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The flu, the scare and the confusion

August 13, 2009 14:39 IST

Swine flu. What a scare it has triggered! Concern would be justified, panic -- certainly no. 

The concerns are on several fronts.

One is the people's habits which go against the requirement.

The second is the ability of the authorities to cope with this, especially in the cities though it is an admitted fact in the past the Indian public health system had risen to the occasion to deal with effectively with small pox, chicken pox and a host of other such serious issues.

Two concerns

The first issue first. Here is what I saw, and was appalled. I have seen people wearing masks, though not as many as one would imagine was the case going by media reports but enough to help me make a judgement, who were at sea about the entire thing.

H1NI or swine flu is transmitted by excretions from a person, which in this case as is so far said to be the droplets when a patient coughs or sneezes. What about the spittle, the urination on the streets. No one has told us if that is safe or otherwise. What about the absence of practice of washing hands? How many public places, including offices have soap on provision? Even municipal offices have toilets without soaps, except for those that serve the senior officials.

In a crowded country, with cities like Mumbai packing people like sardines, where several people live in micro-compact accommodation, is any isolation possible? Is there enough space in already crowded hospitals? And what about the private hospitals which are being drafted into this containment/management endeavour? Who pays for it when the patient is ushered in?

Street-smart business

The general belief now prevalent is that if one wears the green mask the flu can be wished away which is not quite the case. The only beneficiaries are the sellers of the masks. There are already reports of black-marketing in this item even if the mask is of no use. The N95 masks which are said to be relatively more useful are just not available because worldwide, there is only one manufacturer. India "is placing an order" now so they can arrive, if available, after Sunday from overseas.

Swine flu has been in the air for quite some time and the Indian authorities had been content with screening arrivals at airports and did precious little to have a contingency plan in place. Vaccines and masks would have been the first priority. When the media blew it into a crisis -- it created a panic and the government began to respond. No protocols were issued to private hospitals, who now need up to nine days to get ready with isolation wards.

Mere placebos

I said the N95 masks are relatively more useful, not absolutely so, because already some doctors have said that even the N95 does not really arrest the flow of a virus through their pores. So the green masks and the white cotton one quickly tailored and brought into the market at the railway stations are contraptions that serve as mere placebos, not save a person from potential risk.

The street-smart Indian entrepreneur has already started recycling the discarded masks posing a greater health hazard to the population. When it comes to making money, nothing should or does come in the way, according to this class of entrepreneurs. Recall the hoarding and recycling of discarded syringes and needles in Gujarat. With every major public issue, a scandal is always round the corner. Perverse Indian ingenuity is never lacking.

Question mark

What puts the question mark on the authorities' abilities is the manner in which some decisions were taken. The health secretary, according to media reports not denied yet, swallowed and distributed Tamiflu to some journalists in Pune saying that was a good prophylactic. The British Medical Journal has warned against the indiscriminate use of the drug lest it builds resistance or leads to mutations of H1N1. The wrong thing was done by the wrong person and a wrong example was set.

The Mumbai municipal corporation has decided to allow all suspected cases, not just the confirmed cases to be administered Tamiflu. That could be a major public health faux pas on the lines outlined above. If all suspected cases are to be so treated and make its use so widespread contrary to the Centre's caution against making that only weapon open for across the counter sale or even on prescription by the private medical practitioners, we have a greater tragedy looming.

Is it not a fact that this country's one major health management issue is the indiscriminate use of antibiotics and free sale of several other 'prescription only' drugs and the adverse consequences thereof?

Let us look at this business of closing schools.

Closing schools

Shouldn't the Mumbai municipal corporation, which is mandated to both run schools -- it runs half of the primary schools in the city -- and administer public health issues decide on how to contain the spread? But what does it do? Sends text messages (SMSs) to parents asking if they would like it done. That is shirking of responsibility; it takes the cake. If crowded Mumbai responds thus, neighbouring Thane and Navi Mumbai decide to close all schools. Obviously, there is no protocol in handling what could be a crisis.

On the other hand, closing schools can take away the children from peer contact. But what about the parents who commute in overcrowded crowded trains, who may bring the infection home?  Cinema halls may be closed for a few days -- strangely, the suggestion is a week's break for schools and just three days for the theatres! -- but what about the all pervasive crowds across the city? Perhaps the only way is to shut down entire cities where the flu has taken a grip. Nothing else makes sense.

Mexico did it.

Any takers?

Mahesh Vijapurkar