Wednesday, April 29, 2009

Swine Flu: Do NOT stock up on antivirals

I was pleasantly surprised to receive a comment from Jon LaPook, M.D., chief medical correspondent, CBS Evening News (with Katie Couric). I had in an earlier blog referred to swine flu and some of the tips Jon had recommended. In it, I mention one of the tips as: ‘Keep a stock of antivirals’. However, I stand corrected. It should have read: ‘Skip stockpiling antivirals’. Jon also provides an excerpt:

"Skip stockpiling antivirals. We all love to have control, and if not actual control then at least the illusion of control. Enter Tamiflu and Relenza, the anti-viral drugs that can lessen the severity of flu if taken within 48 hours of the onset of symptoms. Why not hoard them now? Shouldn't you have some "just in case"? For most healthy people, the answer is an emphatic “no,” something I confirmed today with both the CDC and the New York City Department of Health. Yet I called several New York City pharmacies this afternoon and was told there’s been a run on Tamiflu. As a physician, I know how tough it can be to “just say no” to an insistent, worried patient. And I haven’t totally gone over to the dark side of not remembering what it’s like to be a patient; believe me, there’s an insistent, worried patient hiding inside many physicians, myself included. But inappropriate use of Tamiflu and Relenza can lead to the swine flu becoming resistant to these medications – the same thing that’s happened with overuse of antibiotics. The virus is sensitive to these drugs now but that could change with overuse.

In addition, shortages created by hoarding would hamper our ability to treat patients with regular flu, which affects millions of people and kills about 36,000 annually in the U.S. And shortages during an outbreak of swine flu might contribute to a more rapid spread of the virus. So, ironically, the unused Tamiflu in your medicine cabinet could increase the likelihood of the disease infecting you and your loved ones."

Tuesday, April 28, 2009

Swine Flu: Now a cause for some concern

Although no cases of swine flu have been reported in India, its outbreak in several parts of the world have raised some concern. However, with Indians travelling a lot nowadays, it may do good to exercise caution before drawing up travel plans. A visit to Mexico should certainly be out for the moment. For those having planned to visit the US, it might be useful to check whether the places they'd be staying in are those where some cases have been reported. Overall, there is no cause for major concern. The bird flu, for example, was hyped up a bit, and apart from millions of chickens having been culled everywhere, it led to a sense of panic. In this case, there is no need to panic as yet. The deaths have only been reported from Mexico.

On the Huffingtonpost Web site, an excellent one for the latest information about happenings all over the world, I was reading about swine flu, which seems to have caught many people in different parts of the world completely unawares. Dr Jon LaPook, chief medical correspondent, of CBS Evening News, puts the whole thing in perspective in his article on the site. He says that nearly 2,000 cases of swine flu have occurred in Mexico, resulting in 149 deaths. The US has reported only 40 cases (no deaths yet), but the numbers are growing, according to him. Dr LaPook calls the situation fluid and says that nobody knows exactly what might happen. He offers some tips though:

- Keep a stock of anti-virals
- Practise good hygiene, such as hand-washing, covering your mouth with a tissue when you sneeze and throwing the tissue away, staying home if you are not well, etc
- Keep yourself informed about the disease (he suggests

I also received an email from a friend that provided a lot of background info about the swine flu virus. Those interested in learning what it is all about can read on.

What is Swine Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there?
Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Can humans catch swine flu?
Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

How common is swine flu infection in humans?
In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.

What are the symptoms of swine flu in humans?
The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can people catch swine flu from eating pork?
No. Swine influenza viruses are not transmitted by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

How does swine flu spread?
Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What do we know about human-to-human spread of swine flu?
In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.
In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

How can human infections with swine influenza be diagnosed?
To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

What medications are available to treat swine flu infections in humans?
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

What other examples of swine flu outbreaks are there?
Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

Is the H1N1 swine flu virus the same as human H1N1 viruses?
No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

How does swine flu spread among pigs?
Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

What are signs of swine flu in pigs?
Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

How common is swine flu among pigs?
H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.
While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.
Is there a vaccine for swine flu?
Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

Monday, April 27, 2009

What are campaigns for?

Election campaigns are on across India. I was speaking to a few people today in the neighbourhood I stay - a motley group of youngsters, adults and the older generation. The overwhelming sentiment was one of despair.

