The swine flu outbreak exposes the inadequacies of the country’s public health care system.

AFP

In Pune’s state-run Naidu Hospital on August 5, people wait to be tested for the A(H1NI) virus.

THE first case of swine flu death in India occurred on August 3, when a 14-year-old girl, Rida Shaikh, died in Pune because of the failure to diagnose the case in time. Within the next 15 days, the mortality figure shot up to 25. During this period what was in evidence was a knee-jerk reaction from the government, on the one hand, and misplaced panic among the public, on the other. Given the lack of an adequate and clear response from health officials and the hysteria whipped up by the visual media’s obsession with tracking and dwelling at length on each and every death, an irrational fear of the new global pandemic gripped India.

At present, the disease, caused by the triple-reassorted flu virus A(H1N1), has spread to 170 countries with a visibly rapid and efficient human-to-human transmission. After the initial period of predominantly imported cases of infection, mainly from North America, swine flu has now firmly established itself in the country, with the transmission having taken root at the community level. Now there is efficient transmission among people who neither travelled abroad nor had direct contact with people returning from abroad.

As of August 18, the total number of positive cases in India was 2,026 with 25 deaths. Pune reported 13 deaths and the others were reported in Bangalore (5), Mumbai (2), Ahmedabad (1), Chennai (1), Vadodara (1), Nashik (1) and Thiruvananthapuram (1). With the sudden spurt in the number of deaths, the contradiction in Union Health Minister Ghulam Nabi Azad’s claim about 10 days earlier that the swine flu in the country was under control could not have been starker.

Though there is a pandemic preparedness plan on paper, it does not seem to be something that has been well thought out and can be put to operation. “There still is no preparedness plan for outbreaks [any outbreaks] leave alone pandemics,” said Randeep Guleria of the All India Institute of Medical Sciences (AIIMS), New Delhi.

When Mexico reported the flu, Tamiflu stocks were acquired but no attempts were made to strengthen the laboratories or train people or increase the supply of ventilators and other isolation equipment.

Interestingly, only sometime in August experts from the National Centre for Disease Control (NCDC), New Delhi (formerly National Institute of Communicable Diseases, NICD), began imparting training to doctors and PhD students from the States even as the Centre worked overtime with testing proper swine flu cases. The government’s attitude seemed to have been that the disease was mild and nothing was happening, so why stockpile?

“There needs to be a push-pull factor,” said Guleria. “The States do not know what to do. Despite several meetings, there is a sense of lethargy and indifference, while the Centre goes all out once the pandemic is at the doorstep.”

Once the pandemic truly hit the country, the government went about the task of acquiring equipment such as ventilators (for critical cases); reagents for real-time polymerase chain reaction (PCR) testing for H1N1 virus; fresh 20 million doses of Tamiflu medicine, in addition to the earlier stock of 10 million; and large numbers of masks. But it appeared to be a case of trying to upgrade the system in a matter of days without any strategy.

Even after the World Health Organisation (WHO) declared that swine flu had become a phase 6 pandemic and its spread could not be contained, the government spent time and resources on screening and testing all instead of focussing on immediate treatment to those with the severe form of the disease.

The airport screening that was initially deployed was pretty much useless because those who were asymptomatic – without fever and within the incubation period of seven days – did not get detected. The process depended essentially on self-reporting by passengers. However, citing the success of the operation in Andhra Pradesh as an example in defence of the government’s initial strategy, V.B. Katoch, Secretary in the Department of Health Research, said the policy of quarantine and isolation had worked initially.