City Room: Cuomo Declares Public Health Emergency Over Flu Outbreak

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With the nation in the grip of a severe influenza outbreak that has seen deaths reach epidemic levels, New York State declared a public health emergency on Saturday, making access to vaccines more easily available.

There have been nearly 20,000 cases of flu reported across the state so far this season, officials said. Last season, 4,400 positive laboratory tests were reported.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Gov. Andrew M. Cuomo said in a statement.

Under the order, pharmacists will be allowed to administer flu vaccinations to patients between 6 months and 18 years old, temporarily suspending a state law that prohibits pharmacists from administering immunizations to children.

While children and older people tend to be the most likely to become seriously ill from the flu, Mr. Cuomo urged all New Yorkers to get vaccinated.

On Friday, the Centers for Disease Control and Prevention in Atlanta said that deaths from the flu had reached epidemic levels, with at least 20 children having died nationwide. Officials cautioned that deaths from pneumonia and the flu typically reach epidemic levels for a week or two every year. The severity of the outbreak will be determined by how long the death toll remains high or if it climbs higher.

There was some evidence that caseloads may be peaking, federal officials said on Friday.

In New York City, public health officials announced on Thursday that flu-related illnesses had reached epidemic levels, and they joined the chorus of authorities urging people to get vaccinated.

“It’s a bad year,” the city’s health commissioner, Dr. Thomas A. Farley, told reporters on Thursday. “We’ve got lots of flu, it’s mainly type AH3N2, which tends to be a little more severe. So we’re seeing plenty of cases of flu and plenty of people sick with flu. Our message for any people who are listening to this is it’s still not too late to get your flu shot.”

There has been a spike in the number of people going to emergency rooms over the past two weeks with flulike symptoms – including fever, fatigue and coughing – Dr. Farley said.

Mayor Michael R. Bloomberg and Mr. Cuomo made a public display of getting shots this past week.

In a briefing with reporters on Friday, officials from the C.D.C. said that this year’s vaccine was effective in 62 percent of cases.

As officials have stepped up their efforts encouraging vaccinations, there have been scattered reports of shortages. But officials said plenty of the vaccine was available.

According to the C.D.C., makers of the flu vaccine produced about 135 million doses for this year. As of early this month, 128 million doses had been distributed. While that would not be enough for every American, only 37 percent of the population get a flu shot each year.

Federal health officials said they would be happy if that number rose to 50 percent, which would mean that there would be more than enough vaccine for anyone who wanted to be immunized.

Two other diseases – norovirus and whooping cough – are also widespread this winter and are contributing to the number of people getting sick.

The flu can resemble a cold, though the symptoms come on more rapidly and are more severe.

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Aaron Swartz, Internet Activist, Dies at 26

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Aaron Swartz, a wizardly programmer who as a teenager helped develop code that delivered ever-changing Web content to users and who later became a steadfast crusader to make that information freely available, was found dead on Friday in his New York apartment..




An uncle, Michael Wolf, said that Mr. Swartz, 26, had apparently hanged himself, and that a friend of Mr. Swartz’s had discovered the body.


At 14, Mr. Swartz helped create RSS, the nearly ubiquitous tool that allows users to subscribe to online information. He later became an Internet folk hero, pushing to make many Web files free and open to the public. But in July 2011, he was indicted on federal charges of gaining illegal access to JSTOR, a subscription-only service for distributing scientific and literary journals, and downloading 4.8 million articles and documents, nearly the entire library.


Charges in the case, including wire fraud and computer fraud, were pending at the time of Mr. Swartz’s death, carrying potential penalties of up to 35 years in prison and $1 million in fines.


“Aaron built surprising new things that changed the flow of information around the world,” said Susan Crawford, a professor at the Cardozo School of Law in New York who served in the Obama administration as a technology adviser. She called Mr. Swartz “a complicated prodigy” and said “graybeards approached him with awe.”


Mr. Wolf said he would remember his nephew, who had written in the past about battling depression and suicidal thoughts, as a young man who “looked at the world, and had a certain logic in his brain, and the world didn’t necessarily fit in with that logic, and that was sometimes difficult.”


The Tech, a newspaper of the Massachusetts Institute of Technology, reported Mr. Swartz’s death early Saturday.


Mr. Swartz led an often itinerant life that included dropping out of Stanford, forming companies and organizations, and becoming a fellow at Harvard University’s Edmond J. Safra Center for Ethics.


He formed a company that merged with Reddit, the popular news and information site. He also co-founded Demand Progress, a group that promotes online campaigns on social justice issues — including a successful effort, with other groups, to oppose a Hollywood-backed Internet piracy bill.


But he also found trouble when he took part in efforts to release information to the public that he felt should be freely available. In 2008, he took on PACER, or Public Access to Court Electronic Records, the repository for federal judicial documents.


The database charges 10 cents a page for documents; activists like Carl Malamud, the founder of public.resource.org, have long argued that such documents should be free because they are produced at public expense. Joining Mr. Malamud’s efforts to make the documents public by posting legally obtained files to the Internet for free access, Mr. Swartz wrote an elegant little program to download 20 million pages of documents from free library accounts, or roughly 20 percent of the enormous database.


