With the rise in swine flu (H1N1) cases across Mumbai, the Brihanmumbai Municipal Corporation (BMC) has issued treatment protocols. Depending on the severity of the infection, patients will be divided into A, B and C category. Only patients under C category with severe symptoms will be admitted to the civic-run Kasturba Hospital.
According to the BMC’s data, only 21 swine flu cases were recorded in the city in July last year whereas the number has climbed to 64 as on July 24 this year. This has become a cause of concern for the civic body.
As a precautionary measure for bed management in case of any swine flu outbreak, the BMC has bifurcated patients into three categories. Patients under A category with mild fever (body temperature below 38 degrees Celsius), cough, throat irritation, body ache, headache, diarrhoea and vomiting will not require swab flu test. Also, there is no requirement to take Oseltamivir — a recommended drug both for prophylaxis and treatment of influenza. These patients will only require home isolation.
Moderately symptomatic patients with fever higher than 38 degrees Celsius, severe sore throat and running nose will be categorised under B category. As per treatment protocol, swabs will be collected for testing and doctors can recommend Oseltamivir with home isolation. C category is for patients with more severe infection who will require hospitalisation.
According to a circular issued on July 27, in the third category in addition to other symptoms mentioned in A and B, if the patient has complaints of breathlessness, chest pain, hemoptysis, hypotension, bluish discoloration of nails, then he or she must be admitted to the hospital and swabs must be collected for testing.
Patients under C category will be admitted to the civic-run Kasturba Gandhi Hospital. “As Kasturba Hospital is a special hospital for infectious disease, all confirmed H1N1 cases shall be admitted there. Other health facilities will be granted permission for admitting the H1N1 confirmed cases if H1N1 caseload increases,” reads the circular.
The civic body has also cautioned high-risk groups — pregnant women, children below five years of age, people above 65 years of age and those with comorbidities — to be more cautious.
Since the 2009 swine flu pandemic, the influenza virus has remained highly infectious and the present strain is as, if not more, infectious, causing severe outcomes as compared to other influenza subtypes. Each year, a different strain emerges as the dominant one due to the presence of multiple influenza strains. These changes in strain types and subtypes are taken into consideration during vaccine research to offer maximum efficacy.
In response to speculation that this year’s strain is far more infectious, Dr Nilesh Shah, president and chief of science and innovation at Metropolis Healthcare, said, “That any strain of influenza and swine flu is infectious or not can be determined only by objective evidence like molecular test (RNA sequencing) and epidemiological surveillance, linkage studies and contact tracing. So, it is yet to be determined as studies are ongoing to look for the genetic shifts and drifts.”
The disease is not only restricted to Mumbai but has spread across the state and has claimed seven lives — three in Kolhapur and two each in Pune and Thane as on July 21. In the same period, the state recorded 142 swine flu cases.
“Though the prevalence of influenza is equal among patients of all age groups, the most hospitalisations are observed in elderly patients with chronic lung disorders, diabetes and immunocompromising conditions. The most common symptoms are high-grade fever (102-103), malaise and exhaustion, which are identified as classic influenza symptoms,” said Dr Hemlata Arora, senior consultant, Internal Medicine and Infectious Diseases, Nanavati Hospital.
Doctors also said symptoms often overlap with Covid-19 or other mosquito-borne diseases, which further adds to the confusion in diagnosis. “But the severity of symptoms and involvement of upper respiratory infections with malaise helps us accurately diagnose and treat the condition,” Dr Arora added.
For patients who test positive for respiratory viruses such as Influenza or H1N1, following are the recommendations:
3. Follow respiratory hygiene and precautions similar to Covid-19 infection.
4. Ensure adequate hydration and fluid intake
5. Monitor oxygen levels and temperature.
6. In case of any warning symptoms or worsening health, consult doctor immediately.
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