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H1N1 Virus / Swine Flu – Discuss

The swine flu epidemic in India shows no signs of being tamed. In fact, according to a new research conducted by MIT Professor Ram Sasisekharan and research scientist Kannan Tharakaraman, there's speculation that the H1N1 strain of this virus has undergone mutation, which is responsible for the flu spreading faster and taking twice the amount of time and medication to be treated (TIME, MIT News). The researchers point out in the report of their preliminary findings that their claims can't be corroborated until there's more scientific information collected. The spread of the disease is also being attributed to unusually high humidity that's caused by unseasonal rains across the country. The reported tally of deaths due to the H1N1 strain of the swine flu virus has come up to 1370 out of the 25,000 positive tested cases reported as of March 12, 2015 (TIME). According to the Union Health Ministry's data, Gujarat has reported the highest number of fatalities caused by the virus, with a disquieting count of 322 (NDTV).

In 2009 during the first outbreak of the swine flu virus, even though the World Health Organization (WHO) deemed it a Level 6 epidemic wrongly, India's public health system felt the pressure and wasn't able to effectively combat the effects and spread of the flu. This time around though, thorough attempts are being made to spread awareness about preventive care the fact the MIT researchers don't have basic data to verify their claim speaks poorly of our country's healthcare priorities. The economically disadvantaged aren't able to access even basic testing facilities and are being admitted only by ill-equipped government hospitals when their condition has deteriorated, sometimes even beyond help. It's disconcerting to note that there are only 21 centers in the country that can test for this flu, and this is obviously causing undue strain on the diagnosis process, thereby affecting the quality of information collected that could help corroborate the MIT professor's research findings. Medical News Today has gone on to report that the virus has certainly become more virulent since the 2009 "epidemic." In 2009 the disease was first detected in Mexico and rapidly spread across the world and has been circulating in varying degrees ever since. Although the disease isn't communicable through pigs, the flu derives its name due to the similarity of the structure to a kind of flu that pigs commonly contract.

While the extent of the threat and virulence of this possibly new deadlier strain of virus is being observed, everyone is looking to India's public health officials to ramp up surveillance and detection facilities and for provision of more medical aid to high risk endemic areas. Haryana's health minister Anil Vij's solution is to encourage people to abandon the "Western" habit of shaking hands to greet people and adopt the homely "Namaste" hand gesture instead to curb the communicability of the disease (The Hindu). While this may be a witty yet oddly practical response to the outbreak, it's disheartening to hear half-hearted rhetoric from those responsible for community health, and is representative of the systems

unpreparedness to deal with this epidemic. The lack of answers at home and from helpers abroad is fostering an unhelpful and dangerous air of fictitious solutions across the country. Some reports say that in Karnataka, donkey milk is believed to be the divine cure to this epidemic, and a Whatsapp message thread possibly more viral than the disease itself has been doing the rounds promoting the efficacy of homeopathy and its swine flu combating properties (Karnataka Everyday). The poor are the most vulnerable since they don't have access to the most sanitary environment, or the means for private aid, considering the failings of the public medical facilities, and are left to rely on fiction.

It is a paradox that the 14th World Congress on public health was held in Kolkata earlier in March to discuss new initiatives in the public health sector intended to expand opportunities and effective aid for the global health community, while health officials at home can't definitely say whether the virus has mutated, or answer for how they intend to care for the rising number of positive cases that are being reported. The National Health Policy (2002) and the Report of the Macroeconomic Commission on Health and Development (2015) emphasized the need to increase the total public health expenditure from 2 to 3 per cent of the GDP. But as of 2014, budget allocations have stagnated at 1%, and states manage their health budgets independently. 297 billion rupees have been allotted in 2015's budget report (Reuters). While private hospitals are charging people exorbitantly, encouraging vaccination for everyone, though vaccines are only effective for immunocompromised patients, and by prescribing expensive anti flu drugs, patients in need of immediate care are unable to be cured because of the flaw in the system in identifying and diagnosing patients affected in the nascent stages. Public health officials and institutions are unable to address the basic cyclical nature of the flu in relation to immunity, which is also further affected by geographic location, and the activity of the H1N1 strain in response to weather conditions. India needs to take a page from the global response to the Ebola outbreak in 2014 and address the issues. In the system's defense, adequate steps are being taken to inform the public about good hygiene habits and how it prevents the communicability of the virus and it's simple common-cold like symptoms. It breeds care and cognizance but the system doesn't have the follow up care to create a complete process of care for infected patients who self-identify the symptoms. The symptoms include seasonal flu-like symptoms like cough, fever, sore throat, fatigue, chills and sustained discomfort like bodyaches, and exacerbation of existing conditions like diabetes and asthma. Its more serious complications include pneumonia, respiratory failure, shortness of breath, severe abdominal pain, and dizziness (WebMD).

The WHO may have been chastised for wrongly deeming the 2009 swine flu pandemic a Level 6 epidemic, but even that tested the limits of the Indian public health system's capacities. This speaks volumes about the systemic breakdown in the response to an epidemic and continued neglect of health in national priorities. If every outbreak tests the

limits of our routine systems, an actual emergency will paralyze the nation and we will be reliant on international aid and intervention. If we are to overcome the crumbling infrastructure and efficiently tend to the people affected by the flu, we need to reallocate funds or combine public and private sectors to open more accessible and orderly testing centers, equipped with the technology and people to collect and analyze data, and further use this data to streamline prevention and treatment efforts to high risk areas and demographics. Furthermore, the public health system and its needs must be prioritized to be enabled to cope with a future hazard before responses are activated only in the wake of casualties.

Pranati Reddy