<TABLE border=0 cellSpacing=0 cellPadding=0 width="100%"><TBODY><TR>H1N1 flu: Get used to it, it's here to stay
</TR><!-- headline one : end --><TR>Very soon, the virus will be everywhere; measures to combat it will have to evolve too </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Bertha Henson, Associate Editor
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<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->So, when the new school term starts tomorrow, what can we expect? Long queues at the school gate? Students turned away because they failed temperature checks or were caught lying about their recent travel history? Teachers multi-tasking as nurses and wardens?
Singapore is in a bit of a bind over the H1N1 flu outbreak. It is doing a balancing act at the moment - trying to restrict the spread of the bug as much as possible before declaring that the war is over, let's get on with business as usual.
Except that it will not be business as usual, at least for a while, unless everyone is clear about what being down with the H1N1 flu virus means, how the bug works, and who it will affect most.
It also means being clear about where the country stands in the short history of the virus since it emerged in Mexico in April.
First, there is little point suggesting that we should be replicating actions - or inaction - adopted elsewhere, because different countries are at different stages of the flu outbreak.
In the United States, one million people are said to be infected. Almost everyone (98 per cent) who has the flu there has caught the H1N1 variety. The bug spread so fast that there is little that the health authorities could do to contain it.
So they've given up ordering the shutting down of schools since there is an equal chance of catching the flu by simply stepping out of the house. In some cities, they are not even testing flu patients for the virus any more.
In pandemic parlance, it moved - very swiftly - from the containment stage to what is known as the mitigation stage. This is when flu numbers are so huge that it is better to focus on people most vulnerable to the disease.
Singapore is straddling both stages.
With new cases surfacing in the hundreds, there is little point delaying the new school term since a student can just as likely be infected walking on the streets. But there is also no reason to worsen the outbreak and cause an exponential surge by letting students from affected countries into classrooms.
This is important because young people under 20 appear to be more susceptible to the flu. Whole classes might well have to be on medical leave if the bug spreads like wildfire.
There is something to be said for a 'slow burn'', as Health Minister Khaw Boon Wan put it. If the numbers surge exponentially, hospitals will be clogged with severely ill flu patients, as is the case now in the hospital emergency departments in the US.
What becomes then of heart or cancer patients in need of critical medical treatment?
That is why preparations are being made for general practitioners and polyclinics to tend to flu patients, including those with H1N1, instead of having them converge at hospitals.
By the way, H1N1 patients are being isolated now in the Communicable Disease Centre and hospitals only to stop them from spreading the infection, not because they are languishing in pain. This is part of the containment strategy.
Most do not even need to be hospitalised and could have recovered just as well at home with medication.
The H1N1 virus is not like the Sars virus, which does not discriminate between the young and the old, the healthy and the unhealthy, and leaves its victims dead or in terrible pain.
Asian countries now operating in Sars mode would have to change tactics soon as, unlike Sars, the H1N1 flu is, well, the flu and will hang around for some time.
The numbers will spike sharply, especially since the H1N1 flu bug is more infectious than seasonal flu.
It is inevitable and very soon, everyone would have been exposed to the virus in one way or another.
So, yes, it is a pandemic, but it is not a lethal pandemic. Most will recover. But because its reach is so wide, 'high-risk'' groups should be on their guard because they could become severely ill.
American scientists reported last Friday that of the H1N1 flu patients who had to be hospitalised, 32 per cent had asthma. Those with chro-nic obstructive pulmonary disease were tied, at 32 per cent, and obesity was reported in 27 per cent of the patients.
The average age of flu victims is 12. It is 20 for hospitalised patients and 37 for those who have died.
Of the 90 or so people dead, nine in 10 had underlying health conditions.
This means that medical attention must turn to protecting these 'high-risk'' groups who could end up in hospital - or dead. This is why frontline doctors here have been told to send mild cases home on medical leave and keep the Tamiflu drug for high-risk patients.
Worldwide, news reports on the H1N1 flu bug have started proliferating again because people are dying - about 240 people so far.
