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Diving deep into the influenza outbreak

31 May 2018 12:00 am - 0     - {{hitsCtrl.values.hits}}

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After the Dengue fiasco last year, the Seasonal Influenza Virus has taken centre stage as the most recent health scare. The disease is said to be spread mostly in the southern region of the country, claiming several lives including those of several young children. With not much information available on the present status of the disease, speculation is high, blowing the situation out of proportion. The Daily Mirror spoke to several individuals who are directly involved in dealing with the situation at different levels, clearing the air about these speculations and obtaining information on how to prevent the further spread of the disease. 

Health authorities are making a rough assumption that the disease came with the tourists

Hospitals and ICU’s overflowing with patients
 It’s reported that there have been 19 deaths so far of small children due to fever during the last 28 days, and 12 deaths from pneumonia in the Matara District General Hospital alone. Inside sources claim that the hospitals in Matara District are overflowing with patients having fever, and the bulk of the patients are being cared for at the Matara District General Hospital, Karapitiya Teaching Hospital, Kamburupitiya Hospital, Walasmulla Hospital, Tangalle hospital, Balapitiya Hospital and Elpitiya Hospital.   

ICUs in the district are overflowing with patients having fever and this includes the ICU’s in the hospitals in private sector as well, according to the sources. Out of the 4 people deceased, on the 28 May at the Matara Hospital, 3 are due to respiratory causes. Three people including a 21-year-old youth have passed away due to pneumonia on 28 alone, at the Matara General Hospital.   

On inquiring about the disease control measures taken it was initially reported that the schools of 8 divisions in Matara as well as all the pre-schools will be closed until June 1. Two epidemiology teams have been dispatched to the area to investigate the outbreak, according to the sources from the Health Ministry. Southern Province Chief Minister Shan Wijeyalal De Silva has requested an urgent report on the outbreak from the Regional Director of Health Services.   

Daily admissions to the hospital for other disease conditions have drastically reduced. Patients don’t show up at the clinics nor do they present themselves for routine pre-scheduled surgery out of fear for the disease outbreak” he revealed

The silence maintained by the Government and the health ministry regarding this matter has become a source of frustration to the general public. The difficulty in obtaining correct information regarding the disease and the number of affected people has driven undue fear and panic into the residents. 

“All major surgeries in Karapitiya Teaching Hospital have been suspended due to the fever situation”
Dr. Janath Liyanage GMOA Branch President at the Karapitiya Hospital

“ Almost all our ICU beds are currently being occupied by patients having fever,” stated Dr. Janath Liyanage, Consultant Paediatric Surgeon and GMOA Branch President at the Karapitiya Teaching Hospital (KTH) when asked to reveal the current situation at the hospital. Explaining further, he claimed that the ICU has been full for about two months now. All the major surgeries have been suspended until further notice, because the hospital cannot supply the required aftercare in the ICU for the patients undergoing these surgeries due to the ICU being overcrowded with patients having fever. “As a paediatric surgeon, I haven’t been able to do any major surgery for the past 2 months because of the unavailability of the ICU’s”, proclaimed Dr. Liyanage.   

As for the overall situation in the southern province, he stated that even the doctors weren’t aware of the exact situation, due to the patients being sent to hospitals throughout the province.   

“Not educating the public about the disease adequately has resulted in causing panic among the general population and there is the assumption that a deadly unknown germ is spreading in the Southern Province. Daily admissions to the hospital for other disease conditions have drastically reduced. Patients don’t show up at the clinics nor do they present themselves for routine pre-scheduled surgery out of fear for the disease outbreak” he revealed.   

When inquiring into the source of the disease and the strain of the virus he explained that the influenza epidemic commenced last November in US, causing almost 4000 deaths. “In Sri Lanka, as far as we know, the disease started somewhere around Weligama area, so we can make a rough assumption that it came with the tourists,” he said.   

“Like the H1N1 strain that caused a pandemic in 2009 worldwide, it’s currently the influenza strain called H3N2 that is going around, though in a much smaller level, according to international data. So we are assuming that it’s the same strain that we are currently experiencing”, stated Dr. Liyanage.   

He emphasized that up to now, the Epidemiology Unit in Sri Lanka has failed to release any information on the virus strain or the specification of treatment to the healthcare workers. “Usually, an infectious disease like this is treated according to a national guideline prepared and released by the Epidemiology Unit. When we requested for an updated guideline they asked us to follow the guideline which was released in 2015”, he said.   

