Swine Flu: Awareness and Cure

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Search 19th February Public Speak discussion here: http://www.newsonair.com/Public-Speak.aspx

TOPIC: General Studies 2

• Issues relating to development and management of Social Sector/Services relating to Health
• Development processes and the development industry the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders.

In news: The country is once again facing an outbreak of swine flu, with hundreds falling victim to the disease. According to data from the Health Ministry, since the beginning of the year, over 9,000 cases of swine flu have been reported from across the country, with 312 deaths. The worst affected states are Rajasthan (2,941 cases, 107 deaths), Gujarat (1,431 cases, 55 deaths), Delhi (1,669 cases, 7 deaths), Punjab (335 cases, 30 deaths), MP (98 cases, 22 deaths) and Maharashtra (204 cases, 17 deaths).

However, this would represent just a fraction of the numbers. The data corresponds to the number of cases registered in hospitals and PHCs (primary health centres). The actual numbers could be several times more, with countless swine flu cases being ascribed to a passing flu.

The Flu: Also called swine flu, the initial symptoms are similar to that of the common flu — cough, fever, and diarrhoea. Since both are viral in nature, it is not easy to differentiate in the early stages. Swine flu is highly contagious and communicability begins from day one of onset of symptoms.

H1N1 flu is also known as swine flu caused by swine influenza virus that is endemic in pigs. The ‘H’ stands for hemagglutinin and ‘N’ for neuraminidase – both proteins on the outer layer of the virus.

H1N1 typically spikes between January and March in North India, and abates as the summer sets in. It resurfaces during the monsoon and lasts until after the rains. Younger children may potentially be contagious for longer periods.

If a patient’s condition deteriorates and he or she develops severe lung infection called ARDS (Acute Respiratory Distress Syndrome), the patient would have to be given higher oxygen support. A further deterioration would require ventilator support, and if that is not sufficient, the patient would have to be put on the ECMO (Extra Corporeal Membranous Oxygenation), which is an artificial lung machine. The ECMO facilitates oxygenation of blood and removal of carbon dioxide, outside the body. So, the machine takes over the work of the lungs, which can rest and heal. This may take a week to two weeks.

According to the Pune-based National Institute of Virology, the virus has not undergone any significant mutation and the virulence has remained nearly unchanged. It has, however, undergone point mutations which resulted in a new strain — the Michigan strain — replacing the California strain that has been prevalent since the 2009 pandemic.

The high H1N1 flu toll points to a failure to put necessary systems and precautions in place:

Poor surveillance system: India’s surveillance systems are still poor and underestimate the influenza burden substantially. If numbers are unsatisfactorily tracked, so are changes in the viral genome. India submits a woefully small number of H1N1 genetic sequences to global open-access databases for a country of its size and population. Sequencing is important because it can detect mutations in genetic material that help the virus evade human immune systems, making it deadlier. Because India does not sequence a large enough sample of viral genomes, it would be missing mutations that could explain changes in the lethality of the virus. Put together, the numbers data and sequence data will enable sensible vaccination decisions.

Lack of push for vaccination: Vaccination is the best weapon that India has against this menace, because Oseltamivir, the antiviral commonly deployed against flu, is of doubtful efficacy unless administered early enough. Yet, India has thus far stayed away from vaccinating even high-risk groups such as pregnant women and diabetics, because influenza is thought to be a more manageable public health challenge compared to mammoths such as tuberculosis. Better surveillance of influenza will possibly change this perception by revealing the true scale of this public health issue.

Large-scale vaccination covering high- risk groups such as health workers, people with lung, kidney, liver and heart disease, diabetics and the elderly could reduce the impact of the viruses in States such as Rajasthan, Maharashtra, Gujarat, Telangana and the National Capital Region, all of which had a large number of cases three years ago.

A universal preventive programme should be considered. Non-availability of sufficient doses of quadrivalent vaccine as well as profiteering on the demand have not been addressed. If a vaccine has proven efficacy in reducing the burden of seasonal influenza, it must be made part of the public health system. An umbrella scheme such as Ayushman Bharat can easily provide it to everyone using public and private institutions. India must prepare for it with a comprehensive programme that covers all the States.

Study & Upgradation of Vaccines is important: There are 41 Virus Research Diagnostic Laboratories in India and they can study the nature of infections to provide genetic insights to peer scientists. This can help develop vaccines and remedies.

The Way Forward:

• With swine flu epidemics striking with regularity throughout the year, an important first step to stop the spread of the disease would be to accept that there is a problem. Acceptance of an outbreak leads to public awareness and more effective measures being instituted against the disease.
• A large part of the responsibility to contain the spread of the infection falls on us as a community. People who experience flu-like symptoms should seek appropriate medical advice and should voluntarily quarantine themselves at home to limit the spread of the disease.
• Awareness programmes on countering the spread of this highly contagious disease should be conducted at regular intervals, by both the government and private healthcare providers.
• A provision for subsidising expensive vaccines for healthcare workers at all levels, starting with the staff in PHCs, is a necessity, especially during an epidemic. Doctors and healthcare personnel posted in remote PHCs should be alerted about the outbreak of an epidemic at the earliest.
• Treatment with the oseltamivir tablet, commonly called Fluvir, Tamiflu and Anti-Flu, when started early, is effective against the infection. The swine flu test, which costs more than Rs 6,000 in the private sector, could also be considered for subsidy so that more people can take it.

Connecting the Dots:

1. Swine flu outbreak is a reminder that there is no room for complacency as far as infectious diseases are concerned. Discuss in relation to the rising number of cases in India.
2. The reported cases and deaths due to the spread of H1N1 virus are on the rise in comparison with previous years’ records. Discuss the reasons behind it. Also elaborate on what preventive steps should be taken by the government.