higher than in a usual flu season" during the pandemic.


2009 swine flu pandemic, Cause
In June 2010, scientists from Hong Kong reported discovery of a new swine flu virus: a hybrid of the pandemic H1N1 virus and viruses previously found in pigs. It was the first report of a reassortment of the pandemic virus, which in humans had been slow to evolve.


2009 swine flu pandemic, Cause
Nancy Cox, head of the influenza division at the U.S. Centers for Disease Control and Prevention, has said, "This particular paper is extremely interesting because it demonstrates for the first time what we had worried about at the very onset of the pandemic, and that is that this particular virus, when introduced into pigs, could reassort with the resident viruses in pigs and we would have new gene constellations. And bingo, here we are."


2009 swine flu pandemic, Cause
Pigs have been termed the mixing vessel of flu because they can be infected both by avian flu viruses, which rarely directly infect people, and by human viruses. When pigs become simultaneously infected with more than one virus, the viruses can swap genes, producing new variants which can pass to humans and sometimes spread amongst them. "Unlike the situation with birds and humans, we have a situation with pigs and humans where there's a two-way street of exchange of viruses. With pigs it's very much a two-way street."


2009 swine flu pandemic, Cause, Transmission
Spread of the H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something—such as a surface or object—with flu viruses on it and then touching their face.


2009 swine flu pandemic, Cause, Transmission
The basic reproduction number (the average number of other individuals whom each infected individual will infect, in a population which has no immunity to the disease) for the 2009 novel H1N1 is estimated to be 1.75. A December 2009 study found that the transmissibility of the H1N1 influenza virus in households is lower than that seen in past pandemics. Most transmissions occur soon before or after the onset of symptoms.


2009 swine flu pandemic, Cause, Transmission
The H1N1 virus has been transmitted to animals, including swine, turkeys, ferrets, household cats, at least one dog, and a cheetah.


2009 swine flu pandemic, Prevention
Because the H1N1 vaccine was initially in short supply in the U.S., the CDC recommended that initial doses should go to priority groups such as pregnant women, people who live with or care for babies under six months old, children six months to four years old and health-care workers. In the UK, the NHS recommended vaccine priority go to people over six months old who were clinically at risk for seasonal flu, pregnant women and households of people with compromised immunity.


2009 swine flu pandemic, Prevention
Although it was initially thought that two injections would be required, clinical trials showed that the new vaccine protected adults "with only one dose instead of two;" thus the limited vaccine supplies would go twice as far as had been predicted. Health officials worldwide were also concerned because the virus was new and could easily mutate and become more virulent, even though most flu symptoms were mild and lasted only a few days without treatment.


2009 swine flu pandemic, Prevention
Officials also urged communities, businesses, and individuals to make contingency plans for possible school closures, multiple employee absences for illness, surges of patients in hospitals, and other effects of potentially widespread outbreaks. Disaster response organizations such as Direct Relief helped by providing protective items to clinical workers to help them stay healthy throughout flu season.


2009 swine flu pandemic, Prevention
In February 2010, the CDC's Advisory Committee on Immunization Practices voted for "universal" flu vaccination in the U.S. to include all people over six months of age. The 2010–2011 vaccine will protect against the 2009 H1N1 pandemic virus and two other flu viruses.


2009 swine flu pandemic, Prevention, Public health response
On 27 April 2009, the European Union health commissioner advised Europeans to postpone nonessential travel to the United States or Mexico. This followed the discovery of the first confirmed case in Spain. On 6 May 2009, the Public Health Agency of Canada announced that their National Microbiology Laboratory (NML) had mapped the genetic code of the swine flu virus, the first time that had been done. In the U.K., the National Health Service launched a website, the National Pandemic Flu Service, allowing patients to self-assess and get an authorisation number for antiviral medication. The system was expected to reduce the burden on general practitioners.


2009 swine flu pandemic, Prevention, Public health response
U.S. officials observed that six years of concern about H5N1 avian flu did much to prepare for the current H1N1 outbreak, noting that after H5N1 emerged in Asia, ultimately killing about 60% of the few hundred people infected over the years, many countries took steps to try to prevent any similar crisis from spreading further. The CDC and other U.S. governmental agencies used the summer lull to take stock of the United States response to H1N1 flu and attempt to patch any gaps in the public health safety net before flu season started in early autumn.


