According to the state health department in Karnataka, over 400 cases of swine flu have been confirmed. The government, which plays a crucial role in addressing expected fears and concerns among people, often does not respond adequately or soon enough. This leads to several myths and misconceptions, which only further aggravate the crisis. Private players and quacks use these opportunities to make a quick buck. It is therefore important that people have access to some basic information.
What is swine flu?
Different strains of Influenza virus have occurred over the last several years. Over time, people develop immunity to one particular strain, and it can then manifest as a mild respiratory disease that often resolves without treatment. However, in some population groups such as children, especially if they are malnourished, the elderly and the immunocompromised, even these strains can lead to high morbidity and fatality.
Different Influenza strains exist and are transmitted among animals such as pigs, chicken, birds, ducks, bats etc. and causes disease among the animals e.g. bird flu, swine flu, horse flu, dog flu etc. These strains then can cross over to domestic animals which come in contact with them or in their vicinity. Humans who are in close proximity to these domestic animals can get infected. The virus can mutate in humans and begin to spread. The World Health Organisation (WHO) has issued a six-stage classification of how a pandemic evolves -a process through which the influenza virus is transmitted from a wild animal to a domestic animal to a human and finally from one human to another, with potential to even spread from one country to another leading to a pandemic.
When these animal strains cross over from animals to humans, often humans have no immunity to it at all and the morbidity and fatality can be high. When these outbreaks start happening, then there is panic. Vaccines are developed in a hurry and people at high risk are asked to protect themselves with vaccines.
What are the symptoms of swine flu?
The common symptoms of swine flu are fever, sore throat, muscle pain, body ache, severe headache, coughing and fatigue. In more serious cases, it can cause pneumonia and be fatal for children, elderly and the immunocompromised.
If during the course of the illness, the patient additionally develops difficulty breathing, dizziness, confusion, severe or persistent vomiting, continuous fever for three days, or recurrence of fever and cough after the symptoms improve, then they have to go to a medical facility.
In children, the danger signs are fast breathing, bluish discolouration of the skin, decreased fluid intake, severe or persistent vomiting, drowsiness, extreme irritability, improvement of flu symptoms but recurrence of fever and cough, continuous high fever for more than three days. This requires urgent medical care.
Management of swine flu
Patients who have an uncomplicated illness, and are not in a group known to be at higher risk of developing a severe or complicated illness, may not need to be treated with antivirals. Persons at increased risk for severe disease include pregnant women, the very young and very old, immune-compromised people, and people with chronic underlying medical conditions. A decision to treat will depend upon clinical judgment and availability of antivirals. Patients who present for medical attention, but do not receive antiviral treatment, should be counselled on signs of progression or deterioration of illness and advised to seek medical attention immediately, should their condition deteriorate or persist. Bed rest, with adequate fluids and paracetamol for the fever, will be enough for most patients. However, at the onset of any of the danger signs, the patient should immediately seek medical care. In uncomplicated infections, swine flu typically begins to resolve after three to seven days, but the malaise and cough can persist two weeks or more in some patients.
There are guidelines for preventing the spread of disease. Swine flu is contagious about one day before symptoms develop to about five to seven days after symptoms develop. People who develop the signs and symptoms can wear a face mask so that every time they cough they are not releasing the virus into the air and putting others at risk. They should cover their nose and mouth with a tissue when coughing or sneezing. It is better to stay at home and avoid going out to work, school or to public places until free of fever for 24 hours.
For those caring for sick patients or exposed, the virus can be inactivated by personal hygiene such as washing with soap especially after coming in contact with animals or an infected patient. If hands are contaminated with the virus, the infection can spread by touching the face, eyes, nose and mouth. Contact with an infected person, especially by children, elderly and the immunocompromised, should be avoided as much as possible, till at least 24 hours after the fever stops.
Vaccination for swine flu
Vaccines are not a long-term solution because each time the virus mutates or reaches the human from a different animal source, humans have almost no immunity. It would be almost impossible to protect humans from each and every strain of the virus especially as no one knows into what form it will mutate. The vaccine can be given to health care and emergency medical staff who are taking care of patients and also to those at risk. It is not required for the general population or as part of routine immunisation.
What should the government do?
It is very important that the government and public health authorities are honest and in control. The worst thing that they could do is to give false reassurances. Being factual is important and this should be shared widely through regional media, fact sheets etc. It is also important that adequate human resources and medicines are available for the care of sick patients in a timely manner.
The cost of responding to each and every public health crisis can work out much more expensive than investing in good preventive measures and public health infrastructure. India has a very strong curative model with strong commercial incentives and this is dangerous because unfortunately private hospitals stand more to gain when there is disease than if it is prevented. Current insurance-based health schemes in India are flawed because they focus more on a curative, procedure-based model, but hardly any thought has been spared for prevention of disease at a primary level, controlling disease when it does occur and health promotion among people. Health promotion is essentially about ensuring that people have adequate resources to develop their immunity and avoid many diseases in the first place. This requires ongoing commitment and political will and not knee-jerk reactions each time a public health crisis occurs.
(The writer is a public health doctor and researcher based in Karnataka)