The fact is that as many as 1.5 million people die in a normal flu season worldwide. Here in Singapore, the figure averages 600 a year.
Since not too much of a fuss is made about it, should we then be fussing when the H1N1 flu bug starts killing people?
That depends on whether this strain, which is quickly replacing other strains as the dominant strain, is more deadly.
American scientists think that about 37 out of every 10,000 people infected could be killed by it - if overall flu statistics have been accurately reported. The consensus, however, is that under- reporting is the norm.
So it might well be that after the H1N1 flu bug has made its round of the world, scientists could give the news that it is no different from the 10 per 10,000 kill rate of seasonal flu.
It's a big 'if''.
It might also well be that after the virus makes its round via the southern hemisphere, it could have mutated and become more resistant to drugs.
As World Health Organisation chief Margaret Chan said: 'The virus is still very stable...But we all know the influenza virus is highly unpredictable and has great potential for mutation.'
For the general population, it seems best then to treat this H1N1 flu bug as the usual seasonal flu bug - but with some extra care.
Here's a peek at what is to come:
In the coming months, groups of people may be sent home - from workplaces or schools - to recover from the flu or in case they develop the flu, to avoid infecting others.
Companies will develop work-from-home strategies, while schools will refine home-based learning. No one will bat an eyelid at people coming and going.
There is no need to segregate H1N1 patients from others since the bug is circulating everywhere. Likewise, travel advisory telling people not to go to certain countries will be a thing of the past, since the bug is here too. Home quarantine orders will be meaningless.
Over time, people would get used to the bug in their midst and it would be known as just 'the flu' again.
So, you see a doctor, get medication and go on medical leave.
'The best protection for people is to cover your mouth when coughing or sneezing and wash your hands thoroughly and frequently.
'If you are experiencing influenza-like illness, stay at home and do not go to school or work and do not travel. You should stay at home for seven days or until a day after the symptoms have disappeared.'
No, that was not from Mr Khaw but from an American health official. It is flu advice now being given out the world over.
[email protected]
</TR><!-- headline one : end --><TR>Very soon, the virus will be everywhere; measures to combat it will have to evolve too </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Bertha Henson, Associate Editor
</TD></TR><!-- show image if available --><TR vAlign=bottom><TD width=330>
</TD><TD width=10>
-- PHOTO: ISTOCKPHOTO
</TD></TR></TBODY></TABLE>
<TABLE><TBODY><TR><TD>
</TD></TR></TBODY></TABLE>
<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->So, when the new school term starts tomorrow, what can we expect? Long queues at the school gate? Students turned away because they failed temperature checks or were caught lying about their recent travel history? Teachers multi-tasking as nurses and wardens?
Singapore is in a bit of a bind over the H1N1 flu outbreak. It is doing a balancing act at the moment - trying to restrict the spread of the bug as much as possible before declaring that the war is over, let's get on with business as usual.
Except that it will not be business as usual, at least for a while, unless everyone is clear about what being down with the H1N1 flu virus means, how the bug works, and who it will affect most.
It also means being clear about where the country stands in the short history of the virus since it emerged in Mexico in April.
First, there is little point suggesting that we should be replicating actions - or inaction - adopted elsewhere, because different countries are at different stages of the flu outbreak.
In the United States, one million people are said to be infected. Almost everyone (98 per cent) who has the flu there has caught the H1N1 variety. The bug spread so fast that there is little that the health authorities could do to contain it.
So they've given up ordering the shutting down of schools since there is an equal chance of catching the flu by simply stepping out of the house. In some cities, they are not even testing flu patients for the virus any more.
In pandemic parlance, it moved - very swiftly - from the containment stage to what is known as the mitigation stage. This is when flu numbers are so huge that it is better to focus on people most vulnerable to the disease.
Singapore is straddling both stages.
With new cases surfacing in the hundreds, there is little point delaying the new school term since a student can just as likely be infected walking on the streets. But there is also no reason to worsen the outbreak and cause an exponential surge by letting students from affected countries into classrooms.
This is important because young people under 20 appear to be more susceptible to the flu. Whole classes might well have to be on medical leave if the bug spreads like wildfire.
