Swine Flu Monitor for India

amit · Post by **amit** » 13 Aug 2009 19:45

I wonder if there's a genetic reason for such a high number of deaths in a space of a few days in India.

If you recall the Sars epidemic a few years ago in Asia, many Indians were affected, however, if I'm not wrong almost no one died - it was said then that this was due to built-in immunity of Indians. But many dozens of people with Chinese lineage died in China and South-east Asia.

Now I find it interesting that there's been a minimal number of deaths from the swine flu in Chinese majority countries but India is badly affected.

Is it because a badly mutated form on the virus has reached India or has it something to do with the level of resistance?

ShauryaT · Post by **ShauryaT** » 13 Aug 2009 21:30

amit wrote:Is it because a badly mutated form on the virus has reached India or has it something to do with the level of resistance?

Pure mismanagement and panic mode reaction, in my view. I am not saying it is easy to arrest the spread of this virus. However what a population needs most in these times are clear instructions from their primary care providers, and accessible treatment as opposed shoving an entire city to a single hospital (till recently) - and preventing qualified care providers from doing their jobs! A city like Mumbai or Pune probably have 100's of labs between them, what you need is rapid certification of as many labs as possible on their ability to perform the H1N1 test and any care provider being able to ask their patients to perform these tests.

I am afraid these knee jerk reactions will take our economy down.

shiv · Post by **shiv** » 13 Aug 2009 21:33

Shaurya - the mismanagement had already started in the US. India should have put an advisory about travel to the US.

ShauryaT · Post by **ShauryaT** » 13 Aug 2009 21:37

shiv wrote:Shaurya - the mismanagement had already started in the US. India should have put an advisory about travel to the US.

Maybe, Shiv. If that is what would have helped then so be it. However, please do not make this an NRI vs India thing. I have lived through the agony, when I was there and am calling it as I see it from personal experience.

BijuShet · Post by **BijuShet** » 13 Aug 2009 21:51

shiv wrote:Shaurya - the mismanagement had already started in the US. India should have put an advisory about travel to the US.

But any travel advisory to the US by GoI would hurt Indian economy more than the US as IT workers and their families do make a bulk of the traffic to the US. Inspite of this mismanagement no US cities had to be closed down and the US media even though alarmist did play it down and there was no run on scarce resources like masks and Tamiflu. All in all calling the pot black would not be helping the kettle. We all are wishing for India/Indians to manage this Paki like flu in the most efficient manner and all critical comments are made with the desire for a better outcome. No malice intended or implied.

Satya_anveshi · Post by **Satya_anveshi** » 13 Aug 2009 21:54

I recently visited India and took a long flight with one stop over in the middle east. The first leg of the travel from US to the middle east is good 14-16 hours.

Now, call me paranoid but I was thiking all the following lines:

-during this 14-16 hours, passengers will eat and drink only that provided by the flight attendant (not even water is allowed to be carried at the US airpoint into the plane)
- Passengers will HAVE to eat and drink food otherwise they will starve
- passengers will most likely clean everything they took before the flight
-air, temparature, food, water everything is controlled during this time

Now, isn't this a great window of susceptibility IF the airline management company has any sort of ill-intentions?
If it is indeed such, aren't some actions taken to prevent such long distant flights purely as risk mitigation policy?

any thoughts from the learned?

BijuShet · Post by **BijuShet** » 13 Aug 2009 21:59

Satya_anveshi wrote:I recently visited India and took a long flight with one stop over in the middle east. The first leg of the travel from US to the middle east is good 14-16 hours.

Now, call me paranoid but I was thiking all the following lines:
...
-air, temparature, food, water everything is controlled during this time

Now, isn't this a great window of susceptibility IF the airline management company has any sort of ill-intentions?
If it is indeed such, aren't some actions taken to prevent such long distant flights purely as risk mitigation policy?

any thoughts from the learned?

If exposed this airline would loose all credibility and no one will ever fly it again. Such an outcome would be a deterent for any airline to try such a stunt. Looks like I could sell you one of my hats bro

shiv · Post by **shiv** » 13 Aug 2009 22:11

BijuShet wrote: But any travel advisory to the US by GoI would hurt Indian economy more than the US as IT workers and their families do make a bulk of the traffic to the US. Inspite of this mismanagement no US cities had to be closed down and the US media even though alarmist did play it down and there was no run on scarce resources like masks and Tamiflu. All in all calling the pot black would not be helping the kettle. We all are wishing for India/Indians to manage this Paki like flu in the most efficient manner and all critical comments are made with the desire for a better outcome. No malice intended or implied.

Well the numbers tell the story. The US has had 400 deaths. "lack of panic" is what led to the spread in the first place. There should have been better care. There wasn't. There should have been more concern. There wasn't. It should have been contained by the oh so rich and organized US.

At one stage the WHO threw up its hands and said "it's a pandemic"

That is because no country on earth could restrict entry to the US. But it IS a tough life isn't it? Because of its clout the US can afford to be lax and still be praised. When India with a bigger and poorer population has a problem it becomes "mismanagement". I do think it is utter hypocrisy to be critical of India's tolerance for terrorist deaths by comparison with the US's reacting to every terror death and then being critical of India for worrying about 20 deaths and calling the panic "mismanagement". What do people want? US style management and thousands of deaths? Gimme a break.