“GMOA is having a meeting with the minister to talk about expanding the ICU facilities. We have only 7 ICU beds, even though we have the space adequate for 6 more beds. We requested for the instruments last year, but so far they have not been given. So we are trying to add at least two or three additional beds and equipment to the ICU, to keep the hospital at a functional level,”he said.  Dr. Liyanage also stressed that the secondary infections are more dangerous than the Influenza itself. Most of the children presenting with fever, cough and cold improve within 3 to 4 days. Even though other symptoms disappear the cough can persist. They may again develop high fever with respiratory difficulties and cough, due to another germ that entered the system, due to the weakened tissues from influenza. These infections can be dangerous, causing respiratory failure and sometimes even death.

“Influenza not only limited to Southern Province”
Dr. Ananda Wijewickrama Infectious Diseases Hospital, Angoda

 When asked if there is a risk of the virus spreading to the other regions, Dr. Ananda Wijewickrama, Consultant Physician at the Infectious Diseases Hospital, Angoda revealed that contrary to the popular belief, the disease currently persists in other areas of the country, though at a lesser level. He stated that the IDH has been receiving influenza patients for the past 1 1/2 months, currently having around 5-6 admissions of suspected influenza patients per day.” The condition of the majority of these patients is not in serious and they are treated outside,” he further claimed.   

When inquiring into the specific strain of the virus he explained that the samples have been sent abroad to be analyzed. This is because Sri Lanka doesn’t have the facilities to analyze the virus and it might take some time for the results to arrive. “The strain of the virus isn’t important in treating the disease, because the treatment methods are similar between the strains of influenza”, he reassured.   

The Daily Mirror further learned from him that the vaccine for influenza is recommended to a limited number of people who exposed to risk, even in countries like UK; where they experience yearly outbreaks of influenza virus. These groups ‘at risk’ include youngsters, the elderly, those who are suffering from chronic illnesses and healthcare workers. Therefore the vaccine isn’t required for each and every person and is better to be taken if recommended by a medical profession, he advised.   
 The vaccine, which is currently available only in the private sector, is not hundred percent effective due to the rapidly changing nature of the virus, he further claimed.   
Department of Health and Department of Education along with private and public media organizations have a big role to play in preventing the spread of influenza, stressed Dr. Wijewckrama.   

 Patients don’t show up at the clinics nor do they present themselves for routine pre-scheduled surgery out of fear for the disease outbreak

When asked if there is a change in the severity of the disease compared to the previous years, Dr. Wijewickrama claimed that he didn’t observe a drastic change as such, since there were similar incidences of severe influenza during the past couple of years, resulting in pneumonia and sometimes causing deaths of people in vulnerable groups.   

The cause for the deaths associated with Influenza is mostly due to the delay in seeking medical care, he commented, explaining that sometimes patients wait until they have severe illness and respiratory difficulty to seek medical help. He added that sometimes the primary care doctors themselves fail to recognize that the patient needs hospitalized care. Dr. Wijewickrama also underscored that the main cause for the high morbidity in most patients with Influenza isn’t the influenza virus itself, but the secondary infections caused by bacteria. Most of this bacteria, which becomes deadly does not respond to antibiotics and it all relates again due to the ignorance of the patients, he declared. “Whenever a person develops a cough and cold, and even if it’s a viral illness, patients expect antibiotics to be prescribed. They demand antibiotics from the doctor or sometimes self-medicate themselves after obtaining medicine from pharmacies. Even some doctors are responsible for prescribing antibiotics inappropriately. So with the frequent use of antibiotics, the body becomes resistant to them and curing these bacterial infections becomes very difficult”, explained Dr. Wijewickrama, who strictly advised patients and the doctors not to use antibiotics unless the disease is of bacterial origin.   

Numerous attempts made by the Daily Mirror to contact the Epidemiology unit to obtain the confirmed statistics and information on the disease spread proved futile.  

Prevention and seeking medical attention
Dr. Ganganath Gunathilake Consultant in Paediatric Respirtory Medicine

According to Dr. Ganganath Gunathilake, Consultant in Paediatric Respirtory Medicine, educating people regarding prevention is crucial in minimizing the spread of the disease. Being aware and maintaining a good respiratory hygiene can go a long way towards controlling the spread of the disease.   

