Mumbai is a city that has been hailed for its resilience, especially after multiple bomb blasts, and not even the November 26 terror strike still so clearly etched in memory, did not bring about the sort of panic that a certain virus has indeed brought about. Schools are shut, cinemas are closed. While the city has not emptied out as Pune has, there is anxiety in the air.
Even a slight cough can make people look askance at you. Most people shield themselves with kerchiefs or dupattas or even surgical masks which by all accounts have become scarce.
In fact, there are many other reasons for which Mumbais citizens should cover their faces. This is a city notorious for its poor public hygiene and cleanliness. Many of the mask-wearers seem unaware of the Municipal Corporations drive against spitting: it is common to see people delicately lift their masks and spit on the road. The Corporation is silent on its health and hygiene measures in the context of the latest situation on the flu front.
The dos and donts with regard to the flu include using a handkerchief when you cough or sneeze. These are norms of civilised behaviour which are rarely adhered to in public places. Fever, gastro-enteritis, dengue, leptospirosis, malaria and other diseases have driven people to the citys public hospitals.
On August 13, in the citys 24 civic hospitals there were 324 cases of fever, 68 of gastro-enteritis, four of leptospirosis, six of dengue and 89 of malaria. Three deaths due to fever, malaria and gastro-enteritis were reported on August 11, while the previous day there were two deaths due to gastro-enteritis and leptospirosis. On August 7 there were three deaths from malaria and one from gastro-enteritis. Leptospirosis claimed a victim on August 8, the same day that Fahmida Panwala succumbed to the A(H1N1) flu.
While the flu deaths make headlines, from January through August 13 there were 38 suspected deaths due to malaria in the city, 10 of them in August, according to official figures. In 2009, a total of 3,92,998 blood samples were taken for malaria, of which 12,632 proved positive. So far in August, 1,830 people have tested positive for malaria. The measures the government has taken to keep schools and colleges shut, apart from cinemas, citing the pattern that Mexico followed, seems out-of-proportion.
According to the World Health Organisations latest World Health statistics for 2009, India reported 1,476,562 cases of malaria in 2007. Even the civic authorities concede that malaria is the real public health challenge. But going by the over-the-top reaction to swine flu, you would not guess that. In this context, the alarm over swine flu cannot but be seen to be misplaced, to say the least.
According to National Family Health Survey (NFHS-3) 2005-06, the prevalence of medically treated tuberculosis (TB) is much higher in Mumbai than in all of urban Maharashtra (590 versus 367 per 100,000). And, within Mumbai, it is much higher among slum-dwellers than non-slum-dwellers (690 compared with 458 per 100,000). Although all women and men in Mumbai have heard of TB, only 70 per cent know it is spread through air as a consequence of coughing or sneezing, according to NFHS-3. Yet, almost everyone in the city knows that swine flu is in the air and is spread through coughing and sneezing. This explains the explosion of masks and handkerchiefs.
The queues at the designated civic hospitals to test for the H1N1 virus are unceasing, though there are only two testing facilities and they are overburdened. The Maharashtra government seems to have reacted with knee-jerk responses. It first said the drug Tamiflu must only be had if people test positive for swine flu. A few days later it said Tamiflu would be given to those whose throat swabs are taken. Finally it has decided that anyone with symptoms can be treated with Tamiflu even without testing. This has sent confusing signals to an already worried population. Now there is a clamour to make Tamiflu available with chemists. The government has so far resisted this move and is only extending the option of treatment to private hospitals.
Each death increases the alarm and causes the panic button to be pressed. The media, too, are responsible for the panic reaction. While swine flu is breaking news, the Maharashtra government is dealing with severe drought-like conditions in parts of the State and on that front too it is not exactly covering itself with glory: squabbles have broken out among politicians over which areas should be given the drought-hit tag. This has led to an updating of the number of drought-hit taluks and a revision exercise is expected. Chief Minister Ashok Chavan faced flak from Deputy Chief Minister Chhagan Bhujbal at the Cabinet meeting last Thursday over the allegedly inept handling of the swine flu situation, among other issues.
As the experts have suggested, there has to be a measured response to the flu and it must be treated with due caution which is not to say that a cavalier approach is warranted. It is time, then, to take off those masks and get real.