Change ahead. Are we ready?

When the whole world witnessed the H1N1 influenza pandemic in 2009-10, India was significantly affected too. When we are in the midst of another pandemic, of COVID-19, is there something that we can learn from the 2009-10 experience?

Worldwide, the US CDC estimates that up to 5,75,000 people lost their lives during that pandemic. Data from the public domain in India reveal that India had 44,987 confirmed cases, and 2,728 confirmed deaths due to H1N1 influenza in 2009-10. There were undoubtedly many more  H1N1 cases, as every patient with fever and cough did not undergo testing for H1N1 in India. Limited healthcare resources, the scarcity of approved virology labs, under-reporting of influenza-like illness (ILI), etc., contributed to numerous cases and deaths being undiagnosed as influenza. India was not ready to face a pandemic in 2009. Health systems and hospitals were pretty much left to manage it on their own.

What happened after 2010? Did H1N1 influenza go away?

No. It didn’t go away.

In 2019, India had 28,798 confirmed H1N1 influenza cases and 1,218 deaths, as per the NCDC (National Centre for Disease Control, India). In 2018, India had 15,266 confirmed cases and 1,128 deaths, and in 2017, 38,811 confirmed cases and 2,270 deaths.

What is troubling is that these numbers are for a viral illness that has a vaccine and a reasonably useful antiviral medicine, oseltamivir (Tamiflu^®, Antiflu^®, Fluvir^®, etc.).

Subsequently, H1N1 influenza became “endemic” to India. An endemic infection is one that is frequently responsible for disease in a country without importing from another country.

Why don’t we see this reported in the media?

Most of the media highlights what is new and sensational. They gauge the people’s interest and spend more time on them. How long will public attention focus on the same problem? It is well-known that public memory is short. We can add that public and media attention is temporary or even ephemeral.

So, the reporting about H1N1 has taken a backseat, possibly on pages 9 or 13 of our newspapers. They are hardly given any screentime on TV news too. Underreporting contributes to this media apathy about “endemic” diseases. Media apathy may result in government apathy and gradual escalation of diseases.

What about COVID-19?

COVID-19 is a much bigger pandemic. It’s a new virus with many theories about its origin. This new coronavirus spreads much more quickly and easily than influenza. To make it worse, we have neither a vaccine nor an effective medication, yet.

In the next few years, COVID-19 will certainly trouble our population, even if we develop a vaccine and effective medicines, as proven by the H1N1 story above. This virus will become “endemic” like the H1N1 influenza virus and keep raising its ugly head every year and claim thousands of lives. Media will start focusing less and less on COVID-19 and move on to something else.

COVID-19 faces a new India. There is some hope.

In 2020, India’s capacity is much better. Our government has decisive leadership, our regional administration machinery is better in many districts, our labs are better prepared, our people are more aware, and our entire country is together at this troubling time.

As time progresses, we will definitively diagnose more and more patients with respiratory illnesses as H1N1, COVID-19, or another specific viral infection. What we simply label today as “viral respiratory infection” may soon be called “non-COVID, non-H1N1 viral infection” after ruling out these deadly diseases using specific diagnostic tests. We may also start accurately identifying many other viruses that cause similar illnesses, including adenovirus, rhinovirus, respiratory syncytial virus, etc.

What should we do?

The critical steps to slow down and stop both COVID-19 and H1N1 (along with its cousins H3N2, H5N1, & influenza B) are the same. What we are doing now as a country – physical distancing, personal hygiene, cough etiquette, mask hygiene, avoiding spitting in public, etc. – will help us in fighting both.

Whether we get a vaccine or not, effective medicine or not, we have to stay as disciplined. We have to improve our social behavior and personal hygiene. Eventually, this will reduce not just these respiratory infections but also typhoid, amoebiasis, cholera, viral diarrhea, and many other common illnesses that are troubling us from eternity. Reduced infections will reduce the use of antibiotics too. This personal hygiene movement should become a core module of the Swachh Bharat Mission.

The emergence of HIV in the 1980s changed the way people behaved in bedrooms. The September 11 (9/11) attacks in 2001 permanently changed the way we implemented security, especially evident at airports. COVID-19 is one such pivotal event. It should change our social behavior and personal hygiene practices in every aspect of daily life. If not, it will be a lost opportunity.

This COVID-19 pandemic can be a turning point in the health (and economy) of India. Are we ready?

Kannada version of this article: ಬದಲಾವಣೆ ಮುಂದಿದೆ – ನಾವು ಸಿದ್ಧರಾಗಿದ್ದೇವೆಯೇ?

This article was originally published in The Sunday Guardian. Reproduced with permission.

Shashikiran Umakanth

Dr Shashikiran Umakanth (MBBS, MD, FRCP Edin.) is Professor & Head of Internal Medicine at MMMC, Manipal Academy of Higher Education, and has clinical responsibilities at the Department of Medicine, Dr TMA Pai Hospital, Udupi, Karnataka, India.