Though most h1n1 patients develop a mild infection, the Union Health Minister says India should gear up for a large-scale outbreak. Public health experts fear that once the virus reaches remote, rural pockets, it will be impossible to track.
Suchita Chauhan (40), Block Pramukh of Joshimath in the northern state of Uttarakhand, has a television set and keeps updated by watching the news.
Ask her what swine flu is and she says promptly: “It’s that videshi (imported) fever that TV goes on about. We have bigger problems here.”
And she does.
As much as 93 per cent of Uttarakhand’s geographical area of 51,125 sq km is mountainous and 64 per cent is under forest cover. The state has 121 health facilities open 24x7, but that is clearly not enough to treat its population which is close to 10 million (100 lakh).
“It takes hours to reach the road, let alone a doctor. Not being able to reach a health centre or a district hospital is a major reason for complications and death,” says Chauhan, who lives in Paini village, located at over 6,000 feet and home to 600 people. The nearest road is one kilometre away.
“No one goes to a doctor for a fever, we use the hakim in the next village. Hospitals are for serious illnesses. My husband is a daily-wager. How can I expect him to take a day off from work just to take me or the children to a doctor in Joshimath?” asks Chauhan.
A NIGHTMARE AVERTED
Public health experts don’t even want to consider what could have happened had the H1N1 outbreak started in a village and then spread to a city. “It would have been a nightmare. It would have been reported to the Centre only once people had started dying. By then, it would have become impossible to track it,” says an epidemiologist at the Union ministry of health, who did not want to be named because he is not authorised to speak to the media.
As a case in point, he cites the ‘Saharanpur mystery fever’ that strikes Saharanpur and Meerut in western Uttar Pradesh between September and November with chilling regularity every year, killing children — at times close to 100 — within a few weeks.
Each year, the district administration tries to control it for a few weeks before calling the Centre, which sends experts from the National Centre for Disease Control (NCDC) on a fact-finding mission. Samples are collected, tested and a mystery killer is pronounced — usually “viral encephalitis of unknown origin”.
But by then, the outbreak is over and the children are back at school.
“Though the Saharanpur fever has a high mortality rate — it kills four in five children infected — it is not as infectious as H1N1. If it was [as infectious], we’d be in big trouble,” says Dr Shiv Lal, director-general, NCDC. (H1N1 causes approximately one death per 200 people infected.)
Creeping up on us
Already, H1N1 has crept to smaller towns such as Beed, Parbhani, Chengalpattu, Gadag, Idukki, Rohtak and Raipur, which reported one death each till Friday, prompting Union Health Minister Ghulam Nabi Azad to ask the states to be on high alert.
“Today, we are reporting cases that are indigenous, with no travel history abroad. This is all the more reason to gear up for a large-scale pandemic in the country,” said Azad on Friday.
Public health experts fear that once the virus reaches remote, rural pockets, it will be impossible to track, largely because villagers are not likely to reach a hospital to report symptoms of fever.
On Friday, the Centre put the ball in the states’ court. “Public health spending has increased to 1.41 per cent of the GDP from approximately 1 per cent when the National Rural Health Mission was launched, in 2005. The Eleventh Plan allocation of Rs 1,40,135 crore for the health sector is a whopping 227 per cent increase over the Tenth Plan outlay… We (the Centre) can go up to a point, don't expect us to go beyond a point,” said Azad.
His statements were not well received by the states. “We accept that health is a state subject but… it is a collective responsibility to deal with the issue,” was Gujarat health minister JN Vyas’s response.
With the Centre and states refusing to take charge, the best India can hope for is that H1N1 gets milder still and no deadly new outbreaks happen soon, as they do in Saharanpur.