The government shut down the free library program, and Mr. Malamud feared that legal trouble might follow even though he felt they had violated no laws. As he recalled in a newspaper account, “I immediately saw the potential for overreaction by the courts.” He recalled telling Mr. Swartz: “You need to talk to a lawyer. I need to talk to a lawyer.”


Mr. Swartz recalled in a 2009 interview, “I had this vision of the feds crashing down the door, taking everything away.” He said he locked the deadbolt on his door, lay down on the bed for a while and then called his mother.


The federal government investigated but did not prosecute.


In 2011, however, Mr. Swartz went beyond that, according to a federal indictment. In an effort to provide free public access to JSTOR, he broke into computer networks at M.I.T. by means that included gaining entry to a utility closet on campus and leaving a laptop that signed into the university network under a false account, federal officials said.


Mr. Swartz turned over his hard drives with 4.8 million documents, and JSTOR declined to pursue the case. But Carmen M. Ortiz, a United States attorney, pressed on, saying that “stealing is stealing, whether you use a computer command or a crowbar, and whether you take documents, data or dollars.”


Founded in 1995, JSTOR, or Journal Storage, is nonprofit, but institutions can pay tens of thousands of dollars for a subscription that bundles scholarly publications online. JSTOR says it needs the money to collect and to distribute the material and, in some cases, subsidize institutions that cannot afford it. On Wednesday, JSTOR announced that it would open its archives for 1,200 journals to free reading by the public on a limited basis.


Mr. Malamud said that while he did not approve of Mr. Swartz’s actions at M.I.T., “access to knowledge and access to justice have become all about access to money, and Aaron tried to change that. That should never have been considered a criminal activity.”


Mr. Swartz did not talk much about his impending trial, Quinn Norton, a close friend, said on Saturday, but when he did, it was clear that “it pushed him to exhaustion. It pushed him beyond.”


Recent years had been hard for Mr. Swartz, Ms. Norton said, and she characterized him “in turns tough and delicate.” He had “struggled with chronic, painful illness as well as depression,” she said, without specifying the illness, but he was still hopeful “at least about the world.”


Cory Doctorow, a science fiction author and online activist, posted a tribute to Mr. Swartz on BoingBoing.net, a blog he co-edits. In an e-mail, he called Mr. Swartz “uncompromising, principled, smart, flawed, loving, caring, and brilliant.”


 “The world was a better place with him in it,” he said.


Mr. Swartz, he noted, had a habit of turning on those closest to him: “Aaron held the world, his friends, and his mentors to an impossibly high standard — the same standard he set for himself.” Mr. Doctorow added, however, “It’s a testament to his friendship that no one ever seemed to hold it against him (except, maybe, himself).”


In a talk in 2007, Mr. Swartz described having had suicidal thoughts during a low period in his career. He also wrote about his struggle with depression, distinguishing it from sadness.


“Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness.”


When the condition gets worse, he wrote, “you feel as if streaks of pain are running through your head, you thrash your body, you search for some escape but find none. And this is one of the more moderate forms.”


Ravi Somaiya contributed reporting.



This article has been revised to reflect the following correction:

Correction: January 12, 2013

An earlier version of this article incorrectly identified the police who arrested Mr. Swartz, and when they did so. The police were from Cambridge, Mass., not the Massachusetts Institute of Technology campus force, and the arrest occurred two years before Mr. Swartz’s suicide, but not two years to the day.



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Beijing Air Pollution Off the Charts

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Alexander F. Yuan/Associated Press


Fashionably masked women on Saturday outside an amusement park in Beijing. The World Health Organization has standards that judge an air-quality score above 500 to be more than 20 times the level of particulate matter in the air deemed safe.







BEIJING — One Friday more than two years ago, an air-quality monitoring device atop the United States Embassy in Beijing recorded data so horrifying that someone in the embassy called the level of pollution “Crazy Bad” in an infamous Twitter post. That day the Air Quality Index, which uses standards set by the United States Environmental Protection Agency, had crept above 500, which was supposed to be the top of the scale.




So what phrase is appropriate to describe Saturday’s jaw-dropping reading of 755 at 8 p.m., when all of Beijing looked like an airport smokers’ lounge? Though an embassy spokesman said he did not immediately have comparative data, Beijing residents who follow the Twitter feed said the Saturday numbers appeared to be the highest recorded since the embassy began its monitoring system in 2008.


The embassy’s @BeijingAir Twitter feed said the level of toxicity in the air was “Beyond Index,” the terminology for levels above 500; the “Crazy Bad” label was used just once, in November 2010, by an embassy employee using the Twitter account. According to the Environmental Protection Agency, levels between 301 and 500 are “Hazardous,” meaning people should avoid all outdoor activity. The World Health Organization has standards that judge a score above 500 to be more than 20 times the level of particulate matter in the air deemed safe.


In online conversations, Beijing residents tried to make sense of the latest readings.


