The Silent Killer: The Truth About H1N1 In Oman

25 Oct 2018
POSTED BY Y Magazine

Fever, fatigue and body aches may be more than just random chills. As health officials warn of the dangers of this year’s influenza season, Team Y investigates how lethal the threat is in Oman, and what we can do to protect ourselves from succumbing to it.

How has a vicious form of a traditional, much-dreaded winter ailment made world headlines in recent weeks?

According to health officials in the United States, this year’s influenza season is more dangerous than any since the catastrophic H1N1 or ‘Swine Flu’ epidemic of 2009.

And amid global reports of the health risks, awareness campaigns exhorting people to get flu jabs this winter have gone into overdrive.

To the average Omani resident, H1N1 Flu isn’t a matter of concern. A survey Y conducted over the past week found that 98 per cent of the 213 people we talked to believe that H1N1 flu is a thing of the past.

Gone too soon

Gone too soon: Joshua Caleb Anderson – H1N1’s last known victim in Oman.

But former Oman government employee Hazel Anderson, who lost her eight-year-old son Joshua to the virus, knows differently.

Joshua died from the disease in March, the last known victim of H1N1 in Oman.

However, he was a fit boy – a budding rugby player and an avid adventurist who had taken a shine to his parents’ penchant for travelling.

But, all it took was for the young British boy to play outside with a group of his friends in Muscat.

All his friends fell ill the following week – some tremendously sick while others weren’t affected as much, explains Hazel.

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She adds: “That’s classic H1N1 – it didn’t affect everyone as it affected Joshi (Joshua). In fact, my eldest son Joel also got H1N1 and all he had was a mild cough.

“This is the problem with influenza but you could be passing it on to somebody else.”

What exactly is H1N1 Flu?

As per health information website WebMD, it is a relatively recent strand of influenza virus that first came to light in 2009.

It spread across the world so quickly that it was termed a pandemic.

The roots of the (Influenza A) virus are linked to the ‘Spanish Flu’ of 1918 that killed 100 million people. In its core form, it’s essentially a strand of the flu virus that has mutated.

With Joshua, after he contracted the virus it also spread among members of his family. So, family members fell sick over the course of the week, but had shown different symptoms.

Albeit, even 16 hours before his demise, Joshua hadn’t shown any real signs of the flu.

Meanwhile, Adrian, Joshua’s father, developed symptoms that included the clamming up of his chest and mild fever – something he – at that time – believed he’d picked up by working long hours.

He says: “It was all very much flu-like symptoms and for a short period. It only lasted for a few hours for me.”

Moreover, at the onset of the symptoms, the family was already trekking in the foothills of Mount Kanchenjunga in Sikkim, India.

Hazel says: “It wasn’t more than 24 hours before (after reaching India) and three days after his exposure that Joshi came down ill. He had no symptoms initially but he woke up the next morning and felt sick.

He complained of a head- and leg-ache – and at that time, the family didn’t think too much of it. Still, Hazel gave him a dose of Paracetamol.

“We presumed that it was the same bug that was going around in the family, so we weren’t overly concerned,” she says.

Hours went by, and he still hadn’t recovered.

Hazel says: “I gave him more Paracetamol in the evening but by then he had become very fidgety, still with only a very mild fever.

“He then asked for some water, which I then offered. But, to my surprise, he couldn’t see the bottle. He couldn’t reach it. And that’s when I became nervous.

“This wasn’t normal for Joshi, so I immediately called the nurse. By that point, he was so sick that he went into convulsion. He had never faced anything like this before, and he was soon taken to the local hospital.

“But he died very soon after.”

The date was March 21, 2018. Following the passing of Joshua, Hazel and her youngest son George spent two and three days in intensive care, respectively.

However, it was only upon autopsy at the St. Thomas Hospital in London, UK, and further investigation by the World Health
Organisation (WHO) that it was revealed that the little boy had been struck down by the deadly H1N1 influenza virus. The cause of death was attributed to viral sepsis – a severe inflammatory response to a viral infection – set in motion by the H1N1 virus.

Any speculation that he had picked up the virus in India was rejected due to the incubation period, which for H1N1 stands at 4-6 days; though, the virus can be activated in the body in mere hours, in some cases. Moreover, clusters of influenza had been reported in Oman, with some students and teachers hospitalised with severe cases of flu.

H1N1 in Oman

Even though Joshua spent his last moments outside the country, he is among several that contracted the disease in Oman. In 2009 alone – during the H1N1 endemic – the Sultanate witnessed a staggering 7,000 cases of the flu, of which 30 people died.

The numbers only rise as we move outside Oman. Worldwide, the virus was believed to have taken the lives of more than 18,000 (as per statistics revealed by the World Health Organisation in 2010) – but after a public outcry and careful investigation, the number was increased to 284,500.

Since then, Oman has had the virus under control, with only small outbreaks occurring – and the numbers haven’t seemed to be big enough to warrant a warning across the nation.

But, Joshua’s recent death and another death in October 2017 involving an Omani man now brings us to the question: is it time for Oman to take a stand on the matter and declare H1N1 an active virus with the potential to instigate an endemic?

The official line

To assess this, we contacted experts in the field. While several doctors in the private and public sectors declined to speak to us, we contacted a senior consultant from Oman’s Ministry of Health (MoH) – who agreed to speak to us in return for complete anonymity.

He begins by asking us: “Are you worried by H1N1 or concerned that this has the potential to harm the people in the country?”

We answer: “Yes.”

He confirms that our concerns are indeed reasonable, and then takes out a piece of paper in which he explains: “H1N1 Flu is one of those viruses that never really concerned humans until the outbreak of 2009.

“It was a period of concern, but even then, the matter was blown out of proportion by the World Health Organisation (WHO). Don’t misread my words: I’m not telling you that the virus is harmless; it’s incredibly deadly for some patients.

“Luckily, if diagnosed and treated, this disease can be cured – but the little boy Joshua was incredibly unlucky to have experienced what he did. May his soul rest in peace.

“What we need to do, though, is create awareness. And we need awareness that will lead to positive growth within the people of society. Right now, the Ministries across the GCC – not just Oman – are afraid that people would panic if we revealed such information.

“This would be detrimental to countries that are slowly looking to shift its focus into the field of tourism – Oman included.

“But, what we need to do is to educate that the virus does indeed exist in the country, and that steps can be taken to prevent yourself from getting it.

“Currently, there’s a fatal flaw in the system (across the world): we are not strictly required to report to the authorities of H1N1 deaths if the patient is over the age of 18 and below 55 unless we were aware of it at that time.

“Several cases are known to be filed under the paradigm of seasonal flu. And if the person is suffering from other diseases, they can put that as the primary cause of death. Up to an extent, that could be why the numbers of H1N1 cases are relatively low.

“A patient won’t necessarily succumb to the virus alone but rather does so from the complications it brings, especially if the host body is suffering from existing illnesses. Also, if a patient isn’t treated for H1N1 flu in due time, then they may also develop a bacterial infection, which can aggravate the condition of the patient.”

How is it transmitted?

Based on our interview, we learn that a subject acquires H1N1 flu in the same way as seasonal flu. It’s an airborne disease that can spread when people cough, sneeze or share utensils. This is because the viral load is present in huge quantities in
saliva and mucous – and can spread when you come into contact with these tiny droplets.

Once exposed to the air, however, the virus can lose its ability to transmit over time. So, a virus can infect a person only between the two and eight-hour span under normal seasonal conditions of Oman.

The doctor then adds: “The age group of people it affects is what matters. So, those with weakened immune systems or developing immune systems can be prone to it. Anyone who is about 10 and below, and over the age of 60 can be prone to the disease. But, you must know that the virus doesn’t discriminate based on age.

“It attacks the most vulnerable immune systems – and you could be a 15-year-old and find yourself with H1N1 flu.”

These are some of the symptoms of the H1N1 flu as recorded by the MoH: fever, cough, sore throat, runny nose, chills, body aches, fatigue, nausea, diarrhoea, and vomiting – all similar to what a seasonal flu would normally cause.

The doctor steps in to clarify: “The virus is very similar to other strains of Influenza virus. I’m not advocating this, but H1N1 Flu, in most cases across the world, goes unnoticed – and doesn’t even require medical attention. If the person isn’t under the risk of developing any life-threatening illnesses, the effects of the virus should reduce over the span of a week.”

The dangers of self-medication

To understand more about H1N1 treatment, we contact a senior pharmacist at the Khoula Hospital. Marwan* believes that flu medication has come on in leaps and bounds over the past decade or so but adds: “Under no circumstances can I reveal the medication we use to treat H1N1 cases here in Oman.

“What I can tell you is that if someone is found infected, there are strong antiviral drugs that we administer to the patient.

“I won’t reveal the names here as it can lead to self-medication. This, in turn, can be disadvantageous in the long run, especially if the virus starts developing resistance to the drugs.

“The drug will only be prescribed following a nasopharyngeal test to detect the presence of viral activity.

“Always remember that a doctor should be your point of contact for any disease. By self-medicating, you could be putting yourself at risk. Moreover, keep in mind that these medicines are only capable of lessening the effects of the flu and reducing symptoms than, say, curing the illness.”

Nevertheless, the onset of the flu season in Oman – which normally ranges between the initial months of May and June, and then again in October when winter officially sets in – means more people will be exposed to influenza (not just H1N1).

Last year, for instance, a shocking 952 cases of influenza (seasonal flu) was reported in Oman until late October, of which nine people lost their lives. This, as per the MoH is well within the normal range when compared with deaths from previous years.

The numbers for this year haven’t been revealed – but our source at the MoH believes that the cases have been steadily decreasing over the years. For instance, the overall cases of flu stood at 1,492 in 2016.

But, as we enter the flu season this year, are we – the residents of Oman – at a serious risk of acquiring this potentially life-threatening illness?

The answer to that, as it turns out, depends on whether you’re vaccinated for influenza or not.

How can you prevent H1N1?

So, while you are prone to influenza (potentially even H1N1) and fall into a high-risk category under normal circumstances, you can take precautionary measures by simply taking the influenza vaccine.

Hazel and Adrian are now strong advocates of the flu vaccination. They chime in together: “We were behind in our knowledge of the influenza vaccine and never had taken it before.

“But a part of us coming forward to talk to Y Magazine is to share the message that the flu jab is available in Oman and it costs RO4 in places like the Muscat Private Hospital. You’ll need to check with the doctors or pharmacists whether there are stocks before heading there as there’ll be a consultation charge of RO25.

“Though, we can tell you that these jabs are available all over Muscat.”

*Marwan from Khoula Hospital, too, supports a precautionary vaccination for children and adults. He says: “Unlike other viral inoculations, the influenza jab can only be effective for one year. And even though its success rate isn’t as high as with some other viral vaccinations, it’s the best bet for those who want to take extra protection from the virus.

“The reason for its lack of dependability has nothing to do with the vaccine itself, but rather that of the strand mutating and picking up different strains of the virus. This means, we here may have to look at changing trends in the GCC and other parts of the world – especially Asia and Europe – where the residents of Oman predominantly travel to.

“So, even if the virus is brought in here, we can fight it by altering the vaccine.

Albeit, at this point, even Marwan accepts that figuring out which strains may reveal themselves every season is a difficult process.

The vaccination, much like other viral jabs, fights the disease by developing antibodies (cells that are used by the immune system to neutralise pathogens such as pathogenic bacteria and viruses) over a period of time.

“This shouldn’t dishearten you, as some form of protection is always better than nothing. And what’s better is that the vaccines can protect you against four flu viruses – these are called ‘quadrivalent vaccines’.

“There have been reports that the flu jab has been as effective as 70 to 75 per cent in Oman – though, it’s inevitable that whether this year’s vaccination will hold up next year.”

Keep in mind that a flu jab will require at least two weeks to develop the necessary antibodies to develop; meaning, you’ll need to act quickly to protect yourself from the seasonal influenza.

The Andersons have already vaccinated themselves for this season – and Hazel reports that her kids have already batted away a flu outbreak earlier this month.

She tells us: “So, there is a question whether the flu jab works, and I can safely say that it does. Joel and George have both been vaccinated and they were able to fend off the flu outbreak in their school this season.”

But all of this begs us to ask the important question: why aren’t the Ministry of Health and school bodies encouraging and backing flu vaccinations in Oman?

Today, Adrian and Hazel stand tall as the greatest campaigners of the flu jab. Hazel’s post on Facebook may be cautious as she writes in the post: “Influenza vaccinations are available in Oman but few of us are aware of this. No, they don’t always work, but in September, when the new influenza season starts, it is worth considering. Please educate your family and friends about the risks of flu. Please share this information”.

At the time of publishing, her post has received more than 143 reactions, 104 shares, and 65 comments.

Hazel says: “While the ministry was very diligent in following up and providing us with support in Joshi’s case, there’s a definite lack of communication between the ministry and the residents of Oman.

“Moreover, we learned that private hospitals do not always test for, or feed accurate statistics back to the ministry. There is no sense of a cover up; just that communication needs to be improved so that the expat communities are fully aware of the risks.

“That said, there is no epidemic in Oman. It’d be considered as an endemic, if anything.”

Our constant efforts for an official comment from the Ministry of Health are in vain, with the government body failing to provide us with any response (as of October 23, 2018).

But, a quick investigation reveals that a circular passed within local media houses in late 2017 did alert residents in the “high-risk” group to “get themselves vaccinated”.

“As a semi-tropical country, seasonal influenza viruses continue to appear throughout the year in the Oman. The virus starts in early September and continues until mid-May,” the ministry states in the circular.

Probing further, we learn that all inoculations fall under the ‘Expanded Programme of Immunization’ (EPI) act set in motion by the Communicable Diseases Surveillance & Control department at the MoH, and that children under the age of six would receive 13 mandatory vaccinations for preventable diseases; sadly, the flu jab is not among them. But, as it turns out, not everyone believes in the influenza vaccination – or vaccination in general.

The anti-vaccination movement

In passing, we learn about Sameera al Mahrooqi, a 32-year-old government professional and mother-of-four. She says: “I don’t trust vaccinations. They’re essentially frailer viruses that are injected into your system. And I don’t know how that’s acceptable.”

Sameera falls among a small category of patients who are allergic to neomycin, a key ingredient in the Hepatitis B vaccine.

“I don’t remember much but my parents tell me about how I had seizures three times after the vaccination. Moreover, I also developed hives on my face – and it keeps recurring up to an extent that I’ve grown to detest vaccination in general.”

Our source at the MoH begs to differ. He explains: “I believe that anyone refusing to believe or partake in providing vaccinations must be prosecuted. While everyone has their own right to believe whatever they want to, they mustn’t put the lives of their children at risk.Get them vaccinated. My only advice would be to check with your local general practitioner to see if you’re allergic to any of the strands in the vaccines.”

Today, Sameera forms the small crowd of silent activists that forego vaccinations for their children in Oman. It’s illegal to do so in Oman, as it’s mandatory to vaccinate every child in the Sultanate.

She is backed up by several tens of thousands of individuals that form the core of the ‘Anti-Vaccination Movement and Parental Refusals of Immunisation of Children’ movement in the USA.

Whether you support the immunisation movement or not, though, there’s no denying that a flu jab could have possibly saved Joshua’s life.

As his mother says: “Everyone is vulnerable if you don’t take precautions.

“Could we have saved Joshi if we knew that it was H1N1 from the onset? His scenario was very fast-moving: we could have had to take him to hospital for a brain scan in the morning and this would have confirmed the inflammation. He could have then been given a couple of drugs to reduce inflammation and ventilated if necessary.

“Even then, he may not have made it. Joshi was one among 100,000 – an unlucky one.

“This only goes to show that flu can kill perfectly healthy children.”

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