A dangers posed by the H1N1 Swine flu, and whether it deserves the sobriquet of ‘Pandemic’, answers are being demanded because of the amount of money that has been spent on it globally and whether this expenditure was justified. We take a look at the many areas of public life where vast amounts were invested due to the swine flu scare:

Airports: The first cases of Swine flu entered India from abroad by channels such as air travel. So swiftly checking at international airports became the norm, with doctors and other health officials being placed at the site to monitor people coming in. Scanners and other detection devices such as thermal cameras were installed at very considerable cost at airports to try and screen and thereafter isolate those infected with Swine flu.

Healthcare costs: The government has incurred tremendous expenditure procuring and stockpiling Tamiflu tablets, equipping public hospitals with testing faculties to detect swine flu positive individuals and setting up isolation wards for swine flu positive patients. Further there has been a great deal of money spent on vaccine procurement. Since there is no indigenous vaccine currently available, in the country it was necessary to conduct clinical trials of imported vaccines to determine their safety and efficacy for Indian populations. There was increased pressure on already stretched public health care systems with vast crowds and long lines of people wanting to be tested and requiring medical attention for their swine flu infection.

Effect on the Educational System of the country: Countless numbers of schools have lost countless productive teaching days because of the swine flu scare firstly because of a government directive and then out of abundant caution or possibly due to parents pressuring school authorities to close schools. Whatever be the reason, one now wonders if there was sufficient reason for school closures.

Negative impact on Tourism: The swine flu scare has negatively impacted tourism in the country, with people choosing not to travel to Indian because of the H1N1 scare.

Negative Impact on the Movie industry: With the stress being placed on swine flu spreading in public places, particularly those where people tend to congregate in large numbers, people chose to stay at home rather than go to theatres to watch their favourite stars. A lot of money was lost due to this.

While the swine flu pandemic had this negative impact on several areas of public life, there have been those that have benefitted: certainly pharmaceutical companies have benefitted, with the government and people rushing to procure swine flu medication. Then manufacturers of surgical masks and hand wash liquids and hand sanitizer gels have also profited greatly from the pandemic.

Add to this there is now the emerging nexus between the board members of the WHO and several international pharma companies, which leads us to ask several questions about whether this was just a scare that was blown out of proportion of whether there was need to label Swine Flu a pandemic?

We are informed that around 3.7 million people in England alone have already been vaccinated against H1N1 flu at the urging of the WHO according to this NDTV report. 62 million Americans have received H1N1 shots and Chinese health experts told the WHO this week that a similar number had been vaccinated against the virus in China. And there is now real cause to wonder if people and governments were really required to undergo the expenses that they have? Has the world been taken for a ride in the interests of big pharma companies? These and several other pertinent questions are currently being asked.

• 

  Swine Flu: Sociological Risk Factors For Indians

• 

  Swine Flu Q & A’s

• 

  Swine Flu Vaccine Update

• 

  Swine Flu Impacts Haj and Haj Pilgrims

The minister, Dinesh Trivedi said it was important to find out whether there was ever a nexus between pharmaceutical companies and WHO which made the global health watchdog declare H1N1 flu a pandemic virus.  ”We definitely demand an inquiry. WHO is not god,” he was reported as having said.

Earlier WHO director general Margaret Chan herself had said that the H1N1 pandemic was not as serious as anticipated. She said that this was the first pandemic to occur since the revolution in communications and information technologies. For the first time in history, the international community could watch a pandemic unfold, and chart its evolution, in real time.

According to her the worst may be over but cautioned “But it would be unwise for anyone to reach firm conclusions before April, when the normal influenza season usually ends. There is still quite a lot of winter left.”

Health minister Ghulam Nabi Azad however gave a more toned down response, and implied that the swine flu scare had helped prepare for other pandemics in the future. “We have been telling people not to panic over the H1N1 virus. The only good thing is that the alarm has left us well prepared for a similar influenza pandemic in the future. In the last six months, virus testing laboratories have increased from the existing two at NICD, Delhi and NIV, Pune to 44 laboratories. Out of these, 26 are in the public sector and 18 in the private sector,” he said

According to the report, dead birds found in West Bengal’s Murshidabad area were found to have been infected with the bird flu virus. once again bird culling is being done in the area and a team from the health ministry has also been deployed to the area where house to house surveillance will be carried out with tests being carried out on those that show flu like symptoms such as cough, cold and respiratory illnesses. Isolation wards have also been set up to contain the virus.

While the virus strains are of course different, the other chief differences between avain and swine flu are:

• The dangers posed by bird flu are actually far higher. As many as 60% of infected individuals have died so far whereas the mortality among those infected with swine flu is far lower, the same as common or seasonal flu.
• Bird flu spreads from handling or being in contact with infected animals whereas the swine flu virus does not spread easily from animal to humans.
• On the other hand the swine flu virus is highly contagious and spreads easily from human to human. Sneezing and shaking hands is also likely to spread the virus.
• Swine flu is a pandemic and has infected far more people the world over than the bird flu. As many as 5 million Americans were infected with the H1N1 swine flu from the time the disease first emerged in mid-April until mid-December, and about 11,200 people died, according to official figures. An estimated 246,000 hospitalisations took place in the US due to this.