“This is a historic record for Beijing,” Zhao Jing, a prominent Internet commentator who uses the pen name Michael Anti, wrote on Twitter. “I’ve closed the doors and windows; the air purifiers are all running automatically at full power.”


Other Beijing residents online described the air as “postapocalyptic,” “terrifying” and “beyond belief.”


The municipal government reported levels as high as 478 on Saturday in central Beijing, according to The Associated Press. It was not immediately clear why the number was lower, but even that level is considered hazardous according to the United States Environmental Protection Agency standards. (By comparison, the air quality index in New York City, using the same standard, was 19 at 6 a.m. on Saturday.)


Pollution levels in Beijing had been creeping up for days, and readings were regularly surging above 300 by midweek. The interior of the gleaming Terminal 3 of the Beijing Capital International Airport was filled with a thick haze on Thursday. The next day, people working in office towers in downtown Beijing found it impossible to make out skyscrapers just a few blocks away. Some city residents scoured stores in search of masks and air filters.


Still, there was little warning that the United States Embassy reading would jump above 700 on Saturday. Some people speculated that the monitoring system, which measures fine particles called PM 2.5 because they are 2.5 microns in diameter or smaller, might have malfunctioned once it got beyond 500.


But Nolan Barkhouse, an embassy spokesman, said the monitor was operating correctly.


It was unclear exactly what was responsible for the rise in levels of particulate matter, beyond the factors that regularly sully the air here. Factories operating in neighboring Hebei Province ring this city of more than 20 million. The number of cars on Beijing’s streets has been multiplying at an astounding rate. And Beijing sits on a plain flanked by hills and escarpments that can trap pollution on days with little wind. Meanwhile, one person hiking at the Great Wall in the hills at Mutianyu, north of Beijing, took photographs of crisp blue skies there.


Xinhua, the state news agency, reported on Dec. 31 that Beijing’s air quality had improved for 14 years straight, and the level of major pollutants had decreased. A municipal government spokesman told Xinhua that the annual average concentration of PM 10, or particles 10 microns in diameter or smaller, had dropped by 4 percent in 2012, compared with one year earlier.


Chinese officials prefer to publicly release air pollution measurements that give only levels of PM 10, although foreign health and environmental experts say PM 2.5 can be deadlier and more important to track.


There has been a growing outcry among Chinese for municipal governments to release fuller air quality data, in part because of the United States Embassy Twitter feed. As a result, Beijing began announcing PM 2.5 numbers last January. Major Chinese cities have had the equipment to track those levels, but had refused for a long time to release the data.


The existence of the embassy’s machine and the @BeijingAir Twitter feed have been a diplomatic sore point for Chinese officials. In July 2009, a Chinese Foreign Ministry official, Wang Shu’ai, told American diplomats to halt the Twitter feed, saying that the data “is not only confusing but also insulting,” according to a State Department cable obtained by WikiLeaks. Mr. Wang said the embassy’s data could lead to “social consequences.”


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Aaron Swartz, Internet Activist, Dies at 26

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Aaron Swartz, a wizardly programmer who as a teenager helped develop code that delivered ever-changing Web content to users and who later became a steadfast crusader to make that information freely available, was found dead on Friday in his New York apartment..




An uncle, Michael Wolf, said that Mr. Swartz, 26, had apparently hanged himself, and that a friend of Mr. Swartz’s had discovered the body.


At 14, Mr. Swartz helped create RSS, the nearly ubiquitous tool that allows users to subscribe to online information. He later became an Internet folk hero, pushing to make many Web files free and open to the public. But in July 2011, he was indicted on federal charges of gaining illegal access to JSTOR, a subscription-only service for distributing scientific and literary journals, and downloading 4.8 million articles and documents, nearly the entire library.


Charges in the case, including wire fraud and computer fraud, were pending at the time of Mr. Swartz’s death, carrying potential penalties of up to 35 years in prison and $1 million in fines.


“Aaron built surprising new things that changed the flow of information around the world,” said Susan Crawford, a professor at the Cardozo School of Law in New York who served in the Obama administration as a technology adviser. She called Mr. Swartz “a complicated prodigy” and said “graybeards approached him with awe.”


Mr. Wolf said he would remember his nephew, who had written in the past about battling depression and suicidal thoughts, as a young man who “looked at the world, and had a certain logic in his brain, and the world didn’t necessarily fit in with that logic, and that was sometimes difficult.”


The Tech, a newspaper of the Massachusetts Institute of Technology, reported Mr. Swartz’s death early Saturday.


Mr. Swartz led an often itinerant life that included dropping out of Stanford, forming companies and organizations, and becoming a fellow at Harvard University’s Edmond J. Safra Center for Ethics.


He formed a company that merged with Reddit, the popular news and information site. He also co-founded Demand Progress, a group that promotes online campaigns on social justice issues — including a successful effort, with other groups, to oppose a Hollywood-backed Internet piracy bill.


But he also found trouble when he took part in efforts to release information to the public that he felt should be freely available. In 2008, he took on PACER, or Public Access to Court Electronic Records, the repository for federal judicial documents.


