There seems to be a lot of confusion and disagreement between the Centre and states’ over the directives and guidelines for containing of swine flu.

The states are not happy with the Centre’s recent directive regarding testing of only high-risk patients and keeping non-serious patients in home quarantine.

Delhi and Madhya Pradesh, which have managed to keep the H1N1 spread under check, wants to continue testing each suspect case. “Unless and until we know who is positive how can we go quarantine them at home? Testing helps contain spread of the disease and we want to continue with that,” said Delhi health minister Kiran Walia. The minister said home quarantine leads to further spread of the virus. Hence, anyone who tests positive should be hospitalised for effective treatment, he said.

The Centre has issued advisories to limit testing of cases to only high-risk patients since there was a shortage of reagents. However, buckling under pressure, the health ministry said states can continue testing if they want but, at their own cost. The Centre made it clear that it will no longer provide free reagents for testing.

“I would also like to request the state government to make some urgent arrangement to procure stocks for three-layered surgical mask, personal protective kit, N-95 respirator, testing reagents, sample collection kits, viral transport medium and life support equipment like ventilators on their own,” Union health minister Ghulam Nabi Azad said at a meeting of state health ministers and health secretaries.

There is also disagreement about administration of Tamiflu. “Sometimes patients are put on the drug for just flu-like symptoms but they test negative later. How do we know that the person actually required the medicine?” asked Walia.

“Irrational use of Tamiflu can make people resistant to Tamiflu. Random use of Tamiflu can have very serious implications,” Madhya Pradesh health secretary SR Mohanty said.