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The deadly effects of swine flu

Tuesday, March 24, 2015
By Abhishek Vissapragada

Senior doctors now feel that the number of cases affected by this disease is getting static as the temperature rises day by day

Just like the Ebola epidemic which had gripped the world, especially the African countries, the H1N1 virus or more commonly known as swine flu has gripped India as it has spread in many parts of the country. In India, there have been a total of 32,000 cases reported for swine flu and the total death toll has reached 1,895 as on March 21.

Of these there have been a total of 4,007 cases in Maharashtra and the total death toll was 342. In Mumbai alone there have been 1,396 cases and 33 deaths. Even as the temperature in the city is rising and the environment is becoming unfavorable, diseases persists, the number of cases keep rising along with the death toll. This article will delve into the many aspects of the disease and its implications using data provided by the Brihanmumbai Municipal Corporation helpline (022-24114000) and those that are there in the public domain.

This disease had first struck India in 2009. During that time, many people didn't know much about the virus or its treatment which was under development. India recorded its first swine flu related death on August 3, 2009 as a 14-year-old girl, a resident of Pune died due to the disease. The World Health Organisation (WHO) had declared it as a pandemic on June 2009. Till March 2010, India had recorded more than 29,000 cases of which about 1,400 deaths had occurred. But on August 2010, the WHO declared that the pandemic was over, saying that worldwide flu activity had returned to typical seasonal patterns.

The disease has been persistent and has claimed many lives since 2011 to 2013 until it came in the limelight again in 2014. Its first victim in Mumbai was a 50-year-old Andheri resident who died on February 16, 2015. Since then the number of deaths and cases has also risen in the city.

The BMC helpline which was started on February 5 this year has received a total of 761 calls as on March 14, 2015. Of these, there have been 439 calls in February and 322 calls made in March this year  to inquire about the disease.

But Dr. Suleman Merchant, Dean of Sion Hospital at Parel feels that the number of cases of swine flu is now stabilizing.

 “I feel that the cases has become static as the temperature in the city increases. There is no alarming increase in the number of people affected by it and that is good,” said Dr. Merchant.

Dr. Ramesh Bharmal, Dean of Nair Hospital felt that the number of swine flu cases is now declining. “As per our reports and the number of patients we are receiving in our hospital, swine flu is now on the decline in the city,” said Dr. Bharmal.

H1N1 Virus
H1N1 virus  is an Orthomyxovirus that contains the glycoproteins haemagglutinin and neuraminidase. Haemagglutinin causes red blood cells to clump together and binds the virus to the infected cell. Neuraminidase are a type of glycoside hydrolase enzyme which help to move the virus particles through the infected cell and assist in budding from the host cells. Some of the symptoms of the H1N1 virus are cough, fever, sore throat, runny nose, body ache, headache, fatigue and chill. The disease spreads into the environment when someone coughs or sneezes. The virus which is released in the air, stays in the neighboring area and people who come in close contact with the carrier  then contract the disease by breathing in the suspended particles containing the virus.

Swine flu cases reaches its peak during the winter season as it depends on the favorable climate to attack the population. But, the weather has been erratic with unseasonal rains and the temperature dipping and increasing from time to time throughout the country this year. Dr. Merchant felt that the unseasonal rains helped in reducing the disease spread to an extent in Mumbai. “The unseasonal rains helped wash away suspended particles that consisted  of the H1N1 virus in the atmosphere. These particles first enter the atmosphere when a swine flu patient coughs or sneezes and stays in the air due to pollution. The rains helped deter their spread and reduce the number of cases,” said Dr. Merchant.

Dr. Bharmal also felt that the weather has played a role in reducing swine flu cases. “Yes the weather has played a role in the decline of swine flu cases as it has been very erratic and thus has become unsuitable for the virus to persist or spread,” said Dr. Bharmal.