The database charges 10 cents a page for documents; activists like Carl Malamud, the founder of public.resource.org, have long argued that such documents should be free because they are produced at public expense. Joining Mr. Malamud’s efforts to make the documents public by posting legally obtained files to the Internet for free access, Mr. Swartz wrote an elegant little program to download 20 million pages of documents from free library accounts, or roughly 20 percent of the enormous database.


The government shut down the free library program, and Mr. Malamud feared that legal trouble might follow even though he felt they had violated no laws. As he recalled in a newspaper account, “I immediately saw the potential for overreaction by the courts.” He recalled telling Mr. Swartz: “You need to talk to a lawyer. I need to talk to a lawyer.”


Mr. Swartz recalled in a 2009 interview, “I had this vision of the feds crashing down the door, taking everything away.” He said he locked the deadbolt on his door, lay down on the bed for a while and then called his mother.


The federal government investigated but did not prosecute.


In 2011, however, Mr. Swartz went beyond that, according to a federal indictment. In an effort to provide free public access to JSTOR, he broke into computer networks at M.I.T. by means that included gaining entry to a utility closet on campus and leaving a laptop that signed into the university network under a false account, federal officials said.


Mr. Swartz turned over his hard drives with 4.8 million documents, and JSTOR declined to pursue the case. But Carmen M. Ortiz, a United States attorney, pressed on, saying that “stealing is stealing, whether you use a computer command or a crowbar, and whether you take documents, data or dollars.”


Mr. Malamud said that while he did not approve of Mr. Swartz’s actions at M.I.T., “access to knowledge and access to justice have become all about access to money, and Aaron tried to change that. That should never have been considered a criminal activity.”


Mr. Swartz did not talk much about his impending trial, Quinn Norton, a close friend, said on Saturday, but when he did, it was clear that “it pushed him to exhaustion. It pushed him beyond.”


Recent years had been hard for Mr. Swartz, Ms. Norton said, and she characterized him “in turns tough and delicate.” He had “struggled with chronic, painful illness as well as depression,” she said, without specifying the illness, but he was still hopeful “at least about the world.”


Cory Doctorow, a science fiction author and online activist, posted a tribute to Mr. Swartz on BoingBoing.net, a blog he co-edits. In an e-mail, he called Mr. Swartz “uncompromising, principled, smart, flawed, loving, caring, and brilliant.”


Mr. Swartz, he noted, had a habit of turning on those closest to him: “Aaron held the world, his friends, and his mentors to an impossibly high standard — the same standard he set for himself.” He added, however, “It’s a testament to his friendship that no one ever seemed to hold it against him (except, maybe, himself).”


In a talk in 2007, Mr. Swartz described having had suicidal thoughts during a low period in his career. He also wrote about his struggle with depression, distinguishing it from sadness.


“Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness.”


Ravi Somaiya contributed reporting.



This article has been revised to reflect the following correction:

Correction: January 12, 2013

An earlier version of this article incorrectly identified the police who arrested Mr. Swartz, and when they did so. The police were from Cambridge, Mass., not the Massachusetts Institute of Technology campus force, and the arrest occurred two years before Mr. Swartz’s suicide, but not two years to the day.



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Flu Deaths Reach Epidemic Level, but May Be at Peak

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Deaths in the current flu season have officially crossed the line into “epidemic” territory, federal health officials said Friday, adding that, on the bright side, there were also early signs that the caseloads could be peaking.




Officials from the Centers for Disease Control and Prevention, speaking on a telephone news conference, again urged Americans to keep getting flu shots. At the same time, they emphasized that the shots are not infallible: a preliminary study rated this year’s vaccine as 62 percent effective, even though it is a good match for the most worrisome virus circulating. That corresponds to a rating of “moderately” effective — the vaccine typically ranges from 50 percent to 70 percent effective, they said.


Even though deaths stepped — barely — into epidemic territory for the first time last Saturday, the C.D.C. officials expressed no alarm, and said it was possible that new flu infections were peaking in some parts of the country. “Most of the country is seeing a lot of flu and that may continue for weeks,” said Dr. Thomas R. Frieden, the C.D.C.’s director.


New outpatient cases — a measure based on what percentage of doctor visits were for colds or flu — dropped off slightly from the previous week, to 4 percent from 6 percent. The trend was more pronounced in the South, where this year’s season began.


Dr. Frieden cautioned that the new flu figures could be aberrations because they were gathered as the holiday season was ending. Few people schedule routine checkups then, so the percentage of visits for severe illness can be pushed artificially high for a week or two, then inevitably drop.


Deaths from pneumonia and the flu, a wavy curve that is low in summer and high in winter, typically touch the epidemic level for one or two weeks every flu season. How bad a season is depends on how high the deaths climb for how long.


So far this season, 20 children with confirmed flu tests have died, but that is presumably lower than the actual number of deaths because not all children are tested and not all such deaths are reported. How many adults die will not be estimated until after the season ends, said Dr. Joseph Bresee, the chief of prevention and epidemiology for the C.D.C.’s flu branch. Epidemiologists count how many death certificates are filed in a flu year, compare the number with normal years, and estimate what percentage were probably flu-related.