The common refrain was that after 60 years of Independence, most parts of the country are still bereft of infrastructural development. Not only that, communalism, casteism and what have you, are getting worse by the day, most felt. If in Kerala, you are identified by the party you belong to, here, it is the caste you represent, said one youngster.

Vijay Kumar, a sports journalist with the Express once, now in his 70s, said he had nothing to look forward to - a garbage dump outside his house was cleared only once in a while, there were frequent power cuts, water supply was erratic, storm water drains had choked as a result of which floodwater had entered his house last monsoon, and wherever he went, he found corruption and disrespect for humankind, even the elderly. So, what's the point in voting, he asked me.

Politics was all about muscle and money, everybody agreed. Unless you had goons to support you and money to splurge, it was a useless exercise. I tried to convince them that no matter what, the best way to voice frustration was at the hustings, by voting on poll day. A few were leaving town on voting day, they didn't really care. Premila, a young mother, said that she had never voted, not did she want to. How can you vote for the kind of people who stand for elections, she thundered. Everybody seemed to nod in unison. I felt outnumbered and could not find anything to say.

As I was about to say bye and leave, two journalists with a leading newspaper came by. They had just been on the campaign trail of a local biggie. It was something they had wanted to experience firsthand. Now back, they looked famished and deprived of sleep. Reason: they had to wait for four hours for the biggie to arrive. Under sweltering heat. And when finally he did make an appearance, fleeting as it was, all he did was fold his hands in a namaste, wave and smile. Somebody thrust a mike at him and he was forced to speak - a few words of what he would do if they voted for him. And in a few moments he had turned the corner street and disappeared in a cavalcade of vehicles and hangers-on. Life returned to normal almost as soon as he left, except for the film songs that blared from the loudspeakers.

Can't you write about how they steal power from our lines to play the music, a shopkeeper had asked one of the scribes. "Well, I might as well write about that," the reporter thought aloud, "Might be a better story than about his campaign trail."

Friday, April 24, 2009

Relying on the 'power of truth'

N.S. Venkataraman is standing from the Chennai South constituency in the general elections. Tamil Nadu goes to the polls on May 13. Here is an email I received from him. Venkataraman, of course, is a skilled writer – his correspondences are almost legion. This one is short and, yes, sweet.

Several people think that in the absence of money power and muscle power, it would be impossible to win elections....but, this is the same country where principles of peace won over violence and got us our freedom from the British.

Today, as we face the problems of injustice, corruption and dishonesty, we see that its roots are in the basic inadequacies of parliamentarians, who fail to perform their duties after getting elected on party popularity.

I am contesting in the forthcoming election under the leadership of Mr. V. Kalyanam, close associate of Mahatma Gandhi and his personal secretary. I believe in the power of truth. If you want good changes in this country in the coming years, then, this is the start of a long journey.
I am a chemical engineer offering consultancy services to Indian and international companies. I have been working for over fifteen years with the deprived and differently-abled section of the society, providing various forms of support including financial support for education for poor students and running free computer schools at various centres in Tamil Nadu.

Let us join hands today. For further details please log on to or contact me at

Tuesday, April 21, 2009

Life without the Tigers

It is a difficult part of the year for many in India this year - the heat and the elections coming together. Temperatures across the country are soaring; heat waves and deaths resulting from them can be expected any time now. The poor in the villages are perhaps the worst affected, with no money to go to a doctor when an emergency strikes.

As far as the elections are concerned, the cacophony is yet to start, of drumbeats, fire crackers and loudspeakers, all used to tempt people to vote for candidates whom they hardly know. In Tamil Nadu, the elections are quickly coming under the shadow of the catastrophe that is unfolding in Sri Lanka. A 'general strike' has been called for tomorrow, to protest against the Lankan advance into LTTE's last bastion. Images that are coming from the last-held LTTE territories are most discomforting. Civilians are fleeing, families, the elderly and children. Most people are in a state of sever shock. People are dying by the dozens daily and many, many more are getting killed in the firing. With the Sri Lankan government keen to finish the war against the Tigers, a war that has been raging more 26 years now, there seems to be little chance of a ceasefire.