There is something to be said for a 'slow burn'', as Health Minister Khaw Boon Wan put it. If the numbers surge exponentially, hospitals will be clogged with severely ill flu patients, as is the case now in the hospital emergency departments in the US.
What becomes then of heart or cancer patients in need of critical medical treatment?
That is why preparations are being made for general practitioners and polyclinics to tend to flu patients, including those with H1N1, instead of having them converge at hospitals.
By the way, H1N1 patients are being isolated now in the Communicable Disease Centre and hospitals only to stop them from spreading the infection, not because they are languishing in pain. This is part of the containment strategy.
Most do not even need to be hospitalised and could have recovered just as well at home with medication.
The H1N1 virus is not like the Sars virus, which does not discriminate between the young and the old, the healthy and the unhealthy, and leaves its victims dead or in terrible pain.
Asian countries now operating in Sars mode would have to change tactics soon as, unlike Sars, the H1N1 flu is, well, the flu and will hang around for some time.
The numbers will spike sharply, especially since the H1N1 flu bug is more infectious than seasonal flu.
It is inevitable and very soon, everyone would have been exposed to the virus in one way or another.
So, yes, it is a pandemic, but it is not a lethal pandemic. Most will recover. But because its reach is so wide, 'high-risk'' groups should be on their guard because they could become severely ill.
American scientists reported last Friday that of the H1N1 flu patients who had to be hospitalised, 32 per cent had asthma. Those with chro-nic obstructive pulmonary disease were tied, at 32 per cent, and obesity was reported in 27 per cent of the patients.
The average age of flu victims is 12. It is 20 for hospitalised patients and 37 for those who have died.
Of the 90 or so people dead, nine in 10 had underlying health conditions.
This means that medical attention must turn to protecting these 'high-risk'' groups who could end up in hospital - or dead. This is why frontline doctors here have been told to send mild cases home on medical leave and keep the Tamiflu drug for high-risk patients.
Worldwide, news reports on the H1N1 flu bug have started proliferating again because people are dying - about 240 people so far.
The fact is that as many as 1.5 million people die in a normal flu season worldwide. Here in Singapore, the figure averages 600 a year.
Since not too much of a fuss is made about it, should we then be fussing when the H1N1 flu bug starts killing people?
That depends on whether this strain, which is quickly replacing other strains as the dominant strain, is more deadly.
American scientists think that about 37 out of every 10,000 people infected could be killed by it - if overall flu statistics have been accurately reported. The consensus, however, is that under- reporting is the norm.
So it might well be that after the H1N1 flu bug has made its round of the world, scientists could give the news that it is no different from the 10 per 10,000 kill rate of seasonal flu.
It's a big 'if''.
It might also well be that after the virus makes its round via the southern hemisphere, it could have mutated and become more resistant to drugs.
As World Health Organisation chief Margaret Chan said: 'The virus is still very stable...But we all know the influenza virus is highly unpredictable and has great potential for mutation.'
For the general population, it seems best then to treat this H1N1 flu bug as the usual seasonal flu bug - but with some extra care.
Here's a peek at what is to come:
In the coming months, groups of people may be sent home - from workplaces or schools - to recover from the flu or in case they develop the flu, to avoid infecting others.
Companies will develop work-from-home strategies, while schools will refine home-based learning. No one will bat an eyelid at people coming and going.
There is no need to segregate H1N1 patients from others since the bug is circulating everywhere. Likewise, travel advisory telling people not to go to certain countries will be a thing of the past, since the bug is here too. Home quarantine orders will be meaningless.
Over time, people would get used to the bug in their midst and it would be known as just 'the flu' again.
So, you see a doctor, get medication and go on medical leave.
'The best protection for people is to cover your mouth when coughing or sneezing and wash your hands thoroughly and frequently.
'If you are experiencing influenza-like illness, stay at home and do not go to school or work and do not travel. You should stay at home for seven days or until a day after the symptoms have disappeared.'
No, that was not from Mr Khaw but from an American health official. It is flu advice now being given out the world over.
[email protected]