Pune at the center of the current outbreak - with half the deaths and 25% of the cases started of with 25 odd school kids who got infected on a trip to the US. The number of people who got infected in the US is huge. The US should have taken more care. I do believe the initial mismanagement was in the US and the secondary mismanagement was the result of the dependence of the world economy on the US. Wait for the US to issue a travel advisory about India when deaths start mounting here and then let us talk about the economy and lives of Indians.

Satya_anveshi · Post by **Satya_anveshi** » 13 Aug 2009 22:15

BijuShet wrote:If exposed this airline would loose all credibility and no one will ever fly it again. Such an outcome would be a deterent for any airline to try such a stunt.

Of course. But the key word is "if" and second keyword is plausible deniability. Third is my unwilingness to assume that the loss of credibility of an airline company alone is sufficient to leave this possibility/susceptibility unaddressed.

Anyway..I already mentioned that this could well be my paranoia

shiv · Post by **shiv** » 13 Aug 2009 22:19

Satya_anveshi wrote: Now, isn't this a great window of susceptibility IF the airline management company has any sort of ill-intentions?

A long confinement in any enclosed space provides a lovely window of susceptibility. People should ideally be screened before leaving. I bet the US will start doing that to Indians once we get a few million cases and a few thousand deaths. But I digress

People sitting near to a guy coughing, sneezing and snorting will be inhaling clouds of viruses and the sick guy will be depositing viruses on every seat/handle/tap he touches every time he goes to the loo. When he hands his cup/plate to the air hostess - she will transfer some viruses to the trolley and then onto other objects.

This is the ideal environment for spread - like classrooms and barracks.

Muppalla · Post by **Muppalla** » 13 Aug 2009 22:20

Rediff interview with Dinesh Trivedi - Minister of State for Health

The maintenance of such a lab even without testing could be more than one lakh rupees a day. The private sector is not into social service; they want to make money. The government has 12 functional labs in the country; on paper there are 16 labs!

In Kolkata, I have visited one such lab, which has state-of-the-art technology. We as countrymen should be proud of it. Doctors told me that they can test 92 cases per day. Another machine is coming, so they will be able to conduct 180 tests.

If you read any European or American medical journal, most of them have praised the way India has controlled swine flu. We are screening 100 per cent of passengers at international airports. If an infected passenger is found, we go through the list of passengers, track down and contact each and every passenger sitting around that patient in the aircraft.

Since the government contacts them, they are bound to respond and tell us if they have caught swine flu or not. We have visited so many air-passengers' houses. You have to understand that in India more than lakh patients die due to viral flu, malaria and TB. But, nobody gives it in headline news. I am also, not trying to distinguish between rich and poor. Swine flu has suddenly become disease of high society because it has come through people flying abroad. Rich patients are scared to do anything with the government. They may have justification. They are scared to be in isolated beds in government hospitals. Many of them have never seen government hospitals.

When blasts occur in a middle class locality there is not as much coverage as it was in case of the November 26 attack on the Taj hotel. We already have serious diseases and that too requires attention of the people and the media.

I am hopeful that as it happened in Mexico, the virus would become weak as it passes on from one person to another person to another and so on. Swine flu started in Mexico but the deaths are decreasing there. We will have a graph of infected patients that will go up but it would come down soon. Sorry to repeat myself, but there is nothing to worry. If you get it, you get it. All cases are not terminal. It can become terminal if you run away from it. If you get any symptoms, go to the government doctor. Get the test done if he advises. Take medicines and let life go on.

The Indian government tried to stop the flu from coming to India. We requested western countries to try screening passengers. But, you know this is a unipolar world. The western countries would have stopped flights from India, Pakistan or Bangladesh in a similar case. This flu is imported. It's difficult to guess how the disease will mutate. But the silver lining in the current situation is that in a couple of months we are definitely going to have the vaccine. Importantly, the virus weakens as it is passes on from person to person. So, we will have to withstand this storm for a while.

BijuShet · Post by **BijuShet** » 13 Aug 2009 22:50

shiv wrote: Well the numbers tell the story. The US has had 400 deaths. "lack of panic" is what led to the spread in the first place. There should have been better care. There wasn't. There should have been more concern. There wasn't. It should have been contained by the oh so rich and organized US.

At one stage the WHO threw up its hands and said "it's a pandemic"

That is because no country on earth could restrict entry to the US. But it IS a tough life isn't it? Because of its clout the US can afford to be lax and still be praised. When India with a bigger and poorer population has a problem it becomes "mismanagement". I do think it is utter hypocrisy to be critical of India's tolerance for terrorist deaths by comparison with the US's reacting to every terror death and then being critical of India for worrying about 20 deaths and calling the panic "mismanagement". What do people want? US style management and thousands of deaths? Gimme a break.

Pune at the center of the current outbreak - with half the deaths and 25% of the cases started of with 25 odd school kids who got infected on a trip to the US. The number of people who got infected in the US is huge. The US should have taken more care. I do believe the initial mismanagement was in the US and the secondary mismanagement was the result of the dependence of the world economy on the US. Wait for the US to issue a travel advisory about India when deaths start mounting here and then let us talk about the economy and lives of Indians.

