Don't panic: Govt

The unfortunate death of 14-year-old Rida Shaikh in Pune has triggered a nationwide panic reaction.

People wait in long queues outside government hospitals to get themselves checked, states issue inter-country travel advisories, schools shut down their entire premises and governments are taking legal steps in order to carry out forcible testing and control people’s entry and exit at ground zero.

Is the panic justified? Ask any doctor and the answer would be an emphatic no. “This is a self-remitting mild disease. Only one death is reported out of 711 cases till Friday night,” said Randeep Guleria, Professor of pulmonary medicine at the All India Institute of Medical Sciences, Delhi.
The scare mongering, precipitated by media reports to some extent, has made health officials combative. “More children die from asphyxia or sepsis than H1N1. Our infant mortality rate is 55 per 1000 live births. Do you report them so aggressively,” Health Secretary Naresh Dayal shot back at the media.
“There is absolutely no need to panic,” Dayal assured.
Officials admitted that the scare was triggered by Rida’s death coupled with mismanagement of patients in Pune, the morning after. A deliberate gap maintained by the government between the public and private sector hospitals in the last two months added to the crisis.

Teenagers at risk
Out of 615 positive cases till August 6, as many as 129 cases were children in the age group of 10-14 years. Another 100 positive cases had an age profile between 15 and 19 years. “Vulnerability of this age group is causing the worries,” Dayal said.
After grappling with the initial panic, the administration has now opened additional centres for diagnostic, sample collection and treatment, besides reaching out to the private sector.
“This being the beginning of the influenza season, we are expecting a surge in people coming for check ups,” said Vineet Chawdhry, Joint Secretary in the union Health ministry.   
The government has done away with the isolation of suspect cases till the test results come, in order to encourage people to volunteer for checks. Patients may opt for treatment in home quarantine.
On Friday, the central government asked the states to identify more hospitals and diagnostic facilities to cater to increasing patient load. The idea is to identify at least three hospitals in the state capital and one hospital at the division level.

Strict norms have been laid out for private hospitals treating H1N1 infected patients. They must have an isolation area, while the diagnostic laboratories should be having bio-safety level two plus containment and reverse transcriptase polymerase chain reaction (RTPCR) machines for detecting the virus.

Those who get H1N1 positive results from accredited private laboratories can get the Tamiflu tablets from government outlets as the medicine stock are held by the government to prevent its abuse. Taking the drug as a preventive could make the person drug resistant when he or she actually gets a H1N1 attack.
In addition to the two top-end government laboratories with BSL-3 containment – National Institute for Communicable Diseases, Delhi and National Institute of Virology, Pune – 16 more laboratories with BSL 2+ containment have been given permission to diagnose the H1N1 virus.

At the moment both NIV and NICD are testing 5000 patients each. Chemical supplies will be enhanced for 10,000 tests at NICD and 12,000 at NIV. Each of the 16 new laboratories can carry out 200-300 tests, said V M Katoch, Director General of Indian Council of Medical Research. Apart from an American supplier, a new German firm has been identified to supply the chemicals.

Tamiflu availability is being decentralised. Apart from a national stock of 16 million tablets, all metros will be stocked to treat 10,000 people at any given point of time. A district level stock for 1000 people will also be kept.

Community hit
States have been advised to set up their own helpline in their native language. The government will continue with airport screening as one third of total cases were detected at the airports, said Dayal. The high risk fliers – children, elderly, pregnant women and those with chronic disease - have been advised to wear protective masks at the airports or inside the plane.

The virus has spread into the community with local transmission reported from Pune, Panchgani, Delhi and Bangalore.