VZCZCXRO4071
RR RUEHAST RUEHBI RUEHCI RUEHDBU RUEHDH RUEHHM RUEHLH RUEHLN RUEHMA
RUEHNEH RUEHPB RUEHPOD RUEHPW RUEHSL RUEHTM RUEHTRO
DE RUEHNE #1286/01 1701306
ZNR UUUUU ZZH
R 191306Z JUN 09
FM AMEMBASSY NEW DELHI
TO RUEHC/SECSTATE WASHDC 7085
INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA
RHMCSUU/CDR USCENTCOM MACDILL AFB FL
RHMCSUU/CDR USJFCOM NORFOLK VA
RUCUWSU/USSTRATCOM OFFUTT AFB NE
RUEAIIA/CIA WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RUCPDOC/DEPT OF COMMERCE WASHDC
RHEBAAA/DEPT OF ENERGY WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RHMCSUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RULSDMK/DEPT OF TRANSPORTATION WASHDC
RHEFDIA/DIA WASHINGTON DC
RUEHC/DEPT OF INTERIOR WASHDC
RHMCSUU/FAA NATIONAL HQ WASHINGTON DC
RHMCSUU/FBI WASHINGTON DC
RHMFIUU/USPACOM HONOLULU HI
RHMCSUU/CDR USSOCOM MACDILL AFB FL
RHHJJAA/JICPAC HONOLULU HI
RUEKJCS/JOINT STAFF WASHINGTON DC
RUEANQA/NGA HQ BETHESDA MD
RHMCSUU/NGIC INTEL OPS CHARLOTTESVILLE VA
RHEHNSC/NSC WASHDC
RHEHAAA/WHITE HOUSE WASHDC

UNCLAS SECTION 01 OF 03 NEW DELHI 001286 
 
SENSITIVE 
SIPDIS 
 
HHS FOR OGHA AND PASS TO ANNE CUMMINGS AND DANIEL MILLER 
CDC ATLANTA FOR CCID AND PASS TO NANCY COX, STEPHEN BLOUNT, ANN MOE 
AND STEVE REDD 
PASS TO NIH FOR ROGER GLASS, THOMAS MAMPILLY, JAMES HEDDINTON AND 
GRAY HANDLEY 
PASS TO FDA FOR MAC LUMPKIN AND MARY LOU VALDEZ 
PASS TO AIAG FOR AMBASSADOR ROBERT LOFTIS, HELEN REED ROWE, AND 
CRAIG SHAPIRO 
USDA PASS APHIS AND FAS 
DOT PASS SHATLEY 
FAA PASS TNASKOVIAK 
 
E.O. 12958: N/A 
TAGS: KFLU AEMR ASEC CASC KFLO TBIO KSAF KPAO PREL PINR
AMGT, MG, EAGR, EAIR, ECON, PREL, SOCI, IN 
SUBJECT: INDIA - H1N1 FLU UPDATE 
 
REF: A. NEW DELHI 860 
 ¶B. NEW DELHI 879 
 ¶C. HYDERABAD 63 
 
¶1. (SBU) SUMMARY: As of 19 June, India has 44 confirmed H1N1 cases, 
including two infections caught within India.  Mission expects this 
number to increase over the near future.  The Government of India 
(GOI) takes H1N1 and the possibility of recombination in India very 
seriously and is trying to plan an effective response.  Despite that 
focus, airport screening procedures remain inconsistently applied 
and are not likely to improve, and government quarantine facilities 
are woefully substandard - Mission has had to intervene on behalf of 
quarantined American Citizens to ensure access to basic necessities 
such as running water and air conditioning.  The GOI has requested 
that the U.S., as the source of India's H1N1 problem, take 
responsibility by starting airport exit screenings.  END SUMMARY 
 
H1N1 CASES INCREASE, U.S. BLAMED, MEDIA ISN'T HELPING 
 
¶2. (U) As of noon local time 19 June, India has confirmed 44 cases 
of H1N1, including two indigenous cases, and no deaths.  Of the more 
than 329 people that have been tested, only about a third were 
identified during airport screening, the remainder have 
self-reported.  The number of positive cases is likely to increase 
over the short term, though conflicting environmental conditions 
make it hard to predict the future course of H1N1 infections. 
Extreme heat conditions throughout India make it harder for the 
virus to survive.  Cases thus far have been mostly imported by 
wealthier travelers.  However, a face-to-face culture and 
tremendously dense population - including groups that are 
immune-compromised, or that have poor nutrition, inadequate hygiene 
and sanitation, and little access to medical care - provide a 
potentially efficient virus breeding ground.  India's Ministry of 
Health and Family Welfare (MOH) remains very concerned about H1N1, 
and especially that it could recombine and become more virulent in 
India.  In response, the MOH has drafted a response plan that draws 
heavily from CDC and WHO information and is available at 
www.mohfw.nic.in.  The GOI has not issued any new official travel 
warnings or taken any agricultural or trade-related actions in 
response to the increase in H1N1 cases or the WHO pandemic level. 
 
