A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

The association between stress and psoriasis is one of the better-documented cases of the mind and skin connection within dermatology. Consistent across studies, at least in most case series, there is a sizable proportion of patients who experience an important stressful event within the weeks prior to onset or flare-up.

The mechanism is quite clear cut. While the skin is often seen as being passive, it is far from it. Skin itself is immunologically active, having a stress response system of its own, able to produce corticotropin-releasing hormone and cortisol independently from adrenals.

The Mind-Skin Connection

Under prolonged stress, the shift happens in the hypothalamic-pituitary-adrenal axis, leading to a reconfiguration of the immune response towards inflammatory pathways, specifically IL-17 and IL-23 pathway which was targeted by most biologics developed up to now.

Neuro-endocrine innervations lead to the release of neuropeptides such as substance P, attracting inflammatory cells while lowering the threshold of itching. Chronic stress also impairs barrier recovery process, relevant for a disease where the slightest skin damage leads to a plaque formation.

So whenever a patient claims stress caused her flare-up, she is describing an actual immunological phenomenon.

And the cycle, which is the part that entraps people.

And here lies the complexity, the place where I believe most of the articles end prematurely.

Also read: ‘Sunscreen Is A Health Essential’: UK Skin Cancer Survivor Urges Govt To Scrap Tax

Stress Aggravates Psoriasis

Then the psoriasis becomes the source of stress. Highly visible plaques on hands, scalp or face are hard to hide within a culture where we greet, eat and worship with our hands. Patients start dressing in ways that conceal their plaques. They avoid public showers, salons, wedding events. Itch affects their sleeping habits, causing higher inflammation levels.

Then come the questions patients do not usually disclose unless specifically asked. The shame. Some patients have experienced people wondering whether they could catch the condition. Some of them have been asked to leave the salon where they went. This is not just an annoyance, but also a hurt, directly feeding back into the loop.

The prevalence of depression and anxiety in psoriasis is much higher than among healthy people. Moreover, these problems cannot be explained only by a reaction to one's appearance. The same inflammatory mediators, which cause psoriasis, are now associated with depression. Therefore, psoriasis and depression can be two symptoms of one inflammatory condition.

Also read: Mpox Spreads in Guinea-Bissau, Half Of Suspected Cases Are Children

What Really Helps?

Here I need to be very careful, since the idea that stress provokes psoriasis can be twisted into the belief that the patient has caused his/her own illness. But it is not true and is insulting to people suffering from the condition. It should be said again that psoriasis is a genetically based immune disorder. It is stress that exacerbates the disease.

Within this framework, stress management techniques are useful and there is the trial evidence for their efficiency. In one study, mindfulness-based intervention helped to improve the outcome and even accelerated clearance with phototherapy.

Physical exercise has an independent anti-inflammatory effect and treats metabolic syndrome associated with psoriasis. Sleeping is an obligatory factor because sleep deprivation increases the level of cytokines that we need to suppress. Cognitive behavioral therapy helps people to cope with itching-scratching cycle.

There is no doubt that alcohol and smoking make psoriasis worse, although they are usually used as a coping strategy in response to stress. They serve as an additional burden on health.

All of this is important but not an alternative to treatment. Topicals, phototherapy, systemic medications, and biological agents still remain the core of the treatment regimen. Stress management is only an adjunct, and I always remind my patients about it so that they never feel guilty for taking medicine.

Treat The Whole Person

Now I ask two questions at each review of psoriasis. How much of the body surface area is affected and how much of the person's life does it occupy. The answer to these questions often does not coincide.

I saw patients with rather small involvement of the skin surface, whose psoriasis completely ruined their self-esteem. And I met patients with large involvement who coped with the disease perfectly.

Body surface area does not measure suffering. If we treat only what we can see, we will treat half of the disease.

H1N1 cases are rising across several Indian states, with infections, hospitalisations and deaths being reported. However, the Indian Council of Medical Research (ICMR) has said the increase is not unusual and that no new strain is driving the current rise.

The ICMR has clarified that the circulating Influenza A (H1N1) pdm09 viruses have been present in India since 2025 and that no new strain has been identified.

ICMR Director General Dr Rajiv Bahl has said H1N1 accounts for nearly 98% of Influenza A cases currently detected in India, while H3N2 accounts for around 2-3% of cases.

