SWINE FLU -- A (H1 N1) influenza

SWINE  FLU  --  real & unreal

Dr. T. Rama Prasad,  www.rama-scribbles.com

November 20, 2018

          There is a news report  in THE HINDU newspaper of November 20, 2018 that there is a shortage of A (H1 N1) influenza (Swine Flu) vaccine in Coimbatore ( ? due to overconsumption) in the wake of fake messages being circulated in social media platforms on the Net saying that Coimbatore has been declared as 'RED ZONE' for this disease.  In this digital age, the media, the public and the officials play up or play down an issue according to their logic / sensitisation quotient / official directives / need / whims / fancies.  For example, the TIMES OF INDIA newspaper of November 21, 2018 published the following: "Govt may be 'dressing up' H1 N1 death data ... Almost every day for the past two months H1 N1 deaths have been reported across the state (TN) yet the official toll for the viral disease released by the public health department on Monday (19.11.2018) for 2018 is 23."

          Many matters are skewed towards otiose objectives ... too much medicine in urban areas and insufficient medical care in the vast rural hinterland ... too much talk and too little work ... seemingly sophisticated strategies and shockingly poor results ... on November 19, 2018, the World Health Organization has accepted the defeat of their global fight on the old disease, malaria, as the number of cases has increased by 2 million to 219 million in 2017, killing 4,35,000 people.  And, tuberculosis is killing 1,000 persons every day in India today.  And now, again is the surge of Swine Flu, let alone the other diseases which are revelling.  The data of Integrated Disease Surveillance Programme (IDFSP) of Union Health Ministry shows that in 70 days (January to March 10 of 2019) across India, 605 people died due to Swine Flu and 19,385 cases were reported.   Officials and politicians projected that the disease was under control,  but the proof of the pudding is in the eating.  We can't get rid of the little mosquito which causes many diseases but we plan to reach Mars and beyond to locate aliens !  Skewed towards theory !

          The quadrivalent vaccine (splitviron, inactivated) for the Michigan strain of H1 N1 virus which is in circulation in Tamil Nadu this season (2018) costs around Rs. 1,400 per dose.  With our notorious 'norms',  many are needlessly vaccinated and numerous are needlessly treated with the antiviral drug, Oseltamivir which lit up the face of pharmaceutical industry with impish glee.  It is not only a waste but may be detrimental to health when taken unnecessarily.   Improper use of antibiotics has already produced numerous drug-resistant bacteria and superbugs killing innumerable number of people.  When a drug can be purchased across the counter without a prescription, you can be sure that the drug would become useless in course of time due to drug resistance.  When Oseltamivir is  indiscriminately used just for the benefit of doubt (with or without prescription) in undetermined cases of sore throat and fever,  we can be sure that it is a recipe for disaster by drug-resistant viruses.  

          We yet do not know fully about new drugs and vaccines.  For instance, the anti-Dengue virus vaccine was banned shortly after its introduction.  The world is run on money.  Was it not alleged that the top brass at the global level declared 'Swine Flu' as pandemic years ago in 2010 out of vested interests?  If interested to read more about the new viruses, read my articles contained in the following links:

1.   http://drtramaprasad.blogspot.com/2018/11/swine-flu-h1-n1-influenza.html                                                                   2.   http://drtramaprasad.blogspot.com/2017/10/dengue-virus.html                                                       3.   http://drtramaprasad.blogspot.com/2017/05/zika-virus.html

The following is the text of my 'Scribbling' written long ago in 2010.

SWINE  FLU (A/H1 N1 influenza)

