Influenza A (H1N1) Revised Guidelines as on 14.8.2009

In order to prevent and contain outbreak of Influenza-A H1N1 virus for screening, testing and isolation following guidelines are to be followed:

At first all individuals seeking consultations for flu like symptoms should be screened at healthcare facilities both Government and private or examined by a doctor and these will be categorized as under:

Category- A

• Patients with mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised as Category-A. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor.

• No testing of the patient for H1N1 is required.

• Patients should confine themselves at home and avoid mixing up with public and high risk members in the family.


Category-B

(i) In addition to all the signs and symptoms mentioned under Category-A, if the patient has high grade fever and severe sore throat, may require home isolation and Oseltamivir;
(ii) In addition to all the signs and symptoms mentioned under Category-A, individuals having one or more of the following high risk conditions shall be treated with Oseltamivir:

• Children less than 5 years old;
• Pregnant women;
• Persons aged 65 years or older;
• Patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS;
• Patients on long term cortisone therapy.

• No tests for H1N1 is required for Category-B (i) and (ii).

• All patients of Category-B (i) and (ii) should confine themselves at home and avoid mixing with public and high risk members in the family.




Category-C

In addition to the above signs and symptoms of Category-A and B, if the patient has one or more of the following:

• Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails;

• Irritability among small children, refusal to accept feed;

• Worsening of underlying chronic conditions.

All these patients mentioned above in Category-C require testing, immediate hospitalization and treatment.

Swine Flu Scenario in Pune

The number of death victims associated to Swine Flu has touched 6(it was 5 when I started typing this) and the scare is quite palpable amongst the citizens of Pune. I have been carefully observing the developments in the last couple of days and wanted to register some of my thoughts on this issue.

First and foremost of the concerns is that it has been more than a week and the government is yet to come with the defined protocol to follow while dealing with Swine Flu. It is understandable in a situation like this, the government cannot work with some pre-set guidelines and needs to condition their strategy and evolve different protocols as the situation demands.

Just the day after the first victim had died, the government attributed it to not approaching the designated health care facilities in time and losing valuable time by consulting the private medical practitioners. In-fact, one of the health department official(I think it is the health minister of Maharashtra) went as far as telling that licensing of the private doctors will be cancelled if they treat someone showing swine flu symptoms.

Just a day or two after that, government is suggesting that private doctors needs to treat them and should not send them away. The ambiguity and dilemma in defining the strategy to deal with how situation evolve is understandable. But should not they deal with some forethought. I mean if within a couple of days, one imagines a scenario of engaging private medical professional in handling the crisis, what is the need to take such an aggressive posture.

And the information also seems going back and forth on all the issues associated, like administering Tamiflu to suspected individuals and everything. The teacher who lost his life in pune was asked to go back and told that he is not a possible suspect by the same government doctors when he has approached them. Such cases are in the rise, so the diagnosing doctors decision whether to send the sample for testing or not is still very ambiguous.

Even for simple things like procuring the masks to protect against the virus, the special protection masks, which are not so easily available at-least needs to be made available to the high risk people such as the pregnant women or other ailing people who are more risk prone and are under medical care and more susceptible to medical infection.

Also with the number of death counts increasing, it is a issue of serious concern, whether the government has any strategy on how intensive and critical care departments will cope with high patient numbers.

It is not just enough to request people not to panic, without making adequate actions that would make them feel confident of the situation.

As regards to spreading the awareness and establishing the proper information to communicate, the fundamental issue as stated in the earlier paras are to establish and define, clearly what needs to be communicated.

One of the doctors on TV, suggested that information spread through radio does not seem to be happening at all, I think all media tools like SMS, FM radio channels all need to be channelized for the information spread. Fortunately it is reported that the spread of the Flu is not large in rural areas, in the event of such a spread, the information spread through Radio needs to be effectively used.

I will keep posting on whatever that in the course of time thoughts I have on this issue that needs to be shared with.