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How Covid ‘downsized’ India’s influenza problem & why experts say it’s not good news yet

Data shows India has reported just 65 cases of influenza and no related deaths as of July this year. In 2019, the year before Covid, there had been 28,798 cases and 1,218 deaths.

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New Delhi: Eighteen months of masking, social distancing and hand hygiene amid the Covid pandemic may have come with some unforeseen collateral benefits — seasonal influenza (H1N1) cases dropping to a minimum this year.

While H1N1 numbers do tend to fluctuate year-on-year based on the infectiousness of the virus in circulation, the tally till 31 July this year is 65, with no deaths.

In 2020, the total number was 2,752 with 44 deaths, and 28,798 cases and 1,218 deaths in 2019, the last pre-Covid pandemic year.

While doctors point to a possible decrease in testing (hence low number of cases) owing to the overwhelming focus on Covid, a downward slide has been a global trend since the pandemic hit.

As it happens, Covid and influenza have similar symptoms — fever, sore throat and body ache among others.

“… flu cases and deaths in the US and worldwide dropped to unprecedented lows, and influenza remained scarce this summer for the second consecutive flu season in the Southern Hemisphere. Between October 3, 2020, and July 24, 2021, of the 1.3 million specimens tested by clinical laboratories and reported to the US Centers for Disease Control and Prevention (CDC), 2136 were positive for influenza virus, and 748 deaths were coded as influenza, according to CDC data provided to JAMA,” read a report in JAMA last month.

The World Health Organization (WHO) had declared the end of the global influenza pandemic in 2010 but predicted that the virus will circulate for some years to come as seasonal influenza. In view of this, countries, including India, started influenza surveillance. The Indian government also recommends annual vaccinations for vulnerable groups, particularly the elderly and children.

According to a note circulated by the health ministry earlier this year, seasonal influenza is caused by a number of circulating influenza viruses such as Influenza A HINI, H3N2 and Influenza B.


Also read: Precautions against Covid may have just killed the flu in 2020


Testing versus masks

Data available with the National Centre for Disease Control (NCDC) shows that pre-2019, India’s H1N1 numbers stayed below 1,000 only twice in the past — in 2011 and 2014.

In 2011, 603 cases and 75 deaths were reported while three years later, 937 cases and 218 deaths were reported.

“The use of masks to curtail transmission of the Covid-19 virus has also contained the transmission of other respiratory viruses in several countries. Though physical distancing too has helped, it is the widespread use of masks that has had a major impact on both droplet and aerosol spread of respiratory viruses. Influenza case numbers had fallen with masks and started rising again in places which have opened up with relaxation of masking rules,” said Dr K.S. Reddy, president of the Public Health Foundation of India and adjunct professor of Epidemiology at Harvard.

However, doctors say the change in situation in India could be a result of reduced testing.

“Last year, we hardly saw any cases of influenza … it had completely disappeared. But this time, we are seeing more cases and it is not really the flu season yet. It is possible that people are not being tested for H1N1 once they have tested negative for Covid,” said Dr S. Chatterjee, consultant medicine at Indraprastha Apollo Hospitals.

“In our hospital, when symptomatic people test negative for Covid, we are doing other tests. So unless we have figures of how many people have been tested, it may be difficult to say whether it is really down.”


Also read: How to handle Covid plus dengue, malaria or seasonal flu? Health ministry issues guidelines


Reduced herd immunity?

Epidemiologists, meanwhile, are arguing whether the dip in influenza cases is something to be celebrated or if it comes with its own problems with populations becoming more vulnerable due to a dip in herd immunity.

“The use of non-pharmaceutical interventions (NPIs), such as social distancing, lockdowns and the massive use of masks, have not only largely prevented the spread of SARS-CoV-2, but also of other respiratory viruses such as influenza or respiratory syncytial virus (RSV). This decrease has been so high that, in most countries, the influenza and RSV epidemic has not occurred,” Spanish researchers wrote in the journal Vaccines in April this year.

“Far from being a beneficial fact, this can be problematic, since the absence of circulation of certain pathogens can lead to a decrease in herd immunity against them. This can promote the rise of more serious, longer-lasting epidemics that start sooner. To alleviate the collateral effects that may occur due to the decrease in circulation of viruses such as influenza, it is necessary to increase the production of influenza vaccines, carry out mass vaccination campaigns and focus on vaccinating the main drivers of this virus, children,” the report added.

(Edited by Manasa Mohan)


Also read: Severity, lethality, defence: How new coronavirus stacks up against seasonal influenza


 

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