Swine Flu Update: Five Things Not to Do

The global rise in swine flu has showed few signs of slowing. Now in 11 countries, the H1N1 flu virus was confirmed on Thursday in the Netherlands and Switzerland; in Canada, cases rose to 27 and in the U.S., the caseload increased to 109 in 11 states, with hundreds of school closures that sent some 160,000 students home. Meanwhile, the World Health Organization (WHO) has said that a new flu pandemic is imminent, yet some pharmacies (in New York City at least) are temporarily running short of the antiviral Tamiflu. So, no one would blame you for feeling scared about getting sick.

But when people get scared, they sometimes say or do dumb things. That includes Vice President Joseph Biden, who said Thursday morning on the Today show that the swine flu virus could spread easily on airplanes, and that he has advised his family against traveling anywhere on mass transit. "When one person sneezes, it goes all the way through the aircraft," Biden told Today host Matt Lauer. "I would not be, at this point, if they had another way of transportation, suggesting they ride the subway." (See the top 5 swine flu don'ts.)

In fact, as Dr. Richard Besser, the acting director of the Centers for Disease Control and Prevention (CDC), pointed out just a few hours later, there's no real risk for a healthy person in the U.S. to ride mass transit — not with the outbreak as small as it is currently. It's true that crowded trains and subway cars can be a vector for disease transmission if sick people are on board. You can catch the flu if you're within about six feet of a sick person — otherwise known as the "breathing space" — who coughs or sneezes on you, and a small amount of the virus can survive on inanimate surfaces. But with just a tiny number of cases in the U.S. right now, there's little risk that you'll encounter a sick person — certainly not enough to make it worth becoming a shut-in. (See pictures of thermal scanners hunting for swine flu.)

(To the Vice President's point about air travel: Aboard a plane, the air flows side to side, with air circulating in from above and traveling across rows — with little front-to-back air movement — before exiting the cabin. Most aircraft also ventilate the cabin with fresh air from outside and use HEPA filters to clean recirculated air.)

But misconceptions spread quickly during the early stages of a new disease outbreak. In Egypt, authorities culled some 300,000 pigs — even though there was no evidence that the H1N1 virus was circulating in these pigs or was actively passing from pigs to people. In France, authorities have said they want to ban flights to and from Mexico, even though WHO officials and other epidemiologists say such extreme measures are likely to hurt far more than they'll help. (The E.U. rejected the French request on Thursday.) "The risk of collateral damage [on top of the flu] is very real," says Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

With that in mind, click here for five things not to do in dealing with the swine flu frenzy.

See pictures of the swine flu outbreak in Mexico.

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Researchers Find First Signs of Autism Even in Infancy

Show the average 14-month-old baby a sealed jar of cookies, and you get some pretty predictable behavior. The child will reach for the treats and, when thwarted, look beseechingly at the nearest adult. The request for help — delivered with eye contact, gestures and often with pleading sounds — is unmistakable. But some babies don't do it. One little boy, captured on video by psychologist Wendy Stone at Vanderbilt University, repeatedly places a researcher's hand on the cookie jar but never once looks at her face to see why she isn't responding. Eventually, tragically, he gives up.

Show the average 18-month-old a video of toddlers at play, and you can bet that the tot will be mesmerized by scenes with strong emotion: a fight or kiss. But some babies have other interests. At the Yale Child Study Center, psychologists Warren Jones, Ami Klin and Sarah Shultz measure when toddlers stop blinking — a reliable indicator of rapt attention. The typical child will stare at the scene of a kiss, but a child with autism will be transfixed by the opening and closing of a door. (See six tips for traveling with an autistic child.)

Experiments like these, presented at a recent conference at Columbia University's Teachers College, are helping researchers identify the signs of autism at ever earlier ages. For parents, says Stone, director of Vanderbilt's Treatment and Research Institute for Autism Spectrum Disorders, "the average age of first concern is 17 months, though a diagnosis isn't typically made until age 3. That's a long time to be concerned and not know what to do."

In 2007, the American Academy of Pediatrics recommended that doctors begin screening babies for autism at 18 months, but researchers have yet to refine the tools for making a reliable diagnosis at that age. One issue, says Catherine Lord, director of the University of Michigan Autism & Communication Disorders Center, is that there is so much individual variability in how babies develop. Another challenge is that many of the signature signs of autism — delayed speech, repetitive movements or fixations on particular toys or objects — involve language and motor skills that babies have not yet acquired. That's why identifying the signs of autism before age 2 often involves the absence of typical behavior as opposed to the presence of aberrations.