Stats From Wiki: Swine flu (outbreak in the US)
2009 US Swine Flu Summary
Number of States/Territories with Reported Cases = 47
Number of States/Territories with Confirmed Deaths = 28
Earliest Confirmed Infection in US = March 28, 2009
First Death Inside the US = April 27, 2009
First Death of US Citizen = May 5, 2009
Number of People Hospitalized = 6,506 (as of August 7)
Fatalities = 436 (as of August 7)

I agree that 400+ deaths in the US is a large number. If I understand your post correctly then you are suggesting that there must be a general sense of Panic (i.e. hieghtened sense of awareness) to prevent this large number of deaths. Well I am glad that did not happen even though I may become the next victim and a statistic. Instead I see in the US, companies and retail outlets etc trying to tackle the problem by actually providing free alcohol rub dispenser bottles. All medical facilities providing masks for free in the reception area. The CDC is actively working on this and all other strains of flu and is trying its best to come up with a cure/vaccine. In the short run each citizen/resident is advised to practise simple/good sanitary practises to prevent the spread of this flu. I want GoI and Indians to do something similar. Not all deaths are preventable but we must aim for the maximum good given our scarce resources. Simple instructions from GoI and its healthcare professionals like using a kerchief while sneezing and staying indoors when sick may be better than the sense of Panic being broadcast 24x7 on Indian media. GoI energies would be better spent on ensuring that more labs can perform testing for this flu and more medical facilities have protocols established to handle this epidemic. We see all of this in practice in the US and thus feel a little more secure in trusting the ability of Gotus. I want my fellow Indians to enjoy this sense of trust in their health professionals ability to manage this flu.

Shivsaar as a side note I see you get annoyed when poster (usually NRI's) are being critical of GoI's action. Do you think we are acting like brownsahebs who wish to lord over their fellow citizens? Speaking for myself only, I do not feel superior to any other Indian. I get to enjoy some previleges in the US that are not ordinarily available to my fellow citizens in India but that does not make me smug. I wish my fellow Indians to be able to enjoy the same privileges while residing in India. We are critical of GoIs actions because we feel that mother India can be a better place. I came to these shores (after 10 years here it seems like home now) to ensure a better future for my family but I wish that those left behind can seek a better future within India too.

BTW a Happy Krishna Janamashtami to all. My lunch of adde & per (Large Idli & Sweetened Coconut mil) is getting cold.

BijuShet · Post by **BijuShet** » 13 Aug 2009 22:58

Muppalla wrote:Rediff interview with Dinesh Trivedi - Minister of State for Health

The maintenance of such a lab even without testing could be more than one lakh rupees a day. The private sector is not into social service; they want to make money. The government has 12 functional labs in the country; on paper there are 16 labs!
...

This is the kind of reporting I want to read. I hope Mos for Health Dinesh Trivedi gets front page/prime time coverage. He is talking sense and without being hysterical. Such a calming message will be more useful than sloganeering "house is on fire lets all run in circles". Kudos to the minister and his team.

SwamyG · Post by **SwamyG** » 13 Aug 2009 23:13

^^^^
Great interview - well measured soothing answers.

samuel · Post by **samuel** » 14 Aug 2009 00:39

So the issue here is that
a) US did not ask people to stop visiting. India did not ask people to stop going or get certified before returning that "passenger doesn't have it."
b) Instead GoI chose to screen on arrival. Obviously, a totally arbit and lax approach, just a typical indian f*ck up, that is easily cheated. (of course, it's beneficial if one participates in the process, but why, the typical question pops, must we be subject to it when even USA doesn't do it?).
c) Then GoI has the gall to force people who would've never seen the door of one, to go to guvmand hospital and make things difficult. (of course it works reasonably if you go as asked).
d) Many that had complications or did not get to it in time or went to a private place died, but that is more evidence of mismanagement. (yet to be decided, terrible as the loss is).

If that is the charge sheet, well, my wife and I decided to book our tickets home with family.
We'll be glad to head to safdarjang or aiims or wherever they send us if it comes to that.
I'll repeat, thus,
There is a way to test.
There is a solution.
There is a vaccine coming.
The govt. is being very responsive.
What else can one ask for?

JMT
S

hnair · Post by **hnair** » 14 Aug 2009 03:18

There is a rather weird silence by US mass media towards the deaths. Maybe MJ's death overshadowed this. Or maybe their new healthcare hoo-haa must not be derailled by something as small as a pandemic

Till now in US, swineflu episodes was used more to browbeat Mexicans, than being considered as a real threat to general public. US has a lot of common amenities compared to India, which can lead to spread of this illness. I would guess once their schools reopen after the vacations, we might see a spike in public interests as well as incidents.

The frisking of Dr APJ gave us the guideline to follow: instead of checking thermal signature at Indian airports, we should ask the airlines to check their passengers **at US airports** before boarding the flight from US. That way atleast other passengers wont get affected and we dont have to waste our meagre resources on a mounting number of carriers originating from US.