Many people are getting ill this year because the country is also having widespread outbreaks of two diseases with overlapping symptoms, norovirus and whooping cough, and the normal winter surge in common colds. Flu shots have no effect on any of those.


Spot shortages of vaccines have been reported, and there will not be enough for all Americans, since the industry has made and shipped only about 130 million doses. But officials said they would be pleased if 50 percent of Americans got shots; in a typical year, 37 percent do.


Dr. Bresee said that this year’s epidemic resembles that of 2003-4, which also began early, was dominated by an H3N2 strain and killed more Americans than usual.


Nevertheless, more Americans now routinely get flu shots than did then, and doctors are much quicker to prescribe Tamiflu and Relenza, drugs that can lessen a flu’s severity if taken early.


The C.D.C.’s vaccine effectiveness study bore out the point of view of a report released last year by the University of Minnesota’s Center for Infectious Disease Research and Policy. It said that the shot’s effectiveness had been “overpromoted and overhyped,” said Michael T. Osterholm, the center’s director.


Although the report supported getting flu shots, it said that new vaccines offering lifelong protection against all flu strains, instead of annual partial protection against a mix-and-match set, must be created.


“But there’s no appetite to fund that research,” Dr. Osterholm said in an interview Friday.


“To get a vaccine across the ‘Valley of Death’ is likely to cost $1 billion,” he added, referring to the huge clinical trials that would be needed to approve a new type of vaccine. “No government has put more than $100 million into any candidate, and the private sector has no appetite for it because there’s not enough return on investment.”


At the same time, he praised the C.D.C. for measuring vaccine effectiveness in midseason.


“We’re the only ones in the world who have data like that,” he said.


“Vaccine effectiveness” is a very different metric from vaccine-virus match, which is done in a lab. Vaccine efficacy is measured by interviewing hundreds of sick or recovering patients who had positive flu tests and asking whether and when they had received shots.


Only people sick enough to visit doctors get flu tests, said Thomas Skinner, a C.D.C. spokesman, so the metric means the shot “reduces by 62 percent your chance of getting a flu so bad that you have to go to a doctor or hospital.”


During the telephone news conference Friday, Dr. Frieden repeatedly described the vaccine as “far from perfect, but by far the best tool we have to prevent influenza.”


Most vaccinations given in childhood for threats like measles and diphtheria are 90 percent effective or better. But flu viruses mutate so fast that they must be remade annually. Scientists are trying to develop vaccines that target bits of the virus that appear to stay constant, like the stem of the hemagglutinin spike that lets the virus break into lung cells.


During the 2009 swine flu pandemic, many elderly Americans had natural protection, presumably from flus they caught in the 1930s or ’40s.


“Think about that,” Dr. Osterholm said. “Even though they were old, they were still protected. We’ve got to figure out how to capture that kind of immunity — which current vaccines do not.”


At Friday’s news conference, Dr. Bresee acknowledged the difficulties, saying: “If I had the perfect answer as to how to make a better flu vaccine, I’d probably get a Nobel Prize.”


Read More..

Flu Deaths Reach Epidemic Level, but May Be at Peak

Label:




Deaths in the current flu season have officially crossed the line into “epidemic” territory, federal health officials said Friday, adding that, on the bright side, there were also early signs that the caseloads could be peaking.




Officials from the Centers for Disease Control and Prevention, speaking on a telephone news conference, again urged Americans to keep getting flu shots. At the same time, they emphasized that the shots are not infallible: a preliminary study rated this year’s vaccine as 62 percent effective, even though it is a good match for the most worrisome virus circulating. That corresponds to a rating of “moderately” effective — the vaccine typically ranges from 50 percent to 70 percent effective, they said.


Even though deaths stepped — barely — into epidemic territory for the first time last Saturday, the C.D.C. officials expressed no alarm, and said it was possible that new flu infections were peaking in some parts of the country. “Most of the country is seeing a lot of flu and that may continue for weeks,” said Dr. Thomas R. Frieden, the C.D.C.’s director.


New outpatient cases — a measure based on what percentage of doctor visits were for colds or flu — dropped off slightly from the previous week, to 4 percent from 6 percent. The trend was more pronounced in the South, where this year’s season began.


Dr. Frieden cautioned that the new flu figures could be aberrations because they were gathered as the holiday season was ending. Few people schedule routine checkups then, so the percentage of visits for severe illness can be pushed artificially high for a week or two, then inevitably drop.


Deaths from pneumonia and the flu, a wavy curve that is low in summer and high in winter, typically touch the epidemic level for one or two weeks every flu season. How bad a season is depends on how high the deaths climb for how long.


So far this season, 20 children with confirmed flu tests have died, but that is presumably lower than the actual number of deaths because not all children are tested and not all such deaths are reported. How many adults die will not be estimated until after the season ends, said Dr. Joseph Bresee, the chief of prevention and epidemiology for the C.D.C.’s flu branch. Epidemiologists count how many death certificates are filed in a flu year, compare the number with normal years, and estimate what percentage were probably flu-related.


