Express News Service

Even as people were grappling with an unusually-aggressive strain of Influenza, Covid cases and positivity rate began to show an upward trend, leading to considerable alarm in government and health circles. According to medical experts, however, while everyone does need to be alert and take precautionary measures, there’s no need yet to hit the panic button, reports Ashish Srivastava

A large number of citizens in the national capital have, of late, been suffering from respiratory illnesses. While hospital OPDs are packed with patients complaining of symptoms mostly associated with Influenza, Covid-19 cases too are on the rise. After a gap of five months, the daily tally of Covid-19 cases breached the 100 mark last week even as the positivity rate crossed 5%, giving rise to alarm.
One person also succumbed to the disease in the city last week.

India usually sees a seasonal rise in Influenza cases from January to March and again from August to October. But this time, the outbreak has been particularly serious in terms of the severity of symptoms as well as the number of people who came down with the disease. According to the Union Health Ministry, the most prominent subtypes of Influenza in circulation in the country are Influenza A (H1N1) and Influenza A (H3N2).

An ICMR survey has shown that 50 per cent of patients down with respiratory infection cases who are admitted to hospitals over two months had H3N2 Influenza, the government told the Lok Sabha last week. As per official data, a total of 1,161 cases of H3N2 were reported in the country. Delhi recorded the highest with 370 cases.

“Almost everyone is affected by Influenza. Every third patient coming to OPD with complaints of fever and cough is turning out to be infected with Influenza,” said Dr Akshay Budhraja, a pulmonologist at Aakash Hospital.“Their family history reveals that all such patients have had someone in their families who contracted Influenza within a week,” he added.

Importance of testing

While both the diseases are self-limiting for healthy individuals, it’s the differentiation between the two which is causing a worry since both the diseases exhibit almost similar symptoms.“The testing of patients for Covid and Influenza has declined, so it is difficult to establish the exact number of H3N2 or Covid-19 patients,” said Dr Ashok K Rajput, consultant, pulmonology & sleep medicine, CK Birla Hospital

According to doctors, testing is imperative as it helps in the identification of the disease which eventually determines the treatment protocol that needs to be followed.

“A lot of complacency regarding testing can be observed. We advise everyone to get tested for Influenza and Covid-19 but only 25 per cent are undergoing the RT-PCR. Mostly, people are relying on self-medication with over-the-counter (OTC) drugs which are not recommended. Proper treatment can only happen after diagnosis of the disease,” Dr Budhraja said.

Although both Influenza and mild Covid-19 have some common symptoms, doctors say there are ways to differentiate between the two. The H3N2 subtype of Influenza A virus is quite virulent and causes a fever ranging between 101 to 102 degrees Fahrenheit that lasts for 3-5 days and a prolonged cough and cold for up to three weeks. According to doctors, the hospitalisation rate for patients affected by the H3N2 Influenza is far more compared to other Influenza viruses like H1N1. However, most patients already suffer from underlying health conditions.

“Patients who have breathing illnesses like Asthma, are immuno-compromised or those who had organ transplant or suffer from life-threatening diseases and the senior citizens are vulnerable,” said Dr Bhudhraja. While the disease is usually mild in vulnerable groups, it can turn severe and put one at risk of complications and even death. However, doctors advise that any person experiencing difficulty in breathing, low blood pressure, bluish lips, seizures, confusion, must be hospitalised immediately.

“People who are over 65 years old and those who suffer from co-morbid conditions such as diabetes, heart problems, and chronic lung infection are at a higher risk of developing severe disease even if they do not have a history of contracting Covid-19,” said Dr Vikas Deswal, senior consultant in Internal Medicine at Medanta Medcity.

Don’t pop antibiotics on own

Meanwhile, doctors have cautioned against the indiscriminate use of antibiotics without medical diagnosis and are urging people not to resort to self-medication. Though the practice of self-treatment is a common phenomenon, especially when people contract the Influenza virus, health experts are trying to make people aware that the incorrect usage of antibiotics could cause way more harm than good.

“If one has symptoms like fever, cough, and cold, antibiotics are not recommended. This only needs antipyretics for fever or inflammatory drugs besides anti-tussives for cough and cold,” Dr Rajput said.

“Many people are popping antibiotics on their own, but individuals with symptoms such as fever, cough, runny nose, sore throat, or breathing difficulties should seek medical attention,” said Dr Deswal said.  The Indian Medical Association (IMA) also came out with a statement urging people not to self-medicate with antibiotics.

“Using antibiotics like Azithromycin and Amoxiclav etc, that too without caring for dose and frequency, and stopping them once you start feeling better, is a recipe for disaster. It leads to antibiotic resistance, so when you really need them, they will not work,” the IMA said in a statement.

Why cases are rising?

According to experts, a new sub-variant of Covid-19 called XBB.1.16 could be at play. The Indian SARS-CoV-2 Consortium on Genomics (INSACOG) has detected 204 cases of this new variant; 19 of them are from Delhi alone.

On Influenza, the experts said the abrupt change in weather and pollution is the main cause. Besides, masks had protected people from Influenza for the past couple of years. But as there is no mask mandate now, people are more susceptible to contracting the seasonal flu. As for the need for vaccination, there is no clarity so far.

After the nationwide Covid-19 vaccination campaign, the hesitancy for jabs among people has come down and people have become more aware of the benefits provided by vaccination. Also, the panic regarding H3N2 is forcing people to reach out to hospitals offering flu shots.  But the doctors are not very keen on them. They said that the vaccination will not give immunity to the people against the virus right after the inoculation.

“Although there has been an increase in H3N2 cases, now may not be the best time to get vaccinated, as the ideal time is typically before the onset of winter. It takes approximately 2-3 weeks for immunity to develop after vaccination, and by then, the Influenza season may be over,” Dr Deswal said.

“We are not advising against it (vaccine) but it should be kept in mind that the vaccine will not give immunity right away,” said Dr Surajit Chatterjee, senior consultant, Internal Medicine at Indraprastha Apollo Hospitals. However, doctors say vaccination should be mandatory for vulnerable groups like the elderly and those suffering from co-morbidities.

No reason for panic yet

Though many people are falling sick, many for a long duration, due to either Influenza or Covid-19, experts said that there is nothing to panic about.“No evidence has emerged so far that suggests that the new Covid-19 variant could increase disease severity, hospitalisation and mortality,” the Union Health Ministry has clarified regarding the detection of XBB-1.16.

Dr Budhraja said that most patients who displayed severe symptoms of Influenza and required emergency medical intervention were either elderly, suffered from co-morbidity, or were severely immuno-compromised. However, there is unanimity among health experts and the government that citizens must remain alert and if possible, get vaccinated.

“COVID-19 and Influenza share a number of similarities in terms of mode of transmission, high-risk population, clinical signs and symptoms. While this may present a clinical dilemma for the attending doctors in terms of diagnosis, this also renders both these diseases easily preventable by following simple public health measures like avoiding overcrowded and poorly ventilated settings, using a handkerchief/tissue while sneezing or coughing, wearing a mask in crowded & closed settings, maintaining hand hygiene, avoiding spitting in public places, etc,” an advisory by Union Health Ministry read.

“The best way to prevent the spread of respiratory illnesses is to follow proper precautions such as wearing masks, avoiding crowded places, washing hands frequently, and avoiding contact with people who are symptomatic,” Dr Deswal pointed out.

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