Amit Paranjape’s Blog

Is the paranoia around H1N1 in Pune / India justified? – A look at some factoids & information resources

Posted in Current Affairs, Healthcare & Medicine, Pune by Amit Paranjape on August 12, 2009

Honestly, I don’t have the exact answer. Only time will tell whether we, the citizens of Pune (and India) over-reacted, or should have done a lot more. All we have right now are statistics, data-points, examples from other regions of the world, and expert advisories to look at and  learn from. 

In this article, I am listing out the various relevant factoids, observations and information resources that I have stumbled upon over the past few days. I will let the readers draw their own conclusions.

What is painfully clear though is that we don’t have enough data, and we often don’t rely on credible sources of information. In absence of data and facts, the common population is always swayed by ‘headlines’ and ‘sound bites’ – Sadly, this is true even in the 21st century. Thanks to the latest technology, data can be accessed easily; yet this same technology can also help in spreading rumors a lot faster as well.

Here are some factoids and observations:

1. According to WHO and other estimates, there are nearly 1 Billion cases of normal flu (influenza) each year.  Around 3-5 Million of these are severe and 300,000 – 500,000 of these result in deaths.

Statistically speaking (based on a simple extrapolation that India’s population is apprx 1/5 of World Population) that translates to 200 M cases, 600,000 – 1 M severe cases, and 60,000 – 100,000 deaths.

For a city of Pune, that translates to 500 deaths/year or 10 deaths/week.

All these are huge numbers. And yet, until a few weeks back, we hardly even thought about ‘influenza’ as something serious! 

2. On a related topic – Pollution levels in Pune and in all major Indian cities are at very dangerous levels. Yet very few perceived the need to wear masks over all these years. Do we know the statistics of upper respiratory problems in major Indian cities?

3. According to WHO (World Health Organization), the recommended mask to protect against H1N1 infections is the one that meets the N95 standard. Yet, these constitute a miniscule amount of the ones being worn around in Pune. The others don’t really offer any significant help. For a complete list of Do’s and Don’ts regarding masks – please refer to the next section.

4. Commonsense tells us that it is better to wear masks in crowded places; but they are not very critical when walking or driving on uncrowded, open roads. Yet, what we are seeing around in Pune is quite the opposite. It is also amazing to see so many people wearing masks that are covering their mouths, but not their noses?!

5. Last year, over 200 riders lost their lives in 2-Wheeler Accidents in Pune – many of these deaths could have been prevented had the riders been wearing helmets. Yet I see so many people on Pune roads today wearing masks but not helmets!

6. According to what I have read thus far, the H1N1 strain is not significantly more virulent than the traditional influenza virus. The prescribed treatments are also very similar to normal flu.

7. Most individuals who get infected with H1N1 will get back to normal in a few days (similar to the normal flu). This is not a virus like HIV that an individual will carry with him / her for the rest of their lives!

8. Apparently, a vast percentage (by some accounts, up to 90%) of the Indian population tests +ve on the skin test for TB (Tuberculosis). Majority of these tests yield a –ve result on a follow-up (and more reliable) X-Ray test. Disease causing germs (viruses and bacteria) are present everywhere – in most of the cases, the immune system should be able to take care of them! It is only when the immune system becomes weak (in case of old age, young children, patients suffering from certain chronic ailments, etc.) do these germs present any significant danger.

 

Here are some useful information sources:

1. Flu related statistics (from Roche Laboratories – makers of Tamiflu)  http://www.flufacts.com/impact/statistics.aspx

2. Comprehensive Flue Related Information from US Dept of Health & Human Services and CDC (Center for Disease Control)  www.flu.gov  http://www.cdc.gov/h1n1flu/

3. Comprehensive Flue Related Information from WHO (World Health Organization) http://www.who.int/csr/disease/swineflu/en/

4. A map based depiction of Flu cases across the globe http://www.healthmap.org/en

5. WHO – FAQ about H1N1 http://www.who.int/csr/disease/swineflu/frequently_asked_questions/what/en/index.html

6. WHO – Document regarding use of masks http://www.who.int/csr/resources/publications/swineflu/masks_community/en/index.html