Many people are getting ill this year because the country is also having widespread outbreaks of two diseases with overlapping symptoms, norovirus and whooping cough, and the normal winter surge in common colds. Flu shots have no effect on any of those.


Spot shortages of vaccines have been reported, and there will not be enough for all Americans, since the industry has made and shipped only about 130 million doses. But officials said they would be pleased if 50 percent of Americans got shots; in a typical year, 37 percent do.


Dr. Bresee said that this year’s epidemic resembles that of 2003-4, which also began early, was dominated by an H3N2 strain and killed more Americans than usual.


Nevertheless, more Americans now routinely get flu shots than did then, and doctors are much quicker to prescribe Tamiflu and Relenza, drugs that can lessen a flu’s severity if taken early.


The C.D.C.’s vaccine effectiveness study bore out the point of view of a report released last year by the University of Minnesota’s Center for Infectious Disease Research and Policy. It said that the shot’s effectiveness had been “overpromoted and overhyped,” said Michael T. Osterholm, the center’s director.


Although the report supported getting flu shots, it said that new vaccines offering lifelong protection against all flu strains, instead of annual partial protection against a mix-and-match set, must be created.


“But there’s no appetite to fund that research,” Dr. Osterholm said in an interview Friday.


“To get a vaccine across the ‘Valley of Death’ is likely to cost $1 billion,” he added, referring to the huge clinical trials that would be needed to approve a new type of vaccine. “No government has put more than $100 million into any candidate, and the private sector has no appetite for it because there’s not enough return on investment.”


At the same time, he praised the C.D.C. for measuring vaccine effectiveness in midseason.


“We’re the only ones in the world who have data like that,” he said.


“Vaccine effectiveness” is a very different metric from vaccine-virus match, which is done in a lab. Vaccine efficacy is measured by interviewing hundreds of sick or recovering patients who had positive flu tests and asking whether and when they had received shots.


Only people sick enough to visit doctors get flu tests, said Thomas Skinner, a C.D.C. spokesman, so the metric means the shot “reduces by 62 percent your chance of getting a flu so bad that you have to go to a doctor or hospital.”


During the telephone news conference Friday, Dr. Frieden repeatedly described the vaccine as “far from perfect, but by far the best tool we have to prevent influenza.”


Most vaccinations given in childhood for threats like measles and diphtheria are 90 percent effective or better. But flu viruses mutate so fast that they must be remade annually. Scientists are trying to develop vaccines that target bits of the virus that appear to stay constant, like the stem of the hemagglutinin spike that lets the virus break into lung cells.


During the 2009 swine flu pandemic, many elderly Americans had natural protection, presumably from flus they caught in the 1930s or ’40s.


“Think about that,” Dr. Osterholm said. “Even though they were old, they were still protected. We’ve got to figure out how to capture that kind of immunity — which current vaccines do not.”


At Friday’s news conference, Dr. Bresee acknowledged the difficulties, saying: “If I had the perfect answer as to how to make a better flu vaccine, I’d probably get a Nobel Prize.”


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Bits Blog: Windows 8 Failed to Reverse PC Slump During Holidays

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For weeks, there have been signs that the public was not buying new PCs over the holidays in the numbers many had hoped. Now add to them new figures from IDC, one of the best-known scorekeepers for the market, showing that worldwide PC shipments declined 6.4 percent in the fourth quarter from a year earlier.

That decline was worse than the 4.4 percent drop that IDC had previously forecast for the fourth quarter. It was also a sign that the biggest thing to happen to the PC business in years — Microsoft’s release of the Windows 8 operating system and the millions of dollars that went into promoting it — did not rescue an industry that suffered a nasty sales slump for most of last year.

Collectively, PC companies shipped 89.8 million computers over the fourth quarter, compared to 95.9 million a year earlier.

The challenges of the PC business lately have been well documented, all factors causing the soft holiday sales, including the inclination of people to buy tablets like the iPad instead of laptops.

But the PC market also appeared to be hurt by a mismatch between the touch capabilities in Windows 8 that Microsoft advertised so heavily and the types of PCs on most store shelves, many of which did not have touch screens. Loren Loverde, an analyst at IDC, said in an interview that Microsoft and its hardware partners needed to introduce newer PC designs that could more fully exploit Windows 8.

“It would really behoove the PC industry to get out there and deliver a consistent message,” he said.

IDC does not include sales of tablet computers in its PC shipment numbers, even devices like Surface, the first version of which runs a variation of Windows 8 called Windows RT. But sales of Surface and other Windows tablets were estimated to be modest enough over the holidays that they probably would not have made a significant change in the numbers of the PC business had IDC included them, according to Mr. Loverde. IDC has not yet released its estimates for tablet sales over the holidays.

Another research firm, Canalys, painted a bleaker outlook for the PC market with a report released earlier in the day. “The launch of Windows 8 did not reinvigorate the market in 2012, and is expected to have a negative effect as we move into 2013,” said Tom Evans, a Canalys analyst, said in the report. “Windows 8 is so different to previous versions that most consumers will be put off by the thought of having to learn a new OS.”

