It is four months since the gravity of the swine flu outbreak that started in Mexico became evident to the international community. India was not spared from the three flu pandemics of the last century. It ought to have been clear from the start of this one that the country must be prepared to face a new contingency. Yet for all the pandemic preparation that is supposed to have been completed, it is the Union Health Ministry’s lack of planning that has been on displa y in recent days. Even before the first swine death occurred in India recently, a large number of countries across the world were coping with massive outbreaks of pandemic flu. But the central government, which must provide leadership for the nation, appears to have drawn few lessons from the experience of those countries.
It has utterly failed to prepare the public for a rapid spread of the flu virus within the country. In stark contrast, the scientists of the U.S. Centers for Disease Control and Prevention (CDC), who led efforts to keep the American media and the public informed, have been at pains to emphasise both what was known and unknown about the virus and its behaviour. Thus from the very beginning, when the U.S. had only a handful of confirmed cases, the CDC has been driving home the point that the confirmed cases were only the “tip of the iceberg.” Far more transmission of the virus could actually be occurring among humans that was not being picked up. Thus towards the end of June, when the U.S. had over 27,000 confirmed cases, including 3,000 hospitalisations and more than 130 fatalities, a leading CDC scientist declared that there could have been “at least a million cases” in the country up to that time. Union Health Minister Ghulam Nabi Azad, on the other hand, insisted that swine flu in the country was under control. He spoke about how the government had managed to “limit the cases of swine flu to a few individuals, considering the size of our population and country.” The result is that as swine flu cases and resultant deaths begin to mount, the government looks ineffective. The public gets the impression that the situation is out of control and starts to panic.
A flu pandemic occurs when a virus arises to which the vast majority of people in the world have no natural immunity. The World Health Organisation (WHO) estimates that about two billion people worldwide — about 30 per cent of the global population — could be infected by the time this pandemic ends. But catching the swine flu is very far from being a grave illness, let alone a death sentence. In fact, data gathered by the WHO from various countries suggest that only up to 10 per cent of confirmed cases need to be hospitalised and fatalities occur in less than one per cent of confirmed cases. But such confirmed cases, it bears reiteration, are only the tip of the iceberg. A great many people who become infected could either be asymptomatic or suffer only mild symptoms. A U.S. document on pandemic planning indicates that only half of those who pick up the virus might even seek medical help. A recent WHO briefing note points out that the majority of patients infected with the pandemic virus worldwide continue to experience only mild symptoms and recover fully within a week, even in the absence of any medical treatment.
But the sad fact remains that when so many people catch swine flu, some of them will develop severe disease and die. The vast majority of severe cases have occurred in high-risk groups, such as pregnant women and those with asthma or other lung disorders, cardiovascular problems, diabetes, suppressed immune systems, or neurological disorders. Obesity appears to be another risk factor. But while the media spotlight is on every person who dies of swine flu in the country, the toll taken by seasonal flu, which people encounter year after year with no more than a shrug, gets overlooked. A large part of the problem is, of course, that India lacks a proper surveillance system to track seasonal flu and many other infectious diseases. The U.S., a much wealthier nation with less than a third of India’s population, sees some 36,000 deaths from seasonal flu each year. Published estimates suggest that India accounts for 20 per cent of the 1.9 million children who die annually of acute respiratory infections in developing countries.
Given the number of people who might seek medical help and need hospitalisation as the pandemic takes hold in India, a few designated hospitals will not suffice. Yet, even in its revised guidelines issued after the Pune schoolgirl died on August 3, the Union Health Ministry asked any person with flu-like symptoms to go to a designated government facility to be checked and, if required, to give a sample for testing. The chaos that ensued in cities like Pune was predictable. In order to prevent health care institutions from being swamped, the U.S. CDC recommends that those who get sick with the virus stay home unless they have signs of severe illness or fall in a high-risk group. The WHO too makes a similar suggestion. Better sense seems, however, to have dawned, with the Union Health Ministry now announcing that it would issue guidelines for private hospitals and laboratories that had the necessary facilities to treat and test patients for swine flu. Measures to mobilise the country’s health care infrastructure, in the public as well as private sectors, ought to have been part of the pandemic plan that the central government is supposed to have worked out and put in place. In all this, rural India and the poor must be given special attention. The swine flu could be at its worst when it affects those who are malnourished, many of whom suffer from chronic diseases and often have little access to health care. At a vulnerable juncture when a drought threatens, this pandemic could test the country’s ability to care for its people. We cannot afford to fail.