Was govt prepared for swine flu?

Could have been better handled if health dept planned ahead, say experts

With the capital witnessing at least 2,999 swine flu cases and 10 deaths this year, health experts say the situation could have been better handled here if the health department had planned ahead.

According to doctors, the season for swine flu cases will now be over with the temperature on the rise. However, panic has gripped the capital with the general public making a beeline for masks and going for tests for the H1N1 virus. Private chemists are seeing a sale of between 200-250 masks everyday. Commuters in public transport and crowded places are seen wearing masks.

The city is also reeling under the shortage of vaccines and Tamiflu syrups for children. Two weeks back, there was a shortage of Tamiflu capsules as well for two days before the government stepped up the stocks. The drug was not available at private chemist shops either.

With no government at the state before the Aam Aadmi Party came to power on February 14, there was a lack of coordination between the state and the Centre in handling the situation, say experts.

The lack of guidelines at an early stage triggered panic among the public who did not know for a significant period of time on the dos and don’ts of the infection or other necessary details like when to go for a swine flu test. Timely awareness could have helped avoid spreading panic among the public.

Recently, the government has taken innovative measures like booking announcement slots in the Metro discussing the “seasonal flu”.  

Early intervention
“The reguations should have been in place from an early stage. The government should have issued guidelines on how people with suspected swine flu should not travel in public transport to avoid an outbreak of the infection. Mega events or gatherings should have been banned. But such instructions are still missing. The need of the hour is effective cooordination between the Centre and the state and a clear cut policy for vaccination,” says Dr K K Aggarwal, Honourary Secretary General, Indian Medical Association (IMA).

The advertisements were issued once there was a spike in the number of cases in January. Since the beginning of the year, the capital has seen a total of 2,999 cases, according to figures by the Directorate of Health Services (DHS). Tests for swine flu were also carried out indiscriminately with the total number of tests conducted on a day even crossing 900.

The government had issued guidelines to private laboratories to test only Category C patients or those who are hospitalised and have shown severe manifestations of the flu. However, walk-in tests still continue, often adding to the panic. Category-B patients or those who are at a higher risk like pregnant women, children below the age of five, those above 60 years of age or those suffering from co-morbid conditions like diabetes, hypertension and showing signs of the flu also do not get tested. In this case, it is best to start treating them with Tamiflu drugs, said doctors.

“Panic-stricken people made a queue for the expensive swine flu tests even though they were suffering from seasonal flu. The labs also continued to overcharge them till the government put a sealing on the price. Only high-risk people or those hospitalised need to get tested,” says Dr Naresh Chawla, member of the Delhi Medical Association (DMA).

Laboratories in city

The government put a sealing on the charges by private laboratories at Rs 4,500 after it was flooded with complaints of over-charging by the labs.

Currently, there are only three government laboratories which are authorised to carry out tests of swine flu. These include the National Centre for Disease Control, AIIMS and VP Patel Chest Institute. Currently; AIIMS is handling 80-100 samples everyday now, including samples from Safdarjung Hospital, Madan Mohan Malviya Hospital and Holy Family Hospital.

“Of the samples being tested, 30-35 per cent are testing positive. The test reports are being cleared in a day when we are updating the nodal officers of the respective hospitals on the results,” says Dr Lalit Dar, Associate Professor, Microbiology team, AIIMS.

VP Patel Chest Institute is handling between 20-30 samples everyday currently. However, if the institute sees an increase in number of samples, it will need an upgradation in infrastructure.

“The number of cases is likely to decline now. However, if the institute has to handle more number of samples, we will need more manpower and an upgradation in infrastructure to deal with the situation,” says Dr Rajendra Prasad, Director, VP Patel Chest Institute.

The NCDC is testing between 200-250 samples everyday, say sources at the centre. The health department’s decision to open two more government laboratories at University College of Medical Sciences and Maulana Azad Medical College still remains pending.

“For testing samples for communicable diseases like H1N1, a bio-safety laboratory is required. The project to upgrade the two more labs is still in the pipeline,” says a senior DHS official. SRL Diagnostics, which is one of the authorised private laboratories to conduct tests for swine flu, the incidence of positive cases of swine flu has consistently gone up from January’s 29.7 per cent  to 34.7 per cent in the third week of February.

“According to the SRL data, Delhi-NCR has a high incidence of swine flu with 40 per cent of the cases reported positive, while Mumbai region reported 25 per cent of the cases positive,” says Sanjeev Vashishta, CEO, SRL Diagnostics.

Vaccination efforts

At a time when the virus is rapidly spreading, there is a shortage of vaccines in the city. The Centre had recommended the state health department to vaccinate healthcare workers who are at higher risk of contracting infection from the H1N1 virus.

“The vaccines will be free for doctors and paramedic staff who are directly dealing with patients admitted at hospitals for swine flu or in the OPD. These healthcare workers are most likely to be vaccinated from Monday,” Dr S K Sharma, Director, DHS, told Deccan Herald.

However, according to senior health officials, the vaccines will not be available by Monday as there is an acute shortage in the supply.

“It would not be possible to arrange for vaccines so early. Even though the health department was in touch with suppliers from the beginning of the season, there is not enough supply of vaccines,” says a senior health official.

The trivalent strain can give around 70 per cent protection against three prevalent virus strains.
Even though experts have ruled out routine vaccination for the general public, it is important that healthcare workers get vaccinated. for the general public basic hygiene care is enough. There is no national policy on vaccination yet.

“It is also important that those in the high-risk groups get vaccinated once a year. Currently, there is less availability of the vaccines in the market. The spread of panic has also played havoc and contributed to the shortage. Those who do not need vaccination also are going for a shot,” says Dr Prasad.

It takes between one-two weeks for a person to develop immunity. “So when the virus is spreading fast, vaccination may not help. A person may be exposed to the infection before the antibodies develop,” says Dr Dar.

Shortage of medicines

For almost two days, government hospitals and private chemists saw a shortage in drugs before the government doubled its stocks.

“For a day, we had run out of Tamiflu drugs. There was a supply of around 5,000 capsules late the same night,” says a senior doctor at RML Hospital.

Krishna Medicos outside the hospital says private chemists around the hospital did not receive the supply for two days. “There was no supply of Tamiflu capsules for two days at the chemists. We had to turn away patients who were prescribed the drug,” says Dinesh Gupta of Krishna Medicos. The DHS also said the capsules would be available at the 13 branches of DMA here.

However, currently the DMA branches are out of stock of Tamiflu capsules. “Each branch was given 50 capsules. In total, we received around 700 capsules which is not adequate. We are exhausted on the stocks now and will contact the DHS on Monday,” says Dr Anil Goyal, president, DMA.

There is still a shortage of Tamiflu syrups for children here with doctors giving a lesser dosage of the capsule cushed and dissolved in milk or warm water as a substitute to children. The DHS has admitted to the shortage.

According to health experts, the government needs to foresee the condition in order to be prepared. “Swine flu is a seasonal flu and it should be anticipated that there will be an outbreak every alternate year,” says Dr Aggarwal.

More number of designated hospitals, better sensitisation of government doctors and clear-cut policies on vaccination for healthcare workers will help the government handle the situation efefctively.

“There is definitely a need to take measures to curtail the number of inefections and deaths in the city,” says a senior doctor.

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