At Punes Prayag hospital,Ram Mehra (name changed) has been battling swine flu for the past 10 days. He was admitted with pneumonia and Acute Respiratory Distress Syndrome (ARDS),and doctors initially felt he would not survive the flu attack. The patient was also immuno compromised as his heart muscle was not adequately pumping blood, says Dr Shrish Prayag,critical care intensivist at the hospital.
However,Mehra pulled through,and now no longer needs ventilator support.
While the number of those to have succumbed to swine flu climbed to six in the city on Wednesday,its cases like Mehras that make it different from previous years. The H1N1 virus has suddenly turned active this month after remaining dormant for more than a year but from what doctors have seen so far,the strain hasnt shown significant changes.
Despite the deaths in quick succession,Pune,too,appears to have come to treat swine flu as just another flu. There is no panic stocking of face masks or queuing up for vaccines and schools have stayed open but for issuing some general guidelines.
On August 3,2009,Pune-based schoolgirl Reeda Shaikh became the first victim of swine flu in India. While sporadic cases were registered last year,it is only this March that the virus has turned increasingly active,with 76 infected with it in one month alone and six dying in the city.
It is the suddenness with which the virus turned active that the medical practitioners find unusual and that they are closely looking at.
Many believe it has been brought on by weather fluctuations in the city cold in the early mornings and nights,with hot day temperatures.
At the National Institute of Virology,experts are assessing the genetic make-up of the virus to see if there is a newer strain. So far there are no significant changes,assures Dr A C Mishra,NIV director. However,studies are underway. Mishra believes that as the temperatures rise with the coming summer,this could just be a short spurt similar to what has been recorded in Mexico and countries in Asia and Central America. Last year globally,swine flu was at an ebb. While short spurts are being recorded in other countries this year,it could well be a short spell where the virus will surge and then die down, says Mishra.
In fact,considering the drastic fall in numbers last year,the state had decided to withdraw the Epidemic Diseases Act invoked in 2009 to prevent the disease from spreading. State officials say they may let the Act continue for now.
The government has held hectic meetings to work out preventive measures,led by Deputy Chief Minister Ajit Pawar. One of the moves discussed was to ensure adequate stock of oseltamavir tablets in Pune. Private practitioners have also been told to keep an eye out for patients with suspect symptoms.
However,the city is taking the deaths in its stride. Chemists who had faced a shortage of face masks three years ago stock only a few now because of lack of demand. Gone are the queues outside government hospitals or centres for screening. While schools have not issued any advisories,parents have been urged not to send their children if unwell.
Its only patients with severe symptoms such as fever lasting a few days,throat pain and breathlessness who are being admitted to isolation wards by hospitals. Throat swabs are taken of patients who have strong clinical presentations for swine flu. Oseltamavir tablets are administered immediately. The others are being handled by the outpatient departments.
Dr Mohan K T,the consultant pulmonologist at Aditya Birla Hospital,finds a difference among patients reaction to the virus as well.
A pregnant woman who was infected with swine flu in the seventh month had a premature delivery and has been on the ventilator for over 20 days now. But she is pulling along, he points out,adding that three years ago,among those at highest risk of the virus were pregnant women,apart from diabetics,and persons with congestive heart failure and other ailments.
Most of the patients to have died this month had a medical problem,district civil surgeon Dr Vinayak More pointed out.
Serum Institute of India is also unlikely to go ahead with production of the intranasal vaccine against swine flu. Serum was the first in the country to manufacture such an indigenous vaccine. However,sales had not been high and a million doses had to be destroyed. Dr Rajeev Dhere,senior director at Serum Institute of India Ltd,believes that due to the vaccination and exposure to the virus the past few years, a herd immunity has developed. Serums efforts are now concentrated towards a trivalent seasonal flu vaccine that can effectively combat H1N1 virus,Influenza B and H3N2 virus.
Dr D B Kadam,head of Department of Medicine at B J Medical College and Sassoon General Hospital,sums it up: Swine flu is more of a seasonal flu now.