The hysteria surrounding the outbreak of H1N1, or the more colloquial and misrepresentative name �€˜Swine Flu�€™, has dominated the national and perhaps less so, global psyche for a few months. The rate at which the virus has spread has been disproportionate to the media coverage received in India, which has not shied from painting a virtual apocalyptic scenario �€“ understandable, given their fixation for maximizing TRP ratings. Yet the response of the Government of India (GOI) has been questionable. While there is no doubting the �€˜success�€™ to which national policies have been able to contain the spread of the virus thus far, one cannot help but be skeptical that our tendency to self-aggrandize is premature given that the H1N1 virus has just hit our shores. The H1N1 virus is here to stay. How effectively the GOI can combat the disease through proactive rather than reactive measures, will determine if �€˜swine flu�€™ grows into a national pandemic or, remains a contagious virus, albeit within the watchful confines of the Health Ministry. The worst is not over - and it is important to ensure that the people of India and those charged with �€˜protecting�€™ the electorate are not complacent in their efforts to contain the virus.

At the time of writing, the latest count for the H1N1 virus in India stood at 55 deaths, with most of the victims coming from Maharashtra. While a sizeable number of those who lost their lives had pre-existing diseases and compromised immunity, the rate at which their condition deteriorated and the ease at which the virus was contracted has created a panic within the populace. Cities such as Pune, where the virus has been most prolific, are a far cry from the usual �€˜hustle & bustle�€™ that has come to represent one of the country�€™s fastest growing IT and manufacturing hubs. While deserted streets and people donning face masks might be more resemblant of a horror movie, the impact on the city�€™s economy has been very real. IT companies which employ more than 200,000 people in the city, have adopted precautionary measures, with giants such as Infosys and Fujitsu Consulting asking employees displaying any of the symptoms to remain at home. Meanwhile, Pune�€™s restaurant and commercial businesses have taken a huge hit, with several enterprises preferring to remain closed as open businesses find few takers. The fact of the matter is that Pune�€™s economy has responded in a manner that is likely to become more prevalent in the coming months, as the H1N1 virus mutates and settles within communities. 

The GOI and doctors have repeatedly pointed out that more people in the country die each day from Tuberculosis, Heart Disease, Road Accidents and Tobacco related illnesses �€“ a fair comparison to say the least. Yet, what makes the H1N1 virus �€˜special�€™ is that very little is known about the disease, with the production of the only known anti-viral �€˜Tamiflu�€™, produced by one company thus far. With an indigenous H1N1 vaccine not expected to be ready before the latter half of this seasons�€™ winter, in February 2010, the country might fall short in its preparedness to deal with a large-scale outbreak. 

The global spread of the virus indicates that cooler temperatures are more conducive to the survival and commutability of the disease, with countries in the southern hemisphere bearing the brunt of H1N1 to date. Chile, Argentina, Australia, and the UK have been hit the hardest, with England recording over 30,000 confirmed cases in a week. The World Health Organisation (WHO) reports that close to 1800 people have died globally and more than 182,000 have been infected as of 13 August this year �€“ a number that is expected to increase as the more heavily populated northern hemisphere slips into winter season. Of increasing concern however, is that as the influenza survives within societies for longer periods of time, a more virulent strain of the virus could become increasingly dominant and durable within clusters of society, even during the summer months. H1N1 virus could infect more than two billion people globally within the next two years, an aspect which is particularly worrying given that this strain has never been witnessed and everyone on the planet is immunologically vulnerable. 

Thus far, India�€™s battle with the H1N1 virus has been aided by relatively high summertime temperatures and by the sheer fact that the virus has been more prevalent in the country�€™s urban centres and amongst the middle to upper class. However, as the northern belt of the country enters into winter and temperatures cool over the rest of India, the number of H1N1 cases will increase. An internal government report estimates that between 3-5 million people will require vaccination after a full-fledged pandemic hits the country, with the WHO estimating that approximately 33% of India�€™s population will be infected. As with all viruses, H1N1 will mutate and is likely to pose a major challenge to the socio-economic stability of the country. In addition, questions must be asked as to whether India�€™s health care system is equipped to deal with a nation-wide epidemic, with the country spending only 5.2 % of its GDP on health care, leaving it ranked at a 171 out of 175 countries globally. Furthermore, the number of trained medical professionals for infectious diseases (ID) is staggeringly low, leaving the population vulnerable to communicable diseases. 

As mentioned, cases of the virus have been largely limited to the country�€™s urban centres. However, with a population density of approximately 345 people per square kilometer, it could be only a matter of time before the number of confirmed cases surge. By comparison, Australia, the UK and the US have population densities of 2.84, 246 and 31 respectively �€“ yet they comprise some of the worst hit countries. An outbreak of H1N1 amongst India�€™s rural population or slum dwellers is likely to go by relatively unnoticed, as the common man remains oblivious to the symptoms �€“ which are deceivingly similar to the common flu. 

The question asked should not be �€˜if�€™ the country will face a wide-scale outbreak of H1N1, but rather �€˜when�€™? The coming months will see a surge in confirmed cases, and it is likely that northern India and cities such as New Delhi, with cooler temperatures, will be hardest hit. High population densities and unhygienic conditions are likely to exacerbate the problem. The H1N1 virus could very well become the worst pandemic in recent history.