Pandemic of panic! H1N1 mess!

H1N1 (Swine) flue claimed its first Indian victim – 14 year old girl Reeda Shaikh on 3rd August. This conclusive diagnosis was made by our ‘scholarly’ media. Headlines screamed in the national & regional dailies with all the dramatic effects at their command. Build up had been steady over past couple of weeks. Daily reportage covered numbers, schools affected, classes or whole schools shut down temporarily, and travellers abroad going down on return. Pune had been declared the swine flu capital of India. Great story in the making was awaiting its opportunity. Tragedy of 3rd August provided that moment. Bereaved family’s grief must be immense. Sense of loss may nudge them to fear the worst – neglect by hospital authorities (Jahangir in this case), incompetence or worse. One may understand if the family acts out of anger. But if media or government authorities were to lose their reason or balance, then that would be inexcusable. Media should report responsibly. Government authorities should supervise & lead health efforts responsibly. Neither should compound crisis.

Media’s reporting I have often found erroneous, disjointed or incoherent. I have often sighted its lapses in my blog articles. Here I assume that whatever has appeared in the two papers I accessed, Indian Express & Sakal, is authentic. Joint Commissioner of health services of Maharashtra government has asked the Police commissioner of Pune to file a case of negligence in treatment against Jahangir hospitable. Health minister has assured government help to family of the victim in case they decided to file a compensation case against the same hospital. Even Chief Minster has reiterated the charge of negligence. Municipal commissioner has stated that Pune Municipal Corporation (PMC) was not informed of death until 2 hours after the event at 16:37 hours. All of them have assumed that Rida died of H1N1 (swine) flue infection. Presumptive guilt seems to be the basis of all these statements.

National Institute of Virology (NIV) has confirmed H1N1 infection in the throat swabs & samples of the victim sent to it for testing. Does this indicate victim died of H1N1 infection? Everyone has assumed so. Since it was the first death where H1N1 infection was present, was it not responsibility of all concerned government health authorities & medical community to conclusively establish the exact cause of death? Similarly shouldn’t they have etched out exact sequence of events that culminated in the tragedy to develop prognostic indicators for future cases? Many times a patient may have pre-existing condition/s that may be aggravated fatally by another infection, which by itself may not prove fatal. Was this possibility explored? What about reaction to administered drugs? I have no idea what such an investigation would involve. May be an autopsy would have been needed to be conducted. Reports indicate that body has already been interred. Nothing in the whole brouhaha indicates that such contemplation even remotely touched anybody’s fervid mind.

I hold no brief for Jahangir or Ruby or for that matter any other hospital. If they were negligent then they should be punished. However, presumption of guilt is no proof. It may sound an expedient strategy in the short run, but would prove to be the undoing of the government as we shall see later. Do the police have the competence or training to establish medical negligence? Directorate of health services (DHS) should be performing this job if they have the competence or else involve National Institute of Communicable Diseases (NICD) to do it. If proved, then DHS should act as a complainant & lodge the case with police.

I searched the website of NICD. I was aghast to read what I found under the heading “What is new?”

WHAT’S NEW?

S. No.

Diagnosis of Outbreak

Area Affected

Period

1

Unknown Disease

Thiruvellur, Tamilnadu

23rd Mar – 27th Mar 2002

2

Jaundice

Mandi,Himachal Pradesh

19th Mar – 02nd April 2002

3

New outbreak

Mandi,Himachal Pradesh

19th Mar – 02nd April 2002

Searching on the site for H1N1 flu or Swine flu, gives this reassuring information.

Your search for swine flu did not match any documents.

  • Make sure all words are spelled correctly.
  • Try using fewer words.
  • Try using more general keywords.
  • Try different keywords.

I fervently hope someone will research this site & prove me wrong. Tell me that I must have been hallucinating. This is our national vanguard in our fight against known & unknown communicable diseases.

I had no choice then but to visit CDC (Centre for disease control & prevention), that Mecca of communicable (& other) diseases, where everyone goes to source latest authentic information. Here is what I learnt.

H1N1 flu ( I will drop the now erroneous useSwine flu’ as the virus is found to be ‘quadruple reassortant’, see website for details) is almost indistinguishable from other flues as it has the same following symptoms ->

“Influenza (also known as the flu) is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes on suddenly and may include these symptoms:

  • Fever (usually high)
  • Headache
  • Extreme tiredness
  • Dry cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle aches
  • Stomach symptoms, such as nausea, vomiting, and diarrhoea, also can occur but are more common in children than adults

These symptoms are usually referred to as “flu-like symptoms.”

What about fatality? “Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.”

Modesty seems to be byword when talk gets to severity & infection rates -> “CDC is still learning about the severity of novel H1N1 flu virus. At this time, there is not enough information to predict how severe novel H1N1 flu outbreak will be in terms of illness and death or how it will compare with seasonal influenza. So far, with novel H1N1 flu, the largest number of novel H1N1 flu confirmed and probable cases have occurred in people between the ages of 5 and 24-years-old. At this time, there are few cases and no deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this novel H1N1.”

What about infective period for disease to be communicated? -> “At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. CDC is studying the virus and its capabilities to try to learn more and will provide more information as it becomes available.”