2009 swine flu pandemic, Prevention, Public health response
Preparations included planning a second influenza vaccination program in addition to the one for seasonal flu, and improving coordination between federal, state, and local governments and private health providers. On 24 October 2009, U.S. President Obama declared swine flu a national emergency, giving Secretary of Health and Human Services Kathleen Sebelius authority to grant waivers to requesting hospitals from usual federal requirements.


2009 swine flu pandemic, Prevention, Vaccines
By 19 November 2009, doses of vaccine had been administered in over 16 countries. A 2009 review by the U.S. National Institutes of Health (NIH) concluded that the 2009 H1N1 vaccine has a safety profile similar to that of the seasonal vaccine.


2009 swine flu pandemic, Prevention, Vaccines
In 2011, a study from the US Flu Vaccine Effectiveness Network estimated the overall effectiveness of all pandemic H1N1 vaccines at 56%. A CDC study released 28 January 2013, estimated that the Pandemic H1N1 vaccine saved roughly 300 lives and prevented about a million illnesses in the US. The study concluded that had the vaccination program started two weeks earlier, close to 60% more cases could have been prevented. The study was based on an effectiveness in preventing cases, hospitalizations, and deaths of 62% for all subgroups except people over 65, for whom the effectiveness was estimated at 43%.


2009 swine flu pandemic, Prevention, Vaccines
The effectiveness was based on European and Asian studies and expert opinion. The delay in vaccine administration demonstrated the shortcomings of the world's capacity for vaccine-production, as well as problems with international distribution. Some manufacturers and wealthy countries had concerns regarding liability and regulations, as well as the logistics of transporting, storing, and administering vaccines to be donated to poorer countries.


2009 swine flu pandemic, Prevention, Accusations of conflict of interest
In January 2010, Wolfgang Wodarg, a German deputy who trained as a physician and chaired the health committee at the Council of Europe, claimed that major firms had organized a "campaign of panic" to put pressure on the World Health Organization (WHO) to declare a "false pandemic" to sell vaccines. Wodarg said the WHO's "false pandemic" flu campaign is "one of the greatest medicine scandals of the century".


2009 swine flu pandemic, Prevention, Accusations of conflict of interest
He said that the "false pandemic" campaign began in May 2009 in Mexico City, when a hundred or so "normal" reported influenza cases were declared to be the beginning of a threatening new pandemic, although he said there was little scientific evidence for it.


2009 swine flu pandemic, Prevention, Accusations of conflict of interest
Nevertheless, he argued that the WHO, "in cooperation with some big pharmaceutical companies and their scientists, re-defined pandemics," removing the statement that "an enormous amount of people have contracted the illness or died" from its existing definition and replacing it by stating simply that there has to be a virus, spreading beyond borders and to which people have no immunity.


2009 swine flu pandemic, Prevention, Accusations of conflict of interest
The WHO responded by stating that they take their duty to provide independent advice seriously and guarded against interference from outside interests. Announcing a review of the WHO's actions, spokeswoman Fadela Chaib stated: "Criticism is part of an outbreak cycle. We expect and indeed welcome criticism and the chance to discuss it". The WHO also stated on their website that "The world is going through a real pandemic. The description of it as a fake is wrong and irresponsible". In March 2010, the Council of Europe launched an enquiry into "the influence of the pharmaceutical companies on the global swine flu campaign", and a preliminary report was in preparation.


2009 swine flu pandemic, Prevention, Accusations of conflict of interest
On 12 April 2010, Keiji Fukuda, the WHO's top influenza expert, stated that the system leading to the declaration of a pandemic led to confusion about H1N1 circulating around the world and he expressed concern that there was a failure to communicate in regard to uncertainties about the new virus, which turned out to be not as deadly as feared. WHO Director-General Margaret Chan appointed 29 flu experts from outside the organization to conduct a review of WHO's handling of the H1N1 flu pandemic. She told them, "We want a frank, critical, transparent, credible and independent review of our performance."