¶3. (SBU) The Indian government and public are beginning to point 
fingers at the U.S. as the root of India's H1N1 trouble.  Minister 
of State for Health Dinesh Trivedi told reporters on 16 June that 
"The U.S. is the main source [of swine flu] as far as India is 
concerned.  In Mexico, when people leave the airport, they are 
properly monitored and screened. Similarly, Americans should also 
provide some kind of screening at the point of departure."  Union 
Minister of Health and Family Welfare Ghulam Nabi Azad said that the 
disease was not controlled globally and that he had requested the 
Ministry of External Affairs (MEA) prevail on swine-flu affected 
countries to start screening passengers bound for India to cut down 
 
NEW DELHI 00001286  002 OF 003 
 
 
on the "spread of the deadly virus."  Mission's Acting Health 
Attache responded to MEA requests to conduct U.S. exit screenings 
with an HHS, DHS and State Department-coordinated response that 
stated exit screening for H1N1 in travelers exiting the U.S. was not 
cost-resource efficient at this time, nor was it effective in 
preventing the spread of H1N1.  As such, the Health Attache 
explained that exit screening is not taking place and is not being 
recommended by HHS.  (NOTE: This response mirrors current WHO 
guidelines. END NOTE) 
 
¶4. (U) COMMENT: The Indian media has been quick to jump on any 
potential H1N1 story, often taking creative license and without 
verifying facts.  In one case (noted below) the media created a 
potential hazard at a government facility.  The media also was 
camped outside the Airport Public Health Office's Delhi airport 
quarantine facility during an Embassy visit last week. END COMMENT 
 
SCREENING AND QUARANTINE FACILITIES NOT SO GOOD 
 
¶5. (SBU) Anecdotal reports from Mission travelers show that the 
MOH-mandated airport screenings (health questionnaire and 
examination by medical personnel) continue to be inconsistently 
applied.  At Delhi's International Airport, some Embassy staff have 
passed through the health checkpoint without any screening; some 
have been asked basic questions about their health; and some have 
been lined up and checked with an aural (ear) thermometer that was 
used on every person without disposable covers or adequate 
sterilization.  India is still not using thermal scanners, and it is 
unclear whether the GOI is still considering them as an option given 
their spectacular failure during initial demonstration at Delhi 
Airport. 
 
¶6. (SBU) Mission has serious concerns about the quality of India's 
government quarantine facilities.  Both Delhi and Hyderabad have had 
to intervene directly when American Citizens were quarantined in 
government facilities that were extremely unsanitary, not 
air-conditioned, subject to stray animal visits, and lacked basic 
amenities such as running water, a private toilet, or telephone.  In 
Chennai, an American family was given permission to check themselves 
into a private hospital after they expressed health and security 
concerns.  The press had reported all of their names and, falsely, 
that they had H1N1.  Consequently, a large media swarm was waiting 
outside the government hospital when they tried to provide samples 
for testing.  In Kolkata, an Indian citizen walked out of the city's 
sole quarantine facility after waiting for hours without treatment, 
complaining it was unhygienic and mosquito-infested.  She was 
returned to the ward by the authorities to stay until her test 
results, which were negative, came back.  In addition to the poor 
conditions, we have received complaints by some American Citizens 
about the quality of medical care and that doctors are 
uncommunicative about treatment.  REFTEL C provides more details on 
quality of care and facility issues in Hyderabad specifically. 
 
NEW DELHI 00001286  003 OF 003 
 
 
 
¶7. (SBU) We suspect these are not isolated cases and that conditions 
are similarly dismal at other government quarantine facilities. 
Mission will continue to follow up with quarantine hospitals and the 
MOH to assess the quality of facilities and care, and to advocate 
for improved conditions wherever possible.  The MOH has indicated it 
is willing to certify and provide Tamiflu to the cleaner, better 
financed, and more well-appointed private hospitals.  However, those 
hospitals have so far rebuffed Mission requests to take paying 
American quarantine patients for what appear to be press and/or 
business-related, rather than clinical, concerns.  The MOH has 
indicated that home quarantine is not an option.  Acting DCM advised 
MEA Joint Secretary Gaitri Kumar of Mission efforts to increase the 
options for quarantined visitors.  She appreciated the information, 
thought it was a great idea, asked Mission to keep her in the loop, 
and contacted the MOH about the matter.  The Embassy is also 
exploring with other Foreign Missions the option of a joint demarche 
drawing GOI attention to the issues, and requesting improvement in 
the quality of facilities and care. 
 
COMMENT 
 
¶8. (SBU) The GOI is taking H1N1 very seriously and is actively 
engaged in response planning exercises, but their implementation 
efforts are falling far short of the mark.  A large influx of cases 
is likely to overwhelm the current response capability of the 
government medical system.  In addition, continued press focus on 
deplorable facility conditions and substandard medical care is 
likely to discourage self-reporting of illness, potentially leading 
to greater spread of the virus.  In a worst case scenario the 
combination of increased transmission, inadequate medical 
facilities, and aggressive media attention could lead to an outbreak 
the GOI cannot contain, and more opportunities for the virus to 
increase its virulence through recombination with local influenza 
strains.  Mission will continue to advocate for American Citizens 
and work with Central and State authorities towards effective 
solutions.  END COMMENT 
 
BURLEIGH