What the specialists have to say

Doctors say while people need to be cautious, there is no need to panic.

Dr Khusrav Bhajan, critical care specialist, PD Hinduja Hospital
There is no need to panic but one should not take it lightly. People who are flocking to the screening centres should understand that mortality of swine flu is less than 1%. The government cannot be blamed all the time as they had issued travel advisories that people travelling abroad should be careful. Yet, people ignored the risks.

The government can definitely rope in private hospitals for better isolation facilities and patient care. People are under the impression that they will go for testing and end up getting infected by the virus. Also, Tamiflu consumption should be in limits and the government is taking enough steps to restrain its availability.

The Hinduja hospital has been testing people for Influenza A and B, and throat swabs of only suspected patients are sent for final testing. But, rapid testing that is done using nasal swabs are not 100% reliable. Their sensitivity is 60% and specificity is 80%. But, it is also true that the test is much cheaper as it costs about Rs1,000 as compared to Rs10,000 that the final testing costs. Also, the results are out in about 15 minutes as opposed to the PCR testing that takes about 24-48 hours. People should try and boost their immunity by drinking plenty of fluids, eating more nutritious food and leading a healthy life. Smokers should avoid smoking for better immunity.

Dr Arshad Ghulam Mohammad, vice-president, Association of Medical Consultants
We have a problem and  have to cope with it. Panicking is not an option, but at the same time we should not take it lightly. In a population of 1.2 crores in Mumbai, there have been three deaths so far . We have to understand that we are losing almost 100 times of this number to diseases like malaria, TB and malnutrition. We need to have a sense of balance. Our association, on its part, is educating doctors constantly on nuances of the ailments as well as educating patients. Even in western  countries they have seen a peak and now they have overcome it. In the US, thousands had tested positive for influenza H1N1 but not many have died. This could mean both-better management by their authorities as well as precautions. But, citizens have to be more responsible. People are seen disposing their masks in open places. Also, patients are refusing to get themselves or their children quarantined. It is absolutely unacceptable. They have to understand that the patients requires proper treatment and good monitoring. Under the Epidemic Act the state is also empowered to use coercion to quarantine  patients. 

Dr Aashish Contractor, head of department of cardiac rehabilitation, Asian Heart Institute
If someone has recently had a heart surgery, or someone is actively under treatment for an ongoing cardiac problem, then they are slightly compromised. But there is still no reason to panic.

Someone with cardiac problem is as vulnerable as any other elderly person, or a young child. They ought to take the same precautions to protect themselves.

Some preventive steps that can be taken are to avoid going to overcrowded places, wash hands frequently, make sure your immune system is strong, etc.

From what I understand, the H1N1 virus is exactly like the influenza virus. The only difference is that it is a mutation. Currently, the virulence level of the virus is very low, although it spreads extremely fast. However, the number of deaths due to swine flu worldwide is not worrying, as it is similar to the number of deaths due to flu.

In the US, the peak was in May, and experts predict that it might come back in in December, with more virulence. However, it is difficult to predict what direction the virus will take in India.

Dr Vijay Tamhane, dental surgeon
The threat of swine flu has put all health care providers on high alert. To prevent the transmission of respiratory infections including influenza in health care settings, respiratory hygiene /cough etiquette infection control measures should be implemented at the first point of contact with a potentially infected person.

All patients should be screened by telephone for symptoms of flu before attending the practice and again on arrival at the practice. Infected patients should be segregated from healthy ones.

For the general public, personal hygiene should be a top priority. The public should also be aware that bad dental hygiene could possibly increase the risk of swine flu. A study by the British Dental Health Foundation reveals that bad dental habits help spread germs. People should be aware that often times bacteria survives on the moist surfaces of the toothbrush bristles for weeks. The organisms on the toothbrush inject the toothpaste tube through contact during dispensing of the toothpaste. After an episode of cold or flu, the toothbrush and toothpaste should be changed.