There is now an apprehension of what will happen if the two viruses intermingle; if such a resultant virus will be both highly contagious as well as deadly. The reason that this fear has surfaced is due to the fact that the swine flu virus is already prevalent in the area that the examples of bird flu have been seen. Fortunately it is only this geographical area that is seeing instances of avian flu among birds, nowhere else in the country has this been noted.

The WHO has listed symptoms such as cough, fever, cold, body ache, running nose and sore throat as the common symptoms of swine flu however sometimes people do no display all these symptoms and there have been cases where patients have had only fever or only cold and still tested positive, according to the minster.

“Consider testing of non-symptomatic patients also for H1N1 and administer Tamiflu. At least, there is no shortage of Tamiflu,” Azad has therefore suggested according to this Indian Express report.

As the trials for the Swine flu vaccine are proceeding apace in the country, there are glad tidings that the first imported consignment of swine flu will be arriving in the country next month from a French pharma company, Sanofi Aventis according to this DNA report.

It is to be remembered however that even when the vaccine finally made available in the country, it will be made available for the use of the higher risk groups first, before being made available for use by the common man. Doses will be first provided to the high risk groups like doctors, health care workers, etc, who are most vulnerable to contract the H1N1 infection, the Health minister was quoted as having said.

It was also clarified that once the indigenous vaccine is out again priority will be given to individuals from the high risk groups like pregnant women, senior citizens and children.

Meanwhile the swine flu death toll in the country has now gone up to 1,082 and the total number of people infected with the virus now stands at 27,901. ‘Till date, samples from 117,943 people have been tested for Influenza A (H1N1) in government laboratories and a few private laboratories across the country and 27,901 of them have been found positive,’ according to an official statement.

Swine flu cases in the national capital of Delhi reached the 9,570 and children continue to be the worst sufferers there according to this PTI report, some 5,330 children being affected by H1N1 virus, causing the disease.

According to the WHO, India continues to report maximum number of cases of swine flu in the south east Asian region.

As the H1N1 Swine Flu threat continues to dog Indians, with no vaccine available to counter dangers posed by it,  there seems to be some hope in sight with the nasal spray swine flu vaccine, developed indigenously by Pune’s Serum Institute being given the go ahead for human testing.

The Drug Controller General of India (DCGI) has given the go ahead to the pharmaceutical company to test the nasal swine flu vaccine, which has already been successfully tested on animals and is now ready to be tested on humans according to this PTI report. According to the report, Serum Institute is now in the process of identifying 50 “completely healthy” adults to undertake ‘phase- I’ human clinical trials in Pune, Delhi and Ahmedabad, according to Dr Rajiv Dhere, director of the company.

Unlike regular vaccines that are administered by injection or orally, this swine flu vaccine is in the form of a nasal spray. In other countries this is already available in spray form and is sold under the brand name ‘Flumist’. It’s actually made up of live but weakened flu viruses that allow your body to develop immunity to the flu virus.

There could be certain side effects that occur from the nasal swine flu, such as sore throat, runny nose, cough. Some people can develop muscle aches or even fever.

Although the swine flu vaccine in its spray form is easier to administer (especially for those that have a dislike for needle jabs), research done with the seasonal flu spray vaccine has shown that the spray may not be as effective in creating immunity as the injectible form of the vaccine. This is especially true for adults, however it has been seen that the spray works better is certain groups such as children. More research is required for the swine flu nasal spray however.

According to the report, the bridging trials are first step towards taking up a vaccine inoculation programme among high-risk groups in the country, such as pregnant women, children, health care workers and persons with co-existing morbidities.

“Bridging trials are needed till indigenous H1N1 vaccine is developed. The trial will help assess safety and tolerance among the diverse population in India. Several other hospitals in the country will also take part in the trials,” the swine flu coordinator in Andhra Pradesh was quoted as having said.

The process of making the H1N1 Swine flu vaccine available for commercial use in India is seems finally to have got on track. According to reports Zydus Cadila, the Indian company that is closest to producing an indigenously prepared H1N1 Swine flu vaccine for the Indian market has commenced clinical trials for their vaccine, subsequent to being given the go ahead by the Drug Controller General of India.

One of the big challenges that is to face the country’s swine flu prevention programme is the upcoming Kumbh Mela that is due to start in the hill state of Uttarakhand in the Dehradun, Rishikesh and Haridwar region on 15 January, which is among the largest periodic human congregations in the world.

The precaution of 150 doctors and 31 temporary hospitals to control the spread of swine flu at the mela has been taken by the state authorities. A stock pile of 3 lakh Tamifllu tablets have also been stockpiled by the authorities which have been supplied by the centre for the purpose.

