Swine Flu: Inconsistency press statement and lack of coordination seen in this epidemiological control
Why taking so long in getting lab result? Who recommended Ayush medicine?

Dr Suresh Singh *

People taking precaution against Swine Flu in March 2015 :: Pix - Hueiyen News Service

As of today (March 16 2015), out of 5 suspected cases, 2 died (1 lab confirmed one, another suspected one); of the remaining 3, one has improved and discharged accordingly and the other 2 are undergoing treatment at RIMS and Shija Hospital respectively according to Health Minister T. Phungzathang.

The unfortunate died one was admitted to private Shija Hospital on 27/02/2015 after being told that ventilator and other facilities are not available at RIMS This is according to the husband of the late victim. The husband further told media personnel that Tamiflu medicine was not available at various points at that time and expressed his disgust that his wife might have been saved had the medicine was administered in time.

My sympathy and prayer goes to both the families of the 2 victims. Though RIMS formed a fact finding team, it needs a through and impartial enquiry. Furthermore, we are not told yet the results of the other samples send for confirmation. What is going on?

Many pertinent questions do arise from this epidemic.

1st one is why it is taking so long in diagnosing the case? The 1st patient was admitted on 27/02/2015 at Shija hospital and the test was confirmed only on 5/3/2015.

The 2nd pertinent question is why the sample is sent to Bombay (preferably Private lab SRL) costing about Rs 5,000/or so to the patient party and not to GOI lab at NICD, Delhi. The same can also be sent to NICED, Kolkata and Regional Medical Research Centre (RMRC) at Lahowal, Dibrugarh (near medical college) and other centres at free of cost.

The 3rd pertinent question is why the medicine Tamuflu tablet is not available on time? According to a press report, though Health Director O. Ibomcha expressed that the required medicine was procured from 11/02/2015, he could not clearly stated whether these are available at the treating centre/centres.

The 4th one is whether private Shija hospital informed the Health Directorate in time about the suspected cases as there is a standing order to inform such cases?

And the 5th one is whether Health Directorate sent such circular to various private hospitals, JNIMS and RIMS about this specific disease and control measures to be taken? Even today, newspaper reports had quoted that RIMS was not specifically informed about the +ve cases.

Normally medical directorate public health section should collect the sample and send the same to Delhi on special arrangement at free of cost and the result would have been confirmed in 2/3days. Hence the above 5 pertinent questions have to be analysed and remedial measures taken.

Another area is the origin of this epidemic. According to Dr. Palin of Shija hospital, there was no history of the confirmed case going out of the state. However, Health Director Dr. Ibomcha stated that the victim visited Sikkim.

Hence, it is better to avoid inconsistency and the health Directorate, which is the final authority, should be bold enough and give a clear statement of either imported or indigenous one. To me, it looks like an imported case. With Assam confirming 10 cases and Mizoram sending 5 samples for confirmation, it is sure that the disease has spread to N-E region.

Epidemic data reveals that India has been fighting the disease since 2010 with 1,763 death and 20,603 affecting in that year alone. The virus H1N1 emerged in 2009 and killed more than 18,000 people worldwide between 2009 and 2012. In India alone, according to Union Home Ministry officials, more than 1,600 people died because of the disease with around 28,400 people suffering in the last 2 _12 months.

Recent reports suggest that Massachusetts Institute of Technology (MIT, USA) found the Indian strains more virulent than others. Either way, the virus is not going to die a natural death as it is found in sporadic form from 2010 onwards in India. Overall, India's control measures for this particular virus are dismal and not up to the mark. Manipur will face similar situation and hence, we have to plan and act accordingly for our own.

Another confusing scenario is the supposedly free treatment by Ayush medicine Arsenic 30 in our state. Newly created Ayush Director (AD) K. Loken is quoted by various newspapers as saying that the AD has planned to purchase for treatment of 10 lakh people.

The pertinent question is – is it recommended by the Govt. of India and if so why it is not included in the advisory? To the best knowledge of the writer, it is, so far, not recommended by the GOI.

Also, why the Health Director, who is the boss of this disease control, is remaining silent? Who is the i/c in our state?

The prediction in my last article in this column - State Health Policy at the top: too many Directors leading to lack of co-ordination and system failure - is becoming true.

It is appropriate that the health minister and the health commissioner clarify this position. Instead of purchasing so many Ayush tablets, I will recommend purchase of H1N1 proven mask and distribute it freely if the state has resources. That will be a wise step.

Though certain lapses were seen in the beginning, the public in general should not panic now. The measures so far taken lately are satisfying. With public awareness becoming more and more, the pressure to the doctors and the health institutions will become more and more acute.

What the ordinary people should do is - follow the guidelines seen in newspaper/ electronic media. That means "prevention is better than cure" is the best medicine. This I say with my rich knowledge and experience gained during our successful Bird Flu Epidemic Control in our State in June/July 2007 while I was Health Director.

It is worth to remember that Bird Flu was contained in greater Imphal area by a fighting team of 20 survey teams consisting 20 doctors, 63 supervisors and 717 workers. For the present, the only thing is that the Medical Directorate should face it calmly and courageously with special reference to the 5 pertinent points raised above.