Swine flu resurfaces in the city of Delhi, reiterating the need for hand hygiene

Health Care, Heart Care Foundation of India, Medicine 1 Comment

Number of cases are on the rise; however, precaution and NOT panic is the key

New Delhi, 21 January 2019: After two suspected swine flu deaths in a Delhi hospital, it has been confirmed that the number of suspected swine flu cases in the city are on the rise. The symptoms have been reported as being very similar to normal influenza and the primary reason for the spurt in the number of cases is the dry winter chills. Given the common symptoms, swine flu is often misdiagnosed or ignored. Patient with symptoms and any co-morbid conditions like diabetes, cancer, and kidney disorders need to very careful.

Seasonal influenza (H1N1) is a self-limiting viral, air-borne diseases spread from person-to-person, through large droplets generated by the act of coughing and sneezing, indirect contact by touching a contaminated object or surface [fomite transmission like telephone, cell phones, computers, door handles, door bells, pens, toys etc.] and close contact [including hand shaking, hugging, kissing]

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Swine flu presents with fever of more than 100 F with cough or sore throat in the absence of any other main cause. The diagnosis is confirmed with a lab test using rRT/PCR technique. Mild or uncomplicated flu or swine Flu is characterized by fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting. There is no shortness of breath. In progressive swine flu, a person can also experience chest pain, increased respiratory rate, decreased oxygen in the blood, labored breathing in children, low blood pressure, confusion, altered mental status, severe dehydration and exacerbation of underlying asthma, renal failure, diabetes, heart failure, angina or COPD. Severe or complicated swine flu is characterized by respiratory failure, requirement of oxygen or ventilator, abnormal chest x-ray, inflammation of the brain, lowering of blood pressure to less than 60 and involvement of the heart muscle. These patients will have persistent high fever and other symptoms lasting more than three days.”

Tamiflu (oseltamivir phosphate) is the treatment of choice but it should be taken under medical supervision. It must be given in the first 48 hours. It is given in severely low patients, pregnant women, underlying organ disease or age less than 5 years.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Flu vaccine can be given to all. It should be given to all high-risk patients. The virus spreads through droplet infection and spreads with a person coughs, sneezes, sings or speaks. The virus can cover only a distance of 3 to 6 feet.”

Some tips from HCFI

  • The standard prevention is respiratory hygiene, cough etiquette and hand hygiene. Hand washing should be performed before and after every patient contact or infectious material and before putting and after removing gloves.
  • Stay 3 feet away from the person who is coughing.
  • Hand hygiene can be performed by washing with soap and water or with alcohol-based hand drops. If hands are visibly soiled, they should be washed with soap and water.
  • Patients should be placed in a private room or area. The health care staff should wear a face mask while entering the patient’s room. When leaving the room, the health care workers should remove the face mask, dispose it off and then perform hand hygiene.
  • Patients should wear a surgical mask and should be aware of respiratory hygiene, cough etiquette and hand hygiene.
  • Droplet precaution should be taken for seven days after illness onset or 24 hours after resolutions of fever and respiratory syndrome.
  • One should not cough in the hands, handkerchief but instead cough either in the tissue paper and dispose it off or in the side of the arm.

This is good news: PCR teams to be first doctors on spot in Delhi

Health Care Comments Off

PCR vans are usually the first to respond to a road emergency, and now the police control room personnel are set to turn paramedics to manage accident trauma, reported the TOI (Jan.17, 2019). The Delhi PCR vans will now carry cervical collars and fracture braces, among other medical accessories, to provide proper care within the crucial first five minutes of an accident. The van will now also carry ice packs and eye shades to ensure that the victim is in comfort and the pain from the injuries is managed before they are shifted. Additional training will also help the police personnel to judge and deal with the medical condition of the victims.

Doctors from AIIMS and NGOs, who already teach the cops how to provide cardio-pulmonary resuscitations and undertake basic procedures, will instruct them in life-saving measures.

This is good news indeed.

Any delay in treatment in acute emergencies can mean a difference of life and death for the victim. Most acute emergencies will require emergent evaluation and treatment without any delay. The large majority of deaths occurs either at the scene or within the first four hours after the patient reaches a trauma center.

The concept of “golden hour” emphasizes the need for rapid intervention during the first hour of care following major trauma. Prompt medical treatment during the golden hour has the highest likelihood of preventing death.

“Platinum 10 minutes” refers to first ten minutes after trauma and refers to the importance of starting first aid within 10 minutes to reduce the chances of death.

Heart Care Foundation of India (HCFI) is actively engaged in training people from all walks of life, including school children, in the life-saving technique of hands-only CPR (CPR 10).

There is substantial evidence to suggest that CPR is effective in the first 10 minutes of cardiac arrest. After 10 minutes of death, there is practically no chance of recovery unless patient is in hypothermia. So, we created a formula of 10 which is “within 10 minutes of death (earlier the better), at least for the next 10 minutes (longer the better, up to 25 minutes), compress the centre of the chest of the victim with a speed of 10×10 i.e. 100 per minute”.

This way the public can remember the technique of CPR after sudden cardiac death. It is easy to learn and easy to do and one does not need to be a doctor or be certified in this technique to do CPR.

Numerologically also, the CPR equates to number 10. In English alphabets, ‘C’ comes at number ‘3’, ‘P’ comes at number ‘16’ and ‘R’ comes at number ‘18’. If we add the three i.e. C=3, P=16, R=18 (3 + 16 + 18 = 37) and, if we further add the two digits in ‘3 + 7’, the total we get is ‘10’. So, numerologically also, ‘CPR 10’ should be an effective way to remember.

HCFI had also provided training on CPR for 100% PCR vans (over 8000) in Delhi in 2014 along with the Indian Medical Association (IMA) and Delhi Red Cross Society.

The PCR vans should also be equipped with Automated External Defibrillator (AED) machine and personnel should be trained in the use of the AED. Defibrillation within 3 to 5 min of collapse can result in survival rates as high as 50-70%.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA