Voices Anand Neelakantan Ravi Shankar Sumeet Bhasin Neha Sinha Anuja Chandramouli Mata Amritanandamayi MAGAZINE Buffet People Wellness Books Food Art & Culture Entertainment NEW DELHI january 22 2023 SUNDAY PAGES 12 Symptoms of bad flu Fever or feeling feverish/chills Cough Sore throat Runny or stuffy nose Fatigue (tiredness) Muscle or body aches Headaches Vomiting and diarrhoea (more common in children than adults) The Uncommon Flu The recent outbreak has shown the unexpected, disastrous face of the seemingly harmless common flu. Why is it particularly bad this time and how do we tame it? T By Arman Khan here are cafés that lull us into believing that all our woes will dissolve into thin air only if we relish that extra cup of cappuccino. For Sudeshna Saxena, a 27-year-old freelance illustrator and graphic designer based in Bengaluru, an unassuming visit to her favourite café in the city turned out to be a nightmare. Make no mistake: The iced latte was all right and the croissants fresh enough. Only her hair was wet and she was sitting right under the AC vent of the café. A day later, the cold gripped her. Or, so she thought. “It was the week when it rained heavily in the city, no thanks to the cyclonic disturbance in Tamil Nadu,” she recounts. “I didn’t think it was the flu until I started waking up every day over the next 10 days with sneezing fits and a runny nose that just wouldn’t stop.” Saxena describes the sneezing as “almost violent”, unlike anything she had experienced before. The Dolos didn’t work, the runny nose was so endless that she had to give up on tissues and instead go for copious rolls of kitchen towels. “In this period, I had brain fog for more than a week with a stiff neck, heavy head and just allaround heaviness,” she adds. “Normally, I don’t fall sick, so I didn’t have anything at home for immediate relief and it didn’t help that I’m generally reluctant to seek aid.” The root of it all? A resurgent influenza season, causing a ‘twindemic’ with the rising number of Covid cases, or even a ‘tripledemic’, with a third pathogen, respiratory syncytial virus, or RSV in the mix. Across India , and the world, hospitals are stressed by these parallel surges. The Atlantic has called this “the worst paediatric-care crisis in decades”. In America, in December, the Center for Disease Control (CDC) director Rochelle Walensky said in a press conference that nearly 17 out of every 100,000 people in the country have the flu and that it's “the highest we’ve seen at this time of year in a decade”. As far as India is concerned, although the National Centre for Disease Control (NCDC) hasn’t publicly issued a statement concerning the rise of flu cases, it reports that as of November 30, 2022, there were 12,881 reported cases related to the flu and 399 deaths. Over the past few months, the surge of the tripledemic has manifested differently in our cities. While there is no direct link between Covid and flu—immunity against one does not guarantee protection against the other—the ramifications of rising cases of the two are increased hospitalisations and rising demands of medicines, pain relievers, etc. The common reason attributed to a “change in the weather” no longer holds ground at a time when cases such as Saxena’s show us that the flu this time has taken on a much stronger, darker hue. So, what are the factors behind the sudden rise in cases, and subsequent hospitalisations this time? What really makes the past few months the worst for flu in almost a decade? Apart from localised factors such as high pollution, the primary reason attributed to the rising flu cases, according to CDC, is that people have weakened defences after not being exposed to flu and RSV because they have been working or schooling from home during the pandemic. Across the world, the rates for flu vaccinations in vulnerable populations—such as those 65 and older, children and pregnant women—are also at an all-time low. “Tripledemic refers to all three viruses surging at once, not necessarily and not usually in the same person simultaneously. There are intermittent spikes of viral infections that first affect patients who are immunocompromised.” Dr Indu Bubna, pulmonologist Fight the virus Understanding the flu “There has been a spike in cases related to the upper respiratory tract and existing lung infections,” says Dr Hemalata Arora, senior consultant at internal medicine and infectious diseases at the Nanavati Hospital, Mumbai. “It’s possible that this might be the worst flu season ever because when it comes to cities like Delhi and Mumbai, it’s compounded with air pollution.” From a technical perspective, Arora explains that the telltale signs of a particularly bad flu season include a rise in cases of pneumonia, entire families catching the flu, and children and other vulnerable groups in the population such as pregnant women and the elderly getting badly affected. “We have to understand that the ‘tripledemic’ phrase refers to all three viruses surging in the population at once, not necessarily and not usually in the same person simultaneously,” says Dr Indu Bubna, a pulmonologist with a private practice. “There are intermittent spikes of these viral infections coming in that first affect patients who are immunocompromised.” The flu, put simply, is a viral infection that is spread through the air. Influenza is caused by three types of viruses called influenza types A, B and C (considered different genera), which all belong to the family Orthomyxoviridae. The disease, colloquially called ‘flu’ in humans, is generally caused by viruses A and B. Only a fraction of influenza A subtypes (H1N1, H1N2 and H3N2) are currently in general circulation among people. Bubna says it affects the bridgeportct.gov/FightTheFlu “It’s possible that this might be the worst flu season ever because when it comes to cities like Delhi and Mumbai, it’s compounded with air pollution.” Dr Hemalata Arora, senior consultant at internal medicine and infectious diseases at the Nanavati Hospital respiratory system first because that’s the most common route of the virus to enter your body. With patients having lung fibrosis, asthma and other respiratory conditions, the flu virus only adds to their woes. Depending on the virus and its many variants, viral diseases are further classified as ‘flu viruses’. In 2016, the California strain and the Michigan strain were circulating in India. “So, whenever we are talking about flu, we’re referring to the virus named influenza,” says Dr Jagruti Sanghvi, a Mumbai-based paediatrician. “There is seasonal influenza that manifests as the common cold and the more severe kinds such as H1N1 or swine flu. These are known as ‘severe’ because there are usually multiple organs involved here apart from just the lungs, and are spread via air droplets in the air while talking or sneezing, and fomites that are objects or materials which are likely to carry infection, such as clothes, utensils, and furniture.” She adds that it’s difficult to identify which particular flu or influenza variant is affecting an individual. One could have anything ranging from the ‘seasonal’ flu that goes away within a week to more ‘severe’ flu in the form of H1N1, RSV and even the coronavirus. “It’s important to get yourself tested so that you’re aware of what exactly you’re infected with,” Dr Sanghvi suggests. “Often, you might not even know how immunocompromised you are and if the viral load is high because it’s a severe flu, it could be dangerous.” In Kerala, the avian or bird flu has taken deep roots. Three weeks ago, over 6,000 birds were culled in the state’s Kottayam region. The current outbreak is not new. Between early 2013 and early 2017, 916 lab-confirmed human cases of H7N9, the most common variant of bird flu, were reported to the World Health Organization (WHO). In June 2021, the bird flu strain H10N3 infected a human being, a first, in China. However, experts have always clarified that such a case occurs only when there is prolonged contact between the human and the infected bird. Navigating the tripledemic As the popular quote by science writer, Ed Yong, goes, “Immunology is where intuition goes to die.” Do we know for certain why that friend gets infected with Covid every third month despite being fully vaccinated? Or, why does a young patient with no comorbidities succumb to the virus? In the case of Charu Gaur, the 39-year-old founder and editor of Runway Square, a digital fashion and lifestyle portal, the flu presented itself as a mystery that persisted over three days. “I got the flu in September 2022 where I first thought it was Covid, got tested and it wasn’t and then I had severe Turn to page 2