Swine flu: What you should know

Updated: March 31, 2015 5:56:00 PM

The recent wave of swine flu pandemic underway in India has had thousands of victims in its grip and it is imperative to be acquainted with the right information...

The recent wave of swine flu pandemic underway in India has had thousands of victims in its grip and it is imperative to be acquainted with the right information about it to prevent its spread. There have been myths about how the virus spreads; its cure and various ways to prevent it. People rushing to medical centres to get tested for swine flu without understanding its clinical symptoms is making the situation worse, by aiding the spread of the disease through increased human contact in long hospital ques. One of the most important things to do is avoid the panic and understand the disease before jumping to conclusions.

History of Pandemic Flu

Flu is an infectious disease caused by the Influenza virus. Historically Flu has existed for centuries and infact some early reference to Flu was made by Hippocrates, the Greek physician  considered to be one of the most outstanding figures in the history of medicine, 2400 years ago. Since the year 1918 there has been four pandemic (outbreaks across continents involving large proportions of populations). The Spanish Flu in 1918-1919 (also called Black Death) left an estimated 50 million people dead with nearly 675,000 deaths in the United States alone. Unlike earlier pandemics and seasonal flu outbreaks, the 1918 pandemic flu saw high mortality rates among healthy adults. In fact, the illness and mortality rates were highest among adults 20 to 50 years old.

In February 1957, a new flu virus was identified in the Far East. Immunity to this strain was rare in people younger than 65. In early 1968, a new flu virus was detected in Hong Kong. The Hong Kong flu virus was similar in some ways to the 1957 pandemic flu virus. However, neither was as devastating as the 1918 virus.

In the 2009 flu pandemic, the average age of individuals who died was 19 years. The elderly population exposed to 1918 flu virus had some natural protection and the younger and healthier individuals were more affected. One such reason includes the fact that the flu virus interacts with our immune cells results in the release biochemical substances called the cytokines from human body. These cytokines, though intended to eliminate the virus, make the lungs or other organs as battle grounds.  Not all deaths are due to the virus or the cytokine storms. People with other coexisting medical issues like asthma, diabetes or immune compromised may die of the complications of these medical illnesses brought about by flu.

Decoding the Flu Virus: When to Act?

There are mainly three types of Flu virus (influenza), namely, Influenza A, which caused Spanish flu in 1918 (H1N1), Asian flu 1957(H2N2), Hong Kong 1968 (H3N2), Bird flu 2004 (H5N1). The Spanish flu of 1918 killed approximately 50 to 100 million people and hence was named as Black Death, Influenza B, which is comparatively less intense with less common clinical symptoms, Influenza C, which has had fewer occurrence that previous two strains.

If one was to decode the acronyms in the names of the flu virus – H stands for a protein on the covering of the flu virus and N stands for another protein which in particular is a protein which changes in their configuration from time to time and helps the virus evade immune systems.

Now the seasonal flu and Swine flu are of the same basic virus (H1N1) and there is no difference in the symptoms between seasonal flu and swine flu. However there has been a genetic re-assortment (recombination) of bird flu, swine and human flu viruses as was observed in swine herds in 2009 in Mexico. The fact of the matter is that seasonal flu is still more frequent and common than actual swine flu.

The common symptoms of flu include:

Fever with temperature of 38 degree centigrade and above

Unexplained body ache and feeling weak

Sore throat and cough, nasal congestion

Diarrhoea

Sneezing

Joint pains

No desire to eat

Difficulty in sleeping

It is important to understand that Flu usually resolves and the individual recovers completely with effective symptomatic treatment like paracetamol, oral rehydration and some rest. It is advised to seek medical help only in certain circumstances such as:

Difficulty in breathing or shortness of breath

Pain or pressure in the chest or abdomen

Experience of sudden dizziness or confusion

Severe or persistent vomiting

Recurring symptoms of flu

If you have mild symptoms of sore throat, body ache, fever, vomiting or diarrhoea then stay at home, drink plenty of fluids and take adequate rest. If you need to see your doctor, call up and explain your symptoms and the doctor should make arrangements to see you in the clinic with adequate isolation or infection control measures. A follow up visit is very essential, since flu sometimes may be followed by a bout of pneumonia.

