New Delhi / Bangalore: The swine flu outbreak continued to spread fast, with 11 countries outside Mexico reporting confirmed cases, taking the total number to 150 on Thursday evening, but India, and Asia at large, were still safe.
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The World Health Organization (WHO) late on Wednesday raised its alert level to five, just a notch below the pandemic level of six. India, bracing for a public health battle ahead, announced on Thursday that it would increase its drug stockpile of oseltamivir from three million to 10 million doses.
The Indian government appealed to the public to not panic, but exercise care.
However, it still seems to be lagging in what experts term the most crucial part in epidemic control—surveillance. The government had announced surveillance at nine airports starting Wednesday, but only six—Delhi, Mumbai, Kolkata, Chennai, Hyderabad and Bangalore—have begun screening passengers.
On the testing front, four institutes have been designated for handling blood and saliva samples to check for swine flu: the National Institute of Communicable Diseases (NICD) in Delhi, National Institute of Virology (Pune), National Institute of Cholera and Enteric Diseases (Kolkata), and Regional Medical Research Centre (Dibrugarh). India has received a protocol (a detailed plan of a test) from the Centers for Disease Control and Prevention (CDC) in Atlanta, US. “Since this is a new, unknown virus, we need a protocol for testing it and our scientists are now working to make a primer,” said Shiv Lal, director at NICD, at a press briefing.
WHO’s India representative was also present at the briefing.
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In order to facilitate speedy access to medical essentials, the government has decided to decentralize its stock of medical supplies, such as the oseltamivir capsules, personal protective equipment, N95 masks and three-layered surgical masks. “These are being kept at regional director offices of the Union health ministry located in 19 cities to meet any emergent requirement of the states. A stock of 1,000 tablets of the antiviral are also being sent to the airports,” said Lal.
Flu scare: Travellers filling health declaration forms upon their arrival at the international airport in New Delhi on Thursday. Ramesh Pathania / Mint
Meanwhile, 50,000 passengers who came into the country in the last six days are being checked for clinical symptoms. The incubation period for swine flu is seven days. One passenger from Texas, who reported flu-like symptoms in Hyderabad, was announced to be healthy, though confusion surrounded his case in Hyderabad with the Institute of Preventive Medicine, Chest Hospital (designated nodal location for sample collection) and the state health department somewhat groping in the dark.
When Mint spoke, at 5.30pm, to the Chest Hospital superintendent, there was no information about any samples being collected from anybody who travelled from Texas. The hospital was yet to get any reference from the airport check-ups or otherwise. The health ministry said later on Thursday that the samples had been collected from the family and were on their way to the labs for testing.
“There is often no coordination between government agencies and sometimes they work on cross purposes,” said Shahid Jameel, a virologist at the International Centre for Genetic Engineering and Biotechnology, New Delhi. During past outbreaks, different labs have thrown up different results, but researchers neither share data nor work with a clear strategy, he added.
The two earlier public health emergencies—SARS in 2003 and the bird flu in 2004—forced the world to go into rapid response mode. The epidemic didn’t spiral out of control as there was no clear human-to-human transmission of the virus. But the situation now is different. “We are seeing human-to-human transmission in a sustained manner and that is a serious threat,” said Jameel.
Swine virus, a new strain of the influenza virus that has a genetic mix of human, pig and bird, mutates very fast. “The best defence right now is to identify cases and quarantine them; the less virus spreads, the lesser it will mutate,” he added.
Scientifically, confusion prevails about the nature of the virus. Some say it is less deadly than the bird flu; others worry that a deadlier strain could emerge if the two get mixed. Reuters reported that Masato Tashiro, head of the influenza virus research centre at Japan’s National Institute of Infectious Diseases and a member of WHO’s emergency committee, told Japan’s Nikkei newspaper it appeared the H1N1 strain was far less dangerous than avian flu.
On the other hand, Guan Yi, a microbiologist at the University of Hong Kong, said the swine flu virus could mix with avian flu, or H5N1. “If it goes to Egypt, Indonesia, these H5N1 endemic regions, it could turn into a very powerful (bird flu strain) H5N1—that is very transmissible among people. Then we will be in trouble, it will be a tragedy,” he was quoted as saying by Reuters.
So, containment is still the best option for India and the government is aware of that, said Vineet Choudhary, joint secretary (health), who also ruled out buying or installing temperature checking machines at airports as they distract doctors from manual checking.
If the need indeed arises when cases get confirmed, industry experts say India is prepared. The antiviral drug oseltamivir cannot be sold in the market at the moment; it can only be procured and distributed through the government’s public health channel. “If the situation demands, we could change that. If it becomes necessary, we also have the option of imposing compulsory licensing (currently, Roche holds the patent for oseltamivir and has licensed it to manufacturers) and increasing the supply,” said Choudhary.
Since the Indian patent office had rejected a patent application for oseltamivir in March, it will allow generics or off-patent drug manufacturers in India to manufacture and supply this drug without a royalty to the original inventor.
FAQs on swine flu
What are the symptoms:
Besides increased vomiting and diarrhoea, other symptoms are similar to those of seasonal influenza—sudden fever, muscle ache, coughing, fatigue.
Can it be cured:
Just as in any viral infection, 100% people don’t show symptoms. Swine flu infection does not mean a full-blown disease, it can result in mild illness and can be cured if identified early.
How does it spread:
By droplets when an infected person coughs or sneezes, so masks will help in travelling through infected countries or dealing with sick people. An infected person can spread the virus 24 hours before and three days after the symptoms show.
What is the scare:
Influenza virus, of which swine flu is a new, unknown strain, is a promiscuous bug swapping its genetic material with other flu viruses present in the human or animal body. The more it spreads, the more it mutates in which process it can either get mild or more severe. And unlike in a regular flu, where very young, old and those with a weak immune system (due to any illness) are easily infected, swine flu infects everyone.
Regularly wash hands with soap and water. Using tissues also helps.
How to avoid it:
Social distancing; stay indoors if there is an outbreak. It worked in the 1918 flu pandemic and will work now. If symptoms occur, see a doctor, don’t do self-medication for there could be secondary or co-infections, which will need antibiotics.
Why is there no immunization:
No vaccine exists for swine flu; seasonal flu shots don’t provide protection. Though there are vaccines to be given to pigs to prevent swine flu. Pigs act as a reservoir of both avian and human influenza viruses and hence can catch both the viruses. The current pandemic virus is an outcome of that mixing of species inside the pig and hence humans have very little natural immunity against it.
Though self-treatment is not advisable and drugs are not available in medical stores, an infected person needs to take two capsules of Tamiflu/day for the first seven days. A pack of 10 capsules costs about Rs300.
If one contracts swine flu and recovers, then s/he becomes immune to the virus for life.
C.H. Unnikrishan in Mumbai, Lison Joseph in Hyderabad and Reuters contributed to this story.
Graphics by Sandeep Bhatnagar / Mint