Dr. T. Rama Prasad,  www.rama-scribbles.com

2010

          After a lull of about one year, a resurgence of swine flu is seen during the past several months in India, including Coimbatore. Shockingly, an engineering student studying in Coimbatore district committed suicide recently, because he was diagnosed to be suffering from swine flu (The New Indian Express,         Oct. 20, 2010 ).    This shows lack of awareness of facts about this disease even among literates.  And this prompted me to choose this subject to write about in this journal. The following information is meant for lay public and hence is devoid of technical details.  The knowledge we have about swine flu is still fragmentary and speculative to some extent because this disease has only been identified recently (2009), and the database is changing daily.
 What is swine flu ?           Flu, or influenza, is an acute respiratory illness caused by viruses. Usually it spreads around the world in winters causing numerous deaths annually, even millions in a pandemic episode.  A new type of flu virus,  a combination of genes from human, pig and bird flu viruses, known as “swine flu (A/H1 N1 flu) virus” emerged in April 2009 in Mexico and US,  and had soon spread to many countries warranting to be declared as pandemic on June 11, 2009 by the World Health Organization (WHO). What are the symptoms ?         The symptoms are sudden in onset and include fever, cough, chills, head ache, sore throat, running of nose, breathlessness, body pain, joint pain, weakness, vomiting and loose stools.  The symptoms may vary from mild to severe degree. How it spreads ?           It can spread by  (a)  direct transmission when the swine flu patient sneezes or coughs directly on to the face of another person,  (b)  inhaling air contaminated by sneezing or coughing by the patient  which is the most common way of spread,  and  (c) direct contact from hands to eye,  nose  or mouth.  The hands may be of the patient or somebody who may have touched surfaces like door knobs, telephones, tumblers, etc. which were contaminated by patients.  A single sneeze releases up to 40,000 droplets containing the virus into the environment !   The patients are most infective during the first 3 days of illness and may be infectious up to around 10 days. How to prevent ?         From the above account it should be obvious that prevention includes good personal health habits  such as avoiding direct contact and proximity to swine flu patients,  maintaining  common sense hygienic etiquette by washing hands frequently with soap and water, covering nose and mouth while sneezing and coughing, not touching infected surfaces, not touching eyes, nose and mouth with unclean hands, wearing face masks (surgical or N 95 particle masks)- particularly by the patients.  Using HEPA filters (as used in aeroplanes) in air-conditioned public transport systems,  patients confining themselves to homes and not mingling with persons at home or outside for about 10 to 20 days,  cleaning surfaces likely to be contaminated with patient’s secretions by using alcohol or undiluted chlorine bleach  and strictly maintaining mouth, nose and cough etiquette would curtail the spread of infection. In public toilets, handle the door knobs and sanitary fittings keeping a tissue paper over them to avoid direct contact by hand. In our society, it is observed that even educated people do not strictly follow these preventive steps.
           A more sure way of preventing swine flu is by vaccination  which may cost about Rs.400/-.  It is recommended for high-risk groups such as children,  elderly (more than 65 years)  and people who have asthma, diabetes, heart disease, immune-compromised patients, patients with chronic medical conditions and pregnant women.  The flu vaccines, in general, give 50 to 80 per cent protection, and the immunity develops after 2 weeks and may last for a few years. Safety of vaccination           Often, people anxiously ask about the safety of the swine flu vaccination, as it is a new one  and owing to some controversial reports in the press. It may be said that it is as safe as any other vaccine, and the benefit is more than the risk of not vaccinating the high-risk groups. How to diagnose ?                                                                                                                                     Swine flu is presumptively diagnosed by the history of possible exposure to swine flu patients  and the symptoms,  and clinical features. More certain diagnosis can be done by throat swab test which may cost about Rs.4,000/-. Definite diagnosis may be done by PCR or antigen test or culture which are not generally available. What is the treatment ?           Treatment of the symptoms is all that is required in mild cases in which throat swab test is not done for various reasons. In cases which are tested positive for throat swab test, two antiviral drugs ,  oseltamivir and zanamivir are of use to treat the cases. Their availability is restricted to prevent overuse or misuse which may result in viral resistance or shortage of the drugs (for more on drug resistance, see my article in Co-Chamber Journal of October 2010). Complications           Lung infection (pneumonia) due to superadded bacterial infection or due to the virus itself is a dreaded complication.  Appropriate antibiotics and ventilator support may save the patients. When to resume work or studies ?         Most patients recover in one week. It is said that one can go about with activities when the patient is symptom-free for 24 hours without symptomatic drugs. But still they must observe strict respiratory etiquette and hygiene. Shedding of the virus, as detected by RT-PCR, may be present for 10 or more days in some cases.    Children are infectious for longer time. It is preferable to keep away from activities for 10 to 20 days. Magnitude of the problem           If the Mexico swine flu ends up with a mortality rate of 6 per cent and infects the same number of millions of people as conventional flu viruses, the projected numbers could be as high as 2 million deaths in the US alone !    We do not have reliable statistics and notifications of the cases in India. Controversial commercial issues           As I am writing this for a journal connected with commerce and industry, I may make a mention of some comments the public made to link swine flu to some business interests. Allegations were made that big bosses in industry influenced WHO to declare swine flu as pandemic in 2009 to promote their vested interests in pharmaceutical and allied industries. Very recently public in UK criticised the government for indirectly forcing the public to have swine flu vaccine by combining it with two other strains of the annual winter flu vaccine. They said that it is a government ploy to get rid of the surplus vaccine bought to favour commercial establishments. Patients Association (PA of UK)  stated that the government deprived the public of their right not to choose to have swine flu vaccine for fear of side-effects. The Medicines and Healthcare Products Regulating Agency  (MHRA—UK) received nearly 8,600 complaints of suspected adverse reactions to the swine flu vaccination during the pandemic, last year. Most of them were of minor nature.  A few were of serious nature like Gullain-Barre Syndrome, paralysis and narcolepsy. Dr. Peter Holden of the British Medical Association said: “...This is not a Machiavellian plot to vaccinate everyone against swine flu. There isn’t enough capacity to produce an alternative vaccine for those worried about reaction to swine flu vaccination. The consequences of swine flu are a greater risk than any risk by the vaccine itself...” Realities
          Dear Indian reader, don’t get scared ! Media hype and scare made swine flu prominent. We are all still surviving despite more dangerous germs in our country like “our own” ‘New Delhi metallo-beta-lactamase-1’, other superbugs and the filthy environment.  Swine flu did not reduce our problem of overpopulation even as much as tuberculosis (TB) did ! On an average 1,440 (one every minute)  persons die in India every day owing to TB !    Does anybody report about this in media ?
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