7. WHO – Document regarding cleaning hands as a key preventive measure http://www.who.int/csr/resources/publications/swineflu/AH1N1_clean_hands/en/index.html

28 Responses

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  1. Raghu said, on August 12, 2009 at 5:51 pm

    What would happen if any other disease like typhoid or malaria was detectable in only one hospital in a city? The same kind of paranoia and panic will result. The problem, imo, is not the disease – it is the distribution channels to tackle the disease. It is shocking that the indian government had 3 months to prepare for this (since the outbreak in Mexico) – but chose to wait till the virus hit our shores – so as to say.

  2. Amalesh said, on August 12, 2009 at 7:19 pm

    Nice blog Amar, and this is so very true, something new comes up and people focus on that. But worse things that are going on until now are always ignored…Well said!

  3. Sam said, on August 12, 2009 at 8:45 pm

    Agree with your points.
    But few things are different here than normal influenza
    1 – drugs and tests are controlled by govt
    2 – private tests are not affordable
    3 – No vaccine available yet even in US/UK

    On top of that normal influenza deaths are unheard of [don’t recollect such thing in the neibourhood since last 35 years!]. So statistics are not always to be believed.

    So thats what makes this situation different and probably as dangerous as malaria, chicken gunia, dengue etc.

    Fortunately new strains have not emerged yet, but given the “conditions” of indian cities and awareness levels, thats bound to happen soon😐

  4. Amarnath said, on August 12, 2009 at 9:20 pm

    You cant curb mass hysteria with logic. This is akin to a killer being on lose in a city or the Anthrax scare in 2001 – you could be next. It’s the ease with which you could be next and the possibility of a fatal outcome that makes people panic in such cases.

  5. Amit Paranjape said, on August 12, 2009 at 9:38 pm

    Raghu, Amalesh, Sam: Thanks for your comments.

    Amarnath – Agree with your point around mass hysteria.

  6. Rahul said, on August 12, 2009 at 9:46 pm

    Nice blog Amit.
    This is fear of the unknown. No-one knows how fast this virus can/will spread. So, people are taking caution. Also, lack of healthcare facilities in Pune to deal with this are apparent, so no-one wishes to take any risk. Wearing masks with no one-way valves for inhaling and exaling is not useful at all, since you end up breathing in what you exhaled !! Funny that people do not realize that.

  7. Vaibhav Domkundwar - BetterLabs said, on August 12, 2009 at 11:07 pm

    Well written, Amit. The media is the biggest problem in the current situation – its an absolutely hopeless situation. I wish they did their own research or just read this post to make sure this is all highlighted in their broadcasts.

  8. amitabh said, on August 13, 2009 at 1:06 am

    Amit,
    You make several pertinent points in your post but it may be helpful to differentiate between who acrues the benefits of wearing a mask and who doesn’t [points#3 & 4].

    As the WHO article clearly states, a mask benefits people in close proximity (1 meter or less) of an infected person wearing the mask. A mask is stated as being not very effective at protecting those at risk of being infected – so wearing a mask to a crowded place when you want to avoid being exposed to H1N1 is almost useless if the infected person is not wearing a mask! Put another way, a mask should be worn by those infected by H1N1, to benefit those that are healthy.

    This reference may be helpful-
    http://www.naturalnews.com/026160_preparedness_swine_flu_outbreak.html

  9. Shantaram Kane said, on August 13, 2009 at 7:49 am

    Amit,
    It is necessary to provide information on a variety of preventive steps and also how masks can be abused/misused.

    However, very little is being said about how to contorl other factors to help improve immunity. These include
    1. Abalanced diet – grains, pulses, fruit, variety of vegetables, milk, nuts etc.
    2. Distirbute food intake i.e do not eat too much at one time
    3.Reduce/avoid food whih is likely to lead to system upset and hence, higher succeptibility to any infection
    – Pungent/Sour food
    – Fermented Food – causing allerrgic reactions due to histamine
    – Hydrogenated fats
    – Deeply fried food in excess

    4. Herbal extracts e.g tehre isa recipe going around which talks of tulsi leaves + haldi + 3-4 black pepper seeds to be boiled and teh decoction to be taken. One can think of more receipte’s and they will contribute to improving ressitence.

