M A I N   N E W S

Three more deaths as govt sketches strategy
Pvt labs can conduct tests; airports to have thermal scanners
Aditi Tandon
Tribune News Service

Sanjay, 4, who died in Chennai

New Delhi, August 10
With three more persons succumbing to swine flu today, taking the nationwide death toll to seven, the government reviewed the level of pandemic preparedness in the country, asking states to take charge of the situation instead of depending solely on the Centre for direction and help.

Tamil Nadu recorded its first swine flu fatality with the death of a four-year old boy at a private hospital in the city today. Sanjay, who was on a ventilator, died following multi-organ failure, even as government health officials rushed to the hospital and tried to save him.

Tamil Nadu Health secretary VK Subburaj said the child’s father had returned from Singapore last month. The boy was treated in various hospitals, which did not detect swine flu. An early detection of the disease would have saved him, he said. The boy’s elder brother had also tested positive for swine flu. A six-year old boy near his residence was also found suffering from swine flu. The child had also attended school, at the early stages of flu and the private school where he studied declared a week-long holiday for its primary wing as a precautionary measure.

In Pune, an Ayurvedic doctor and a chemist succumbed to the virus today, taking the total number of H1N1 deaths in Maharashtra to five. Balasaheb Laxman Mane (35), who used to see patients in the slums of Pune, had tested positive for swine flue on August 6. Mane was brought to the government-run Sassoon hospital where he was administered Tamiflu and put on a ventilator, Arun Jhamkar, dean of Sassoon hospital told reporters. The chemist, identified as Sanjay Tilekar (35), was admitted to the hospital with heart problem and fever on August 6. The man also suffered from respiratory tract infection. Meanwhile, shifting gears to combat the deadly virus, the Centre today unveiled fresh initiatives like possibility of allowing private labs to conduct swine flu tests if they followed its guidelines and installation of thermal scanners at all international airports in the country to detect the H1N1 cases.

“We have to work a little harder,” Health Minister Ghulam Nabi Azad told reporters in New Delhi, as people flocked to hospitals for swine flu tests. Azad, who has been asked by the PM to take urgent steps to tackle the menace, said, “ So far, the Centre has been spoon-feeding the states but now they will have to get going, use their own budgets and expertise to combat the virus locally.”

Azad also said he did not favour closure of schools but left it to the state governments and schools concerned to take a call. With cabinet secretary KM. Chandrashekhar watching over as the PM’s representative, the high-level ministry meeting decided today to continue entry screening of passengers at international airports and procure several more thermal scanners.

Tamiflu will not be retailed for the moment though government would supply the drug to recognised private health providers, to be identified shortly. Tomorrow onwards, the Centre will depute teams of additional secretary and joint secretary level officers to cover each state and UT. Till then, the national stockpile of Tamiflu (out of 10 million capsules, Centre has given 75 lakh to states) will be replenished with two crore additional capsules and the government will also import 22,000 swine flu test kits to rule out shortage in states.

In another significant decision, the government said it would allow private labs to test for H1N1 if they got the required accreditation (guidelines have been sent to states) but ruled out free supply of chemical reagents to them. Some private healthcare providers today met the health ministry officials to express their inability to test if the government did not support them with prohibitively costly free reagents.

But Azad ruled that out, saying private hospitals would have to test for H1N1 the way they test for other diseases, some deadlier and costlier than H1N1. “We can’t give them free reagents. We can’t have different parameters for swine flu,” said Azad, asking recognised private hospitals to create separate wards and isolation facilities for swine flu patients to prevent infection. Those that don’t do so would be issued binding directives, the Minister said. On the vaccine front, Azad said, “We will import the vaccine if it is available with other countries before us.” He has, meanwhile, asked ICMR to develop low-cost H1N1 testing kits.

(With inputs from N Ravikumar in Chennai and Shiv Kumar in Mumbai)

Persons with chronic disorders at highest risk
Aditi Tandon
Tribune News Service

New Delhi, August 10
Public health experts say that though swine flu symptoms resemble those of seasonal flu, there are some warning signs typical to H1N1, which include vomiting, diarrhoea and breathlessness.

Especially at high risk are the obese, pregnant women, those under five and above 65 (due to weak immunity system) and everyone with underlying chronic diseases like diabetes, hypertension, renal failure, asthma, bronchitis, cardiac arrest, HIV, and those on chemotherapy. These are the people who need highest testing and treatment priority, with the analysis of five fatalities in India also showing that the victims either had acute breathlessness or were suffering from underlying chronic diseases like diabetes, renal failure or hypertension.

“The government should shift focus away from the mildly infected and lookout for the high-risk categories and those with typical swine flu symptoms. Such people need to be immediately put on Tamiflu even if test reports have not been received. Also, the virus has been seen to cause serious complications in a certain percentage of young, healthy adults, who would typically have acute respiratory disorders,” Dr Ranjit Guleria from the Department of Internal Medicine, AIIMS, today told The Tribune.

He said those with breathing difficulty, those coughing sputum or blood or experiencing sudden fall in blood pressure or chest pain must immediately see the doctor. Experts also believe that creation of awareness is now the key to combating the virus, which is in the air and would gradually cause more deaths as it moves from children (the most vulnerable to infection) into houses, affecting the ill and the elderly. “Although currently the mortality is less than 1 per cent, it would rise later,” said Guleria, citing the US, which has asked the mildly infected to stay at home and is targeting the high-risk persons with associated illnesses that make the virus attack easy.

Consider the present fatalities in India - Fahmida Panwala, who died in Mumbai on August 8, had a history of diabetes and cardiac problems. Babaseheb Mane, who succumbed to the infection today at Pune, had acute respiratory distress syndrome and cardiac arrest so did four-year-old Chennai boy, who was a patient of asthma and was on dialysis for kidney problems. “The boy’s father remained asymptomatic although he had a history of foreign travel and could have harboured the virus which attacked the child, who had asthma and kidney problems,” said Vineet Choudhry, joint secretary, health.

Pravin Patel, the NRI from Ahmedabad, who died within 10 days of returning from Atlanta, also had been admitted to Sanjeevani Hospital with fever, weakness and breathlessness; he was anaemic and had respiratory distress; his chest X-ray chest revealed pneumonitis. Earlier, the 42-year-old teacher who died at Pune’s Sassoon Hospital, had shown symptoms of body aches and sore throat, along with breathlessness.

Dr Robil Tickoo, a private internal medicine specialist, also said people should not wait to see a doctor if they have breathing difficulty, and a feeling of vomiting or diarrhoea. These are dangerous signs, he said.

‘Tamiflu not for kids with seasonal flu’

Paris, August 10
Children with seasonal flu should not be given antivirals such as Tamiflu because harmful side effects outweigh relatively meager benefits, according to a study released today.

In some children Tamiflu caused nausea and vomiting, which can lead to dehydration and other complications, researchers reported.

The study did not cover the current outbreak of swine flu, but its conclusions suggest that antivirals may not significantly reduce the length of illness or prevent complications in children infected with the new H1N1 virus, the researchers said. Carl Henegan, a doctor at John Radcliffe Hospital in Oxford and co-author of the study, said the current British practice of giving Tamiflu for mild illness was “an inappropriate strategy.”

But the drugs had little or no effect on asthma flare-ups, increased ear infections or the need for antibiotics. The study, published in the British Medical Journal, comes 10 days after Britain's Health Protection Agency (HPA) reported that more than half of 248 students given Tamiflu after a classmate fell ill with swine flu suffered side-effects such as nausea, insomnia and nightmares. — AFP