2009 swine flu pandemic, Prevention, Accusations of conflict of interest
In June 2010, Fiona Godlee, editor-in-chief of the BMJ, published an editorial which criticised the WHO, saying that an investigation had disclosed that some of the experts advising WHO on the pandemic had financial ties with drug companies which were producing antivirals and vaccines. Margaret Chan, Director-General of the WHO, replied stating, "Without question, the BMJ feature and editorial will leave many readers with the impression that WHO's decision to declare a pandemic was at least partially influenced by a desire to boost the profits of the pharmaceutical industry. The bottom line, however, is that decisions to raise the level of pandemic alert were based on clearly defined virological and epidemiological criteria. It is hard to bend these criteria, no matter what the motive".


2009 swine flu pandemic, Prevention, Infection control, Travel precautions
On 7 May 2009, the WHO stated that containment was not feasible and that countries should focus on mitigating the effect of the virus. They did not recommend closing borders or restricting travel. On 26 April 2009, the Chinese government announced that visitors returning from flu-affected areas who experienced flu-like symptoms within two weeks would be quarantined.


2009 swine flu pandemic, Prevention, Infection control, Travel precautions
U.S. airlines had made no major changes as of the beginning of June 2009, but continued standing practices which include looking for passengers with symptoms of flu, measles or other infections, and relying on in-flight air filters to ensure that aircraft were sanitised. Masks were not generally provided by airlines and the CDC did not recommend that airline crews wear them. Some non-U.S. airlines, mostly Asian, including Singapore Airlines, China Eastern Airlines, China Southern Airlines, Cathay Pacific and Aeromexico, took measures such as stepping up cabin cleaning, installing state-of-the-art air filters and allowing in-flight staff to wear face masks.


2009 swine flu pandemic, Prevention, Infection control, Travel precautions
According to studies conducted in Australia and Japan, screening individuals for influenza symptoms at airports during the 2009 H1N1 outbreak was not an effective method of infection control.


2009 swine flu pandemic, Prevention, Infection control, Schools
U.S. government officials were especially concerned about schools because the H1N1 flu virus appeared to disproportionately affect young and school-age people, between six months and 24 years of age. The H1N1 outbreak led to numerous precautionary school closures in some areas. Rather than closing schools, the CDC recommended that students and school workers with flu symptoms should stay home for either seven days total, or until 24 hours after symptoms subsided, whichever was longer.


2009 swine flu pandemic, Prevention, Infection control, Schools
The CDC also recommended that colleges should consider suspending fall 2009 classes if the virus began to cause severe illness in a significantly larger share of students than the previous spring. They also urged schools to suspend rules, such as penalties for late papers or missed classes or requirements for a doctor's note, to enforce "self-isolation" and prevent students from venturing out while ill; schools were advised to set aside a room for people developing flu-like symptoms while they waited to go home and to have ill students or staff and those caring for them use face masks.


2009 swine flu pandemic, Prevention, Infection control, Schools
In California, school districts and universities were on alert and worked with health officials to launch education campaigns. Many planned to stockpile medical supplies and discuss worst-case scenarios, including plans to provide lessons and meals for low-income children in case elementary and secondary schools closed. University of California campuses stockpiled supplies, from paper masks and hand sanitizer to food and water.


2009 swine flu pandemic, Prevention, Infection control, Schools
To help prepare for contingencies, University of Maryland School of Medicine professor of pediatrics James C. King Jr. suggested that every county should create an "influenza action team" to be run by the local health department, parents, and school administrators. By 28 October 2009, about 600 schools in the United States had been temporarily closed, affecting over 126,000 students in 19 states.


2009 swine flu pandemic, Prevention, Infection control, Workplace
Fearing a worst-case scenario, the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention and the Department of Homeland Security (DHS) developed updated guidance and a video for employers to use as they developed plans to respond to the H1N1 outbreak. The guidance suggested that employers consider and communicate their objectives, such as reducing transmission among staff, protecting people who are at increased risk of influenza-related complications from becoming infected, maintaining business operations, and minimising adverse effects on other entities in their supply chains.


2009 swine flu pandemic, Prevention, Infection control, Workplace
The CDC estimated that as much as 40% of the workforce might be unable to work at the peak of the pandemic due to the need for many healthy adults to stay home and care for an ill family member, and advised that individuals should have steps in place should a workplace close down or a situation arise that requires working from home. The CDC further advised that persons in the workplace should stay home sick for seven days after getting the flu, or 24 hours after symptoms end, whichever is longer.


