Every year, hundreds of precious lives are lost to Influenza A (H1N1) in India, described by medical experts as just another preventable and curable form of seasonal malady. This season (December-February), so far, the toll has already crossed the 485-mark, and over 3037 people are being treated in hospitals and in homes, in several states, including Goa. In January alone, according to Union Ministry of Health statistics, the total number of deaths stood at 191. Rajasthan, Telangana, Gujarat and Maharashtra are the worst affected by the pandemic. In Rajasthan alone, 176 people have died, highest in the country, while Telangana has recorded over 50 deaths and more than 600 H1N1-positive cases.
Goa has so far registered six H1NI positive cases, including one death, out of the total 29 suspected samples drawn in the last about three months. Of the six H1N1-positive patients, five had a travel history within the country, and the deceased had returned from Hong Kong. He was hospitalized for two weeks, but later developed complications due to his acute diabetic problem, local health authorities say.
Last year (2014), 937 cases of Swine flu (as the influenza is commonly known) were reported, leading to 238 deaths across the country. In 2012, there were 5,044 reported cases, which claimed 405 lives, while there were 5,253 cases and 699 deaths in 2013. Swine Flu (called thus because the virus originally spread through contact with pigs, later mutating to spread through humans), like most flus, is seasonal and easily prevented through vaccination. But, close to six years since the first case was reported in 2009, the Influenza A (H1N1) virus has killed 4407 Indians according to officially recorded numbers. The extent of its spread is, however, far wider.
One of the reasons the virus has captured public imagination is that, it is incredibly infectious. Research led by the World Health Organization (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 the 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 in 19 May 2009 and was screened at the airport.
The WHO declared H1N1 in June 2009 when laboratories had identified cases in 74 countries, and only declared the pandemic to have ended in August 2010. Researchers were 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 and researchers had anticipated sporadic outbreaks of H1N1 influenza virus, but of a smaller magnitude in subsequent years.
However, the larger number of fatalities and HIN1 positive cases within a short period of time in 2015 has raised the question whether Indian healthcare professionals, researchers and policy makers did not see it coming this year, with more deaths in just over a month than there were in all of 2014, 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 health experts say, with the virus now 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.
According to experts, SARS, Swine Flu, Middle East Respiratory Syndrome (MERS) and Ebola, all of them are zoonotic in nature. That means, the virus starts from animals and gets transmitted to humans. Worldwide, this is the phenomenon, and India is not an exception. There are factors like deforestation and captive animal breeding that creates a conveyer facility for viruses to move from its wild to human habitat. And when the virus through humans board a bus, train or plane, it transmits rapidly across a country and the globe.
Transmitted from person to person, swine flu is highly contagious, spreading fairly fast in close proximity. People caring for those already infected are at greater risk of contracting the airborne virus. An unique characteristic of HINI is that even previously healthy people can develop acute respiratory problems and flu-related complications, like bacterial pneumonia. The pandemic has become a regular occurrence in India since 2009, when the first case was reported.
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 deaths are reported. This time, it was done after a former Chief Minister of Rajasthan, the State Home Minister and a Member of Parliament from Andhra Pradesh tested positive.
The situation was reviewed by the Union Ministry of Health and Family Welfare in terms of adequacy of medicines and the readiness and training of doctors and paramedical staff in public health institutions in the States. A round-the-clock outbreak monitoring cell of the National centre for Disease Control is attending to public queries on H1N1 to keep people informed and to dispel apprehensions, since January 24. On their part, the states concerned have done their bit to tackle the crisis, with Rajasthan going a step further by issuing an alert, providing free treatment, and announcing the setting up of task forces right up to district level to monitor the situation on a daily basis.
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 health 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.
The Union Government has begun testing a vaccine, but when it is ready for roll-out, it will be administered only to health workers and high risk individuals. The WHO and the Indian Academy of Pediatrics (IAP) have recommended trivalent influenza vaccine that should be administered to high risk groups just before the monsoon. According to Union Health Authorities, Influenza vaccines are to be exclusively kept for high risk groups and changes in the composition of the vaccine need to be made on a yearly basis, as there have been several studies showing that the effectiveness of the seasonal flu vaccine in many Western countries is extremely low.
(The writer is a freelance journalist)
