President Barack Obama [on tape]: Overnight, we also received confirmation that an infant in Texas has died as a result of this virus, and my thoughts and prayers and deepest condolences go out to the family, as well as those who are ill and recovering from this flu.

Daljit Dhaliwal: I'm Daljit Dhaliwal and that of course was President Obama speaking earlier this morning, and as you heard from him a 23-month-old boy in Texas has died from the H1N1 virus. A spokesman from Houston's Department of Health and Human Services, Kathy Barton, told the Houston Chronicle these details: The child was from Mexico--

John Hockenberry: Oh, more details, interesting.

Daljit Dhaliwal: Yeah, just some more details that are coming through. Apparently this child was from Mexico and had become ill in Brownsville, Texas and was then transported to Houston for treatment, and the child died Monday in an unidentified Houston hospital, and there have been no reported Houston area cases of the disease so far. So that's new information that has been coming in to us, and this of course is the first death outside of Mexico where the outbreak first began. And out of those 65 confirmed cases of Swine flu in the United States, most of them are mild. The CDC of course has still to release more details, but we want to go back again now to Susan Fisher-Hoch. She's in Texas, where she can actually see the border with Mexico and she's an epidemiologist at University of Texas School of Public Health, and co-author of the book, Level 4: Virus Hunters of the CDC. Welcome back to the program.

Dr. Susan Fisher-Hoch: Thank you very much.

Daljit Dhaliwal: I just want to get your reaction to what the President had to say, and also he has been talking, his advice which has been school advice, what are your thoughts on the advice that he's been giving on that front?

Dr. Susan Fisher-Hoch: On which? I'm sorry, I didn't follow that question.

John Hockenberry: He's been talking about, people need to be vigilant, they need to be continual reporting, and they need to be, everyone needs to assist in the collecting of information.

Dr. Susan Fisher-Hoch: That's right. This is all very sensible advice, and pretty obvious stuff. And it's nice to hear it from him. We really all need to work together for this kind of, to prevent this kind of outbreak from spreading.

Daljit Dhaliwal: Does the death of a 23-month-old signal anything? Because most of the deaths up to date have been mostly in healthy adults and not children.

Dr. Susan Fisher-Hoch: That's what we hear from Mexico City, but I haven't actually seen the data. The death of an infant in a flu epidemic is not that unusual, because it's the small children, small and the elderly who are usually the worst affected in these viruses. The real risk is when we start to see a number of older, young adults, between about the ages of 15 and 40, becoming very sick and dying very acutely. That's what really worries us because that's when it becomes very pathogenic.

Daljit Dhaliwal: And your advice to parents of young children right now would be what?

Dr. Susan Fisher-Hoch: Keep them at home. Keep them at home and avoid going to public places, observe the hygiene rules that I think have been pretty well publicized. If you have a mild illness, don't go to the doctor, don't go to the Emergency Room, that's where you're going to get infected. But if the child or any other person in the family starts to have difficulty breathing, then you need medical care.

Daljit Dhaliwal: And you're in Texas. What has the state been, what is the state doing to respond to the virus in your area?

Dr. Susan Fisher-Hoch: Texas is pretty well organized, and has quite a program in place. In fact, we're working with the local health department which is just, Brownsville is part of Region 11, which is right down on the border here, and we're working with them, they're short on people so we're lending them some of our staff to help with that, some of our expertise. And they've got a good program, in fact we've been working with them for several years on this, both with educating their people, getting their plans in place, making sure they've got good community outreach so they can communicate with people who don't necessarily have access to much in the way of media.

Daljit Dhaliwal: Do you think that we need to look differently now in terms of not just the local response but the federal response also?

Dr. Susan Fisher-Hoch: Well I think we were pretty well organized with that. We get a lot of information. The most important thing as far as understanding the epidemic is to get good surveillance in place so we identify the cases, who they are, where they are, and concentrate our efforts around those areas in order to prevent further spread.

Daljit Dhaliwal: A little earlier on we were talking about the advice that President Obama was giving, calling on local authorities to be more vigilant in reporting suspected cases. How effective do you think that those kinds of precautionary measures are going to be? With regards to schools he was saying they should consider closing temporarily if a confirmed case is reported among students.

Dr. Susan Fisher-Hoch: Well that's very good advice for the schools, because the classic story of influenza is epidemics are driven by the school age population. Usually the school age children don't get very sick, but they pass it around like wildfire, so they amplify the epidemic, and in fact one of the things that is being considered nationally is revising the recommendations for a vaccine, which are aimed at the very young and the very old. And there are a few problems with that. The very young and the very old don't respond well to vaccines anyway, and if you vaccinate the school children, and school aged children between about 5 and 20, that age group, they're the ones amplifying the epidemic, and you stop that amplification, then you're protecting the very young and the very old because you don't have kids coming back from school with a virus on board and giving it to grandma.

Daljit Dhaliwal: And put this into context for us. Out of the 65 confirmed cases of Swine flu in the United States, most of them are mild. What are your thoughts on that? Put it into perspective.

Dr. Susan Fisher-Hoch: That's very reassuring, that the numbers are still small. So we'll just have to watch them over the next few days and see what happens. I'm reassured we haven't had an ICU or a very sick or a death in the age group 15 to 40. If we start to see that then we've got a real worry on our hands.

Daljit Dhaliwal: And if that does start to happen, how do you think we need to change things?

Dr. Susan Fisher-Hoch: Well we've been preparing for this because of the bird flu for a long time. One of the possibilities is that there will be really a crisis at the level of intensive care, because if you suddenly have a lot of people requiring ventilation, respirative, ICU care, and you haven't got enough, that's a problem.

Daljit Dhaliwal: Alright, Dr. Susan Fisher-Hoch, thank you very much.