All over the internet people are receiving and passing on messages starting out with words like this:

Received this excellent advice regarding H1N1/Swine Flu from . . .

The blog post or email forwards a message that starts out:

Subject: Possible swine flu prevention
This message is from Dr. Vinay Goyal a renowned doctor who visited last week to lecture on the topic H1N1 (SWINE FLU), its origin and precautions. He is an MBBS,DRM,DNB (Intensivist and Thyroid specialist) having clinical experience of more than 20 years. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital, Tata Memorial etc. Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).

Word for word, people are claiming that Dr. Vinay Goyal “visited last week to lecture on the topic H1N1.” Visited where? The forwarded email never spells this out but the copy I received implies he visited a prostate cancer support group in Kansas. No way. So what’s really going on?

In many regions including the UK it looks as though the H1N1 A epidemic may already have peaked and that most H1N1 cases are mild, with many people recovering unaided. But cases and deaths overall are probably underestimated. According to recent reports, officials have stopped counting so as to save resources. In India, the Ministry of Health does issue daily counts of cases and deaths. By early October they reported 11,507 lab confirmed cases of H1N1 flu with over 300 deaths.

Meanwhile delivery of vaccine is lagging in the the USA, UK and Europe. India has no announced plans for a vaccination program. In July, GlaxoSmithKline CEO Andrew Witty promised to donate Relenza for emergency use in “developing countries.” Perhaps significantly, in India, which is now a major source of low-cost generic drugs, both Tamiflu — which this viral message scoffs at along with masks –and Relenza currently are caught up in agitation over compulsory drug licensing. As H1N1 Influenza A threatens to assume major epidemic proportions, there is a possibility of compulsory licensing being introduced for Tamiflu and Relenza. One Indian blog reports: “Indian generic companies say that they could also swiftly boost the output of antiviral drugs to tackle swine flu in case of demand.”

Compulsory licensing allows a government to force a patent holder who has an exclusive right to grant a license to be used by the state. This is just what companies such as GlaxoSmithKline don’t want to see happen. In July, a BBC nightly news anchor pressed the CEO of GlaxoSmithKline hard on the slowness of H1N1 vaccine supply, the cost (6 UK pounds per dose, about $12.00) and whether the UK might get short-changed on flu vaccine by the producing countries, Germany and Canada. At the close they spend a few minutes on needs of the developing world and the CEO promises to send them Relenza (See UK ‘at front of queue’ for flu vaccine July 23, 2009.

The Indian Ministry of Health (not the media alone) does recommend N95 face masks for hospital employees and certain others at high risk. The message circulating on the internet flatly contradicts this by saying: “The hype in the media about the utility of face masks and respirators as a tool for general protection against H1N1 can’t be deplored enough.”

Most of the advice in this message makes sense at a certain level and might help prevent panic — which never helps — but it does not make full sense. It’s a type of false comfort. The message says:

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. “Hands-off-the-face” approach. Resist all temptations to touch any part of the face (unless you want to eat, bathe or slap).

3. Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water. *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.*

5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6.* Drink as much of warm liquids as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

All these are simple ways to prevent, within means of most households, and certainly much less painful than to wait in long queues outside public hospitals.

What Is going on Here?

1 Riddhi Vinayak Critical Care & Cardiac Center (Malad) is part of a general hospital in Mumbai (Bombay). So far I have not been able to find any listing for Dr. Vinay Goyal at this hospital. (On the other hand, a well-known doctor of the same name, Vinay Goyal, is a specialist in movement disorders and neuro-infectious diseases including Botulism infection.)

2) This viral message, while claiming that face masks and Tamiflu are ineffective, really says has nothing significant about H1N1 flu vaccine, except to conclude “All these are simple ways to prevent, within means of most households, and certainly much less painful than to wait in long queues outside public hospitals.”

3) In India and many other parts of the world it might not be so easy for everyone to wash their hands effectively in clean warm water and with soap (washing without soap is ineffective for disease-prevention purposes). Nor is antiseptic mouthwash available all over the world. Sounds fishy that a thyroid doctor at a general hospital in Mumbai is telling people to gargle with Listerine. True, even the official message from India’s Ministry of Health advises use of tissues to cover mouth and nose while sneezing. Tissues might not be widely available either. US medical sites recommend using tissues or if necessary covering a sneeze with the crook of the elbow.

Babies and young children are among those most at risk of infection and of spreading infection to other children, too pregant mothers and to older relatives. Babies can’t gargle or be forced to blow their noses. Babies and young children usually need a parent or caregiver to wash their hands and wipe and/or cover their noses and mouths if they sneeze or cough.

4) Vitamin C and zinc have never really been shown to prevent colds or flu. The Amla fruit mentioned in this post is Indian gooseberry, which is reputed to have anti-viral properties. “Although fruits are reputed to contain high amounts of ascorbic acid (vitamin C), 445 mg/100g, the specific contents are disputed and the overall antioxidant strength of amla may derive instead from its high density of tanninspolyphenols. The fruit also contains flavonoids, kaempferol, ellagic acid and gallic acid.

