Attachment
The moment one responds to any threat with fear, one loses rational cognition and shifts into emotional and reflex decisions. Fear comes from lack of confidence, which comes from lack of understanding.
For the 2009 flu pandemic, there should have been a war room in New Delhi for cold and factual strategy planning. But we do not have a subsystem of ‘public health’ – the function of which is to look at the community and the environment and learn about the behaviour and tactics adopted by pathogens for their survival and spread. Based on observed facts that are analysed epidemiologically, public health personnel consider various options and choose the best interventions. India’
As a result, fear took root among the top leaders. Fear reflects lack of confidence and leads to over-reaction and errors of judgment. This time we may have got away with our less-than-professional approach because the disease is a mild one; the next time around we may not. Recall how our governments responded, with callous neglect, to the chikungunya fever that emerged a few years ago, causing far greater misery and a death rate that remains unmeasured. No one had instilled fear ahead of that event. So it was not even recognised as a public health problem to worry about.
The approach was wrong both times. Forewarning should lead to preparedness, not panic. Lack of forewarning should not lead to absence of professional response and interventions.
As the scene emerged and evolved from April through July/August 2009, the World Health Organisation kept everyone well-informed and well-guided. Our leaders were not paying attention. "A strategy that concentrates on the detection, laboratory confirmation and investigation of all cases, including those with mild illness, is extremely resource-intensive,"
India obviously wanted to do one better and continue down the path the WHO warned against. Who does not like a good epidemic? Look at the media visibility.
When the minister of health himself comes to the frontline of the battlefield and shouts “Don’t panic!” who will not panic? The first directive through media channels was for ill persons to appear at designated centres for collection of specimens for testing. Anyone who saw the crowds either directly or on TV would certainly believe that there was a huge epidemic. There were other messages that echoed the panic. Apparently the municipal commissioner of Mumbai sought public opinion via SMS on whether or not schools should be closed, allowing people’s imagination to fly wild.
Why was the discretion to selectively test individual patients not left to doctors? The lack of confidence in doctors got out of control and the threat of lawsuits added yet another dimension to the confusion and cacophony. Had the government not responded in panic and plunged into kneejerk responses, instead of taking proactive and deliberate steps, soothing the fears of the public and appointing specific, informed spokespersons to present the official view, the anarchy witnessed over the past couple of weeks could have been avoided.
The media played its part in magnifying the fear psychosis. They pictured a disastrous epidemic when there were only a few cases, and carried on with the self-fulfilling prophecy of projecting the growth of the epidemic, with more expert opinions than facts – were they taking the opportunity to say our channel did this first or better, had more experts, etc.? Medical experts who were interviewed generally doubled up as public health experts.
Significantly, India does not have a public health department in the Ministry of Health and Family Welfare. The director of the National Institute of Communicable Diseases was recently designated as the official in charge of public health. He should have been the official spokesperson of the government. Another potential spokesperson could have been the director general of health services – although the DG is in charge of healthcare, major disease control activities and the NICD come under his purview. Instead, we heard from several spokespersons, who were like the many cooks who spoiled the broth.
What is the purpose of testing ill individuals for presence of H1N1 pandemic influenza virus? Testing in general can serve two purposes. One is a public health purpose, to detect the arrival of the virus in a new locality and see if it has begun to spread – to serve this purpose testing is done on a ‘selected sample’ of ill persons chosen by the public health subsystem. That function is within the government’s purview and the private sector can be excluded from it. The second purpose is to check ill persons for their personal benefit – such testing fits into the healthcare mode and subsystem; it is obviously not ethical to exclude the private sector. India’s response appears to have mixed up these different purposes and separate subsystems.
In healthcare, in cases involving persons at risk of pre-existing pathology that could be complicated by flu, it is the physician’s decision to test or not. If the flu has arrived in the town/community, then it is a good idea to test such persons. But then, as soon as the sample is taken and pending the result of the test, the person should be given Tamiflu. If the patient tests negative, the drug can be discontinued;
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Infochange News & Features, August 2009
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