Among the telltale signs of trouble at 12 months: not responding to one's name; not sharing interests through pointing and eye gaze; lack of joyful expression; an absence of babbling; difficulty establishing eye contact; and staring too long at inanimate objects (see FirstSigns.org for more early-warning signs). Investigators have identified these red-flag signs of autism by looking at early home videos of children who were diagnosed at age 3 or later and by studying the younger siblings of children with autism, who have relatively high rates — perhaps 15% — of the disorder. But no single behavior is indicative, and researchers believe that rather than being given a definitive diagnosis, tots with several of these behaviors should be identified as "at risk" and referred to early-intervention programs. (See pictures of a school for autistic children.)

Research strongly suggests that early intervention is key to improving outcomes for at-risk children. And by identifying these children at younger ages, scientists can better determine which aspects of autism are hardwired and which are the secondary results of living with the disability. There is also growing support in the autism-research community for the view that a significant number of children who are at risk could be protected from becoming fully autistic if they are assisted early enough and given the optimal intervention.

"The environment in the early years has an active role in shaping the brain," says Geraldine Dawson, a leading autism researcher and the chief scientific officer of the advocacy group Autism Speaks. "What we see in autism may be partly the result of not engaging with the social environment. So if you engage the baby through an intervention, you might prevent or at least reduce the development of autism symptoms." (See more about autism.)

Thus, the child who is not taking part in the typical parent-child dance — exchanging smiles and glances, pointing at something of interest, seeking attention — is missing out on a lot of learning and failing to lay the foundations for more complex social behavior. Rather than become experts on social cues, as most humans are wired to do, these children, observes Klin, tend to focus on the physical world — the opening and closing of doors and the properties of inanimate objects.

Several studies from across the country are looking at how to draw at-risk infants into the social world so that they will develop more normally. One National Institutes of Health–funded study, at the University of Washington, begins intervention for at-risk babies at 8 months, says Dawson, who adds, "What we are doing is teaching the parents how to structure interactions to promote eye contact and babbling." Parents learn, for example, to engage their babies in settings where there are few distractions so that facial expressions and language are more salient. They also learn strategies to calm infants who tend to become agitated and stressed by social activity. The intervention is playful in spirit, says Dawson, adding, "Parents get very confident and are able to learn this quickly." The hope, she says, is that for some significant portion of children at risk, "we can begin before the full autism syndrome is present and prevent it from emerging."

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Was the Alarm over Swine Flu Justified?

Like a patient suffering from a particularly tenacious case of, well, the flu, the H1N1 virus seemed to gain ground and then lose it over the weekend, leaving health officials cautious but hopeful that the disease might be on the wane. The number of confirmed infections continues to rise, with the World Health Organization (WHO) reporting 898 infections in 18 countries as of May 3, and the Centers for Disease Control and Prevention (CDC) tallying 226 confirmed cases in 30 U.S. states. The continuing spread led Homeland Security Secretary Janet Napolitano to predict on Sunday that the WHO might soon raise its pandemic alert level from phase 5 to the highest stage, phase 6, which would indicate that a full flu pandemic was underway. "The virus has arrived, I would say, in most of the country now," said Anne Schuchat, interim deputy director for science and public health at the CDC.

But there have been no deaths and few serious cases reported outside Mexico — and even there, the epicenter of the H1N1 outbreak, officials reported that the spread has slowed. As labs slogged through the backlog of suspected H1N1 flu cases, the number of confirmed cases and deaths dropped precipitously, indicating that the initial outbreak that so alarmed world health officials might not have been as serious as first feared. (See the top five swine flu don'ts.)

As a global network of flu experts began to take a good look at the genetic structure of the H1N1 virus, there were indications that the bug might turn out to be little more dangerous than an average flu. Though scientists can't say exactly what genes make a particular strain of flu unusually deadly, all of the viruses that triggered pandemics over the past century — the catastrophic 1918 flu, but also the 1957 and 1968 pandemics — had a particular mutation in the gene that makes a protein called PB1-F2. The H1N1 virus also seems to lack mutations that make the especially virulent H5N1 avian flu, which has killed more than half the people with confirmed infections. (See pictures of the effects of swine flu in Mexico.)