BijuShet · Post by **BijuShet** » 14 Aug 2009 04:01

hnair wrote:...
we should ask the airlines to check their passengers **at US airports** before boarding the flight from US. That way atleast other passengers wont get affected and we dont have to waste our meagre resources on a mounting number of carriers originating from US.

Nairsaar the problem with asking US carriers to screen passengers is one of credibility. If the US carrier certifies all its passengers are healthy, will GoI say all's well and no screening of passengers in India. Besides if a passenger develops the flu while enroute then what are the protocols to handle the other passengers on the flight. There is no good answer other than stopping flights from all countries where there have been Swine flu incidents. How do we handle domestic air travel? I believe such a move will impact Indian businesses more than the other countries. It is a case of damned if you do and damned if you dont.

Stan_Savljevic · Post by **Stan_Savljevic** » 14 Aug 2009 04:08

The Honble Minister had this to say:

The Indian government tried to stop the flu from coming to India. We requested western countries to try screening passengers. But, you know this is a unipolar world. The western countries would have stopped flights from India, Pakistan or Bangladesh in a similar case. This flu is imported.

It is not like folks sitting in South Block dont know what to do, it is going to take some time to put the boot on the other side.

Chellaram · Post by **Chellaram** » 14 Aug 2009 04:31

hnair wrote: Till now in US, swineflu episodes was used more to browbeat Mexicans, than being considered as a real threat to general public.

the general panic may have died out now, but at its height 2/3 months ago, the swine flu hysteria was just as bad in the US as it seems it is right now in India. Schools were closing, people were staying home from work, there was a lot of fear mongering in newspapers, on tv and radio, and even through emails that were mass-forwarded to everyone (this one comes to mind: http://www.sanantoniolightning.com/gitterle.html <-- reading that at the time was scary). Even Vice president Biden added to the hysteria with some of his comments:

"If you're out in the middle of a field and someone sneezes, that's one thing. If you're in a closed aircraft, or closed container, or closed car, or closed classroom, it's another thing."
--
"I would tell members of my family — and I have — that I wouldn't go anywhere in confined places now," Biden said on NBC's "The Today Show." "It's not just going into Mexico. If you're any place in a confined aircraft and one person sneezes, it goes all the way through the aircraft."

amdavadi · Post by **amdavadi** » 14 Aug 2009 06:31

It is still a big deal in US, from what i know atleast in northern california. Just one of the kaiser facility receives 5-7 patients.I think CDC still keeps track of total number of H1N1 in us and want people to go about their business and not lock themselves in their houses.

shiv · Post by **shiv** » 14 Aug 2009 07:03

BijuShet wrote:
Shivsaar as a side note I see you get annoyed when poster (usually NRI's) are being critical of GoI's action. Do you think we are acting like brownsahebs who wish to lord over their fellow citizens?.

Let us get this "NRI" business correct. I did not bring up the NRI bogey in this thread. . Please go back and check the posts You are the second person doing that.

All I am saying is that the US could have managed the epidemic better. I am not blaming NRIs for that and it is beginning to look even more odd that this NRI flag is being raised on the basis of what is known of the history of my opinions. I am not even defending the Indian government.

I think that there is some convoluted reasoning for anyone to take my statement as meaning
1) Critical of the US
2) critical of the NRI
3) Defence of the GoI

Only point 1 is true. It would be easier if it were left at that. Having said that I will make the off topic post that in general I find Indians (not necessarily NRIs) more willing to overlook incompetence in a society we admire or fear (US/China) and more ready to come down like a ton of bricks on Indian society that we have been taught to be slightly ashamed of, but continue to love deeply.

I keep saying this because this has a great bearing on the way Indians conduct themselves in comparison to what they have been taught is right and wrong, and I am in no way accusing you or anyone else personally here. Indians have a deep civilizational memory of what epidemics do, with the population having dealt with epidemics with no known remedy in living memory. Indians seem to react differently when they feel they are up against God as opposed to mortals.

Here is an extract from a narrative by my wife's grand uncle written about a century ago

This happiness was unfortunately short lived. News was received that his elder sister had died suddenly at Mulbagal. She, with her husband and 5 year old son had come home for vacation when the plague epidemic struck. The husband was the first victim to the raging sickness, but was nursed back to health by his devoted wife. Relatives have narrated to me how this devoted lady spent days and nights at her husband’s bed side singing bhajans in her sweet voice. A fortnight after her husband’s recovery, she herself fell a victim to the same disease and died very soon. Father had to rush to Mulbagal to participate in the funeral of his sister and to console his brother-in-law, who was grief stricken and was in a state of shock.

