COIMBATORE: Outside a small house in a village on the outskirts of Coimbatore, P Nanjammal mourns the death of her only son. It began with a fever, she said, that wouldn’t go away. After consulting a local homoeopathy doctor and then going to a private hospital, her son P Thangaraj, 32, was finally admitted to the Government Coimbatore Medical College Hospital where he died in a few days.
“The doctors told me it was swine flu. I didn’t know it could kill people so easily. They also told me that if I or my daughter-in-law or granddaughter developed fever or body pains we must come there immediately,’’ she said.
Her son’s funeral was three weeks ago. And yet, as of October 21, the district of Coimbatore reported zero deaths due to swine flu.
In the last few months, the influenza A (H1N1) virus, popularly known as swine flu, seems to have receded. There is very little about it in the news and, according to doctors, the virus has passed its peak. It is expected to surge again in December though, when cold weather hits.
The State has reported four deaths in all since the entry of the virus in the country, a relatively small figure considering it has had one of the highest number of laboratory confirmed infections in the country — 1,514 as of October 22.
Of these, 332 were from Coimbatore, though no deaths were reported as of October 21.
According to doctors at the Coimbatore Medical College Hospital however, there have been at least eight such deaths in the last three months.
In August this year, after several cases were confirmed from people abroad visiting the city, the hospital began separate outpatient services for suspected swine flu cases. Patients swarmed the department and everyone with the least sniffle reported in. “We were getting more than 100 patients a day and after a point did not have the manpower or resources to continue the clinic,’’ a doctor said.
After a few weeks though, the numbers subsided. From then on, patients who came in and who were suspected to be harbouring the disease were admitted to the quarantine ward and their swabs sent for testing.
“Even now we see one or two suspected cases every week. In the last three months we have seen a growing number of deaths. All of them have been due to swine flu but the cause of death has been reported as either simple pneumonia or other such diseases. Continued from page 1
In one case, the records were actually changed to remove the mention of H1N1 from them,’’ another doctor said. On October 23 and 24, two other patients who were H1N1 positive died while four more suspected to have the disease were admitted, doctors said.
The scary part is, according to the doctors, not so much the deaths themselves but that the concealment could lead to an epidemic, as families were not being warned.
Four days ago, 49-year-old Palanisamy, a businessman from Tirupur died in the hospital. In his case, not revealing the cause of death was made simple by the fact that the report confirming he was positive for swine flu only came some hours after his death. By then, the family had taken the body away for the funeral.
“We were never told the exact cause of his death. He was young and healthy with no prior diseases. We knew it was some kind of fever but they did not tell us what,’’ said his wife P Banumathi.
A doctor at the hospital said the Palanisamy’s test results were positive for H1N1. According to the Ministry of Health and Family Welfare’s guidelines, Palanisamy’s family should have been informed and district health authorities should have maintained an active surveillance on the family members to ensure they did not develop the infection.
Three days after his death, no government health official has visited the family, Banumathi said. They do not even know that Palanisamy died of swine flu or that his wife, 12-year-old daughter and six-year-old son may be at risk of contracting the disease.
“A few weeks ago, another man who was positive for H1N1 died at the hospital. His family did not know the cause of death. Two weeks or so later, his wife and son came to the hospital and were positive as well. We don’t know whom they may have been in contact with or how many more people could be infected,’’ said a doctor.
Safety measures for the protection of families and medical personnel too are few. The standard operating procedure as laid down in the guidelines of the Ministry of Health and Family Welfare is barely followed. “The gowns, goggles, gloves and shoe covers, all of which are supposed to be provided to persons entering the isolation ward are not there. Initially three-layered masks were available but the ward ran out of these. Many doctors and medical staff have to use single-layer masks. As for the N95, I have not seen it yet,’’ said a doctor.
Without personal protective equipment, the staff at the hospital is also at risk of contracting the infection especially while collecting swabs for testing or incubating a severely ill patient. The doctors also said that since the isolation ward did not have ventilators or oxygen supply, very ill patients who were H1N1 positive had to be moved to the intensive care unit in order to be treated.
“Even here safety measures are barely followed. The ICU has other patients who are also very sick with various illnesses. There is no protection at all and all of them are potentially at risk of developing the infection,’’ a doctor said.
Also, patients who were suspected of having the disease were put in the isolation ward along with patients who already had the disease, which meant that even if the suspected case turned out negative, they could still contract the infection as they were in the same room as people who had it, another doctor said. Since there was a shortage of beds here, some sick patients had to lie on the floor.
Several doctors and paramedical staff have also fallen ill and tested positive for H1N1. Since the government medical college does not have testing facilities, tests for H1N1 have been outsourced. The city has two government certified laboratories that are capable of testing for H1N1. However, patients have to pay for these tests and as they are expensive (around Rs 5,000 or more), the hospital also sends samples to the National Institute of Communicable Diseases, Delhi for testing.
Both labs also take in samples from people who walk in and suspect they may have contracted the disease. One lab has tested over 500 samples to date. No statistics are maintained by health authorities on the number of samples sent for testing.
District health authorities were reluctant to speak on the subject to the media. When contacted, a senior hospital official, who did not want to be named, said that all protocols were being followed in the treatment and management of the disease. He said that three-layered and N95 masks were available in the isolation ward and that all safety measures were being followed. “Every time there is a positive case we take down all of the details of the family and ensure that they are kept track of and advised about the disease. The State government has decided that prophylactic medication will not be given to the family. So we tell them to report to the hospital if they develop any symptoms,” he said.
If the patients were from another district, the local district health authorities were informed to monitor the family, he added. He said that ventilators were available and there was a pre-quarantine ward for suspected cases and a separate isolation ward for the positive cases. He also said that schools and colleges were being monitored as some positive cases had been reported among students.
“The government has decided not to allow home quarantine as most patients do not adhere to the rules. So patients are admitted and treated in hospital,’’ he said.
Asked about the deaths, he said that no patients had died of confirmed H1N1. “There have been some suspected deaths but no confirmed death due to H1N1 has occurred,’’ he said.
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