    I have my own vrsions, too.

  10. Parag Dandekar said, on August 13, 2009 at 9:32 am

    H1N1 is a new virus. Therefore, awareness about the same is warranted.Yes, it is a fact that there are about half a million deaths due to common infuenza. Compared to this fact, H1N1 has been less damaging so far. But, yet the results of H1N1 are to unfold in immediate future. In Singapore, H1N1 is already on its way out. There were several thousand cases of infection in S’pore. It did set up a panic reaction in the government and the general public. But now people have gradually come to terms with H1N1. In india. we can take simple precaution of washing hands from time to time, avoiding crowded places and generally observing better cleanlyness.
    I am certain, H1N1 will also pass away after a while like Saars virus.

  11. Niranjan said, on August 13, 2009 at 10:15 am

    Great post, Amit. I totally agree with the lack of reliable, analysable and usable information. So, am adding to the confusion with this interesting take on strengthening immunity – of course collected from a variety of reliable/unreliable sources :))

    Swine Flu can be dangerous for young, otherwise healthy adults as it may be able to induce a “cytokine storm,” in which a patient’s hyper-activated immune system causes potentially fatal damage to the lungs.

    Babies and older adults have weak immune systems which is why they are vulnerable to complications from the usual yearly flu – they tend to get pneumonia and other opportunistic infections after being weakened further by the yearly flu, but don’t have systems which really react strongly to the flu itself either because they are young and have weak immune systems or are older and have many past flu infections to strengthen the specific immunity factors which are the same for many flu strains.

    What happens with young and healthy patients is that their immune systems react so strongly that they can triggers something known as a “cytokine storm”.

    When this happens the person’s immune system overreacts to the totally new flu virus and actually attacks the body’s healthy organs and systems – that makes the healthy approximately 15 to 60 year old individual the most likely to actually succumb to the flu.

    A cytokine storm occurs when the body’s immune system over-reacts to an intruder, such as a virus, by producing high levels of cytokines, which are signaling chemicals that help mobilize immune cells capable of removing infectious agents from the body. When too many cytokines are produced, they can stimulate an inflammatory response in which the accumulation of immune cells and fluid at the site of infection may prevent affected tissues and organs such as the lungs from functioning properly and may even cause death.

    If you notice, some of the deaths in India (and abroad) have been in the age group of 15 to 60 and people with normal health. Some scientists believe that this could be because of the cytokine storm.

    The whole phenomenon is not well understood yet and that adds another strong reason to why people-who-know don’t yet seem to know for sure how dangerous Swine Flu potentially is!

    Anyone shedding light on this aspect?

  12. Nilesh Sane said, on August 13, 2009 at 10:25 am

    The media is not part of a solution in this country, its generally been a part of the problem. Compounding every thing they touch.
    The only positive I which I can draw from this is that people have started to use masks while driving/riding/walking. Atleast they will be protected from the pollution if not anything else.
    The other day I saw these masks being sold by beggars for ten bucks and shockingly, I saw a person buying them. So much for being health conscious!

  13. Amit Paranjape said, on August 13, 2009 at 10:37 am

    Niranjan – Interesting points. Hopefully some other expert might be able to shed light on it?

    Thanks
    Amit

  14. Abhijit Athavale said, on August 13, 2009 at 10:47 am

    I think what has not been made clear to the general public is that a vast majority (90+%) of the people will get cured without any treatment whatsoever due to their higher immunity.

    The SARS virus, which was far more deadly, affected a miniscule percentage of Indians. Why? My thesis: because Indians have better immunity due to the general inhygeinic condictions we face in our daily lives.