There was more bad news to follow. Within a month or so came the news of the death of U***’s wife. She had gone on a visit to Malur where plague had been reported. She returned to Kommanahalli with high fever and before the signs of the dreaded disease could be recognized, she was dead. She left behind a sorrowing husband and 4 young children. The religious studies, at Marikanve were cut short and U***, with his father R***, returned to Kommanahalli to face the catastrophe. By this time, our step mother was pregnant with her first child and the deceased lady was her elder sister. With these tragedies in both the families and the scourge of plague still lurking about in the region, our father decided that their first child would be born in Marikanve instead of Kommanahalli. The engineering project’s colony had an hospital and a trained mid-wife. Father’s younger sister, P***, offered to help with the delivery and was to arrive the following month. Everything seemed to be set for the young couple to welcome their first child. But the scourge of malaria, which always followed the construction of large reservoirs of water, was just round the corner. When *** Bai was 5 months pregnant, she was struck with malaria. Treatment was started through the local doctor but her physical condition was not conducive for strong doses of medicine. Within 2 months she aborted a dead child and in a couple of days she followed it with her own sad end. Except for her young husband no one else was with her when she breathed her last.

shiv · Post by **shiv** » 14 Aug 2009 07:23

BijuShet wrote: If I understand your post correctly then you are suggesting that there must be a general sense of Panic

Wrong. US public health authorities should never have allowed the epidemic to occur. That should have been done right when the virus was fist shown to be spreading. They did not do that. Either they were incompetent, or negligent or the US public health system is incapable of working as it should. That is failure. Not success - notwithstanding public perception.

BijuShet wrote:We see all of this in practice in the US and thus feel a little more secure in trusting the ability of Gotus. I want my fellow Indians to enjoy this sense of trust in their health professionals ability to manage this flu. .

Of course you are more comfortable in the US. Your comfort exists despite what I think is incompetence/negligence of health authorities in the US. You are happy and you think that the epidemic has been managed well. This is your opinion. From your viewpoint, the US is doing fine and you want Indians to be secure like you feel in the US.

In my view your sympathy may be well intended but not your confidence the the way the US has handled it. It could have been handled better in the US, by the US public health system. Indians who know that Indian public health systems cannot handle this well are perfectly justified in doing what it takes to try and protect themselves. This is not mismanagement. It is abundant precaution based on a very real perspective of life in India.

The problem here is applying US standards in India. I happen to think that such application, no matter how well intentioned is still inappropriate when I can see that the US has bungled and the US public is wearing blinkers about that bungling. It is a serious epidemic and the US really should have taken it more seriously. They should have been dead serious right at the start, and they were not. The US health authorities are getting away with murder because US residents largely trust them and feel comfortable in the manner that you have indicated. This is not a model that India can afford to follow.

The whole business was been handled in the US in a laid back and lackadaisical manner until the deaths started increasing after which the system went into high gear. Too late. The idea of good public health is to localise, confine and scotch disease outbreaks before they become epidemics, or worse, pandemics. This was not done in the US. It can hardly be called a success just because one feels secure in the US.

This indicates what i am getting at.

http://www.thesundaily.com/article.cfm?id=36900

SwamyG · Post by **SwamyG** » 14 Aug 2009 08:12

The side-effect of panic and media attention will slowly and steadily improve our system. Our servant-maid in India had told my mom that if she contracted any flu we would have to pay as the family had visitors from USA. It shows the level of information percolation. We should ensure that when we take 2 steps back we don't slide 3 steps back, as long as the country keeps moving in the right direction it is good for the country.

When my eldest son got the fever/flu; we immediately called our pediatrician's office in USA and inquired about the symptoms ithyadi. The office reported the swine flu was very mild in the State.

shiv · Post by **shiv** » 14 Aug 2009 08:18

When public health systems do not function as they are designed to function, epidemics can go out of hand.

Today's ToI has a description of what went wrong in Pune where the outbreak was not taken seriously enough - and authorities failed to follow up the contacts of each person who tested positive.

http://timesofindia.indiatimes.com/Why- ... 892186.cms
Why Pune is H1N1 Ground Zero?
Kounteya Sinha, TNN 14 August 2009, 03:30am IST

According to scientists from the National Institute of Communicable Diseases, the state government failed in the early stages to put in place an effective ‘‘contact-tracing programme’’ — that is, tracing down each and every person who has come in contact with those who tested positive.

They say the answer lies in a combination of reasons that includes administrative lapse as well as some climatic features that are peculiar to Pune.

The protocol for the contact-tracing programme is laid down. Delhi, for instance, is said to have followed it closely and that’s helped it to keep the virulent edge of the flu under control. Records show that out of 6,249 people found to have symptoms and then tested for swine flu, 1,107 were identified through contact tracing. ‘‘The state (Maharashtra) didn’t take contact tracing seriously. By the time it started, the virus had already got entrenched in Pune and had spread,’’ Union health ministry officials said. NICD director Dr Shiv Lal added, ‘‘We are working towards scientifically establishing why Pune is worst hit.’’

Director general of the Indian Council of Medical Research Dr V M Katoch said he was fairly certain that the virus started circulating in Pune much before the first positive case of infection was reported in the city on June 22 when a 24-year-old tested positive after returning from US. Dr Katoch said the virus’s spread was because the community in Pune didn’t take the threat seriously. ‘‘They didn’t report early nor did they visit the designated government hospitals for H1N1 testing. Crucial time was therefore lost in controlling the virus’s spread,’’ he said.

