KARACHI, Oct 14 The Pakistani man deported from Oman who was tested positive for swine flu and was kept in the federal health ministry's quarantine facility near Karachi airport for one week is likely to be discharged on Thursday.

However, national and international health regulators will be left to ponder over flaws exposed in the mechanism adopted against swine flu cases during the handling of the first swine flu case received so far in Karachi.

The executive director of the Jinnah Postgraduate Medical Centre, Dr Musarrat Hussain, told Dawn that doctors had taken absolute precaution in the case of 34-year-old patient, Mohammad Hanif, a native of Matli, Badin. They were of the considered opinion that the victim of swine flu (H1N1) could be discharged from the quarantine on Thursday morning, he said.

“His body temperature has been normal since Saturday, but we did not take a risk earlier by releasing him, as we did not have the patient's history from Oman.”

Interviews and locally available evidence suggest that the man, who along with 600 illegal Pakistani travellers was put in prison before being deported to Karachi, had contracted the H1N1 virus in Oman and the local police and the embassy of Pakistan were well aware of these facts. Yet, he was deported on a commercial flight of Oman Air, without observing the prescribed protocol advised in case of swine flu patients.

Oman's health ministry had diagnosed its first three cases of swine flu -the patients were staying in the US for studies - in June this year. Since then the country has been continuously reporting confirmed swine flu cases, including deaths.

Sources close to those handling the swine flu case said that physicians and aviation personnel were of the considered opinion that Pakistan embassy officials in Muscat and high-ups in the airline should have proactively moved against the shifting of Mohammad Hanif prior to his complete recovery certified by the Oman health authorities.

The sources said that about 200 passengers of the Oman Air flight (WY-321) had travelled along the swine flu patient without any notice to Karachi on Oct 8.

They left the airport soon after the plane landed without knowing about the chances of contracting the virus. They were not even advised to take precautions like “voluntary quarantine” for some days at their residences and see doctors if they noticed any symptoms.

The Centre for Disease Control and Prevention of the US recommends that people with influenza-like illness should remain at home until at least 24 hours after they are free of fever (100 degrees Fahrenheit or 37.8 degrees Celsius), or signs of fever without the use of fever-reducing medicines. Hospitals with centralised air conditioning are also not encouraged to treat swine flu cases as the centralised AC may help in spread of infection within the hospital.

When asked, Prof Nadeem Rizvi, the head of the chest medicine department, JPMC, said that swine flu patients should not have been allowed to travel on commercial flights, as the flu spreads through droplets infections.

Karachi airport health officer Dr Rab Nawaz Wassan told Dawn that the Karachi airport immigration officials received the information about the transportation of Mr Hanif on Oct 7, a day before the scheduled flight from Muscat. He said even the pilot appeared ignorant and claimed that he was not informed or taken into confidence about the development at any stage when asked about the passenger suffering from swine flu. He added that the suggestion to return the flight without off-loading passengers came from some quarters at Karachi airport.

However, Dr Wassan claimed that the airport health staff not only took readings of body temperature of the passengers, but also acquired their details to keep a track of their health conditions following their travel along with an infected person.

Hospitals ready to handle influx of patients?

In the wake of the first swine flu case, health experts said that hospitals, both in the public and private sectors, were ill-equipped and not prepared to deal with such an epidemic.

“God forbid, if we get four to five cases of swine flu simultaneously, we will not be in a position to spare respirators and ventilators for them,” said Prof Musarrat Hussain, adding that it was not possible to exclusively dedicate wards in Jinnah hospital to swine flu cases. He said that the first case of swine flu was surely a wake-up call. He said that he had convened a meeting of senior colleagues on the issue at the JPMC on Thursday.

The quarantine facility near the airport lacked ambulances and facilities for oxygen, monitors or ventilators on its premises. Besides, none of the government-run hospitals in the city had maintained exclusive isolation wards for the outbreak of diseases like swine flu, tuberculosis and bird flu.

In addition, there is no virology analytical laboratory in the city of about 18 million people who have been under threat of different epidemics from time to time. Though the federal health ministry had planned establishment of a standard lab at the Civil Hospital Karachi and placement of camera-based thermal imaging facilities at Karachi airport, the facilities had not been made available so far. The need for such facilities will grow over the next few weeks, with thousands of Hajj pilgrims travelling to and from Saudi Arabia.

A senior doctor at a government hospital said that hospitals should be well equipped and able to respond to an influx of potentially contagious persons, panic-stricken victims and their families by keeping them calm, safe and secure.

According to the guidelines recommended by the international bodies, the avian flu (H5N1) or the swine flu (H1N1) patients need to be kept in a private room that has monitored negative air pressure in relation to the corridor and anteroom or chamber.