Written by Tanu Singhal
With COVID-19 sweeping the globe, we are in the midst of an unprecedented crisis. For me, it brings back memories of the swine flu pandemic of 2009. In April that year we started hearing about a virus with genetic material from birds, swines and humans which was spreading rapidly across the globe. Ours was a new hospital then and I had just started my career as an ID (Infectious Disease) specialist. In July 2009, a 40-year-old man who had returned from the Caribbean walked into my room. He was running fever with chills and had blood-shot eyes. He cut a textbook picture of an H1N1 patient. Promptly, I referred him to the infectious disease hospital in Mumbai — he tested positive for swine flu. He was the first case in Mumbai. I was nervous, I promptly put him on the Oseltamivir medication. I had to travel to Kolkata the next day for a meeting but I skipped it because I feared I might infect others on the flight. Fortunately, I did not fall sick.
Over the next few weeks we started getting more cases and they were admitted in the isolated ICU. There was severe stigma associated with the illness, and I remember being reprimanded in the print media when I suggested to a well-connected parent that their child could have H1N1 infection. Back then, Oseltamivir was in short supply and it needed a special prescription. The tests also could only be done in government centres. We saw many cases and deaths too. However, over the next few months the virus became a part of our lives; we got used to it. Isolation protocols were relaxed and then eventually stopped. Oseltamivir became freely available. Over the past 10 years we have regularly got patients with mild and severe H1N1 flu, with resultant mortalities, but it is just like any other illness.
It did change some things though — we looked at flu with greater respect. Rates of vaccination against flu increased and, for the first time, we started using molecular methods in clinical practice to diagnose respiratory viral infections.
In the years that followed, we continued to have pandemic scares — the Middle Eastern respiratory syndrome coronavirus (MERS CoV) in 2012-2013; and the Ebola virus disease in 2014. We prepared for them as well but fortunately they didn’t reach us. Fast-forward to 2020. I started to hear about COVID-19 sometime in mid/late-January. Towards the end of January India started placing travel restrictions, and I remember going to the Mumbai international airport to speak to authorities about the disease. I also spoke to the hugely apprehensive crew of Air India in Mumbai who were slated to bring back Indian students stranded in Wuhan. February was relatively quiet. Three students tested positive for the virus in Kerala and recovered well, and cases in China also started declining. We were all optimistic that the virus, like the MERS and Ebola, wouldn’t reach us or the rest of the world. In fact, I booked tickets for a summer trip to Europe. But in March, all hell broke loose. By the second week, South Korea, Italy and Iran saw an exponential increase in the number of cases/deaths, with their healthcare systems crumbling under the weight of the disease. Then, cases started growing in Spain, the US, France, Germany, and also India. The government imposed international travel restrictions, followed by home-quarantine, domestic travel restrictions and, finally, a lockdown. We also prepared to admit patients in our isolation ward.
But COVID-19 is not following in the H1N1 footprint. This virus is more devious and spreads faster. The basic case reproduction rate (number of people infected by one person) for COVID-19 stands at 2-3, while that for swine flu is 1.3. The case fatality appears to be higher too — 1-2 per cent for COVID-19 as against 0.1 per cent for the H1N1 flu. There is no anti-viral drug or vaccine for COVID-19 yet, unlike the swine flu, where Oseltamivir was available and a specific vaccine was developed promptly. There were no lockdowns and curfews at the time. Now people are fighting many enemies — disease, hunger and poverty. It is like a state of war. OPD services and elective procedures were affected in 2009 as well but to a much lesser extent. Now we fear the neglect of non-COVID-19 patients and the morbidity and mortality in this group may exceed that due to COVID-19. Other public health programmes for immunisation, TB, HIV, vector-borne diseases are sure to take a hit. This did not happen during H1N1.
Healthcare workers are most vulnerable to COVID-19 and hence, the need for Personal Protective Equipment (PPE) is much more than recommended for flu. We are already staring at PPE shortages, and the morale of the healthcare workers is at an all-time low.
And then, there is the infodemic — the explosion of information on social media now is infinitely higher than during H1N1. Everybody is an expert, many remedies are doing the rounds, and people are self-medicating. Hydroxychloroquine and Azithromycin are being mentioned everywhere. There is an air of panic, anxiety and hysteria.
But compared to 2009, we also have certain advantages now. The responses of the government and public health system are stronger and sturdier, and healthcare systems all over the world are connected like never before. So let us be hopeful. Will this virus just vanish, co-exist with us, or overwhelm us? Time alone can tell.
Dr Singhal is Consultant, Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital in Mumbai
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