Even if H1N1 seems to lack the killer instinct at the moment, flu viruses are unpredictable, and there's no guarantee that it couldn't change form. Flu season in the southern hemisphere is just beginning, and if the virus establishes itself in countries like Argentina or Australia, it could cause real damage. And there are still open mysteries, like why the bulk of the infections in the U.S. — and the confirmed deaths thus far in Mexico — have been found in people who are relatively young, which is unusual for the flu, or why this strain seems to be spreading at a time of year when the flu usually levels off. "These viruses mutate, these viruses change, these viruses can further reassort with other genetic material," said Michael Ryan, the WHO's global alert and response director. "So it would be imprudent at this point to take too much reassurance." (Read "CDC Readies Swine Flu Vaccine.")

Still, a little more than a week after the WHO first swung into high alert, it's easy to wonder whether H1N1 might turn out to be much ado about not that much. Certainly the actions of some countries — like Egypt's impulsive move to cull some 300,000 pigs and China's apparent decision to preemptively quarantine hundreds of Mexican nationals — smack of panic. In the U.S., too, hundreds of schools have temporarily closed down because of suspected or confirmed swine flu cases, with Fort Worth, Texas, making the decision to shut down all city schools until May 11 at the earliest. Several countries have canceled all flights to and from Mexico, and some airlines are cutting way back on flights to the country. If it does indeed turn out that H1N1 is just the normal flu by another name, we may look back on last week's rapid response with chagrin — and be that much less responsive the next time a pandemic knocks on the world's door. (Read "Swine Flu: Don't Blame the Pig.")

But that would be a mistake. First of all, it's important to understand that pandemic does not necessarily equal apocalypse. A pandemic occurs when a new flu virus emerges and starts spreading easily from person to person, and then from country to country. (To declare Stage 6 for H1N1, the WHO needs to see sustained spread of the virus in multiple regions of the world; so far, that has happened only in North America.) A pandemic doesn't mean that a new virus is unusually deadly, only that it spreads easily — as H1N1 seems to do. It wasn't possible to wait to find out how virulent H1N1 would be before initiating a global response; like a fire department receiving an emergency call, the responsible choice is to snap into action, even if it later turns out to be a contained blaze.

And we'll never fully know how much the past week's global response — the travel advisories, the school closings, Mexico's move to all but shut down its capital city — may have helped reduce the extent of the disease's spread. It's easy to become inured to the CDC's unrelenting stream of advice on hygiene — on April 30, we actually had the President of the United States use a news conference to tell Americans to wash their hands more — but there is evidence that such elementary actions can be remarkably effective in slowing the spread of infectious disease. (Studies have shown that towns that instituted similar measures during the 1918 flu had death rates that were considerably lower than the norm.) "I think [the government] has been getting an A-plus for how they've communicated the threat here," says Jeffrey Levi, executive director of the Trust for America's Health. (See "From A-Z: The Year in Medicine 2008.")

The reality is that we live on a planet where new, potentially dangerous diseases are constantly emerging. Over the past six years alone, we've seen SARS, a more virulent bird flu and now H1N1, not to mention countless other pathogens that have escaped public notice but still keep infectious-disease experts lying awake at night. Thanks to the efforts of the WHO, we've built a remarkable early-detection system for new diseases — one sensitive enough to catch major threats and minor ones — and we should be rational enough to heed its warnings without acting as if the sky were falling.

President Obama, in his weekly address on May 2, put it best: "Because we have it within our power to limit the potential damage of this virus, we have a solemn and urgent responsibility to take the necessary steps. I would sooner take action now than hesitate and face graver consequences later." Better safe than sorry — when it comes to diseases, it's as clichéd as washing your hands, and just as smart.

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The Skimmer: How Sex Works

How Sex Works: Why We Look, Smell, Taste, Feel and Act the Way We Do
By Dr. Sharon Moalem
274 pages; Harper

The Gist:

At this point, is there anything we don't know about the biology of sex? Never before has a populace had as much access to information about how their bodies operate. Yet, Dr. Sharon Moalem, a Ph.D. in human physiology, believes that we deserve a one-stop primer on what goes where and why. There's a lot of science behind the book's deceptively simple title. ("See TIME's 100 Most Influential People of the Year.")