Health authorities have urged people not to panic but to remain alert, particularly if symptoms become severe or persist.

States Reporting H1N1 and Influenza Cases

Delhi

Delhi has reported 138 new H1N1 cases in the last 24 hours, taking the cumulative number of H1N1 cases this year to 2,446, the Delhi government said on Wednesday.

The total number of Influenza A cases has reached 3,177 as the city continues to see a rise in seasonal influenza infections.

Maharashtra

Maharashtra is witnessing a significant surge in Influenza A (H1N1) cases, with the 2026 tally already surpassing the total recorded throughout the previous year.

As of August 21, the state had reported 1,109 H1N1 cases, compared with 942 cases in all of 2025.

Mumbai and Pune remain the primary centres of reported infections, together accounting for around 65% of the state's total cases.

Uttarakhand

Uttarakhand has reported 49 confirmed H1N1 cases and five deaths as of late August 2026, prompting a heightened health alert.

The state has also reported 103 dengue cases, including 49 confirmed cases from Dehradun.

Karnataka

Karnataka has recorded 4,212 laboratory-confirmed influenza cases, including H1N1 cases, across 32 districts since January, with the majority of active cases concentrated in Bengaluru.

That compares with 4,583 cases in 2025 and 3,903 cases in 2024.

Kerala

Kerala has reported 7,421 influenza cases and 88 deaths this year, with most fatalities reported among people over 50.

These figures refer to influenza overall and should not be treated as H1N1-specific cases or deaths.

What Does H1N1 Usually Feel Like?

According to the Ministry of Health and Family Welfare, fever and systemic symptoms generally last around three days, although they can persist longer. Cough and weakness may continue even after the fever settles.

Dr GC Khilnani, Chairman, PSRI Institute of Pulmonary, Critical Care & Sleep Medicine, PSRI Hospital, New Delhi, told HealthandMe that common symptoms include body aches, sore throat, headache and fever, which can sometimes be high-grade.

Nausea, vomiting and occasional chest pain may also occur. The illness can be relatively short-lived and may last around three to five days in many cases.

H1N1 Red Flags You Shouldn't Miss

Certain symptoms should not be managed casually at home. These include:

Fever accompanied by breathlessness

Chest pain

Increasing weakness

Confusion

Bluish lips or nails

A noticeable fall in oxygen levels

These symptoms may indicate more serious respiratory involvement and require prompt medical assessment.

Who Needs to Be Particularly Cautious?

Although influenza can affect people of any age, certain groups are more likely to develop severe illness. These include young children, older adults, pregnant women and people with asthma or other chronic lung conditions, heart disease, diabetes or kidney disorders.

People with weakened immune systems are also at greater risk of complications. This includes cancer patients, particularly those receiving chemotherapy or other treatments that suppress immunity.

“An oncology patient may not always develop a dramatic set of symptoms at the beginning. Chemotherapy can affect blood counts and reduce the body's ability to mount an effective response to infection. That is why a new fever or respiratory symptom during treatment deserves earlier attention than it might in an otherwise healthy person,” says Dr Ankur Nandan Varshney, Sr. Medical Oncologist, Medanta Hospital, Noida, told HealthandMe.

Which Tests Are Actually Needed?

Not everyone with a cough and fever needs an H1N1 test. Testing is generally guided by symptoms, severity, risk factors and the clinical situation.

If the doctor suspects influenza and confirmation is needed, testing is usually done using a respiratory sample collected through a nasal or nasopharyngeal swab. Molecular methods such as RT-PCR can identify the influenza virus and help confirm the diagnosis.

“For a cancer patient, I would not look at the H1N1 report in isolation. A CBC with differential, particularly the neutrophil count, can be clinically important during chemotherapy. Depending on symptoms, oxygen saturation and examination findings, the doctor may also recommend a chest X-ray or CT scan to look for pneumonia or other lung complications,” explains Dr Varshney.

Don't Wait for Symptoms to Become Severe

People who are more susceptible to complications should seek medical advice early rather than relying on repeated home tests or taking medicines without guidance.

While many seasonal influenza infections improve on their own, individuals with weakened immunity or other underlying risk factors need closer monitoring and should contact their doctor promptly if symptoms appear or start getting worse.

