This piggyback ride is no fun

Swine flu: Nobody knows if the H1N1 virus can mutate into something more dangerous

Pigs are flying. Not literally, but a flu virus which possibly went through a natural mix-and-match process inside the swine population to pick up virulent capabilities, travelled all over the world in international flights to trigger a global panic. The World Health Organisation is just short of declaring it a pandemic as the virus has infected almost 1,900 people in 23 countries within the last two weeks, killing 31 people.

The first alert came when health officials in the USA and Mexico saw a surge in the number of late season flu cases in late March. Within weeks the virus spread to Europe and Asia, thanks to international travel.

 By April 30, the WHO declared it a phase-5 outbreak which gives a strong signal that a pandemic is imminent. The virus was spreading from human to human as air droplets. Nobody knows if the virus can metamorphose into something even more dangerous.
India swung into action quickly casting a wide surveillance net covering 21 international airports, 12 sea ports and a few key road checkpoints in Uttar Pradesh and Bihar to find out suspected flu cases and check if they are carrying the Mexican H1N1 virus. While the WHO maintained containment was not an option for those countries where the outbreak has occurred, it is still an option for India.

“Our aim is to identify the suspect cases, isolate them and test their samples to find out whether the virus is present. Containment is an option for us,” said Vineet Chowdhary, Joint Secretary in the Union health ministry who is in charge of H1N1 preparedness.

On wrong foot

India was caught on the wrong foot in 2003 when Severe Acute Respiratory Syndrome (SARS) struck. That was the first respiratory health crisis for the lackadaisical Indian health administration which was unprepared for the challenge.

The bureaucrats could not recognise the emergency, delaying preparedness. The ministry brought private doctors in the SARS loop 35 days after the virus was detected in India assuming that people with SARS symptoms will naturally come to government hospitals.
The SARS crisis illustrated poor centre-state coordination. The states did not follow central advice and discharged suspected patients even without collecting samples. Fortunately for India, the disease did not manifest.

Following the SARS experience, the ministry pulled up its socks. It was better prepared to handle the next crisis, avian influenza, two and a half years later. There was better coordination with the Department of animal husbandry as well as with states resulting in speedy distribution of the medicine and equipment. An effective culling strategy was put in place to limit the H5N1 virus’s reach. Adequate resources were available for upgrading the facility and compensating the poultry owners.

The SARS experience has come handy for the health administrators this time while tackling the H1N1. The proforma designed during SARS was dusted off and printed in thousands within the first 48 hours for distributing to the airlines.

“Part-A of the proforma was for passengers who had influenza like symptoms, while Part-B is an advisory for the passengers requesting them to report to a government hospital in case they develop symptoms later,” said Vishwa Mohan Katoch, Director general of Indian Council of Medical Research.

The hospitals where facilities were created and doctors who were trained to handle respiratory disease emergencies during SARS and avian flu outbreaks are back in action. Two laboratories – National Institute of Communicable Diseases (NICD), Delhi and National Institute of Virology (NIV), Pune have been tasked for the laboratory analysis.
Two more – National Institute of Cholera and Enteric Diseases (NICED), Kolkata and Regional Medical Research Centre, Dibrugarh are on stand by if the load increases.

“Though there are suggestions from states to decentralise the laboratory test to other centres, the Centre decided not to do it. Since it’s a new virus (a mixture of avian, swine and human influenza) with unknown behaviour, the laboratories require bio-safety level-3 set ups. Many labs don’t have it,” Chowdhary said.

There is no shortage of medicine either. Since the avian influenza, the government maintained a stockpile of one million Tamiflu tablets. Once WHO raised the H1N1 influenza alert level to phase-5, the centre decided to increase the stock to ten million tablets.
Four manufacturers – Ranbaxy, Cipla, Hetero Drugs and Roche India – were asked to submit bids for supplying additional dosages within one week. From the four bidders, Hetero was selected as the lowest bidder. The first batch of additional supplies is on the way.

The drug companies have also assured the government that they can supply any quantity after 15 days if there is a need. “Medicine prices have gone up slightly because of the surge in global demand,” pointed out Chowdhary.

Another major change in the government’s attitude is an effort to protect the identity of the suspects. Unlike the SARS days, this time the identity of suspected persons have been kept under wraps and their health status is announced only when results from both NICD and NIV are available. Till May 7, samples from 24 persons were analysed and found negative.

Is the risk real?

But is there actually a risk? Many wonder because neither SARS nor bird flu (H5N1) created any major public health problem? Scientists are of the opinion that it might be sheer good luck that the virus has not struck India in a big way.

“The 1918 H1N1 killed millions of people in India. I think in all those examples (SARS and H5N1), India was just lucky,” Daniel R Perez, Associate professor at the University of Maryland, USA told Deccan Herald.

Are states prepared? In a review meeting with the Cabinet Secretary K M Chandrasekhar on May 4, states’ health officials exuded confidence. “Nobody should panic. We have learnt from SARS and H5N1 experience and are better prepared now. Even if the virus strikes, we will be able to contain the virus in a limited way,” Chowdhary said.