Influenza is highly infectious within the first 7 days after symptoms develop. In preventing the spread of droplets, it’s important to remember that a cough can carry droplets a distance of roughly three feet. Therefore, if you are having symptoms like cough, fever and runny nose then it is important to wear a face mask and avoid public places where you can spread the disease to others. Small children having flu symptoms should be kept at home until the symptoms subside.   

All those who come in contact with the virus do not develop symptoms, explained the doctor. The majority would have no symptoms at all while the others would develop symptom ranging from a mild disease to pneumonia. Those who are at the extremes of age, Children under 2 years of age and elderly over 65 years of age, are more likely to develop a  severe illness. Among these children, those having chronic diseases or diseases in organs like the heart or the kidneys are more susceptible. Pregnant women as well as adults, who are suffering from chronic illnesses and having weakened immune systems, are also more vulnerable. If a person belongs to the above categories, it’s important to seek medical attention as soon as the symptoms appear, cautioned Dr. Gunathilake. Patients who are having high fever or respiratory difficulty at any stage of the disease need to seek urgent medical care, he advised.   

Whenever a person develops a cough and cold, and even if it’s a viral illness, patients expect antibiotics to be prescribed. They demand antibiotics from the doctor or sometimes self-medicate themselves after obtaining medicine from pharmacies.

Patients who are having mild symptoms can usually be safely managed at home with adequate hydration bed rest and paracetamol being given for the fever, said the doctor.   

“Secondary Infections cause more harm than influenza”
The majority of those who are aware and taking precautions against influenza believe that it’s the primary disease or the influenza that causes severe illness and death in patients. This is not so, according to the many specialists that the Daily Mirror consulted. All of them agree that while influenza can sometimes cause pneumonia and other severe disease, it’s usually the secondary bacterial infections that arrive after developing pneumonia which causes more harm to the patients.   

“Damage caused to the respiratory tract by the influenza virus makes it easier for the other bacteria to enter and cause infections, explained Dr. Gunathilake, further stating that these can be more difficult to manage than the virus itself. Therefore he cautioned patients to be on the lookout for secondary infections after a viral infection of the respiratory tract. “These infections usually appear as fever reappearing 4/5 days after subsiding of other symptoms”, he commented.   

‘‘Lack of guidance on how to address the present situation’’
D. D. K. Wickra,chchi Matara Divisional Secretary 

When inquired into the initiatives taken by the Government to address the current health problem in the country, Matara Divisional Secretary D. D. K. Wickramaarachchi said that the Government had taken measures to close the primary schools with the onset of the viral flu. These schools were scheduled to be reopened yesterday (May 30). According to Wickramaarachchi, classroom sessions were conducted as usual for students in other grades although a significant drop was witnessed in the number of students who were present. “Plying along the Pasgoda, Kotapola and Kamburupitiya roads, I noticed that there were only around four to five students in school vans that can usually accommodate around twenty. These were students who were returning  home from school and the number was very low compared to the number of students one may observe in a school van on a regular day.   

There is a general fear in sending children to school under the prevailing situation. It has reached a point where the Karapitiya Hospital is no longer receiving additional child patients to the children’s ward in the hospital. My personal view on the matter is that it’s better to close the schools at least until the health authorities issue an official announcement, stating that the prevailing disease situation has been brought under control in the country. To my knowledge, I believe that the Ministry of Health has still not made any official statement regarding the disease. However, it should be noted that even in Matara, there is a general fear that the disease might spread. Currently we are facing a problem due to the lack of proper guidance on how to address the present situation” Wickramaarachchi said.   

“The Ministry’s silence is causing undue panic among the citizens”  

Stating that there are five main hospitals in the south comprising the main hospitals of Karapitiya Teaching Hospital in Galle, the Teaching Hospital in Maha Modara, General Hospital in Matara, Labima Hospital in Kotawila and the District General Hospital in Hambanthota, Wickramaarachchi continued that statistically, it is difficult to assume how many patients with the virus have been admitted to these hospitals. “Also, it is certainly not within my purview or knowledge to statistically determine the number of patients currently admitted to the hospitals for treatment. 

Nevertheless, children have been advised to wear a mask to avoid contracting the disease. But, it’s equally important to ensure that these masks are worn by them in the correct manner to avoid the spread of the disease. On the other hand, there is speculation that the influenza disease might spread again in the months of July and August although this needs to be verified since the information is coming from unofficial sources. Also, given that this is the rainy season, now there prevails a risk of dengue spreading in the locality. As a country, we have not impressed enough weight on this matter despite it being a burning social issue that needs to be addressed immediately” he concluded.   

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