The H1N1 virus, commonly known as swine flu, may be on the rise this monsoon, but doctors said there is no reason to panic yet. What needs attention, they asserted, is not the number of cases alone but who is getting infected, how quickly symptoms are recognised and whether vulnerable patients are protected through vaccination and timely treatment.
The Centre too is keeping a close watch. Union Health Minister JP Nadda on Friday reviewed the situation and preparedness of H1N1, which is a subtype of influenza A, particularly in Delhi-NCR, where the cases are on the rise, and called for continued surveillance, early detection and adequate hospital capacity.
The Health Outlook spoke to Dr Deepak Kumar Das, Senior General Physician and CMO (Administration Wing), Bara Hindu Rao Hospital, Delhi; Dr Vijay Kumar Agrawal, Director, Pulmonology & Sleep Medicine and Senior Consultant, Critical Care Medicine, Yatharth Hospital, Faridabad; and Dr Dawar Masud Rizawi, Director, Pulmonology and Sleep Medicine, ApolloMedics Hospital, Lucknow, to understand the rise in H1N1 cases and the precautions people should take.
Prof. (Dr) Das said influenza cases have continued to occur sporadically since the 2009 pandemic, with seasonal peaks generally seen during the monsoon and post-monsoon period and another rise often occurring around January-February.
“H1N1 cases have continued to occur sporadically since the pandemic. There is no panic situation at present, but cases are being reported, particularly among elderly patients, who need to be a little more cautious,” said Prof (Dr) Das.
The infection is treatable, and medicines are available, he said, adding that vaccination remains an important preventive tool, especially for those at higher risk of complications.
“Vaccination should mainly target the elderly and high-risk groups. India has a very large diabetic population, so diabetics, irrespective of age, should also consider getting vaccinated,” (Prof) Dr Das said.
People aged above 60, pregnant women, children below two years and those with asthma, chronic obstructive pulmonary disease (COPD), diabetes, cancer, other chronic illnesses or weakened immunity are particularly vulnerable to severe disease. Bedridden patients and those with other conditions that lower immunity also need closer monitoring.
He said getting the seasonal flu vaccine before the start of the peak period can reduce the likelihood of infection and, if infection occurs, help lower the risk of serious illness.
However, influenza vaccination remains underused in India.
People in India do not routinely opt for flu vaccination. There is a need for awareness campaigns by the government, particularly targeting elderly and high-risk populations, lamented Prof. (Dr) Das.
Dr Vijay Kumar Agrawal, Director-Pulmonology & Sleep Medicine and Senior Consultant, Critical Care Medicine, Yatharth Hospital, Faridabad, said this flu commonly causes fever, runny or blocked nose, sore throat, cough, headache, body ache, chills, tiredness and weakness. Some patients may develop high-grade fever and severe body aches.
Most patients recover with rest, adequate fluids and symptomatic treatment. The doctors, however, warned against taking antibiotics without medical advice because influenza is caused by a virus, not bacteria.
"While most infections remain mild, certain symptoms should prompt immediate medical attention", Dr Agrawal said, adding they include breathing difficulty, increasing breathlessness, chest pain or tightness, falling oxygen levels, persistent high fever, severe weakness, confusion, unusual drowsiness, bluish lips, dehydration or inability to eat and drink.
The symptoms of H1N1 are similar to those caused by other seasonal influenza viruses, making it difficult to identify the specific strain based on symptoms alone.
Dr Dawar Masud Rizawi, director of Pulmonology and Sleep Medicine at ApolloMedics Hospital, Lucknow, said the rise in H1N1 cases has largely coincided with seasonal influenza activity during the monsoon.
This year, Delhi NCR and many other parts of India have seen a spike in H1N1 cases. The current increase is consistent with the seasonal pattern of influenza. High humidity, fluctuating temperatures, crowding and increased close contact can help respiratory viruses spread during the monsoon.
Dr Rizawai cautioned against treating every flu-like illness as H1N1. In some regions, influenza activity typically rises between July and September.
Another peak can occur in January and February, doctors said. “We are currently going through one peak. Cases should come down for some time and may rise again around January-February,” Dr Rizawai said.
“A fever or cough that improves and then comes back or gets worse” should also not be ignored, he said, as it may signal pneumonia or another complication.
People in high-risk groups should consult a doctor early rather than waiting for symptoms to become severe. Testing, when clinically required, can be done using respiratory samples collected through nasal or throat swabs.
For selected high-risk or seriously ill patients, antiviral medicines such as oseltamivir may be prescribed. Dr Rizawi said these medicines are most effective when started within the first one or two days after symptoms begin, but they should be taken only on medical advice.
The doctors said basic respiratory hygiene remains one of the most effective ways to reduce transmission.
People with fever, cough or cold should stay home, avoid crowded gatherings and limit close contact with elderly people, infants and those with weak immunity. Wearing a well-fitting mask around others, covering coughs and sneezes, frequent handwashing and keeping homes, workplaces and classrooms well-ventilated can also help, advised Dr Agarwal.
Also, those diagnosed with influenza should avoid close contact with others until they recover.
“No panic, but no negligence—stay alert, prevent spread and seek timely care,” Dr Agrawal said as he echoed other experts' views stating that most flu cases are mild, but warning signs should not be ignored. “Seek medical help if there is breathing difficulty, chest pain, low oxygen levels, persistent high fever, severe weakness, confusion, dehydration or worsening cough. Fever that returns after improving may signal pneumonia or another infection.”
Nadda’s review on Friday covered national surveillance data, influenza-like illness (ILI), severe acute respiratory infection (SARI) trends, testing, laboratory surveillance and the preparedness of health facilities.
The Union Health Minister also directed officials to closely monitor influenza trends and identify any unusual rise or clustering of cases. Preparedness in Delhi was also reviewed, including hospital beds, critical-care facilities, oxygen-supported beds, ventilators, medicines, diagnostics and referral systems.
The Centre had earlier, on July 10, advised states and union territories to strengthen surveillance for acute respiratory illness and ensure hospitals were adequately prepared.
Nadda also stressed respiratory and hand hygiene and urged people with persistent or severe respiratory symptoms or breathing difficulty to seek medical advice promptly.
For now, the doctors reiterated the priority is preparedness rather than alarm — particularly protecting those most likely to develop complications. Vaccination, early medical advice, sensible precautions and strong surveillance, they emphasised, remain the best defence against a virus that has repeatedly shown its ability to change and return.
Though cases are being reported from many states like Maharashtra and Karnataka, Delhi has reported a sharp rise with over 1300 infections this season, six times higher than the last year this season.
