The Rajiv Gandhi Institute of Chest Diseases (RGICD) in Jayanagar is swarmed with people waiting in line outside the H1N1 flu ward. Wearing green masks, they wait for hours to get their nasal or throat swab sample collected. Most of them complain of a sore throat or a running nose or fever, afraid that they might have the H1N1 flu, more commonly known as swine flu.

Dr Shashidhar of RGICD appeals to the public to go to a general physician first instead of getting a swab sample taken. Pic: Vaishnavi Vittal.

Dr Shashidhar Buggi, Director of RGICD, urges and pleads with them to go to a general physician first instead of getting a swab sample taken. He manages to convince two youngsters who leave immediately. “Go to your family physician first. Don’t be afraid just because you have got a normal flu”, he tells everyone, but not all are convinced.

The Principal Secretary to the Government, Health and Family Welfare Department, I R Perumal, pitches in. “Why are all of you standing here? Not one of you is coughing. You are not even sneezing. Why do you want to take this test?”, he asks. He appeals to the people not to panic. “You don’t have to keep coming to us (RGICD). There are many flus. There are more hospitals that collect samples. You can go to them as well”, he says.

Panic button pressed

For more than a week now, people have been thronging the RGICD for fear of having contracted the H1N1 virus. Like many doctors say, the panic button has been pressed.

Ask Dr V Ravi, Head of the Neurovirology department at the National Institute of Mental Health and Neuro-Sciences (NIMHANS), if the entire issue is being blown out of proportion and pat comes the reply, “Yes, I think so”.  He adds that there is no need to panic. “It’s like any other normal flu. Lot of media hype is being created. It’s not a killer virus”.

This, even as Bengaluru has reported its first H1N1 fatality, a 26-year-old teacher who passed away at St.Philomena’s hospital in Viveknagar. Dr R Shankar Prasad, Medical Director of the hospital says that the patient, Roopa Anand, was diagnosed with pneumonia when she arrived at the hospital after five days of fever and cough. The cause for pneumonia could be bacterial, viral or fungal, says Prasad, and she was put on antibiotics. When she did not respond to the medicine even after 48 hours, doctors suspected she may have the H1N1 virus. Her swab sample was sent to RGICD and she was put on Tamiflu even before the results were out. In addition, she was on a life support system. Her condition however, deteriorated, and she died on 13 August. It was only after her death that the results came — she had contracted the H1N1 influenza virus.

People waiting to get their swab sample collected outside the H1N1 flu ward at RGICD.Pic: Vaishnavi Vittal.

Among the 20-odd fatalities that have occurred in the country, most of them are said to be due to prior illnesses or complications. Dr Nitin Singh, a paeditrician at the Ulsoor-based Lakeside Medical Centre and Hospital, explains the case of Roopa who is said to have had Lobar pneumonia (caused not by a virus but a bacteria pneumococcus), a condition never before seen in any H1N1 flu case.

Another case, this time from a person who recovered quickly from H1N1. Dubai-based Dr Anil Kumar came to his home-town Bangalore two weeks ago. This 43-year-old pathologist sensed something was wrong when he had prolonged fever and pneumonic symptoms. After his swab sample tested positive for the H1N1 virus, he was admitted to RGICD and quarantined. He was under medication for five days and has recovered now. “There is nothing much to worry. It’s like a regular flu”, he assures you. Kumar’s wife, who was with him during his recovery, did not contract the virus. Kumar has just about recovered, and the couple wears regular masks for protection.

The case of Kumar is reassuring, indicating that there is no reason to panic. Says Dr Savio Pereira, Associate Medical Superintendent, St. John’s Medical College Hospital, “Communicable diseases are ongoing. It’s a continuous cycle. The mortality rate is less than 0.17 per cent for swine flu. There are more serious diseases to be worried about like TB, HIV”. Even Singh says dengue and encephalitis are more serious than swine flu.

The World Health Organisation (WHO) website says “The majority of people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. Of the more serious cases, more than half of hospitalized people had underlying health conditions or weak immune systems”.

But doctors again stress on the basics – personal hygiene. Wash hands thoroughly, cover your mouth while coughing and sneezing and dispose used tissues properly.

Bangaloreans masked, and schools over-reacting

Dr S V Chowti of Mallya Hospital says patients have been approaching him for the past several days, enquiring about the flu. Adding to this panic is the confusion about masks. People are seen wearing masks almost everywhere, while commuting, in classrooms, on the road, and in hospitals.

“The N-95 mask has three layers and is required for doctors and paramedical staff, not for the common man. Please have self restrictions. First consult your physician”, says Perumal. Doctors are repeatedly saying that it isn’t necessary for everyone to wear a mask except if you are working with H1N1 flu patients or if you are a patient yourself. A regular cotton handkerchief or paper tissues would suffice when you sneeze or cough, they say.

