Swine flu in India: fatalities caused by ignorance?

Doctors cite late reporting of symptoms for rising number of deaths; Bengaluru, Rajasthan, and Kerala report high number of fatalities

By Anushka Kaushik
Published: Friday 27 June 2014


Swine flu is back in news with one more death being reported from Kerala on Thursday, taking the total death toll in the state this year up to five. It is another reminder that the number of deaths because of H1N1influenza virus in India is on the rise. The fatality rate reached a high 21 per cent as of June this year, according to information from the Union health ministry.

As many as 58,285 people have been affected and 3,815 swine flu deaths have been reported in India between 2009 and 2013. Globally, the biggest H1N1 outbreak in recent times was reported in 2009 when approximately 90,000 people were infected and 382 people died of the disease, which was classified as a global pandemic at the time. Since then, although efforts at disease control have been successful, people continue to succumb to the disease in various countries.

Swine influenza or flu is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses do not normally infect humans, but the outbreak in 2009 was due to a novel influenza A virus that had not been identified in people before. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns. Human-to-human transmission occurs in the same way as seasonal flu, through coughing or sneezing. The disease spreads very quickly in crowded places and cold and dry weather enables the virus to survive longer. H1N1 is contagious and can spread through direct or indirect contact.

With the latest victim, a 25 year old woman from Kasaragod district in Kerala, succumbing to the virus, the death toll as of this month stands at 90 for India. Doctors and health officials from states where the virus is quickly spreading have stated that a substantial percentage of deaths have been occurring due to patients reporting their symptoms late. This is in stark contrast to the situation in 2009-10 when hospitals in the country could barely keep up with the sheer number of samples that had to be tested as paranoia surrounding swine flu gripped the nation.

Unfortunately, according to health officials, a large number of patients are seeking medical attention when they’ve already reached the last stage of the disease. Neglecting early symptoms such as cold and cough has lead to the development of acute respiratory problems or pneumonia in patients, after which the ability to fight the virus becomes drastically reduced.

Fatality rate much higher now
In Bengaluru alone, 64 cases have been reported till now.  The number of fatalities has been high in states like Rajasthan (which has contributed to 50 per cent of the total number of deaths, with 22 victims), Kerala, Gujarat, and Maharashtra. The severe increase in fatality rate in 2014 is a cause of concern. Currently, the fatality rate of H1N1 stands at 21 per cent (90 deaths in only 414 reported cases), compared to a much lesser 13 per cent in 2013 and 8 per cent in 2012. Delhi, Maharashtra, and Kerala reported the most number of cases in 2009, 2010, and 2011 respectively. It has also been observed that southern and western states of India have reported a higher number of deaths. 
Additionally, as the weather gets more humid with the onset of the southwest monsoons and states receive rainfall, the cases of H1N1 are likely to go up. 
The global pandemic in 2009 had claimed almost 1,000 lives,  largely due to a lack of preparedness and perhaps poor anticipation on the part of government authorities. Since then, the Union as well as state health departments have attempted to ensure sufficient stocks of Oseltamivir, the swine flu drug, as well as generate awareness about preventive measures.
This year, health departments of states such as Kerala and Karnataka have already issued alerts advising people to take preventive measures and check for symptoms.

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