SwamyG · Post by **SwamyG** » 14 Aug 2009 08:25

Few dated dailykos posts:
1) http://www.dailykos.com/story/2009/5/2/ ... -They-Open
2) http://www.dailykos.com/storyonly/2009/ ... eparedness

Satya_anveshi · Post by **Satya_anveshi** » 14 Aug 2009 08:26

Swine flu toll touches 14 in Pune, India's toll 22

TV channels told not to spread swine flu panic

Even ToIlet paper should have been told the same. This mf'ing newspaper caters to that panicky crowd (as you can see majority of links on this thread are from Toilet paper).

Satya_anveshi · Post by **Satya_anveshi** » 14 Aug 2009 08:34

Hey one more thing...people nationwide have forgotten the Mumbai blasts, J&K, Pakistan/Taliban/Musharraf, and drum roll please...the shameful deeds of PM at S-e-S. Wah bhai wah..

shiv · Post by **shiv** » 14 Aug 2009 08:38

Early in an epidemic time and opportunity must not be lost by public health authorities by taking it easy.

For example, yesterday saw the death of a 28 year old schoolteacher in Bangalore, a friend of a friend. She was a LKG (Lower Kindergarten) teacher in Sudarshan Vidya Mandir in Bangalore.

What needs to be done now (and is being done as per my information) is to

1) Scrutinise all contacts that the deceased lady had

family
school children
other teachers in the staff room/school bus
any other contacts

2) If any contact has symptoms of swine flu that person needs to be tested
3) If that tests positive and all contacts of that person should be screened and warned
4) In all cases all contacts need to be warned that they are at risk

Done very early in a disease outbreak and epidemic can be checked. Ideally it should be checked at its source. In this case it was Mexico.

shiv · Post by **shiv** » 14 Aug 2009 08:43

SwamyG wrote:
When my eldest son got the fever/flu; we immediately called our pediatrician's office in USA and inquired about the symptoms ithyadi. The office reported the swine flu was very mild in the State.

I hope your child is well now but that sounds like a silly answer. In order to be serious the health authority needs to ask if your family have been in contact with anyone who has travelled to swine flu affected areas and to report if the flu does not get better/gets worse within a stipulated period of time.

Perhaps this was exactly how the disease was handled from the start.

pgbhat · Post by **pgbhat** » 14 Aug 2009 08:49

shiv wrote:Early in an epidemic time and opportunity must not be lost by public health authorities by taking it easy.

For example, yesterday saw the death of a 28 year old schoolteacher in Bangalore, a friend of a friend. She was a LKG (Lower Kindergarten) teacher in Sudarshan Vidya Mandir in Bangalore.

That is my school.

. I studied there from LKG to 10 std.

SwamyG · Post by **SwamyG** » 14 Aug 2009 08:49

Shiv saar: I need to clarify. We were in Benguluru for more than 10 days when he got the fever - it was only 100.2 -101F; it is considered a mild fever. But because of our anxiousness we called from Benguluru to our 'State'. And this happened 3 days ago. Yes, my son is coming out of the fever. The younger one seems to be having slight fever.

harbans · Post by **harbans** » 14 Aug 2009 12:15

I was thinking that Swine flu like all influenzas originate or are mutated versions of the early 20th century Spanish influenza which killed some 50 odd million people in Europe and Americas..

Though i doubt pigs can fly but is it haraam to get swine flew in Bakistan? I wonder what the esteemed mullahs of LMU say about this..

krishnan · Post by **krishnan** » 14 Aug 2009 12:23

BijuShet wrote:
shiv wrote:Shaurya - the mismanagement had already started in the US. India should have put an advisory about travel to the US.
But any travel advisory to the US by GoI would hurt Indian economy more than the US as IT workers and their families do make a bulk of the traffic to the US. Inspite of this mismanagement no US cities had to be closed down and the US media even though alarmist did play it down and there was no run on scarce resources like masks and Tamiflu. All in all calling the pot black would not be helping the kettle. We all are wishing for India/Indians to manage this Paki like flu in the most efficient manner and all critical comments are made with the desire for a better outcome. No malice intended or implied.

An advisory was issued. Even heard it on TV

Satya_anveshi · Post by **Satya_anveshi** » 14 Aug 2009 20:01

Swine Flu: 5 more die in Pune, nationwide toll rises to 24

ShauryaT · Post by **ShauryaT** » 14 Aug 2009 20:24

shiv wrote:
BijuShet wrote:
Shivsaar as a side note I see you get annoyed when poster (usually NRI's) are being critical of GoI's action. Do you think we are acting like brownsahebs who wish to lord over their fellow citizens?.
Let us get this "NRI" business correct. I did not bring up the NRI bogey in this thread. . Please go back and check the posts You are the second person doing that.

All I am saying is that the US could have managed the epidemic better. I am not blaming NRIs for that and it is beginning to look even more odd that this NRI flag is being raised on the basis of what is known of the history of my opinions. I am not even defending the Indian government.

[/quote]To set the record straight. I mentioned the NRI issue because you suddenly posted a critique of US management of the issue in response to my critiques on the way India has gone about this. If you suddenly bring in a single line post, in response to India's critique that the US mismanaged, it looks like an open fly/ torn shirt argument. By all means, critique the US. For all I care, I will be thrilled to find out that India managed this issue better than the US. However, I do think the verdict is still not out. I am an NRI and have agreed with you in the past on how that can sometimes cloud judgment and am very aware of this fact.