Dr Sujeet Rajan, consultant respiratory physician and pulmonologist, Bombay Hospital
We are seeing a huge number of people flocking to clinics with their queries. The fact is it is not easy to differentiate between a case of simple influenza and H1N1. However, patients with severe disease and who have co-morbidities, such as severe underlying lung disease, heart disease, renal failure, diabetics and pregnant women, need immediate attention. 

The essence of India’s health care is the private health care, which handles a whopping 80% of the health care of the country. But how are we supposed to treat the patient when the drug is not available to us in the private sector? It is ironic that committees are being formed to decide whether private hospitals can treat patients.

Fortunately, there are two drugs, one oral (Tamiflu), which currently is available only with government centres, and the other inhaled (Virenza), which physicians have access to. I would like to urge the government to trust the general practitioners, who first come in contact with the patient. We should have access to prescribe Tamiflu. This will save a lot of time and lives.

Dr Nandita Palshetkar, obstretician gynaecologist, Lilavati Hospital
Pregnant women come under the high risk group. And over the past few days I have had a lot of queries. In fact, a number of husbands have visited my clinic asking for instructions and precautions.

Obviously, pregnant women are vulnerable. I would advice them to avoid crowded place, visiting malls, theatres, travelling in trains, etc. However, this is easier said than done. Nevertheless, they should at least take the precaution of covering their face with a mask.

Another thing they can do is to avoid contact with any person who has cold, fever or cough. Keep a six feet distance from such a person. Also, use hand sanitisers.

Swine flu is now a pandemic. There are reports that India will get a vaccine by November.  However, we will need to combat it till then by creating awareness. Simple things like covering your mouth while coughing, carrying a handkerchief or a tissue paper with you will help.  Also, avoid dieting. Consume antioxidants and multivitamins, particularly Vitamin C, which is available in fruits.

If your immune system is strong, you will recover very easily from the flu.

Dr HB Chandalia, diabetologist and endocrinologist, Jaslok Hospital
Diabetes impairs the immune system. It reduces the ability of such a patient to respond to any kind of infection. They become susceptible to all kinds of infections and viral. So, you will see in a given situation, a diabetic will react differently to a disease than others. The high dosage of medicine makes it difficult for them to fight diseases. A diabetic’s body doesn’t create enough antibodies to fight the infection. Further, an infection doesn’t affect them simply, it aggravates the diabetes too. The sugar levels may go up, other underlying diseases may crop up. In fact, there is a higher chance of morbidity and mortality if a diabetic is infected with a virus.

The best thing for a diabetic to do is to keep their diabetes under control and keep themselves away from situations where they may contract any such disease. However, something like the swine flu will die out on its own. That is the nature of a virus. An epidemic, however, will see some grave fatalities in the population and then some mildly affected population, who will develop immunity for the disease and ultimately die out. Vaccination would be the right way to deal with a virus like this.

Dr Ashish Tiwari, consultant physician, Bombay Hospital
Swine flu is a subtype of Influenzavirus A. The abbreviation H1N1 is derived from the two viral proteins hemagglutinin (h) and neuraminidase (n). The symptoms are similar to the symptoms of regular human flu and include fever, cough, sore throat, sneezing, body ache, headache, chills, fatigue, nausea, vomiting.

My advice is to cover your nose and mouth with a tissue when you cough or sneeze.  Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Also, avoid touching your eyes, nose and mouth.  Try to avoid close contact with sick people.

If you are sick with a flu-like illness, stay at home for at least 24 hours after your fever is gone. And if you share a common space with other household members, wear a facemask.

Learn more about how to take care of someone who is ill. Especially those family members who are at higher risk such as children, elders and pregnant woman. Follow public health advice regarding school closures, avoiding crowds, etc. If you don’t have one yet, consider developing a family emergency plan as a precaution. And most importantly don’t self medicate. Always consult your physician.