Influenza A (H1N1), the dreaded viral infection that became a pandemic in 2009, has made a fierce comeback this year, claiming nearly 678 lives and close to 14,567 cases reported in large number of states across the country, including Goa. According to the Union Ministry of Health, Maharashtra is the worst affected followed by Gujarat, Kerala and Rajasthan. In Maharashtra alone, more than 300 people have died of swine flu (the commonly known name of the influenza). A Central rapid response team of health experts has been deployed in Maharashtra to investigate the rising trend of the disease in the state, where local private health care practitioners say that the number of deaths could be much higher than what the government statistics show.
The growing number of swine flu cases so early (since June) this year has baffled doctors, who are suspecting that the H1N1 virus, which causes the disease, may have mutated. Doctors point out that swine flu commonly appear during post-monsoon or during winter season, but this year, there have been significant number of cases of the disease since June inspite of high temperatures that are not conducive for viral growth or transmission. There was a sudden surge in swine flu cases reported over the last few months, when many people died and a large number of patients with severe symptoms required hospitalisation. Doctors have been insisting that the National Institute of Virology and National Centre for Disease Control, should investigate the reason behind the sudden spurt in swine flu cases early this year, as there is a need to look out for characteristic symptoms of the disease throughout the year so that timely action can save lives.
One of the reasons the virus has captured public imagination is that, it is incredibly infectious. According to doctors, swine flu initially spread by pigs is now transmitted from human to human. It is highly contagious respiratory disease caused by Type A strains of the virus, which is enters the human body through inhalation of contaminated droplets from sneeze of an infected person or is transferred from a contaminated surface to the eyes, nose or mouth of a person. Symptoms of the disease are similar to common viral illnesses, but the intensity is higher. Patients feel lethargic, have high grade fever and sore-throat accompanied by dry cough, among other milder symptoms. Treatment is mostly symptomatic, but delayed diagnosis of the disease can prove fatal for a patient.
Research led by the World Health Organisation (WHO) indicated that one-fifth of the population in 19 countries including India were infected with the virus in 2009-10, the first known season of the virus after a first case was discovered in Mexico in April 2009. The first officially recorded case in India was a 23-year-old man who flew into Hyderabad from the United States on May 19, 2009, and was screened at the airport.
The WHO declared H1N1 pandemic in June 2009 when laboratories had identified cases in 74 countries, and only declared the pandemic to have ended in August 2010. Researchers were then of the view that since this was a relatively new virus, we are likely to see outbreaks for several years before it settles down into a seasonal pattern. In fact, after the H1N1 pandemic of 2009, the WHO had anticipated sporadic outbreaks of the virus, but of a smaller magnitude in subsequent years.
However, the large number of fatalities and H1N1 positive cases since June, has raised the question whether Indian healthcare professionals, researchers and policy makers did not see it coming this year? And with large number of deaths in the last few months, it isn’t yet clear if the virus is spreading faster or if there is better surveillance, or if both are happening. The threat from swine flu to India now needs to be viewed differently, public healthcare experts say, with the virus increasingly settling into what is closer to a seasonal influenza pattern. Experts are of the view that response to a pandemic depends on constant surveillance and monitoring of the evolution of the viral strain already endemic to India.
Transmitted from person to person, swine flu is highly contagious, spreading fairly fast in close proximity. People caring for those already infected are at a greater risk of contracting the airborne virus. An unique characteristic of H1N1 is that even previously healthy people can develop acute respiratory problems and flu-related complications, like bacterial pneumonia. The H1N1 pandemic has become a regular occurrence in India since 2009 when the first case was detected. In fact, over the last eight years since the first case was reported in 2009, the Influenza A (H1N1) virus has killed more than 6,500 Indians according to officially recorded number. The extent of its spread is, however, far wider.
Even then, the public healthcare system is unable to stop the entirely preventable deaths. The level of preparedness of the states affected by H1N1 to manage an outbreak is often reviewed only after a large number of deaths are reported.
Curiously, the information, education and communication campaigns to create awareness among the masses to protect themselves from infection, and steps for timely treatment are launched only when the rounds of outbreak peak. The states have now been advised to ensure that steps are taken to prevent any increase in the number of casualties by encouraging people to approach public healthcare facilities on time, and to educate them on preventive methods. The simple flu becomes deadly as patients come in for treatment only when things go out of hand. Advance planning and readiness to deal with the annual seasonal outbreak by means of simple and cost-effective awareness creation by the public health authorities, would go a long way in preventing deaths, experts say.
(The writer is a freelance journalist).