At home with the flu

We visit an Isolation ward for influenza a H1N1 patients, and come back with positive results.

It is mid-morning on a working day, and Pandit Madan Mohan Malviya Hospital is teeming with patients. Brightly dressed young children and their mothers climb up and down the stairs or wait in long lines in front of doctors’ doors. This is a medium-size government hospital located in Delhi’s Malviya Nagar, which specialises in the treatment of respiratory ailments.

Up on the second floor, above the crowd, a rope slung across a corridor controls access to the swine flu isolation ward. In front of an open door sits a bored security guard wearing a mask. Before he lets us in, he brings the photographer and I each the same kind of mask — a simple surgical mask, flat, pleated, two ties.

 

There is no antechamber; one walks straight into the ward. It is a long room, dim and air-conditioned, divided into three or four bedroom-size sections by chest-high partition walls. Each section contains one or two beds. There is one bathroom for confirmed cases and another, about three metres away, for suspected cases. It is not at all awful, as news reports of other wards, such as the much bigger one at Ram Manohar Lohia Hospital, had led us to expect.

There are currently six inmates. Five are confirmed cases, and one is suspected, as the helpful staff nurse P L Meena explains. He himself wears a full set of personal protective equipment, which includes two different masks, gloves and disposable coverings for the head, torso and shoes. His two assistants are, like us, wearing basic surgical masks.

We are allowed to speak with the lone suspect case, Surekha Bhargava. She has been here about 24 hours and is waiting for the National Institute of Communicable Diseases (also in Delhi) to return her test results.

“We came back from Bangkok in a group,” she says, “and one person got swine flu. My throat was bad, so I came in to be checked.” She points out, slightly aggrieved, that several of her fellow travellers also developed similar symptoms, but they did not want to be tested, “although I am on the phone trying to convince them”. Her family she has told to stay away, keeping in touch on her phone.

“Reports, reports, we are just waiting for it,” she says. Her 14-year-old son has told her, “Ma, just give us the good news that you are negative today.” Ruefully Bhargava says, “This is the first time in my life I am waiting to get a negative.” She is worried that being in the same room as confirmed cases may expose her to the virus, even though she is also taking 75mg of the anti-flu medication oseltamivir (Tamiflu) daily. Confirmed cases get a double dose.

The confirmed patients, each wearing a basic surgical mask, also look well enough. They are standing or sitting, not lying down. No TV or other entertainment is available. Family members are with them, which is not standard in isolation wards in the larger hospitals. The visitors wear masks, but not all maintain the minimum 1 metre separation from the patient. The young parents of one small child, eating while standing up, have to be reminded to keep the child within the enclosure. (Influenza A H1N1 is known to strike younger people disproportionately.)

“I don’t understand what is the concept of isolation,” says Bhargava combatively. “I can see relatives of victims sitting here. Why they are allowed I don’t know.”

“It’s difficult to stop them,” says staff nurse Meena.

Bhargava has no complaints about the staff, but does say that there should be a way to test for swine flu without being admitted. “No test without coming to the ward, and no test, no medication, is the government policy,” she says. “It’s an eyewash.”

“We give them a choice of location,” says Dr R P Vashist, the Delhi government’s nodal officer for swine flu. “People prefer places closer to home.” He explains that the numbers are still small because most cases are “self-declared”, including cases of those who have been physically close to confirmed cases and have later developed symptoms. He adds that, in comparison, “The admission rate is very, very low abroad — in the US it is less than 5 per cent of the total confirmed cases.”

The isolation wards are a low-tech tool. The virus is not nightmarishly potent, since outside North America it has had a low fatality rate, and when sneezed or coughed into the air is usually effective only up to 1 metre from the patient. Although its symptoms differ slightly from the ordinary seasonal flu with which humans have been living with for decades, its mode of propagation, and hence the preventative measures applicable, are much the same.

Dr Amit Banerjee, medical superintendent of Lok Nayak Jai Prakash Narayan hospital, which also has a swine flu ward, summarises the required approach simply: “It’s more of an attitude change than anything else.”

SIGNS AND SOLUTIONS

SYMPTOMS
The symptoms of influenza A H1N1 virus in people are similar to those of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhoea and vomiting. Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.

WHAT YOU CAN DO TO STAY HEALTHY 
* Stay informed.
* Take everyday actions to stay healthy.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Stay home from work or school if you get sick, and limit contact with others to keep from infecting them.

* Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.
* Find healthy ways to deal with stress and anxiety.

Source: US Centers for Disease Control and Prevention