India – Situation Report 2 – September 15, 2009

In the first Situation report on India, on August 13, 2009, I wrote that there had been 20 deaths due to the new H1N1 virus. Today, about a month later, there are now over 200 deaths in India due to the new H1N1 virus. 6,588 people have been reported to be infected. Thus, the case fatality rate for India is 3%, worse than the 1918 pandemic. It is likely that not all cases of H1N1 have been identified. However, it is equally likely that not all deaths have been identified. Thus, as in most countries, we do not know the true CFR. However, there is reason to believe that it is significant.

Today, this startling claim by Indian public health authorities [hat-tip, treyfish]:

From the Deccan Herald, September 16, 2009

Health experts believe the A(H1N1) virus has been mutating with local variants to become more virulent, with low temperatures and wet weather providing an ideal breeding ground.

As a way of substantiating their claims, they say that patients are dying within 24 to 48 hours after being infected by the virus. “The virus is not giving any chance to the doctors to treat the patient. That’s why even patients with good immunity are dying,” said Dr E A Ashok Kumar, superintendent of the government-run Gandhi hospital here.

Dr S V Prasad, superintendent of the government-run Chest Hospital—the nodal agency for swine flu treatment—believed the virus must have undergone change in its genetic make-up as it seem to affect patients faster than before.  Given its virulence, Dr Prasad said the present virus must have emerged from the one imported from abroad, which has mutated with local variants.

It is not clear that there is any sequence data to support the claim that the virus in India differs from the virus present in other areas of the world. However, the alarming nature of the sudden deaths observed after infection is real.

As the number of serious cases mount, the strain on the Indian health care system is becoming dangerously high.

Also from the Deccan Herald:

Meanwhile, authorities at government-run hospitals are forced to turn away the increasing number of patients with A(H1N1) symptoms due to lack of equipment and space.

Corporate hospitals are also closing their doors for Flu patients, fearing that they would spread the virus inside their campuses.

The case of 20-year-old Ashish Raj was an unfortunate one as he had been turned away by no less than three hospitals. Raj was sent away on Saturday by a corporate hospital and two government ones, including Chest Hospital.

Osmania Government Hospital finally admitted him after considerable begging and pleading from Raj’s relatives, before death had put an end to his plight.

Many H1N1 patients in the countries with access to advanced medical care have survived only because they received expensive, state-of-the-art treatment. India has some capacity to provide this level of care, but it is limited to only a small fraction of its population. As more and more people become ill, more and more hospitals will become overwhelmed and more and more people will die for lack of care.

If the chain of infections in India is not interrupted by school and business closures, the strain on the Indian health care system will become unbearable and access to hospitals will cease, not just for H1N1 patients, but for everyone.


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