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Extraordinary breakdown of public health
.jpg "Extraordinary breakdown of public health")
Influenza caused by the H1N1 virus is also popularly called ‘swine flu’. A popular misconception is that ‘swine flu’ is spread by pigs – in fact humans and not pigs infect other humans with swine flu.
The recent spate of infections and deaths, caused by the H1N1 strain of the influenza virus across many states has once again brought into focus India’s ailing health care system. It is unfortunate that discussions on the country’s non-functioning public health system surface only in periods when the health system is faced with a challenge.
What is swine flu?
Influenza caused by the H1N1 virus is also popularly called ‘swine flu’. A popular misconception is that ‘swine flu’ is spread by pigs – in fact humans and not pigs infect other humans with swine flu. Controlling the population of pigs has absolutely no effect on the spread of the disease. The term, ‘swine flu’ dates back to 2009 when the virus affected almost 20 per cent of the global population. Tests on the genetic material of the H1N1 virus showed that it contained genetic material from viruses that cause influenza like symptoms in pigs. It has been speculated that the virus incubated and developed because of peculiar conditions that prevail in the industrial mode of animal husbandry, practiced in many countries across the world. It has now been established that the virus, in all probability, first infected human hosts in Mexico and crossed over to the United States. While the sub-type H1N1 is the dominant form of the swine flu virus, other sub-types H1N2, H1N3, H3N1, H3N2 and H2N3 are also known to cause swine flu.
Poor facilities add to the spread
The important discussion is not whether this is an epidemic but what the public health response to seasonal influenza should be. Influenza, in an overwhelming majority of patients, is not life threatening and even benign. A very small fraction of patients develop severe respiratory symptoms and need respiratory support such as a ventilator to help the patient breathe. The absolute number of such patients during seasonal influenza can be quite large as a very large proportion of the population gets infected.
Patients can get pneumonia through bacterial secondary infection if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs and appropriate antibiotics need to be used. The role of a public health system is to be able to detect those who are at risk of developing more severe symptoms and to monitor and treat them appropriately. Many patients who are dying could have been saved. They are dying because either the public health system does not have adequate facilities or the facilities are clustered in big cities and hence largely inaccessible to most patients.
As a result, private facilities are fleecing vulnerable populations by charging enormous amounts for testing, for prescribing anti-flu drugs and expensive antibiotics and for providing vaccines. Routine testing of all flu patients serves no purpose as most of them will not require specific treatment. Even when they test positive from H1N1, specific anti-viral therapy with drugs (three drugs are now available: oseltamivir – sold as Tamiflu, zanamivir and peramivir) is only recommended in severe cases. Further the drugs are not a cure, act best only if started within 48 hours of the onset of disease, and generally act to shorten the duration of symptoms by an average of 24 hours. Private hospitals are also enticing people to get vaccinated, though vaccination is only recommended for high risk patients like those who are suffering from serious existing illnesses, health workers and contacts of patients with severe illness.
What is frightening about the H1N1 outbreak is not that it is an epidemic which will cause hundreds of thousands of deaths. In all probability it will die down on its own when summer sets in, as all seasonal influenza outbreaks do. What is frightening is that the country’s health system is not in the least prepared to deal with an influenza epidemic, which doesn’t appear to be more severe than most seasonal flu outbreaks.
The government would be happy to dub this as an epidemic, and somehow to then give the idea that it is struggling against odds to provide care under extraordinary circumstances. This is not an extraordinary outbreak, but an extraordinary breakdown of routine public health services.
By: Amit Sengupta
