Facing an unprecedented spike in swine flu casualties, the Health Ministry has issued guidelines not to test flu patients for H1N1, unless essential. This would mean that these patients would still be treated for the disease, but would not add to the already explosive swine flu statistics across the country.
India has reported 5,157 cases of H1N1 since January 1 — 505 of them on February 10. There have been 407 deaths in the first 41 days of 2015 — almost double the total toll of 2014 at 216.
Health ministry in its revised guidelines released Wednesday classified flu cases into category A (who do not need testing and can stay at home but must avoid contact with high-risk family members), category B (who do not need H1N1 tests but may need Oseltamivir) and category C (who may have symptoms like breathlessness blood pressure drop etc who should be tested and hospitalised).
Explained a senior ministry official: “We have categorised patients based on the intensity of symptoms and level of risk. There are some who do not need testing for H1N1 though admittedly many of them would have that infection as it is the circulating virus right now. But they do not need to be treated with Oseltamivir. Healthcare workers do not need personal protective equipment when they treat these patients.”
While the directive may keep numbers down, for health workers it would mean working with or without personal protective equipment. “There is a definite risk of transmission. That’s why in my OPD, I have made it a norm that when examining any patient who has a cough, the staff should use masks. I think the cases are grossly underreported. The government should authorise a lot more laboratories for testing because meticulous data is important,” said Dr Neeraj jain, consultant chest physician at Sir Ganga Ram Hospital.
Doctors in several city hospitals, including private ones, said they are often required to see flu patients without protective gear just because the H1N1 Real time Polymerase Chain Reaction test, which confirms the infection, has not been performed and hence the patient is not categorised as swine flu.
“At times, we have to fight case managers and administrative staff for protective gear. Working without protection exposes us to the risk of infection and given that we are dealing everyday with sick patients with potentially compromised immunity, this is a larger threat,” said a senior resident doctor of a private hospital, requesting anonymity.
“I am directly monitoring the situation and it is under control. The health secretary takes a daily report from the affected states. We are fully prepared. The situation may continue to be same for five-seven more days. We have already purchased enough equipment for treatment and testing,” said health minister J P Nadda.
Categorisationof H1N1 patients
Category A: Patients with mild fever with cough/sore throat. With or without body ache, headache, diarrhoea, vomiting. Do not require testing, hospitalisation or Oseltamivir but have to avoid public places or contact with high-risk family members. Need monitoring
Category B: Additional symptoms like high-grade fever. May need Oseltamivir, especially if pregnant, senior citizens, children, patients with lung/kidney/liver disease/cancer/AIDS etc. No need to test
Category C: Have chest pain, breathlessness, drowsiness, blood pressure fall etc. Need testing and hospitalisation