At the moment, CDC is not sure who the High Risks group are, but expects them to be same as for seasonal influenza until more information is available ->

High-risk groups: A person who is at high-risk for complications of novel influenza (H1N1) virus infection is defined as the same for seasonal influenza at this time. As more epidemiologic and clinical data become available, these risk groups might be revised.

  • Children younger than 5 years old. The risk for severe complications from seasonal influenza is highest among children younger than 2 years old.
  • Adults 65 years of age and older.
  • Persons with the following conditions:
  • Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, haematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus);
  • Immunosuppression, including that caused by medications or by HIV;
  • Pregnant women;
  • Persons younger than 19 years of age who are receiving long-term aspirin therapy;
  • Residents of nursing homes and other chronic-care facilities.

I have given this information at length just to show how fluid the situation is & is still developing. If you have noticed, the largest number of cases has happened between 5 years to 24 years, yet the vulnerable group is still defined in terms of age as below 2 & above 65 years.

Contrast this with the cocksure mentality & kneejerk reactions of our own government authorities. Combine that with media’s senseless hyping with no thought of providing actionable information. And what we may have on hand soon is Pandemic of Panic. Eight close friends of mine have suffered from flu like symptoms in past two weeks. If they & others like them were to rush to Naidu or Sassoon hospital, then 10% of Pune may congregate there.

· Are we to believe that these hospitals have the infrastructure to cope with this influx? Do they have better infrastructure & support mechanisms than Jahangir, Ruby or other private hospitals? Where would commissioners & ministers get admitted if they were in a serious condition? Just find out where they have been taking medical treatment all these years.

· Would not that compound the problem when on a mass scale people with ordinary flu symptoms come in contact with proven H1N1 cases? Would the possibility of exploding host-base as a consequence of this afford more opportunities for virus to mutate? Would not rampant & indiscriminate use of anti-viral treatment aggravate the mutation scenario further?

· Wouldn’t the pandemic of panic turn into pandemic of H1N1 novel flu more certainly in such case?

This is a time for serious discussion, for non-adversarial true Public Private Partnership, and for implementing a realistic & well thought out disease control plan. Not for passing the buck & finding scapegoats. Calm needs to be restored & also sense of proportion. Uncountable Ridas are dying unnecessarily in India due to Malaria, Dengue, Tuberculosis, malnutrition & what not. State of our health system is abysmal. These are larger problems. But these diseases or causes don’t have the glamour associated with H1N1 flue. It won’t do to waste our energies in turning H1N1 flu into a spectacle. But I am afraid that is what will happen. In next 15 days we will have panel discussions on all & sundry TV channels that will blow the panic frenzy sky high. We may rush headlong into a real huge crisis that will be manufactured by the government just to avoid some flak now. It won’t do. We need to show our strong disapproval through protests. I urge the medical community in Pune to come together & put out a informed paper on this issue & also suggest an action plan. As our contribution, let us stay calm & keep our reasoning faculties working.

O O O O O O O O O O O O

Municipal commissioner provided extremely accurate information about the time (16:37 hours) he learnt of H1N1 victim. I wish he shows same accuracy when dealing with other municipal issues. For a starter, I bring to his notice the junction of Baner & Aundh-ITI road. This patch has been repaired more than 7/8 times in last 10 months since the commonwealth youth games. If he has such a faith in the government machinery, then let him explain why this has happened. Below find picture I took today, 5th August 2009.

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2 Responses to “Pandemic of panic! H1N1 mess!”

  1. C N Bal Says:

    After reading your article on the contributions of tthe media, government and others being responsible for the current state of near panic in people with charges flying left and right of negligence etc…a realistic appraisal is in order. Negligence I believe is willful dereliction of duty….doing something when one knows it is the wrong this to do. Acts in good faith is not negligence. These acts are done within the sphere of limited knowledge, time, or both. The attached slides may help people to unerstand what swine flu is.

  2. Sadanand Says:

    Indian government has been claiming that it is fully geared to take on challenge posed by Swine Flu pandemic. We have seen that preparedness during last 11 days since the media frenzy over the first death. Government has now come up with categorization of patients based on symptoms that should have been made available much earlier. However, since it is useful, I have given it below.
    ——————-
    According to the revised guidelines, at first all individuals seeking consultations for flu-like symptoms should be screened at healthcare facilities both government and private or examined by a doctor.

    The patients have been categorised as follows:

    Category A: Patients with mild fever plus cough/sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor.

    No testing of the patient for H1N1 is required. Patients should confine themselves at home and avoid mixing up with public and high risk members in the family.

    Category B: (i) In addition to all the signs and symptoms of Category A, if the patient has high grade fever and severe sore throat, may require home isolation and Oseltamivir;

    (ii) In addition to all the signs and symptoms of Category A, individuals having one or more of the following high risk conditions shall be treated with Oseltamivir: children under five, pregnant women, those above 65 years, those with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS; Patients on long term cortisone therapy.

    No H1N1 tests are required for Category-B (i) and (ii). Such patients should confine themselves at home and avoid mixing with public and high-risk members in the family.

    Category C: In addition to the symptoms of Categories A and B, if the patient has one or more of the following:

    –Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails;

    — Irritability among small children, refusal to accept feed;

    — Worsening of underlying chronic conditions.

    Such patients require testing, immediate hospitalisation and treatment.
    ————————
    Sadanand

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