#dnaEdit: Warning signs

The spike in fatalities from H1N1 cases this year is cause for worry. Until June 8, 89 deaths have been registered while the total reported cases according to official data, 414, is lower than the 5,253 cases reported in 2013. The real concern is that the fatality rate of 21 per cent is much higher than last year’s 13 per cent when 699 deaths were reported. The problem of lowering one’s guard early is evident here. Since 2009-10, the period that H1N1 returned with increased potency and was officially declared a pandemic, the number of reported H1N1 cases declined from 46,131 until December 2010 to just 603 in 2011 following the energetic steps taken to monitor the outbreak. But in the past two years the numbers have risen again averaging 5,000 in 2012 and 2013.

It is high time that the government steps up its awareness campaign alerting citizens about the symptoms of the Influenza A(HIN1) viral infection. In the absence of early detection and treatment, patients have developed acute respiratory distress and secondary complications like pneumonia making it too late for doctors to cure or isolate the patient and prevent further spread. In 2009-10, the government was caught napping, initially, with the tamiflu drug not available in many places. But since then, three generic versions of the drug and a vaccine have been launched by Indian pharma companies. Similarly, the strategy of screening 50 houses in the vicinity for every reported H1N1 case also paid rich dividends. But suspicions abound that the figures provided to the health ministry from the states could be far lower than the actual numbers who contracted H1N1.

This is a major problem that the health ministry should get down to resolving: the absence of reliable statistics and the granular information that can be collated from each patient to create a national reporting system to better understand disease patterns and causes of death. In a recent report on the medical certification of causes of death (MCCD), the Census directorate has revealed that most states do not record the causes of death though required to do so by law. Except for Goa, which recorded a 100 per cent achievement on this count, most states have been lax, logging an average of just 20.2 per cent reportage of MCCD. With few hospitals linked to the chief registrar of births and deaths, improving this system is essential for reliable and representative information that can aid policymakers in suggesting healthcare reforms. Of the total medically certified deaths, circulatory system diseases like heart diseases caused 29.8 per cent of the deaths, infectious and parasitic diseases like tuberculosis and septicaemia caused 13.1 per cent, and respiratory system diseases like pneumonia and asthma 9.5 per cent. Cancers accounted for 4.6 per cent.

While the Census directorate bemoans the absence of conclusive figures, the MCCD pro forma designed by the World Health Organisation offers a wealth of information including the specific sequence of symptoms, events and time intervals from the onset of disease to death, and the immediate and the underlying cause of death. With such information, the health ministry can coordinate corrective action at the local and national levels for firming up the public health delivery system in tackling non-communicable diseases, seasonal viral outbreaks and understanding mutations that are causing fevers that vary in symptoms, morbidity and fatality.