    -Abhijit

  15. Sunil said, on August 13, 2009 at 12:05 pm

    hi Amit,
    Thanks for collecting and publishing all the information together.
    The main issue here is not this disease, which in itself is not such a grave threat to lives. Issue is the inefficiency of the government to tackle emergencies like these. This was also the case with mumbai terror attacks. The administration only wakes up when one is actually faced with certain emergencies. What emerges is absolute panic. I think we are lucky this disease is not such a difficult domain! I dread the day we have to face something more destructive in nature!
    Also the problem with our governance is not having their own assessment of a situation. They only look westwards for ready solutions! Sometimes problems are indigenous, and require apt responses.

  16. Sanjay Deshpande said, on August 13, 2009 at 12:42 pm

    Dear Amit,

    I just have 2 questions:

    1. Is one at a greater risk in H1N1 infection than any other known communicable diseases (like other FLU viruses)? Which means is the mortality rate any higher in this infection than any other infection of the same influenza family?

    2. Whether in case of H1N1 or otherwise what has the Government to do in treating people at large apart from making the treatment accessible and affordable for those who cannot afford it through the public health care system?

    Regards,

    Sanjay Deshpande

  17. soumitra said, on August 13, 2009 at 1:33 pm

    All swines No flu
    Know Swines Know Flu

    Look who is in charge of coordinating the response to swine flu…two of the most corrupt, inefficient and self serving sections of society – bureaucrats and politicians ! what did you really expect ? A sincere honest attempt to help the aam aadmi ! You must be kidding… i will not be surprised if it later on comes out that some newspaper group or a politician had a substantial stake in mask producing factories…

    Kalyug hai bhaiya ! Kalyug…if the flu will not get you, the government will !

  18. kaustubh said, on August 13, 2009 at 3:04 pm

    Just another point..

    If you look it from different perspective this panic / mass hysteria is required to make Indian ppl understand the seriousness and follow the rules..they wont listen to media related awareness programme .. what each one fearing is of death and if tommorow media start saying that virus is not deadly or no one is dying ..each one will be on streets and will be spitting / sneezing and doing all those things which they have stopped due to this fear..

    I agree with Soumitra that mask company must be owned by some politician like we herd about helmet company..

    lot to discuss on this issue..

  19. Amit Paranjape said, on August 13, 2009 at 3:11 pm

    Kaustubh – Good point. If the seriousness goes away, then it will be back to the helmet scenario!

  20. Sojwal said, on August 13, 2009 at 9:58 pm

    Very relevant point someone here mentioned about an infected person needing to wear a mask..reminds me about Japanese people who voluntarily wear a mask without fail as soon as they catch something like even common cold, so that others are not troubled by being infected from them. We, on the other hand are wearing masks only to avoid being infected. It’s one of the fundamental differences in the mindset between us & them.

  21. Bablu Pailwaan said, on August 14, 2009 at 7:59 pm

    Mala tar watate ki Peprat ale naste tar ajun jaast Flu cha prasar zala asta. Peprat bhadak liwale he thikach ahe. Ata public jara sakal wachun shaane zale haye.

  22. sanjay ganorkar said, on August 15, 2009 at 5:34 pm

    dear amit
    nice blog
    very relevent points
    raises many question about other ailments and puts swine flue in a different perspective

  23. Amit Paranjape said, on August 15, 2009 at 9:13 pm

    Sanjay, Thanks for your comments.

  24. Rahul said, on August 17, 2009 at 12:41 pm

    Dear Amit,
    Very informative blog. Intellectual comments as well.
    Thanks for putting all points together and sharing it.
    -Rahul.

  25. […] decreased significantly and every person was wearing masks [2]. Was this kind of panic warranted [3] ? What caused it and what is the outcome that we could expect from […]

  26. kostub said, on August 18, 2009 at 5:44 pm

    Amit, Thanks for the informative posts and the various links.
    You can read my view point at:
    http://hoothoothoot.wordpress.com/2009/08/18/the-swine-flu-panic/

  27. […] Is the paranoia around H1N1 in Pune / India justified? – A look at some factoids & information… […]

  28. Aditi sharma said, on December 31, 2009 at 2:41 pm

    The statistics of deaths are quite under reported in pune.

    See this post..
    http://www.indianrealestateforum.com/p-builders-re-bulls-theory-proved-wrong-post48592/postcount589.html


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