2009 swine flu pandemic, Prevention, Infection control, Workplace
In the UK, the Health and Safety Executive (HSE) also issued general guidance for employers.


2009 swine flu pandemic, Prevention, Infection control, Face masks
The U.S. CDC did not recommend the use of face masks or respirators in non-health care settings, such as schools, workplaces, or public places, with a few exceptions: people who were ill with the virus when around other people, and people who were at risk for severe illness while caring for someone with the flu. There was some disagreement about the value of wearing face masks, as some experts feared that masks may have given people a false sense of security and should not have replaced other standard precautions.


2009 swine flu pandemic, Prevention, Infection control, Face masks
Yukihiro Nishiyama, professor of virology at Nagoya University's School of Medicine, commented that the masks are "better than nothing, but it's hard to completely block out an airborne virus since it can easily slip through the gaps". According to mask manufacturer 3M, masks will filter out particles in industrial settings, but "there are no established exposure limits for biological agents such as swine flu virus". However, despite the lack of evidence of effectiveness, the use of such masks is common in Asia. They are particularly popular in Japan, where cleanliness and hygiene are highly valued and where etiquette obligates those who are sick to wear masks to avoid spreading disease.


2009 swine flu pandemic, Prevention, Infection control, Quarantine
During the height of the fear of a pandemic, some countries initiated or threatened to initiate quarantines of foreign visitors suspected of having or being in contact with others who may have been infected. In May 2009, the Chinese government confined 21 U.S. students and three teachers to their hotel rooms. As a result, the US State Department issued a travel alert about China's anti-flu measures and warned travellers against travelling to China if ill.


2009 swine flu pandemic, Prevention, Infection control, Quarantine
In Hong Kong, an entire hotel was quarantined with 240 guests; Australia ordered a cruise ship with 2,000 passengers to stay at sea because of a swine flu threat. Egyptian Muslims who went on the annual pilgrimage to Mecca risked being quarantined upon their return. Russia and Taiwan said they would quarantine visitors with fevers who come from areas where the flu was present. Japan quarantined 47 airline passengers in a hotel for a week in mid-May, then in mid-June India suggested pre-screening "outbound" passengers from countries thought to have a high rate of infection.


2009 swine flu pandemic, Prevention, Infection control, Pigs and food safety
The pandemic virus is a type of swine influenza, derived originally from a strain which lived in pigs, and this origin gave rise to the common name of "swine flu".


2009 swine flu pandemic, Prevention, Infection control, Pigs and food safety
This term is widely used by mass media, though the Paris-based World Organisation for Animal Health as well as industry groups such as the U.S. National Pork Board, the American Meat Institute, and the Canadian Pork Council objected to widespread media use of the name "swine flu" and suggested it should be called "North American flu" instead, while the World Health Organization switched its designation from "swine influenza" to "influenza A (H1N1)" in late April 2009. The virus has been found in U.S. hogs, and Canadian as well as in hogs in Northern Ireland, Argentina, and Norway.


2009 swine flu pandemic, Prevention, Infection control, Pigs and food safety
Leading health agencies and the United States Secretary of Agriculture have stressed that eating properly cooked pork or other food products derived from pigs will not cause flu. Nevertheless, on 27 April Azerbaijan imposed a ban on the importation of animal husbandry products from the entire Americas. The Indonesian government also halted the importation of pigs and initiated the examination of 9 million pigs in Indonesia. The Egyptian government ordered the slaughter of all pigs in Egypt on 29 April.


2009 swine flu pandemic, Treatment
A number of methods have been recommended to help ease symptoms, including adequate liquid intake and rest. Over-the-counter pain medications such as paracetamol and ibuprofen do not kill the virus; however, they may be useful to reduce symptoms. Aspirin and other salicylate products should not be used by people under 16 with any flu-type symptoms because of the risk of developing Reye's Syndrome.


2009 swine flu pandemic, Treatment
If the fever is mild and there are no other complications, fever medication is not recommended. Most people recover without medical attention, although ones with pre-existing or underlying medical conditions are more prone to complications and may benefit from further treatments.


