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15-Day-Old Cold? Check for Swine Flu

Times of India
17 August 2010
By Malathy Iyer

The Less Virulent H1N1 Virus Is Manifesting Itself In New Ways
Since April 2010, 270 people died due to the H1N1 virus in Maharashtra. Of this, little more than a tenth—35 persons—were from Mumbai. So the city administration is happy. Additional municipal commissioner Manisha Mhaiskar announced last week that swine flu was a problem elsewhere in the state but not in Mumbai. “Mumbai has to be careful, but the situation is very much in control,” she added. The city was one of the hardest hit by the H1N1 virus (apart from Pune) last year. Has the virus spared it of its virulence this year?

The medical community is not convinced. Doctors insisted incidence in Mumbai is still high but is largely undiagnosed. Take for instance, the 15–day cough and cold infection. Said Dr Aashish Tiwari, director (medical services) of upcoming Umrao Hospital in Mira Road, “People are complaining of simple cold and cough lingering for 15 days. Some patients get a relapse of fever within 15 days. These could be various manifestations of the H1N1 virus.”

A doctor attached to many five–star hospitals in south Mumbai said, “Patients are even reaching ICUs, but we find it simpler to not list them as swine flu patients as we can avoid bureaucratic problems with the BMC.” Another senior doctor added, “If you go to ICUs of major hospitals, you will find more than a couple of patients on oseltamivir (one of the two anti–flu medications that works on H1N1).” If Mumbai is not seeing as many patients of swine flu as, say, some cities in Rajasthan, doctors say it’s because testing is down considerably. “The test is expensive. And if a doctor flags off that the patient has H1N1, hospitals have to prove the patient was in an isolation unit. But the units are no longer functional. So we would rather treat the patient on clinical diagnosis.”

In late–July, representatives of hospitals petitioned the state government to lower the stringent norms needed to admit H1N1 patients. “The World Health Organisation has reduced the pandemic alert, yet in Mumbai it’s mandatory for H1N1 patients to be admitted in isolation wards only,” said a chest physician.

Dr Abhay Chaudhary, director of Haffkine Institute, says the WHO decision to relax the pandemic level 6 alert is just an academic exercise. “A pandemic means the virus has spread to so many countries and affected so many people. If relaxed, it doesn’t mean the virus will go away. It can stay for a year or two,” he said, indicating the country will have peaks in the epidemic. But he says infection in 95% cases would need symptomatic treatment of “paracetamol and soup”. “Only about 5% with co–morbidities or recurring fever should be on guard.”

Chest specialist Dr Sujit Rajan says, “Oseltamivir is available only at 110 chemists. If an asthma patient gets H1N1 while travelling it would be difficult to procure the drug.”

15-day-old cold? Check for Swine Flu
H1N1: The silent stalker
Symptoms This Year WHO has lowered the pandemic alert Doctors say many people have common cold and cough lasting for 15 days Earlier, state government experts had reported that the virus is gradually affecting the thorax and the brain, giving way to neurological complications, besides affecting the lungs
Danger Signs Last Year Seasonal influenza and acute respiratory illness, plus at least 2 of the following: Fever Cough Sore throat Body aches Headache Chills and fatigue Diarrhoea and vomiting (possible) In children, signs of severe disease include apnea, tachypnea, dyspnea, cyanosis, dehydration, altered mental status, and extreme irritability

Deaths in Maharashtra since last year: 677
Deaths in Maharashtra since April 2010: 270
Deaths in Mumbai since April 2010: 32
Lab–confirmed cases (cumulative) from May 2009: 7,574
Lab–confirmed cases in the week August 2–8, 2010: 400
Lab–confirmed deaths in the week August 9–15, 2010
  • 51 Toll in mumbai august 1–15, 2010
  • 3 Deaths positive
  • 135 Cases
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