It will be best to keep the focus on India on this thread, IMO.

ShauryaT · Post by **ShauryaT** » 14 Aug 2009 20:44

shiv wrote:Early in an epidemic time and opportunity must not be lost by public health authorities by taking it easy.

Agreed. Also, when this attempt to control turns into an illusion, steps need to be taken to ensure that one is not still living in the world of illusory control and take the next logical step - quickly - to use all assets available to manage the fall out.

We need first line of defense providers enabled. Are they empowered even now? Is quarantining the best way to handle at this stage?

BijuShet · Post by **BijuShet** » 14 Aug 2009 21:15

shiv wrote: Wrong. US public health authorities should never have allowed the epidemic to occur. That should have been done right when the virus was first shown to be spreading. They did not do that. Either they were incompetent, or negligent or the US public health system is incapable of working as it should. That is failure. Not success - notwithstanding public perception.

I am not sure how one can stop the spread of virus across countries and continents in this day and age and especially the US because of the sheer number and variety of people that visit or transit through her borders. Without an outright ban on all international travel this would be impossible. To make matters worse there is a lot of cross border travel by US and Mexican citizens in southern border towns on a daily basis. I am trying to explain the scope of their problem about containment and not trying to defending any inaction by US or Mexican authorities. A good number of US citizens do not trust their govt to do the right thing so any form of govt intervention or travel bans will carry risks of violence by domestic protesters. US public health system can benefit from improvements and there is a big debate going on in the present time discussing ways of improvings it. Hopefully these changes will be able to better manage future outbreaks.

shiv wrote: Of course you are more comfortable in the US. Your comfort exists despite what I think is incompetence/negligence of health authorities in the US. You are happy and you think that the epidemic has been managed well. This is your opinion. From your viewpoint, the US is doing fine and you want Indians to be secure like you feel in the US.

In my view your sympathy may be well intended but not your confidence the the way the US has handled it. It could have been handled better in the US, by the US public health system. Indians who know that Indian public health systems cannot handle this well are perfectly justified in doing what it takes to try and protect themselves. This is not mismanagement. It is abundant precaution based on a very real perspective of life in India.

The problem here is applying US standards in India. I happen to think that such application, no matter how well intentioned is still inappropriate when I can see that the US has bungled and the US public is wearing blinkers about that bungling. It is a serious epidemic and the US really should have taken it more seriously. They should have been dead serious right at the start, and they were not. The US health authorities are getting away with murder because US residents largely trust them and feel comfortable in the manner that you have indicated. This is not a model that India can afford to follow.

The whole business was been handled in the US in a laid back and lackadaisical manner until the deaths started increasing after which the system went into high gear. Too late. The idea of good public health is to localise, confine and scotch disease outbreaks before they become epidemics, or worse, pandemics. This was not done in the US. It can hardly be called a success just because one feels secure in the US.

I think my posts gave you the impression that alls good in the US with regards to the swine flu. Well let me restate my opinion. In my opinion the US govt is trying its best to contain this flu and be in top of this pandemic. It has taken reasonable steps to prevent the spread of this virus without creating a mass hysteria like situation. The US economy is not in its best health and there many other important issues that also deserve attention. The Professionals connected to addressing this flu (inside and outside the govt) are doing all they can and the public is doing its part too. I want the Indian Govt to mount a similar effort to contain this flu. I want fellow Indians to get good medical opinion about preventative care and steps to take in case they are struck by this flu. The link in one of the posts above from Mos Health is something that gives me confidence and I hope gives the same confidence to others. You being a doctor there may be issues that you understand better than I do and hence I will defer to your opinion on medical matters about this pandemic. My frustration stemmed from 2 things. Lack of clear communication by the concerned health officials to the general public and lack of discipline by the media in addressing the real issue. The media running amok like a headless chicken did not help the situation. I have spoken to many in my family back home and there seems to be general awareness of this flu and about steps to take so I admit people are getting some good advise.

shiv wrote: This indicates what i am getting at.

http://www.thesundaily.com/article.cfm?id=36900

Shivsaar the easiest way to raise the public profile on any issue in the US is the judicial/lawsuit way. So no surprise the family has decided to sue the city to raise awareness and also get some form of monetary compensation to make up for the loss of a breadwinner. Even in this case that particular school was closed and sanitized after the detection of the first case. The unfortunate Assistant Principal Mitch Wiener who died in this incident was sick for almost a week before he sought medical help. He probably did not realize the kind of flu he had. Once in the hospital he was sick(in a coma state) for 4 more days before he passed away during which his condition seemed to have impoved according to media reports. A google search of newsreports will confirm these facts.

BijuShet · Post by **BijuShet** » 14 Aug 2009 21:38

shiv wrote:
BijuShet wrote: Shivsaar as a side note I see you get annoyed when poster (usually NRI's) are being critical of GoI's action. Do you think we are acting like brownsahebs who wish to lord over their fellow citizens?.
Let us get this "NRI" business correct. I did not bring up the NRI bogey in this thread. . Please go back and check the posts You are the second person doing that.