2009 swine flu pandemic, Treatment
People in at-risk groups should be treated with antivirals (oseltamivir or zanamivir) as soon as possible when they first experience flu symptoms. The at-risk groups include pregnant and post partum women, children under two years old, and people with underlying conditions such as respiratory problems. People who are not in an at-risk group who have persistent or rapidly worsening symptoms should also be treated with antivirals. People who have developed pneumonia should be given both antivirals and antibiotics, as in many severe cases of H1N1-caused illness, bacterial infection develops.


2009 swine flu pandemic, Treatment
Antivirals are most useful if given within 48 hours of the start of symptoms and may improve outcomes in hospitalised patients. In those beyond 48 hours who are moderately or severely ill, antivirals may still be beneficial. If oseltamivir (Tamiflu) is unavailable or cannot be used, zanamivir (Relenza) is recommended as a substitute. Peramivir is an experimental antiviral drug approved for hospitalised patients in cases where the other available methods of treatment are ineffective or unavailable.


2009 swine flu pandemic, Treatment
To help avoid shortages of these drugs, the U.S. CDC recommended oseltamivir treatment primarily for people hospitalised with pandemic flu; people at risk of serious flu complications due to underlying medical conditions; and patients at risk of serious flu complications. The CDC warned that the indiscriminate use of antiviral medications to prevent and treat influenza could ease the way for drug-resistant strains to emerge, which would make the fight against the pandemic that much harder. In addition, a British report found that people often failed to complete a full course of the drug or took the medication when not needed.


2009 swine flu pandemic, Treatment, Side effects
Both medications mentioned above for treatment, oseltamivir and zanamivir, have known side effects, including lightheadedness, chills, nausea, vomiting, loss of appetite, and trouble breathing. Children were reported to be at increased risk of self-injury and confusion after taking oseltamivir. The WHO warned against buying antiviral medications from online sources and estimated that half the drugs sold by online pharmacies without a physical address were counterfeit.


2009 swine flu pandemic, Treatment, Resistance
In December 2012, the World Health Organization (WHO) reported 314 samples of the 2009 pandemic H1N1 flu tested worldwide have shown resistance to oseltamivir (Tamiflu). It is not totally unexpected as 99.6% of the seasonal H1N1 flu strains tested have developed resistance to oseltamivir. No circulating flu has yet shown any resistance to zanamivir (Relenza), the other available anti-viral.


2009 swine flu pandemic, Treatment, Antivirals effectiveness questioned in healthy adults
On 8 December 2009, the Cochrane Collaboration, which reviews medical evidence, announced in a review published in BMJ that it had reversed its previous findings that the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can ward off pneumonia and other serious conditions linked to influenza. They reported that an analysis of 20 studies showed oseltamivir offered mild benefits for healthy adults if taken within 24 hours of onset of symptoms, but found no clear evidence it prevented lower respiratory tract infections or other complications of influenza.


2009 swine flu pandemic, Treatment, Antivirals effectiveness questioned in healthy adults
Of note, their published finding related only to use in healthy adults with influenza but not in patients judged to be at high risk of complications (pregnant women, children under five and those with underlying medical conditions), and uncertainty over its role in reducing complications in healthy adults still left it as a useful drug for reducing the duration of symptoms. In general, the Cochrane Collaboration concluded "Paucity of good data".


2009 swine flu pandemic, Epidemiology
Note: The ratio of confirmed deaths to total deaths due to the pandemic is unknown. For more information, see "Data reporting and accuracy".


2009 swine flu pandemic, Epidemiology
While it is not known precisely where or when the virus originated, analyses in scientific journals have suggested that the H1N1 strain responsible for the 2009 outbreak first evolved in September 2008 and circulated amongst humans for several months, before being formally recognised and identified as a novel strain of influenza.


2009 swine flu pandemic, Epidemiology, Mexico
The virus was first reported in two U.S. children in March 2009, but health officials have reported that it apparently infected people as early as January 2009 in Mexico. The outbreak was first identified in Mexico City on 18 March 2009; immediately after the outbreak was officially announced, Mexico notified the U.S. and World Health Organization, and within days of the outbreak Mexico City was "effectively shut down". Some countries cancelled flights to Mexico while others halted trade. Calls to close the border to contain the spread were rejected.