What are the warning signs of swine flu?

Q: Probably India has the highest swine flu death cases in the world. The common people are confused as the doctors and government (Ministry of Health and Family Welfare) advice to go for testing after observing the symptoms for 2-3 days, if there is any sign of deterioration. They also advise for no testing and for home isolation if there are mild cold symptoms. But the patients and their family members are scared to take the risk for delay in testing while the fear of catching secondary infection while visiting designated government hospital is also a cause of concern. In most of the death cases, the government hospitals are giving statement that the patient was brought late. Also, the symptoms of common cold and swine flu are very similar and the doctors are also confused to discriminate between the two.

• What are the warning signs and within how much time the patient should report to the hospital? So that the doctors don't report that the patient was brought late.
• What is the incubation period of swine flu?
• It is a well-known fact that most of the people in the cities are suffering from asthma and heart related diseases (e.g. high blood pressure). Do these people need to be extra cautious and get tested immediately?
• As the tests are costly, is that why government hospitals are delaying in testing the patients? In that case when shall a patient decide to get tested from a private laboratory?
• Is the cost of testing and treatment for swine flu covered under mediclaim policy?

A:India does not have the most swine 'flu deaths in the world - as of last week India had reported 225 deaths as against the total of 3,486 deaths globally. Globally 2,96,471 confirmed cases have been reported in the world out of which India has reported just over 7000.

While it is correct that 'Tamiflu' is most effective early in the disease (first 48 hours) patients and even doctors often do not diagnose H1N1 infection when the person first develops flu like symptoms. This is understandable as both the conditions manifest in the same way. Another factor to consider is that Swine 'flu is most often a very mild self-curing infection and the case fatality rate is generally to be much below 1%. Yet another cause for delay is the time taken to get a report even when a test is carried out. Doctors could be more aggressive about presumptive treatment now that Tamiflu is becoming available at selected chemists shops and human cases are increasing. Perhaps one way would be for the doctors to look for evidence of lower respiratory tract infection as such cases are more likely to have severe consequences from Swine 'flu infection. In lay terms if someone has flu like symptoms (cold and cough with temperature) and the temperature is high and the person has respiratory distress (or evidence of lower respiratory tract involvement) then presumptive treatment with Tamiflu under the care of a doctor is warranted together with a test. If the test later comes out negative, Tamiflu should be discontinued.

Wide-spread use of Tamiflu, especially when it is not strictly required can lead to levels of resistance rising in the community, which will mean that we would lose the one oral medicine that we have to treat H1N1 virus.

Tests samples are generally only taken by designated hospitals. They screen to test only those whose symptoms suggest the possibility of Swine flu because testing facilities in the government sector are limited and may not be able to cope with an immense surge in demand. Initially only 2 labs in India were doing all the tests (National Institute of Communicable Diseases, now called National Centre for Disease Control in Delhi and National Institute of Virology in Pune). However the number has been increased to 26 and will soon be 52. Tests have been permitted in selected private labs that meet certain quality criteria. They charge for their tests. Whether or not they are covered by any health insurance depends upon the insurance package.

The incubation period is generally 3 to 4 days but in some cases may be longer up to 7 days. The person with confirmed H1N1 infection can infect others for about 1 day before showing any symptoms to at least 1 day and possibly up to 3 or 4 days after getting better and no longer having fever.