Persistent Disease

By late February this year, 261 people in the country had died of Influenza A (H1N1) while 2,329 had tested positive. In 2009, in the aftermath of the H1N1 pandemic that year, the government had accused the World Health Organisation (WHO) of “exaggerating” the dangers of the virus and spreading “hysteria”, possibly goaded on by big pharmaceutical companies. A year later, the WHO declared the pandemic over but said localised outbreaks of the disease would be witnessed in India since the virus would behave like the seasonal influenza virus and continue to circulate for some years to come. The Ministry of Health has finally woken up to the reality and agreed with the WHO declaration that the H1N1 is now endemic in India. This could mean that the current strain becomes less virulent, leading to fewer casualties than in 2009. On the other hand, as the virus is present in a very large part of the population throughout the year, it also carries the possibility of combining with other endemic viruses to create a deadlier strain. Even though there are many more life-threatening infections in India such as tuberculosis for example, which kills many more people, the persistence of the H1N1 virus should not be treated lightly.

Since the outbreak of the pandemic in 2009 until 2012, there were 53,487 reported cases and 3,224 deaths in India. Currently, Delhi, Haryana and Rajasthan have the highest number of cases while the majority of deaths have occurred in Rajasthan, Gujarat, Haryana and Punjab. These statistics, however, do not tell the full story. Detecting and treating the virus is difficult on many counts. For instance, early symptoms of this strain of influenza are not markedly different from that of other forms. The H1N1 virus is also difficult to diagnose as there are many more viral strains like the H3N1 and the H3N2 now in existence. Naturally then, the treatment too falters. While seasonal flu in the developed countries kills thousands, predominantly the old, in India the H1N1 virus targets the young, pregnant women, asthma patients, those suffering from chronic health conditions (cardiovascular, diabetes, etc) and neurological disorders among others. When there is a sudden increase in cases, there is a real danger of public health facilities being swamped. Another major factor in effective intervention in the event of a breakout of the H1N1 virus is the lack of surveillance and monitoring facilities to keep track of the newer strains. These facilities are poor in any case. Medical experts have pointed out that the country’s infrastructure to study viruses is effectively limited to the National Institute of Virology in Pune, which is already overstretched. Now that we know the H1N1 virus is endemic, the challenge becomes even more daunting. Added to all these factors is the generally poor state of the public health system and the fact that the poor and the undernourished are among the most vulnerable.