Labs have no test kits, time to test 5% Covid-19 samples for H1N1

As the world marked Zoonoses Day on July 6 in the midst of a pandemic caused by a zoonotic disease, the state health department halted testing for H1N1 Influenza A (swine flu), a zoonotic disease, which had caused an epidemic in the state. It has claimed 667 lives since 2009.

This year, the state has only tested 413 samples in six months as opposed to 4,937 samples in 2020. As a result, it has found only one case so far. Last year, the disease had claimed three lives.

This despite the Project Director of the Integrated Disease Surveillance Programme Dr Parimala Maroor telling the media last November that an order had been issued to test 5% of all Covid samples for H1N1. She did not respond to repeated requests from DH for a response.

None of the 12 labs in the state, authorised to test H1N1 (seven of which are in Bengaluru), have received any instructions even after seven months, lab sources told DH.

In H1N1, just like in Covid-19, the virus receptors are found in the upper respiratory tract and can easily attach themselves through the nasal cavity. What's worrisome is that the symptoms of H1N1 and Covid-19 are similar and present in the same manner. H1N1 can lead to viral pneumonia in some cases, which can be serious.

Dr Ambika R, HoD, Microbiology, Bangalore Medical College and Research Institute (BMCRI), one of the 12 labs, told DH, "The H1N1 network was supposed to be reactivated by the State government with the provision of test kits to the referral labs, which did not materialise due to the prevailing Covid situation."

Ironically, BMCRI tests one of the highest number of Covid samples per day in the state but 5% were not tested for H1N1 for the lack of test kits. The lab did zero H1N1 tests this year despite testing 112 samples for H1N1 in 2020, and 193 in 2019.

Indian Council of Medical Research scientist Dr Ashok Munivenkatappa, who heads the National Institute of Virology lab at Rajiv Gandhi Institute of Chest Diseases, Bengaluru, said, “No PCR reagents or consumables were provided and since our laboratory is busy with Covid-19 testing we could not find the time. We haven't received any government order either."

Shivamogga Institute of Medical Sciences is also one of the 12 labs. District Epidemiologist Dr Irfan Ahmed told DH, "All the labs are overloaded with extra work. There is no human resource. As far as my knowledge goes, no such order was issued. These labs are not even testing for black fungus in Covid positive patients for the same two reasons."

Dr Rohit Shetty, consultant, cornea and refractive surgery, and vice chairman, Narayana Nethralaya, Bengaluru, one of the 12 labs, said, "The H1N1 test is different. It requires different kits. Almost all big labs are heavily down with Covid samples. So manpower and kits are also the challenges. There is no communication on HIN1 from the government officially. Once we get the official notification, we shall discuss the logistics."

Dr Sneha S Hegadi, consultant microbiologist at Neuberg Anand Reference Laboratory, Bengaluru, one of the 12 labs, said that only five samples were received by their lab for H1N1 testing in June and none were positive. "We haven't received any official communication regarding testing Covid samples for H1N1 either," she said, over an email.

What the PD IDSP had said in November:

-- Influenza A H1N1 tests must be conducted on all patients with symptoms of cold, cough, fever and acute respiratory infection
-- Health workers to form ward-wise ILI (influenza-like illness) clusters to weed out people with symptoms of the diseases and test them immediately
-- All districts should conduct H1N1 tests on SARI (severe acute respiratory infection) cases even if they test negative for Covid
-- Conduct H1N1 tests on 5% of total Covid positive cases in the State
-- Maintain a stock of Tamiflu tablets
-- Doctors, nurses and other medical staff, who are most exposed to the pandemic, must be vaccinated against H1N1