All I am saying is that the US could have managed the epidemic better. I am not blaming NRIs for that and it is beginning to look even more odd that this NRI flag is being raised on the basis of what is known of the history of my opinions. I am not even defending the Indian government.

I think that there is some convoluted reasoning for anyone to take my statement as meaning
1) Critical of the US
2) critical of the NRI
3) Defence of the GoI

Only point 1 is true. It would be easier if it were left at that. Having said that I will make the off topic post that in general I find Indians (not necessarily NRIs) more willing to overlook incompetence in a society we admire or fear (US/China) and more ready to come down like a ton of bricks on Indian society that we have been taught to be slightly ashamed of, but continue to love deeply.

I keep saying this because this has a great bearing on the way Indians conduct themselves in comparison to what they have been taught is right and wrong, and I am in no way accusing you or anyone else personally here. Indians have a deep civilizational memory of what epidemics do, with the population having dealt with epidemics with no known remedy in living memory. Indians seem to react differently when they feel they are up against God as opposed to mortals.

My bad as I brought up the NRI bogey. I got the impression that you were being critical of how the US Govt handled the situation because we (meaning NRI posters on this thread) were being critical on GoI. Reading your post above clarifies that misconception of mine.

NRI's have an opportunity to compare apples to apples vis-a-vi GoI actions and the country they currently reside in (and many times these are in what is referred to as Developed or Western countries). Many a times we admire the Western Govts efficiency in daily life processes - Dept of Motor vehicles(registration and license) comes to mind as one example. Given India's demographics and economic conditions I understand the dimensions of problems in India are very different than in Western countries. Yet we wish these efficiencies to touch Indian lives too. Many of the NRI's are critical of the practices of their resident countries. We make these criticism to a different audience i.e. to the people who have the power to change conditions. As an example I worry about Social Security system in the US but how will it serve any purpose if I came on BR and lamented about it to fellow Indians. On BR we criticize GoI because we share a common goodwill to India and there are some here who may have the power to effect change in India.

shiv · Post by **shiv** » 14 Aug 2009 22:24

BijuShet wrote:
NRI's have an opportunity to compare apples to apples vis-a-vi GoI actions and the country they currently reside in (and many times these are in what is referred to as Developed or Western countries). Many a times we admire the Western Govts efficiency in daily life processes - Dept of Motor vehicles(registration and license) comes to mind as one example. Given India's demographics and economic conditions I understand the dimensions of problems in India are very different than in Western countries. Yet we wish these efficiencies to touch Indian lives too. Many of the NRI's are critical of the practices of their resident countries. We make these criticism to a different audience i.e. to the people who have the power to change conditions. As an example I worry about Social Security system in the US but how will it serve any purpose if I came on BR and lamented about it to fellow Indians. On BR we criticize GoI because we share a common goodwill to India and there are some here who may have the power to effect change in India.

The reason I personally disapprove of posts such as this one is that it assumes that resident Indians, especially on this board have no idea of what it is like to be an NRI.

So if I ever brought up the RI/NRI bogey it is precisely to scotch the naive (and sometimes patronizing) assumption that RIs are unable to compare apples with apples, while NRI's can - which seems to be what you have said. This is an outmoded and underinformed belief that should be discarded ASAP. It is high time people such as yourself stop assuming that extra gyan has been gained by NRIs which RIs are not privy to. and need to be told about. This was par for the course 35 to 40 years ago when the first of my generation started going abroad and returned with wondrous stories of how they now knew both sides and what was good and bad. Times have changed. Travel and communication is easier and a humongous numbers of Indians have actually lived abroad for extended periods and returned so the NRI experience is no longer as unique and informative as it used to be. And apart from having been an NRI myself before returning, I have exchanged notes about what is what with friends and family who have lived abroad, primarily in the US for up to 40 years and think I have a fair idea of what can or cannot be compared and what confounds the comparison. I have also seen how attitudes about "What is good in the West" changes with time. The things that were praised as "the best in the world" later become so-so and other things look good or worse depending on later experiences. The person who praised healthcare when he had been in the US for a mere 10 years ends up cursing 20 years later because of new experiences. Nothing irritates me more than finding yet another person who discovers the wonders of living abroad and tries to "inform Indians" about what is going on, assuming that they need to be told, not knowing that a lot is blah blah that is subject to change with time.

I can name at least six other BRFites who were RI's - became NRIs and are now RI's again and have a clear picture of both sides. Outside of BRF and in the community that I live in people who are RI's half the time and NRIs half the time are available at 10 people for 4 annas. So please cut the talk about a special ability to compare apples with apples arisiing from your NRI status.

SRoy · Post by **SRoy** » 14 Aug 2009 22:46

I went to Australia in mid June for 10 days. Nothing happened.

Last week I had cold, running nose, slight fever, sore throat and some body ache.

That has passed and now I'm up and running.

There were few German colleagues in the office around 20th july and they were tested positive...we are certain that some number of local staff have got infected.

What happened in my case? I suspect I too was infected, but probably the immune system warded it off.

Shiv, what's your opinion?