People over the age of 65 years, children younger than five years, pregnant women and individuals with diabetes mellitus, heart disease, asthma and kidney disease constitute a high risk group.

Busting Behavioural Myths

We have seen Swine Flu blow out of proportion in the last few weeks. This morning (March 4, 2105) newspapers reported 10 fresh deaths in Gujarat. India has recorded over 14,000 swine flu cases with 800+ deaths. Delhi, while reporting the largest number of cases, has seen better disease management due to a better health infrastructure. States like Rajasthan and Gujarat are the more impacted ones reporting high cases as well as deaths.

It is therefore important to probe what led to the sudden spike. We tend to associate swine flu as a seasonal phenomenon primarily showing an upward spike during peak winter with an expectation of decline as the weather eases out. However that has not been true this time around in India.

DO NOT PANIC. DON’T QUEUE UP FOR TESTS

The single-largest cause for the sudden spread is widespread PANIC. People queuing up at hospitals to get themselves tested as a preventive approach is not necessarily the best thing to do in case of a highly communicable disease like the swine flu. Hospitals are the biggest hubs of infection and it is best to land up at one only if you need to. A simple blood sample collection instead in the comforts of your home on the contrary can keep you safe in case it is a simple viral influenza and not Swine Flu.

Testing for the H1N1 virus should be largely done only for the following two reasons:

To periodically check the viral protein structure to make sure that there is no massive change. Such change would make the virus powerful enough to cause pandemics.

To test for virus in case of severe symptoms that may be explained by some other illness.

AVOID CROWDS

Avoid crowds wherever possible. We often find ourselves in situations that we have little control over – work travel, personal travel, at conferences etc, that all attract crowds and we cannot necessarily avoid. However, malls, markets, movie theatres can definitely take a backseat. As they say, prevention is better than cure.

TRY SIMPLE CONTROL MEASURES

In India, unlike some of our global counterparts, vaccination as a preventive measure is almost an alien concept. In Australia for example, swine flu vaccine is administered free of cost. People are advised to get one. The Center for Disease Control and Prevention recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease. People who should definitely get vaccination are:

Pregnant women

People with chronic health conditions like asthma, heart and lung disease, cancer, diabetes, kidney diseases and people with suppressed immune system

Children in special schools

Healthcare workers

Parents/guardians of infants under six months of age

The flu medicine Osteltamivir (Tamiflu, Antiflu, Fluvir) acts by limiting the replication of the virus inside the body, if started within 48 hours. It is essential that this drug is prescribed in the early phase of illness. Clinical studies have shown that Osteltamivir can reduce the duration of flu illness by one and a half days, if taken early in the course of illness. They also play an important role in reducing the severity of the symptoms and the time taken to recover from the illness. However most people get better and recover without Oseltamivir and the unnecessary use of Oseltamivir can predispose one towards drug resistance. Hence it is essential for a doctor to assess and only if required, prescribe the medication.

Last but not the least, some hygiene preventive measures that have been talked about multiple times but no harm repeating:

Cover nose and mouth with tissue when coughing or sneezing – Swine flu and seasonal flu usually spread by droplets from cough, sneeze, talking by people with flu infection and sometimes by contact (nose/mouth) or through infected objects like towels (virus can survive environmental surfaces)
Wash hands with soap and water regularly and especially after contact with mouth or nose is equally important.

Avoid getting to work place, malls and public gatherings – The Flu can spread from an infected person from one day before the onset of symptoms to one after the fever has settled on its ow.

Stay at home and ensuring good intake of fluids.

Taking a timely flu vaccination before start of flu season is quite important especially if you do not have flu like symptoms or have not had flu till date.

The article is authored by Dr. Satya Mysore, Head of respiratory and Sleep services at HCL Avitas

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