“Especially in patients undergoing cancer treatment, the aim should be to identify deterioration early rather than wait until breathing becomes difficult,” said Dr Varshney.

How Can You Prevent H1N1 Infection?

Simple precautions can help reduce the spread of seasonal influenza:

Wash your hands regularly with soap and water.

Cover your mouth and nose when coughing or sneezing.

Avoid close contact with people who are sick.

Stay home when experiencing flu-like symptoms.

Improve ventilation in shared indoor spaces.

Avoid touching your eyes, nose and mouth with unwashed hands.

Amid a significant surge in H1N1 cases in India, experts say the flu can affect more than just the respiratory system—it can also cause eye symptoms.

H1N1, a strain of influenza A virus, is usually associated with fever, cough, sore throat, body ache, fatigue and other respiratory symptoms. It spreads mainly through respiratory droplets when an infected person coughs, sneezes or talks. However, influenza can sometimes affect areas beyond the respiratory system, including the eyes.

Some people may develop watering, redness, irritation, photophobia or dryness during a flu infection. While these symptoms may improve as the flu resolves, sudden changes in vision should not be ignored.

How Does H1N1 Affect the Eyes?

Speaking to HealthandMe, Dr. Sfurti Maan, Senior Consultant, Internal Medicine, Shalby International Hospital, said that in most cases, eye symptoms are mild and settle with appropriate care. One of the more noticeable problems is viral conjunctivitis.

“The eyes may become red and watery, with burning, irritation or mild discharge. More intense inflammation may cause swelling of the eyelids or conjunctiva,” the expert said.

A person may also develop light sensitivity or general discomfort in the eyes.

Another possible finding is a bright-red patch on the white portion of the eye. This is called a subconjunctival hemorrhage and can sometimes occur after severe coughing or vomiting.

When Should You See A Doctor?

Most H1N1-related eye problems are limited to conjunctivitis. However, rare cases of deeper eye inflammation, including uveitis, retinitis and optic nerve involvement, have also been reported. These complications are uncommon but can affect vision.

“If someone has influenza and develops persistent blurred vision, severe eye pain, marked sensitivity to light or a sudden drop in vision, that should not be treated as routine conjunctivitis. These symptoms need an eye examination,” Dr. Sfurti said.

Dr. Poninder Kumar Dogra, Senior Consultant, Ophthalmology at ShardaCare – Healthcity, said people with influenza should see an ophthalmologist if they experience:

• Sudden loss of vision

• Blurred or double vision

• Flashes of light

• An increase in eye floaters

• Vision problems when looking close up

• Substantial eye pain

• Intense redness or redness around the eye

• An unusual increase in photophobia with discharge

What About Contact Lens Wearers?

Contact lens wearers may develop eye pain, redness and changes in vision. Contacts should not be worn, and an eye examination should be arranged until the eyes have been investigated and an ophthalmic practitioner says they can be worn again.

Fluid loss, dehydration and fever during the flu can cause dryness and discomfort. Various medications may also cause dry eyes.

How Can You Prevent Eye Symptoms?

Annual flu vaccination is one of the key ways to reduce the risk of influenza. Others include:

• Good hand hygiene,
• covering the mouth and nose while coughing or sneezing,
• avoiding close contact with people who are sick
• staying home when unwell.

Dr. Sfurti advised people with flu symptoms to also avoid touching or rubbing their eyes, particularly with unwashed hands. If conjunctivitis is present, sharing towels, tissues, pillows or personal eye-care products should also be avoided.

“It is important not to panic just because H1N1 can affect the eyes. Serious ocular complications are very rare. The important thing is to recognise the warning signs. If there are only redness, watering and mild irritation, it is usually not a reason for alarm. But any significant change in vision deserves prompt medical attention.”

Dr. Poninder told HealthandMe that antibiotic drops or steroids should never be self-prescribed without seeing an ophthalmologist, as they can potentially delay diagnosis or affect the diagnosis of another condition.

Redness with a slight amount of discharge, discomfort or irritation with transient dryness that gradually resolves may not require an ophthalmologist referral. However, sudden loss of vision, intense pain, extreme redness and progressing inflammation should be checked.