September 03, 2009

H1N1–The Road Ahead

With a record 220 cases in just one day, H1N1 flu has captured the imagination of many in the country. Pune authorities have declared it a ‘community spread’ leading to shutting-down of most schools and colleges while Mumbai is still wondering whether to follow suit. There are talks of Government planning new guidelines, but a nagging feeling of lagging one step behind when it comes to taking precautionary measures will soon haunt us. The pandemic had been tugging at our sleeves for long, craving for attention but it is only after the final jolt of the first death in Pune on August 4, 2009 that our health ministry geared up for some serious action.

As per the CDS (The Centre for Development Studies) statistics, only 2% of the flu patients require admissions. As of 7th August, of 6506 patients admitted 436 died with a mortality of 6.7% all over the world and it is still rising. Imagining the worst situation in Delhi, 100% people getting affected by swine flu, with a population of 138 crores, 2.76 lakh people may require admissions. Delhi has a total bed capacity of 41,629 only as on 31st March 2008 with eighty percent beds in the private sector. Clearly we can be seen scrambling for medical attention when such emergencies break out.

“If we start investigating every case of H1N1 virus, I think the government facility will not be able to cope with the rush,” said Dharam Prakash, the Indian Medical Association’s secretary general. So, is it that we being a developing country will face hurdles in developing and facilitating more testing centres? On the availability of proper infrastructure for testing

and the type of testing for H1N1 Swine Flu.

Sunil Lal Sr. Research Scientist, ICGEB (The International Centre for Genetic Engineering and Biotechnology) says “Basically a PCR test (Polymerase Chain Reaction) test is conducted for testing H1N1 patients PCR amplifies specific sequences of the DNA. It takes two hours or less to conduct the test. It should be ensured that the primer used in the test is updated and the right primer is used.”

If all we needed was a clean PCR set-up room and the use of a good primer, which comes along with the WHO test kit, where is the problem? Maybe it is the numbers that generate the anxiety. But that is not the only threat.

In Delhi in the year 2008, as per economic survey, total deaths were 1,00,974. Out of which heart diseases caused 19,362 deaths. With most of medical staff driven towards swine flu, illnesses like cancer, pneumonia, anemia, measles, meningitis, cholera who claim many lives annually might be received with less seriousness. Dr KK Aggarwal President Heart Care Foundation of India says, ‘All flu are same as far as developing complications are concerned and need same consideration for treatment. In complicated flu whether swine or human there is no difference in the line of treatment and both will need tamiflu, which is currently the drug of choice in view of the sensitivity patterns.”

H1N1 is certainly not getting undeserved attention. It has taken 1462 lives worldwide and claiming more every day, but that is not to say that it is the biggest medical tragedy man ever witnessed, only one of the fastest spreading. At a time when the flu has played spoil sport for the economy, can we really afford it? Ranjana Kumari, teacher says, “I have two kids in a joint family. I cannot support them if made to leave my job and sit back if infected. I t is not just the fear of being infected or developing any medical infirmity that dreads us, we are middle class people, who can’t afford to sit back”. In fact this is not a concern that restricts itself to our country, at a time when countries are stashing more funds to curb economic recession and global terrorism, developing proper checking mechanisms, immunization and research for flu is a tough challenge. “These are countries with vulnerable populations and fragile health-care systems,” said Nikki Shindo, acting head of the WHO’s influenza program.

The Flu patient must be isolated for a good seven days under medical supervision until the symptoms subside, any middle income family cannot forfeit one weeks salary to this Flu. This is why it had become imminent for us to take immediate precautionary measures. The Washington Post reporter Bob Stein has expressed concerns over the flu reaching less prosperous, less prepared countries, he laments, “Despite well-run clinics for the wealthy, many of India’s government health services are overcrowded, understaffed, chaotic and antiquated”.

Past month has seen Indian doctors and health officials prepare for the sharp increase in the H1N1 swine flu cases, when the world is preparing for a new round of flu in Northern Hemisphere this winter. The Washington Post report claims, “The virus could cause nothing more than a typical flu season for the Northern Hemisphere this winter. But many experts suspect the second wave could be more severe than an average flu season, which hospitalizes an estimated 200,000 Americans and contributes to 36,000 deaths. Because the virus is new, most people are not immune to it.”

“The virus is still around and ready to explode,” said William Schaffner, an influenza expert at the Vanderbilt University School of Medicine. We could be looking at a very big economic mess but what the future holds still eludes us. We can only set our house in order and be fully armed.

Link: Original Article

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