The authorities said low temperatures and huge crowds may lead to a major outbreak of swine flu that has already killed 13 people in the hill state. Nearly 130 people have been infected by the virus in Uttarakhand. Public awareness drives about the pandemic in the Kumbh Mela region are also planned to be put in place.

“Over 120 doctors have been trained to diagnose and treat swine flu during the congregation. Besides, there are 12 others who have been trained to man Intensive Care Units (ICUs) and operate ventilators in case of emergency situations,” an official was reported as saying, in this report, adding that “There are 19 members who will form the four rapid response teams. In each team there will be at least one epidemiologist along with other doctors.”

Meanwhile the Swine flu death toll in India has now crossed the 1000 mark, with a total of 1037 individuals having succumbed to the deadly virus in the country. Over 27,000 people have tested positive so far.

Finally a step seems to have been taken in the right direction with the H1N1 Swine flu pandemic in India that has so far infected as many as 26,000 people all over the country; and we are now one step closer to the indigenous production of the Swine flu vaccine.

According to this report in the Business Standard, permission to conduct clinical trials has finally been granted to Zydus Cadila by the Drug Controller General of India (DCGI).  This, reportedly is the all important first step that will ultimately introduce the vaccine into the market for commercial use.

“We will roll out 6 million doses in the initial phase (in April),” said Pankaj R Patel, CMD, Zydus Cadila.  These doses will be rolled out at the said time assuming that all goes well with the clinical trials according to the pharma company, which has invested 80 crores in preparing the vaccine indigenously.

We plan to invest another Rs 50 crore on the clinical study and to expand our Moraiya manufacturing facility to eventually produce 12 million doses of the vaccine,” Patel added.

Meanwhile according to this Telegraph India report, Indian pacer Sreesanth, who had been infected with the Swine flu is now fully recovered and should be fit enough to return to the Indian side.

As on date, as many as twenty six thousand individuals have been infected with the deadly virus in India, and the number of fatalities resulting there from is now hovering close to 1000. As per figures computed till yesterday, 990 deaths in all have resulted from the swine flu virus in India.

A total of 275 people have died from the infection in Maharashtra. The total number of people affected with the influenza in the national capital Delhi now stands at 9,481.

The national death toll from the swine flu virus is now up to 831 with more than 24,000 people in all being infected with the highly contagious flu virus.

Maharashtra continues to have the highest number of fatalities, with 251 deaths. The national capital is another area from where there is a steady stream of news of swine flu infections. Out of the 137 new cases reported recently, as many as 59 are children and the total number of persons affected by swine flu in Delhi now stands at 8,888.

Meanwhile Australian researchers have confirmed the recommendation previously made by the World Health Organization, that for children, a one shot dose of the swine flu vaccine is likely to be enough. Although it is school aged children that have been targeted most by the swine flu virus owing to lower immune response to the infection, the Australian researchers have opined that one shot will be enough for children to build up immunity according to this DNA report.

According to experts, it is advisable to provide one dose to as many children as possible over the age of 6 months and under 10 years as possible. The vaccines have been seen to be safe for children as well as pregnant women; and the benefits from the vaccine are seen to far outweigh any risks. The researchers found that most of the adverse reactions to the vaccine were mild to moderate, but the immune responses were strong.

Though the WHO recommends that one shot is enough for children to build up an immune response to the Swine flu virus, a note of caution has been injected by the American National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDCP), Atlanta. “The immunogenicity data suggest that at least some children will be protected after a single 15-microgram dose, but the findings cannot be generalized to all children, which is why it is prudent to give two doses,” CDCP experts were reported as having said.

The swine flu vaccine is only likely to be available to Indians by about March 2010; they are not likely to reach Indian markets before that time according to the report.

According to this Times of India report, there are now 5 centers for swine flu being set up to monitor the situation. Here, treatment for swine flu cases will be offered and the center will also have isolation rooms and ventilators.

On Saturday 12 people died in India from swine flu and this has now taken the total number of dead to 780. More than 23,000 people in all have been affected by the infection.

Whereas Gambhir tested negative and went on to score 21 runs in the T20 match against Sri Lanka in Mohali on Saturday, Sreesanth was admitted to hospital on Thursday with symptoms such as sore throat, body ache and high fever. He will continue to be in hospital for the next couple of days.

No other person of the cricket team has tested positive according to cricketnext.com, and even Mayank Parekh, and video analyst Dhananjay have tested negative for swine flu.

Though no other players displayed any symptoms, as a precautionary measure, antibiotics have been prescribed to players of both teams. Tamiflu has not been prescribed. “The tests for swine flu would only be conducted on cricketers and officials of both teams who develop symptoms. Others could go in for a general check-up. No member of the Sri Lankan team has shown any symptom so far. The situation is under control. There is no need to panic.” G.S. Walia, joint secretary of the Punjab Cricket Association was quoted as having said.