Highlight Reel:

1. On Brazilian waxes: "A new study suggests that the cultural preference for trim pubic hair is having dire consequences for a pesky parasite that has been freeloading in our personal perfumeries for thousands of years ... It seems that waxing down under is like deforestation as far as pubic lice are concerned."

2. On how watching certain types of pornography can increase better sperm: "A 2005 Australian study showed that, when men looked at pornographic images of two men and a woman together, they produced significantly better quality sperm than when they looked at images of just women. Evolutionary biologist Leigh Simmons, one of the researchers on the study, stated that "males ejaculate more sperm, or sperm of better quality, when the risk of sperm competition is high."

3. On female ejaculation: "Today, the existence of female ejaculation is more accepted in the scientific community, although it still has its detractors. From survey results, some sexologists estimate that about 10 percent of women ejaculate during orgasm ... Why don't more women experience ejaculation? It seems that the initial sensation ... is similar to the feeling women get when they need to pee. Not surprisingly, many women put a stop to the stimulation right there. They don't know it's leading to ejaculation and they don't want to pee in the presence of their partners."

The Lowdown:

Less a work of original theory and more a compendium of facts from other people's books and studies, How Sex Works often feels like a retread of an uncomfortable high school sex-ed class minus the acne. Here's a description of how menstruation works, there's a step by step description of how a man gets an erection; here's the reason why women have wide hips, there's a look at why testicles hang dangerously outside the body. Nothing we don't already know.

Where Moalem does venture into new territory — attempting to figure out why girls are experiencing their first period younger and younger, for example — he does so on basis of sometimes contradictory studies and unproven theories that will leave readers bursting with interesting factoids, but few answers. Still, it's easy to imagine parents uncomfortable with discussing the physical aspects of sexuality just handing their kids a copy of this book and saying, "Look, this has all the basics. Come back to me if you want to talk about feelings."

The Verdict: Skim

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Why Your Co-Workers Act like Children

Is your boss a bully who needs to feel important and boosts his ego by withholding important information from you? Or maybe you work with someone who is so fearful of argument or criticism that problems go unsolved because she won't discuss them. And then there's that guy down the hall who's constantly annoying everybody with his dumb practical jokes and loud banter. As the recession sends stress levels into the stratosphere, does your colleagues' weird behavior seem to be getting worse?

If so, you're not imagining it, according to Sylvia Lafair, a Ph.D. in clinical psychology whose book Don't Bring It to Work: Breaking the Family Patterns that Limit Success (Jossey-Bass) was released in March. Lafair's research shows that, much as we like to believe that our behavior is entirely rational and governed by our conscious mind, our thoughts and actions are often driven by the roles we learned in our families as children. And under pressure, we tend to revert to old patterns. That fellow standing at the watercooler telling tasteless jokes at the top of his lungs, for instance, probably comes from a family saddened by some painful event (a serious chronic illness, an early death), where his job as a child was to try to cheer everyone else up. The teammate who will do almost anything to avoid confrontation or criticism most likely grew up hearing way too much of both.

See the world's most influential people in the 2009 TIME 100.

"When a co-worker tries to one-up you and make you feel stupid, you may suddenly find yourself reacting to the older brother who always put you down. Or when your boss demands that costs be cut, suddenly he is your parent who could never make ends meet," says Lafair, adding, "Reactions happen in milliseconds. The trigger is usually stress. As anxiety rises, people's ability to respond in a mature manner goes down." If you've ever witnessed a colleague undergo a complete psychic meltdown over a minor setback or mistake, you know exactly what she's talking about.

In her book, Lafair describes the 13 personality types she's identified — including the persecutor, the avoider, the clown, the martyr, the rebel — and explains how they got that way, how to work with them and, perhaps most important, how to tell if baggage from your own distant past is weighing down your career. It's certainly possible to reach the top in business without ever facing your inner demons, and we've all seen some pretty loony CEOs. But Lafair contends that lasting success is built on self-knowledge. "It's an illusion to think you can be a stellar leader without introspection," she says. For a lot of stressed-out managers, Don't Bring It to Work might be a good place to start.

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