5) The official Indian Health Ministry H1N1/Swine flu website posts info at these urls:
http://www.mohfw-h1n1.nic.in/
http://mohfw-h1n1.nic.in/swin.pdf

As mentioned, they specify (as the Vinay Goyal post does not):

Cover your mouth and nose with a tissue when you cough or sneeze Wash your hands often with soap and water …

They also show a nurse and a child patient wearing masks.

The Indian Ministry of Health links to official AYUSH recommendations (AYUSH is the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy):
http://www.mohfw-h1n1.nic.in/Press%20release%20common%20flu.pdf

An AYUSH publication about H1N1/Swine Flu recommends, among other measures, traditional medicinal concoctions using household spices black pepper, ginger, turmeric, Long Pepper, Tulsi and more. However this AYUSH publication warns people with influenza symptoms to go to screening centers or designated hospitals for diagnosis and for medicine.

Ayurvedic medicine alone can’t protect people from influenza. People do need to avoid panic. Most people who have caught H1N1/Swine Flu have easily survived, even in India and Mexico.

Brent King, M.D., professor and chair of the Department of Emergency Medicine at The University of Texas Medical School at Houston, says: “Emergency departments are experiencing increasing patient loads as the epidemic progresses. Fortunately, most patients are not seriously ill, though many certainly feel terrible.” King says: “But, unfortunately, there is little we can do for these patients that they cannot do for themselves. Resting, maintaining hydration and judiciously using medications to treat fever are the mainstays of managing influenza.”

So far in the his part of the USA, King says, a very small number of people have developed serious respiratory symptoms in association with H1N1 influenza. “People who are concerned that they might be seriously ill should contact their personal physician and follow her or his advice regarding further treatment. As always, emergency physicians are available to evaluate and treat those who are very concerned about their symptoms,” King said.

Young children and pregnant women are at special risk. A study at the US Centers for Disease Control and Prevention, published in May 2009, found that children had no preexisting immunity to the new strain but that adults, particularly those over 60, had some degree of immunity. Children showed no cross-reactive antibody reaction to the new strain, adults aged 18 to 64 had 6–9%, and older adults 33%.

Pediatric neurologists at the UT Medical School at Houston say they expect possible neurological complications, including seizures, from the virus and clinicians should look for H1N1-associated encephalopathy in children. “We expect to see the same problems with H1N1 that we do with seasonal flu. We’re telling our residents to look for meningitis, encephalitis, myositis and peripheral neuritis,” said Ian Butler, M.D., professor and chief of the Division of Child Neurology at the medical school.

Robert Emery, Dr.PH, associate professor of occupational health at The University of Texas School of Public Health, says prevention needs to be the main focus. “Although there is a lot of attention being focused on shots for the seasonal and H1N1 flu, individuals and businesses need to remember the power of prevention and adhere to the basic practices of frequent hand washing and cough control to help prevent the spread of the virus,” Emery said.

Even so, in addition to over 13 thousand lab confirmed cases of H1N1 flu in India, by the end of October there were 465 deaths. In Mexico 5,029 cases and 97 documented deaths occurred. were reported.

India, it is claimed, suffered worst of all nations during the Spanish influenza epidemic after WW1, when many of its trained doctors were unavailable to serve civilians:

http://www.spartacus.schoolnet.co.uk/FWWinfluenzia.htm
LINKS

H1N1 Vaccine Supply Already Running Low BY KRISTIAN FODEN-VENCIL Portland, OR October 8, 2009

In India, daily press releases on H1N1/ Swine Flu cases and deaths are posed by the Ministry of Health:
http://mohfw.nic.in/press_releases_on_swine_flu.htm

The right mask can help prevent swine flu. Consumer Reports Health Blog, April 29, 2009

Some immunity to novel H1N1 flu found in seniors. Lisa Schnirring

Can Masks Help Stop the Flu? By Nick Triggle, Health reporter BBC April 29, 2009

A/H1N1 influenza death toll rises over 4,500, says WHO
www.chinaview.cn 2009-10-10 07:49:11

US, other nations stop counting pandemic flu cases By MIKE STOBBE AP October 10, 2009

Swine Flu Cases Rise; CDC Urges Vaccination
Vaccines for Swine Flu, Seasonal Flu Can Be Given Together, Experts Say
By Kathleen Doheny WebMD Health News, Oct. 9, 2009

Two reports offer new data on severe H1N1 cases by Robert Roos, CIDRAP – Center for Infectious Disease Research & Policy

H1N1 News Page, CIDRAP

Emergency Use Authorization of Relenza (zanamivir)

H1N1 vaccine supply ‘inadequate’ September 20 2009, Al Jazeera

‘Need for perspective’ on swine flu By Roger Harrabin Environment analyst, BBC News 6 May 2009