Home / Opinion / Swine flu: Truth and terror

As winter fades, we were told, so would the flu known by its agent of contagion, H1N1. That’s the swine flu virus, which has already killed more than 600 people in less than two months (100 dying over the last eight days), causing a run on the only drug that works and showing distinct signs of panicking a nation.

It is now hot, not warm, across the great northern plains and southern plateau, but the virus—no more than a few invisible strands of DNA, life’s building block—shows no signs of backing off.

If it continues to kill people at this rate, the virus will equal the death toll of its deadliest year, 2010, in 147 days.

While the H1N1 virus—a cocktail of human, swine and bird flu genes—does not currently appear to be mutating, there appear to be critical gaps in India’s genetic information, Ram Sasisekharan, a leading genetic expert from the Massachusetts Institute of Technology (MIT), Boston, told me.

The genes of the Indian H1N1 strain were sequenced at the National Centre for Disease Control in New Delhi and the National Virology Centre, Pune. Both centres reported no mutations. Sequencing genes is a lot like searching a book—one letter at a time—and looking for spelling mistakes. Computers help speed up this process.

“What was distressing to note is the fact (and to the best of my knowledge) that there was no ‘sequence’ information on the virus (or viruses) currently circulating in the Indian subcontinent, which is key to not only surveillance but also towards an overall strategy that can be put in place to ‘anticipate’ and manage potential viral spread," said Sasisekharan, a professor of biological engineering.

In 2011, a group of scientists led by Sasisekharan demonstrated that it takes only a simple two-letter change in the virus’s DNA code to create a mutation that could spread more easily.

When scientists search the book of H1N1’s genetic code, they look specifically at chapters, or key proteins, that they know are key to how the virus infects humans. Sasisekharan and his colleagues found that changing a base-pair, the two letters I referred to, allowed the H1N1 virus to bind better to human cells.

Any flu virus latches to the surface of cells in the respiratory tract, its favoured destination. The virus then floods the cell with its genetic material, copying itself and, much like a parasite, taking over cell functions. Virus clones kill the cell and stream out, infecting other cells.

Sasisekharan and his colleagues probed a virus strain from 2009, the year more than 200,000 people died across the world. The paper the scientists wrote in the journal PLOS ONE explained how they tested this mutation in ferrets—furry animals with respiratory systems similar to humans—and found the virus “airborne", meaning it could spread through a sneeze, cough or touch of an infected person.

The Indian H1N1 strain is clearly airborne and highly infectious. Public-health strategy in a “rapidly evolving crisis...when people are infected and dying", should be based on the virus’s genetic sequences and evolution, Sasisekharan explained.

Currently, the only drug that works with the Indian H1N1 strain is Oseltamivir, sold under the brand names Tamiflu and Fluvir. You can be vaccinated against the virus for up to a year.

The good news, for now, is that while the number of deaths is high this year, the death rate is not.

Nearly 7% of infected people have died, compared with 23% in 2014, according to government data. Those who die usually have secondary infections that compromise their immune systems, fertile ground for H1N1 to turn deadly. In many people, it may come on like the common flu and quietly disappear.

It is important to understand that the common flu also causes death, usually killing those with secondary infections. Indeed, more than 375,000 Indian children younger than five years die every year from flu-related pneumonia. In the US, flu claims, on average, the lives of more than 23,000 people annually. Across the world, flu kills between 250,000 and half a million people every year, according to the World Health Organization. In pandemic years, the toll skyrockets.

The notorious 1918 Spanish flu pandemic killed more than 40 million people and infected about half the world’s population.

A 1957 Asian flu pandemic claimed 1 million lives, and between 1 million and 3 million died in the 1968 Hong Kong pandemic.

How do you save yourself from the flu, whether H1N1 or any other?

The best way is to stay away from those infected and wash your hands frequently. But it is a flu vaccine that is most effective—and relatively uncommon in India. In the US, 90% of children who died during the 2012-13 flu season were not vaccinated. As we wait and see what happens to the H1N1 virus, it’s a good idea to get that vaccination.

Samar Halarnkar is editor of IndiaSpend.org, a data-driven, public-interest journalism non-profit. He also writes the column Our Daily Bread in Mint Lounge.

Comments are welcome at frontiermail@livemint.com. To read Samar Halarnkar’s previous columns, go to www.livemint.com/frontiermail

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