India reported 214 new cases of H1N1 (swine) flu on Wednesday even as World Health Organization (WHO) warned of a surge in cases with the onset of winter in South and South-East Asia.

“Member states will need to continue updating their plans accordingly. It is important to allocate appropriate resources and maintain the overall pandemic preparedness”, said Dr Samlee Plianbangchang , WHO regional director for South-East Asia in Kathmandu, at the 27th meeting of health ministers.

Plianbangchang added that the agency is also closely monitoring the virus for genetic mutation and drug resistance, and stressed on the importance of public health measures such as frequent hand-washing, respiratory hygiene and cough etiquette, and social distancing measures such as voluntary isolation for slowing the surge.

“Health systems and hospitals in member states need to remain prepared for a surge of severe cases requiring active case management with antiviral and other supportive measures,” he said.

Meanwhile, in New Delhi, the ministry of health and family welfare said there would be no change in its strategy in the coming months. “We have to prepare for the worst and that is what we are doing. Our strategy is that maximum level of clinical services should be available to people and diagnosis should be done on time,” said V.M. Katoch, secretary in the department of health research.

The ministry has already allowed private diagnostic laboratories to test for the flu; it also wants to make the antiviral—oseltamivir (Tamiflu)—easily available.

“Private hospitals that have been designated by states for clinical services for H1N1 flu already have a stockpile of oseltamivir. But we want to make the drug better available since it is 99% effective in treating the flu,” added Katoch.

The government, which has been debating allowing the retail sale of oseltamivir, was expected to pass an order to that effect this week. However, this has been delayed because health minister Ghulam Nabi Azad is in Kathmandu.

“The government is also completing its own procurement procedure before it opens the retail sale of the drug,” said a health ministry official, who spoke on condition of anonymity.

Private labs continue to see a steadily increasing stream of people wanting to have themselves tested for swine flu. Since it started testing in mid-August, SRL Diagnostics has conducted at least 2,000 tests. It receives at least 150 samples a day for testing at its labs in Gurgaon, near New Delhi and Mumbai.

And the results indicate that fears about a winter surge may not be misplaced.

“We have been seeing positive rates fluctuate between 15% and 35%. In the last three days, though, the number of people testing positive has been higher and in Maharashtra it has crossed 40%,” said Sanjeev Chaudhry, chief executive officer, SRL Diagnostics.

H1N1 symptoms are similar to that of normal flu, and people don’t know when to get the test done, he added. Since the price (at private labs) is high, people normally wait till symptoms deteriorate and this is often too late, Chaudhry said.

Another worry, according to WHO, is also that the pandemic flu vaccine may not be available in time for the winter surge. “Vaccine manufacturing capacity is finite. We have to ensure rational distribution of this vaccine when available,” said Plianbangchang.