The Maharashtra state government has encouraged private, municipal and government hospitals to conduct awareness campaigns in their vicinity to help citizens understand the disease and take necessary precautions. The BMC was told to intensify their awareness campaign via posters and through theatres on March 8, 2015. Dr. Merchant also informed that his hospital has conducted such campaigns. “Yes our hospital has done multiple awareness campaigns for different sections of the society. We want to ensure that everyone takes the necessary precautions,” said Dr. Merchant.

Dr. Bharmal confirmed that his hospital has conducted such campaigns. “Our hospital has conducted rallies and poster campaigns in the hospital's vicinity and neighboring areas. We have also given training to our doctors and nurses to handle swine flu cases,” said Dr. Bharmal.

Virus mutation
Recently, an MIT study had found out that the H1N1 virus had mutated and might have become resistant to treatments being administered to patients which could make it dangerous. Dr. Merchant felt that such studies should be taken into consideration. “I have read the study in detail and the proofs provided for the same should not be ignored. We must be cautious and well prepared as the virus is mainly attacking vulnerable population like pregnant women, children, diabetic patients, etc.” said Dr. Merchant.

Dr. Bharmal though felt that these mutations haven't occurred as yet. “We have treated many patients in our hospital but we have not found any mutations in the virus. So I don't think it has occurred till now since no patients shows any symptoms or resistance to any treatment,” said Dr. Bharmal.

For screening of patients that have contracted the disease, hospitals can send the patients samples by conducting a throat swab test or by conducting test in specialized laboratories that have been approved by the government for the same purpose.

      This is done to ensure that the laboratory has proper facilities and technology to conduct such tests on a daily basis as the number of cases will keep increasing with time. Very few laboratories have been given approval to conduct H1N1 test in India. Among these, in Mumbai the government run laboratories in Kasturba Hospital at Byculla and Haffkine Institute at Parel have been given approval.

Recently the Maharashtra government gave approval to Metropolis Hospital to conduct swine flu testing in their laboratory at Mumbai. The laboratory is located at Kohinoor City Mall at Vidyavihar and has a capacity of conducting 1000 tests daily. It will also be accepting samples from other regions in Maharashtra and neighboring states in India for testing. The Hospital also provides facilities to conduct test at patients home for their convenience. In Mumbai, SRL Diagnostic Laboratory is another private sector laboratory which has been approved for testing.

The swine flu testing is free of cost in government run laboratories while in private ones the cost can range from Rs 5000 and below depending on the price fixed by the institution. Samples sent to government laboratories from private hospitals are also charged around Rs 4000 or below.

Swine flu treatment is done in both private and government run hospitals. While the government hospital will provide treatment to patients free of cost, the private hospitals charge the patients according to the facilities they provide. The patients are kept in an isolated ward and are treated for 5-7 days if the disease is detected at an early stage. There are two common medicines provided to patients that have contracted the virus – Tamiflu or Relenza. Tamiflu consists of oseltamivir while Relenza consists of zanamivir. The medicines are provided free of cost by the government in licensed medical shops while in private shops, the cost can range upto Rs 5000 depending on the price fixed by them. The government has also taken measures of providing disposable N95 mask and gloves to medical staff and attendants for those treating H1N1 patients to protect them from the disease.

Seasonal Recurrence
Dr. Merchant believes that if the swine flu menace does end in the city, it will only occur again when the climate is favorable. “As far as I have heard, in Pune the number of swine flu cases is detected throughout the year. Luckily in Mumbai this hasn't happened,” said Dr. Merchant.

Dr. Bharmal feels that the virus can make a comeback even if it is stopped at present. “The number of swine flu cases will depend if the virus remains in areas that have been identified and detect such cases. So it could come back next year too,” said Dr. Bharmal.

Five precautions to be taken for swine flu:
1. Cover your mouth and nose when you sneeze.
2. Use disposable tissues instead of a handkerchief if you have a cold and throw the tissue in dustbin after use.
3. Wash your hands with soap and water or an alcohol based hand rub (hand sanitizer).
4. Try and avoid close contact  with people who have flu.  Maintain a minimum distance of 6-  10 feet to avoid airborne transmission.
5. Patients suffering from flu should stay indoors one day post the last episode of fever (without any fever reducing drugs).

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