Unlike other research firms, Canalys includes tablets in its estimates of PC market shipments. As more people buy tablets made by Apple and devices running various flavors of Google’s Android operating system, Canalys estimated that the share of PCs running Windows and Intel chips would fall to 65 percent in 2013 from 72 percent last year.

Microsoft and Intel will suffer further, with the Wintel PC market share expected to decline to 65 percent in 2013, from 72 percent in 2012.

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The Lede Blog: Activists Document Sit-In by Families of Bombing Victims in Pakistan

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A video report on a protest in the city of Quetta on Friday, from the Pakistani channel Geo News.

Last Updated, 8:31 p.m. Hours after it started on Friday night, Pakistani television began to report on a protest in the city of Quetta, where relatives of scores of people killed in bomb attacks one day earlier sat beside coffins in the street, refusing to bury their loved ones until they received assurance that the state would protect them.

As my colleague Salman Masood reports, most of those killed in Thursday’s twin bomb attacks were Shiite Muslims from the Hazara ethnic group. Hazaras in Pakistan have been the target of a murderous campaign by Sunni Muslim extremists from the Taliban and a related militant group, Lashkar-e-Jhangvi, which claimed responsibility for Thursday’s massacre of 86.

Pakistani activists, angered that the protest was ignored for so long by local media, attempted to draw attention to the sit-in near the site of the attack on Quetta’s Alamdar Road. In a series of Twitter messages, they called on the international press to cover the demonstration and shared photographs of the sit-in as it continued late into the night. The attention of journalists and bloggers in other parts of the country was focused more firmly on Quetta on Friday by the death in Thursday’s second bombing of the well-known Hazara activist Irfan Ali.

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Greece Votes to Raise Tax On Its Higher Earners

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ATHENS — Greek lawmakers voted late Friday to increase taxes on middle- to high-income earners, self-employed professionals and businesses despite vehement objections by the political opposition and several ruling coalition deputies who said austerity-weary citizens should not be subjected to further pain.


The change to the tax code, one of a long line of pledges Greece has made to international creditors in exchange for continued bailout money, passed comfortably with at least 162 of the ruling coalition’s 163 members backing the articles in a roll call that came after two days of heated debate in the 300-seat Parliament.


The fragile coalition government of Prime Minister Antonis Samaras hopes to raise 2.3 billion euros in much-needed revenue from the new law, which increases the amount of income tax paid by those earning more than 20,000 euros a year, trims tax benefits for having children, revokes tax breaks for farmers and increases corporate tax to 26 percent from 20 percent. The new law also increases the amount of income tax paid by self-employed professionals like doctors and electricians, who are widely perceived as not paying their share by understating their income. New rules abolishing a tax-exempt threshold means the self-employed would be taxed from the first euro they earn.


Defending the bill in Parliament, Finance Minister Yannis Stournaras called it “a vital fiscal reform” that would avert additional across-the-board cuts to workers and pensioners.


“Every euro collected in tax revenue is one euro saved from salaries, pensions and social benefits,” he said. He rejected a flurry of amendments from members of two junior parties in the coalition and the opposition, noting that such costly changes would throw Greece off the path to economic health and put further bailout money in jeopardy.


Calling Mr. Stournaras a “political terrorist,” Panagiotis Lafazanis, a lawmaker of the leftist party Syriza, which opposes the terms of Greece’s bailouts, said the tax bill was “the nail in the coffin of social justice,” adding that “Greek society is more important” than its creditors.


Other opposition lawmakers berated the government for planning to impose additional measures in the coming days, including tighter control of the budgets of ministries and state utilities, the reduction of parliamentary employees’ wages in line with cuts to the wages of other civil servants, and the revision of Greece’s second loan agreement with foreign creditors, in the form of special edicts that do not require parliamentary approval. The loan agreement amendment surrenders the country’s rights to protect its assets from creditors, Syriza complained.


Since 2010, the European Union and the International Monetary Fund have committed to two bailouts for Greece worth 240 billion euros in exchange for austerity measures that have hurt Greek living standards, pushed unemployment close to 27 percent and fueled angry street protests.


The new law is to be followed in spring by a thorough overhaul of the tax system that will introduce jail terms for large-scale evaders instead of the suspended sentences handed down now.


Greece’s failure to crack down on widespread tax evasion came into sharp focus over the holidays after prosecutors revealed that the names of three relatives of the former finance minister George Papaconstantinou had been removed from a list of some 2,000 wealthy Greeks with Swiss bank accounts. Parliament is to vote next Thursday on whether Mr. Papaconstantinou, and his successor as finance minister, Evangelos Venizelos, who leads the coalition’s Socialist party, will face a parliamentary inquiry on whether they should be indicted on charges of criminal tampering and breach of duty.


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F.D.A. Requires Cuts to Dosages of Ambien and Other Sleep Drugs

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WASHINGTON — For two decades, millions of Americans have taken Ambien to help them sleep at night. But for years, the Food and Drug Administration has gotten complaints that people felt drowsy the morning after taking the medicine or its successors, and sometimes got into car accidents.




On Thursday, after laboratory studies and driving tests confirming the risks of drowsiness, the agency said that women should be taking half as much.


