Three of the Dartmouth students are currently in isolation at Dick's House, one is in voluntary isolation at an off-campus house and another has returned home to Maine, Turco said in an with interview The Dartmouth.
A suspected case refers to an individual who has a fever of at least 100 degrees Fahrenheit in addition to other flu symptoms, Turco said. The definition does not require, as it had in the past, that the individual have had close contact with communities where the flu is confirmed to be prevalent, Turco explained.
All five students were examined at Dick's House and evaluated for flu-like symptoms. The three in isolation at Dick's House are being treated with antiviral medications to reduce symptoms and protect the clinic's staff and other students, Turco said.
The students are presenting with mild flu symptoms and will be kept in isolation for at least a week, Turco said. Samples from the students have been sent to a state laboratory in Concord, N.H., for further analysis.
Results from the state laboratory will determine whether the students have Type A or Type B influenza virus. If a sample from a "suspected" case tests positive for Type B or for a known strain of Type A, then the individual does not have the H1N1, or swine flu, strain of the Type A virus. If a sample tests positive for an unknown strain of Type A or if it tests negative for both Type A and Type B, the case is considered "probable." The sample is then sent to the Centers for Disease Control and Prevention laboratory in Atlanta, Ga., to confirm whether it contains the H1N1 strain.
The results for the first student, who was admitted to Dick's House on Thursday, could be available on Monday, Turco said. Turnaround time for the state laboratory tests can be up to three days, he said.
Turco said the tests will likely be negative for the H1N1 strain, but he would not rule out the possibility that they could be confirmed as positive.
Other students are likely to exhibit symptoms in the coming weeks, Turco said.
"I wouldn't be surprised if there is a small number of people that test positive for swine flu, but from what I can tell now, the illness will be relatively mild," he said.
Gov. John Lynch, D-N.H., announced in a Friday press conference that state health officials had identified a "probable" case of swine flu involving an Upper Valley resident. College officials confirmed Friday evening that the individual is a Hanover Inn employee.
The employee had been on medical leave since the previous Wednesday. The individual has been treated with the antiviral drug Tamiflu and has reported feeling better, Turco said.
Lynch also announced on Friday that one of the two "probable" cases involving Concord Hospital employees identified last week was confirmed as positive for the H1N1 virus at the CDC.
Lynch announced on Sunday that two additional "probable" cases had been identified. One involves an 18-year-old student at Kearsarge Regional High School, which is about 35 miles southeast of Dartmouth in North Sutton, N.H. The other case involves a 15-year-old student at the New Hampton School in New Hampton, N.H., according to a Sunday press release from the New Hampshire Department of Health and Human Services.
Turco said he believes all four of the "probable" cases being tested by the CDC will be confirmed as swine flu.
While Turco said he believes the risk to the Dartmouth community has increased since last week, he said it is not significantly higher due to the Hanover Inn case.
"I think the acknowledgment is that clearly swine flu is not only in New Hampshire, but also in the Upper Valley," he said.
College officials plan to treat all "suspected" and "probable" cases as if they are confirmed while waiting for tests results from the state and the CDC, Turco said, explaining that College officials will take all necessary precautions to minimize the risk of spreading the virus.
Although the College's policies may change, Turco said students who exhibit flu-like symptoms and check into Dick's House will currently be isolated and treated with antiviral drugs.
"If it gets confirmed, there's nothing more that has to be done because of that," he said.
College emergency planning committees are meeting regularly to coordinate the College's response to the outbreak, Turco said.
A key issue will be determining how to best isolate sick individuals, given the limited number of beds at Dick's House, he said. Although College health officials do not anticipate many new cases each day, state guidelines require that individuals be isolated for seven days, he said.
The College's Emergency Planning Group is looking into alternative spaces and is considering asking students who live nearby to return to their homes to be isolated, he said.
The group is considering all options and has not ruled out the possibility of shutting down the College in the event that a large portion of the Dartmouth community becomes ill, Turco said, though he added that this step is unlikely to become necessary.
Dartmouth does not have a stockpile of antiviral drugs, Turco said, though both Dick's House and Dartmouth-Hitchcock Medical Center have limited supplies.
The New Hampshire Department of Health and Human Services received a portion of the federal government's national stockpile of antiviral medications on Friday. Dartmouth is likely to receive some of the drugs, though the state has yet to determine how it will allocate them, Turco said.
College officials will follow state procedures for administering the antiviral medications to preserve the limited supplies, Turco said. Drugs will be most effective when administered to those with preexisting health conditions, he explained.
College officials do not plan to establish flu clinic services in addition to those provided at Dick's House, though the state may establish neighborhood health clinics if the number of cases in a given area is great enough, he said.
Dartmouth implemented a set of travel policies on Friday in response to the global flu outbreak. The policies mandate, in part, that the relevant dean or vice president approve certain travel away from campus by Dartmouth groups.
Turco noted that the swine flu appears to present mainly in mild to moderate forms in the United States. He said he hopes that the outbreak will not become as severe as health officials have previously predicted.
"I'm very reassured by what hasn't happened," he said. "We haven't seen a significantly increasing number of students present [with symptoms], and we've seen what I would have expected, especially with this new definition [of 'suspected' cases]."
Turco emphasized that the College will continue to monitor the spread of the disease and keep members of the Dartmouth community informed of any changes.
"We think it is so vitally important to make students, faculty and staff aware that we're trying to do this as transparently as possible," he said.
The World Health Organization announced that the number of confirmed cases globally had increased to 658 cases in 16 countries by Saturday.
Michael Ryan, director of the WHO global alert and response team, said in a widely reported teleconference on Saturday that he believes the outbreak is likely to escalate into a pandemic, though he stressed that the term refers to the geographic spread of the disease, rather than its severity.
The WHO currently identifies the swine flu outbreak as a phase 5 global health concern. To be labeled as a pandemic, which is phase 6 on the WHO's pandemic alert system, the disease would have to be spreading at the community level in at least two of the WHO's six regions.
"We have to expect that phase 6 will be reached," Ryan said. "We have to hope that it is not."