Amidst all the frenzy about the flu, is the closing of schools. Last week, it was reported that three schools in the city declared leave for a week. “No one has recommended that schools should shut down. It’s not like the flu will go away in a week. It’s better to screen students. If kids have a cold, send them home. It’s not like you can put the country on hold”, says Dr.Purnima Parthasarathy, Consultant and Head, Infectious Diseases, Manipal Hospital. She advises that children be kept home if they have cold, cough or fever.

H1N1 virus – subtype of Influenza virus

So what exactly is the H1N1 virus?

Put plainly, the H1N1 virus is a subtype of the influenza virus. This flu is also referred to as ‘swine flu’ because tests have shown that its genetic material is similar to some of the influenza viruses found in pigs (swine). Further tests showed that the H1N1 virus has two genes that are normally found in flu viruses in pigs, bird genes and human genes. It’s a ‘reassortment’ of viruses, say doctors.

The H1N1 virus was detected in humans and caused deaths in the United States as early as 1918 and again in 1976, according to the Web-based Wikipedia.

“Every year there is something. Three years back we had H5N1 – avian flu. It is the same virus, it changes character”, says Singh of Lakeside Hospital. He points to the 18th Edition of the Nelson Textbook of Paediatrics which was published about two years ago. The book says that the prognosis for recovery for influenza “is excellent, although full return to normal levels of activity and freedom from cough usually require weeks rather than days.”

Referring to vaccination against viruses in the US, Singh says that there, they anticipate that a certain virus may come. “They make vaccines out of this. They give it to kids in school”, he says. Why is it not done in India then? Singh says the H1N1 flu is not as serious as it is in the US. “We have to be more concerned about TB. It’s not a seasonal flu here like it is in the US”, he says.

Buggi of RGICD completes the contrast between the two countries. It is only in India that so much has been done with regard to swine flu, he says. “Our aim is that no death should occur”, he says. The Principal Secretary (Health) voices a similar opinion. “Our primary task is to save all lives. We are struggling day and night”.

At NIMHANS, six hours to test one sample, free of cost

As people are lining up to get themselves checked for the H1N1 flu, Bangalore’s sole testing centre at NIMHANS, located on Hosur Road, is working round the clock to test these samples. Says Ravi, who heads the Neurovirology department there, “It takes six hours to test one sample. At the end of six hours, we test ten samples. Now we are trying to overlap, so that every two hours we can test a sample. In a day we test 50 samples”.

The real-time PCR at NIMHANS, used to detect if a sample has the H1N1 virus. Pic: Vaishnavi Vittal.

Ravi explains the three main steps of testing for the H1N1 virus.
1.    Specimen collection (carried out in designated hospitals across the city)
2.    Process the specimen in the BSL lab. This takes about one and a half hours. Here the virus is killed and the genetic material of the virus is extracted.
3.    The genetic material of the virus is then run on what is called a real-time PCR (Polymerase Chain Reaction). This takes about three hours. The PCR will check if the specimen has been collected properly, whether the virus is the regular seasonal flu or swine flu, or if there is no flu virus at all.

This entire process is done free of cost for the public in Bangalore and other parts of Karnataka. The testing is carried out by Ravi and a team of seven other specialists: Dr Madhusudhan S N, Dr Anita Desai, Dr Shuba S, Dr Rita Mani and Ph.D students Vijayalakshmi R, Prachi Fadnis and Anshu Srivastav.Once the test is done, the department informs the referral physician through telephone. The information is also passed on to the State and Central Monitoring Cell. Then an e-mail is sent with the information. No paper work is involved unless a specific request is made, in which case you will have to go to NIMHANS and collect it in person. 

NIMHANS is also a WHO reference centre for rabies, Japanese encephalitis and chikungunya.

Treatment

Once the test results are out, the patient if found positive will be admitted in one of the designated hospitals in the city where H1N1 flu cases are quarantined and treated. As most citizens know by now, Tamiflu (drug name Oseltamivir) is the prescribed medicine. This is available as capsules for adults and syrup for children.

Tamiflu is available only in certain hospitals and not in the market to prevent misuse. “We can give Tamiflu only if it is diagnosed, otherwise you will lose your immunity”, says Buggi of RGICD.

Fluvir, more commonly known as Tamiflu is the prescribed antiviral for H1N1 flu. Pic: Vaishnavi Vittal.

In the meantime, people continue to line up at various hospitals in the city to get themselves checked. What needs to be understood is that the situation is nothing to panic about. Singh of Lakeside Hospital reiterates that the number of fatalities can still be counted on your finger tips. Not that this should be a reason to minimize the issue, but it shouldn’t become a reason to be alarmed, he says. Citizens need to keep themselves well-informed and be unfazed by the near mass-levels of hysteria prevalent now.

Stay with the basics, as the doctors say, which is worth repeating here: Wash hands thoroughly, cover your mouth while coughing and sneezing and dispose off used tissues properly.

Click here to see the list of hospitals in Bangalore identified for admission of suspected cases. ⊕