Many of those fleeing have been shown in videos worldwide. They say that they are looking forward to the war getting over quickly so that at least future generations will be able to lead a life of peace. Sri Lanka or Ceylon as it was called in the days when I was a child was once considered 'paradise on earth' - loving and warm-hearted people, great countrysides and tea and coffee estates, and an old-world charm everywhere. 1983 changed all that, with the LTTE and other Tamil groups surfacing and demanding a separate Tamil state, and the massacres that followed. Repercussions of all that did not take too long to hit Madras. There were shootouts in T Nagar and in Kodambakkam. And, of course, we all know about the IPKF and the assassination of Rajiv Gandhi.

What started as a possible legitimate demand by the Tamils veered out of control, so much so that the LTTE was banned as a terrorist organisation by even the United States. Many LTTE leaders have died over the years, but more in recent months and weeks. Others have deserted the force, significantly one of its trusted lieutenants at one time, Karuna, now part of the Lankan government machinery. The script is long dead, and as the end of the war draws near and when you think of the future generations of Tamils in Lanka, you know that the past 26 years have not really been an investment for them. It was in many ways a script that went terribly wrong.

A word about Prabhakaran. Charismatic, even good looking (he could have made a dashing hero in a Kollywood film), he was ruthless and brooked no dissent, qualities that are needed to run an organisation like the LTTE. He created a cult following and has remained elusive in recent years, adding to the legend. What will happen to him eventually is anybody's guess, but if any harm were to come to him, the echoes will be strongly felt in Tamil Nadu.

If only the LTTE and the other Tamil groups had agreed years earlier to a power-sharing agreement with the Lankan government, with the territories in the northeast under their suzerainty, things might have been different today. Nobody here is actually looking forward to the finale. The thought of a Tiger, long held under captivity, being driven to extinction is not really the perfect ending for this story. But then, reality can throw surprises.

Friday, April 17, 2009

A chemical enginer in the poll fray

Indeed, it is Venkataraman, chemical engineer and trustee, Nandini Voice for the Deprived, who will be standing for Kalyanam's party, from south Chennai. The party is also fielding a candidate from central Chennai. Venkataraman says he will spend not more than Rs 3.5 lakh toward publicity and other expenses. He was inspired to join the party when at a meeting in Mylapore eminent persons such as B.S. Raghavan and Vittal urged participation and action rather then only voicing opinion. They were all for him standing in the fray. Venkataraman did not disappoint.

Now, here's hoping that he will be able to communicate his party's viewpoint - clean and efficient governance - to the people of his constituency.

All the best, Mr Venkataraman. May you do well and show others the way.

Sunday, April 12, 2009

Elections - the young and the old

It’s election time and we all know how it feels during election time in India. One of the attempts has been to get the younger generation involved, to get some of them to stand for elections and getting others to the polling booths. So, it was heartening to learn about a young entrepreneur, 28 years old, running a catering service after rejecting jobs with MNCs, now standing for elections from Chennai. That’s the way to go.

I was, therefore, surprised to learn about V. Kalyanam, personal secretary to Mahatma Gandhi during the latter’s last years, now all of 87, registering the Desia Paadhugaappu Kazhagam (National Protection Party ) as a political party and deciding to contest in the parliamentary elections from Chennai. According to an email I received from N. S. Venkataraman, trustee, Nandini Voice For The Deprived, those who stand for elections must “understand the seriousness and severity of the issues facing Indian democracy...” The email goes on to say that the Gandhian philosophy of ahimsa, truth, probity in personal and public life have not been highlighted as principles by any political party in the country and that “the important fact is that when concerned people swearing by Gandhian ideology in personal and public life would contest in the elections, it would give a sense of hope that the tide of corruption and dishonest dealings would be stemmed.”

Venkataraman, a chemical engineer, I understand, will also be a contestant in the election.

Down the hill

The way down the hill, with a splendid view of the Shiva temple in Thiruvannamalai. It's a place that beckons you again and again.

Thursday, April 09, 2009

Perched high on the hill was this trader of embellished stones. He was a craftsman and displayed his skills to us. He probably lived close by, we didn't bother to ask. But perhaps he finds something special in the magic of the hills that is Tiruvannamalai - with a view of the Arunachala temple and vibrations from Sri Ramana Maharshi's abode.

Wednesday, April 01, 2009

Virupaksha Cave

As we came down from Skandasramam, we stopped by at the Virupaksha Cave where Sri Ramana Maharshi meditated for 16 years.

The cave was quite dark inside and there were a few people meditating.

Outside, it was serene, and you felt at peace with yourself.