The new recommendation applies to drugs containing the active ingredient zolpidem, by far the most widely used sleep aid. Using lower doses means less of the drug will remain in the blood in the morning hours, and will reduce the risk that people who use it will be impaired while driving.


Sleeping pills have boomed in popularity with the increasingly frantic pace of modern American life. According to IMS, a health care information and technology company, about 60 million prescriptions were dispensed in 2011, up about 20 percent since 2006. About 40 million were for products containing zolpidem.


The agency’s announcement was focused on women because they take longer to metabolize the drug than men. An estimated 10 percent to 15 percent of women will have a level of zolpidem in their blood that could impair driving eight hours after taking the pill, while only about 3 percent of men do, said Dr. Robert Temple, an official in the agency’s Center for Drug Evaluation and Research.


Reports of aftereffects from sleeping pills have circulated for years, and some doctors questioned why the drug agency took so long to act. Mishaps with sleepy driving — and even strange acts of texting, eating or having sex in the night without any memory of it in the morning — have long been familiar to the medical community.


“In this case, the F.D.A. may be behind the 8-ball,” said Daniel Carlat, an associate clinical professor of psychiatry at Tufts University, referring to residual drowsiness. “This has been a known problem. Few doctors will be surprised hearing about this. They’ll say, ‘Oh yeah, we’ve already seen this in our patients.’ ”


He added that Thursday’s announcement “will be good for public health because it will get patients to ask their doctors about the appropriate dosage.”


Agency officials acknowledged that they had received about 700 reports of driving mishaps with people on zolpidem over the years, with a spike in 2007 after a change in labeling caused more people to call in complaints. But they said it was not easy to draw a direct connection between the reports and the drug. Patients often did not remember what time they took the pill. Sometimes they had been drinking.


It was not until the drug agency reviewed driving simulation studies from controlled trials of the drug Intermezzo, which was approved in 2011 for middle-of-the-night waking, that a more complete picture of the risks emerged. The agency linked the driving simulation information with data from manufacturers on the amount of zolpidem in patients’ blood and determined that levels above about 50 nanograms per milliliter increased the risk of crashing while driving, said Dr. Ellis Unger, an official at the agency’s Center for Drug Evaluation and Research.


Dr. Unger said that all makers of new sleeping drugs would now be asked to conduct driving trials; a spokeswoman clarified that it would not be required.


“A lot of people are wondering about the elephant in the room,” Dr. Unger said. “Why did this take so long? This is science, and our thinking evolves over time.”


The drug agency told manufacturers that the recommended dose for women should be lowered to 5 milligrams from 10 for immediate-release products like Ambien, Edluar and Zolpimist. Doses for extended-release products should be lowered to 6.25 milligrams from 12.5, the agency said. Most sleeping drugs containing zolpidem are now generic.


For men, the agency informed manufacturers that labels should recommend that health care providers should “consider” prescribing lower doses.


Patients taking the higher doses should continue them for the time being, officials said, but should consult with their doctors about lowering them. Doctors can still prescribe the higher dose if the lower one does not work. The lower doses are already commercially available, Dr. Unger said, as they are recommended for older patients.


Sanofi, the manufacturer of Ambien and Ambien CR, said in a statement that it agreed that people taking zolpidem “should always talk to their doctor about the most appropriate dose,” and that the label “provides important information” to determine what that is. The company added that it “stands behind the significant clinical data demonstrating the safety and efficacy of Ambien.”


The drug has also been known to cause sleepwalking incidents, and Dr. Unger said there was evidence that the lower dose might ease such events, though it is weaker than the evidence about next-morning-drowsiness. Dr. Carlat said one of his patients discovered that her weight gain while on the drug was from midnight trips to the kitchen she did not even remember taking.


Dr. Daniel Kripke, professor emeritus of psychiatry at the University of California, San Diego, and a leading critic of sleeping pills, welcomed the move but said the agency was still not doing enough to investigate other possible side effects.


“It’s a very small step in the right direction,” he said. He added that sleeping medications like zolpidem might increase total sleep time by 20 minutes a night, but that most studies suggest that the use of sleeping pills impairs a person’s performance the next day.


Critics of the drug agency said the label on Intermezzo, which very clearly denotes the risks for women, indicate that the agency was aware of these problems earlier.


But Thomas Roth, director of the sleep center at Henry Ford Hospital in Detroit who has been a consultant to sleeping pill makers, said that the drug agency had always been concerned about the potential risks with driving, “but they care about it more now.” He said he believed the lower dose would still be effective for many patients.


Agency officials say all patients are unique and doses will need to be tailored. They say the drugs should be prescribed at the lowest dose required.


Dr. Daniel J. Buysse, professor of psychiatry at the University of Pittsburgh School of Medicine, said he already prescribed the lower dose when he feels it is necessary, by telling patients to cut a tablet in half along the score.


“This just tells me, maybe be a little bit more cautious,” said Dr. Buysse, who has been a consultant for drug companies including the maker of Ambien. “But I do not think it will have a big effect on what I do.”


Andrew Pollack contributed reporting from San Francisco.



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