<TABLE border=0 cellSpacing=0 cellPadding=0 width="100%"><TBODY><TR>Fighting H1N1 flu: Don't go overboard
</TR><!-- headline one : end --><TR>Next wave likely to be deadlier, so it's important not to overstretch resources </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Lee Wei Ling
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<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->In the first two weeks of April, an untypable Influenza A virus began to be identified in Mexico and southern California. It was established within a week that the new H1N1 virus was the product of recombined human, avian and swine influenza viruses.
It spread rapidly. Within weeks, it had spread around the globe. Not even Japan, whose people are almost compulsive about personal hygiene, was spared. It was obvious that Singapore too would be badly hit.
On May 26, Singapore had its first confirmed H1NI case. The patient was a 22-year-old Singaporean who had just returned from New York via Frankfurt. She had developed a cough while on board the plane, but sailed past the thermal scanner at the airport for she was afebrile. She later consulted a GP who sent her to Tan Tock Seng Hospital, where tests confirmed her infection.
Since then, there have been many H1N1 cases that went initially undetected because they were afebrile. Singaporeans are quite obedient and usually trust the Government. So when the Ministry of Health (MOH) introduced thermal scanning, the public thought it was a wise move. Many probably felt that if they were afebrile, that meant they did not have H1N1 and could move around freely. I cannot over-emphasise the danger of a false negative - that is, when a person with the H1N1 virus but with no fever is treated as though he or she is free of the virus.
During the early mild phase of the 1918-1919 Spanish flu pandemic, the reproductive number - that is, the number of new cases attributable to a single established case - ranged from two to five, as compared with the seasonal flu average of 1.3. Since models of containment for the current epidemic assume lower reproductive numbers than have been historically observed, they are likely to be overly optimistic of the success of their containment strategies.
The Centres for Disease Control in the United States reports that the US has had 21,449 H1N1 cases and 87 people have died - a mortality rate of 0.4 per cent. Canada has had 5,170 confirmed cases and 13 deaths - a mortality of 0.25 per cent.
The comparable figures for Europe are 10,562 confirmed cases and four deaths - 0.04 per cent mortality; and for Australia, 4,370 cases and seven deaths - 0.16 per cent mortality. Mexico, where the strain was first spotted, has had 113 deaths out of more than 7,000 confirmed cases - a mortality of 1.61 per cent.
The most recent World Health Organisation data showed that H1N1 has infected nearly 40,000 people worldwide and caused 167 deaths, giving an overall mortality of 0.4 per cent.
In the 39 days since the first H1N1 case was detected here, there have been 1,003 confirmed cases in Singapore and no deaths so far.
It is obvious the H1N1 virus is highly infectious but it has thus far not been more severe in its effects than the seasonal flu. And yet there has been near mass hysteria here, perhaps aggravated by MOH's initial approach.
Its reaction was perhaps shaped by anticipating what the public expected the Government to do. Thus it may have felt it necessary to demonstrate to the public that the Government has taken all the necessary steps to protect their safety and health.
It is like the witch-doctor who performs the rain dance: He may not actually believe that the dance will bring rain, but he performs the dance nevertheless because that is what he thinks the tribe wants and expects from its witch-doctor.
The more logical thing to have done would have been to explain to Singaporeans that the H1N1 virus in its current form is mild. Apart from pregnant women, children younger than two years old, diabetics, people who were immuno-compromised and obese people, the H1N1's effect on otherwise healthy people will be no different from the seasonal flu. This message could have been emphasised while alerting Singaporeans to the possibility of the virus mutating and becoming deadly. If that happened, we would have to adjust our response. But until then, we need not over-react and overstretch our resources.
MOH's latest approach centres on Pandemic Preparedness Clinics (PPCs). These are primary health-care providers which form a vital part of the ministry's Flu Pandemic Response Framework.
PPCs are supported with personal protection equipment and Tamiflu. All polyclinics are part of the framework. Being islandwide, PPCs will help ensure effective assessment and treatment of people with flu-like illnesses.
Doctors should exercise judgment in prescribing anti-virals like Tamiflu, taking into account patients' risk of developing influenza-related complications, the prevalence of H1N1 in the community and the risks and benefits of treatment. There has already been one H1N1 patient in Japan who did not respond to Tamiflu. It is well known that a significant proportion of influenza viruses - but not H1N1 yet - has become resistant to Tamiflu.
It is good that MOH has finally stepped down its procedures against H1N1. But temperature-taking is still being carried out. I wonder how many confirmed H1N1 cases were detected by thermal screening, and how many false negatives there have been. The manpower devoted to thermal screening, and the inconvenience it has caused the public, are significant.
We can be better prepared by studying the pandemics of the 20th century. All three major pandemics of the last century were characterised by multiple waves. For instance, the lethal Spanish flu wave in the autumn of 1918 was preceded by a first wave in the summer that led to substantial morbidity but relatively low mortality. Recent studies suggest that these early mild outbreaks partially immunised the population.
We do not know yet whether another wave of H1N1 will hit us. If it does, the next wave is likely to be more deadly, if history is any guide.
The writer is director of the National Neuroscience Institute. Send your comments to [email protected]
Sure, save some $ for my shopping trips! *hee*hee*
</TR><!-- headline one : end --><TR>Next wave likely to be deadlier, so it's important not to overstretch resources </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Lee Wei Ling
</TD></TR><!-- show image if available --><TR vAlign=bottom><TD width=330>
</TD><TD width=10>
<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->In the first two weeks of April, an untypable Influenza A virus began to be identified in Mexico and southern California. It was established within a week that the new H1N1 virus was the product of recombined human, avian and swine influenza viruses.
It spread rapidly. Within weeks, it had spread around the globe. Not even Japan, whose people are almost compulsive about personal hygiene, was spared. It was obvious that Singapore too would be badly hit.
On May 26, Singapore had its first confirmed H1NI case. The patient was a 22-year-old Singaporean who had just returned from New York via Frankfurt. She had developed a cough while on board the plane, but sailed past the thermal scanner at the airport for she was afebrile. She later consulted a GP who sent her to Tan Tock Seng Hospital, where tests confirmed her infection.
Since then, there have been many H1N1 cases that went initially undetected because they were afebrile. Singaporeans are quite obedient and usually trust the Government. So when the Ministry of Health (MOH) introduced thermal scanning, the public thought it was a wise move. Many probably felt that if they were afebrile, that meant they did not have H1N1 and could move around freely. I cannot over-emphasise the danger of a false negative - that is, when a person with the H1N1 virus but with no fever is treated as though he or she is free of the virus.
During the early mild phase of the 1918-1919 Spanish flu pandemic, the reproductive number - that is, the number of new cases attributable to a single established case - ranged from two to five, as compared with the seasonal flu average of 1.3. Since models of containment for the current epidemic assume lower reproductive numbers than have been historically observed, they are likely to be overly optimistic of the success of their containment strategies.
The Centres for Disease Control in the United States reports that the US has had 21,449 H1N1 cases and 87 people have died - a mortality rate of 0.4 per cent. Canada has had 5,170 confirmed cases and 13 deaths - a mortality of 0.25 per cent.
The comparable figures for Europe are 10,562 confirmed cases and four deaths - 0.04 per cent mortality; and for Australia, 4,370 cases and seven deaths - 0.16 per cent mortality. Mexico, where the strain was first spotted, has had 113 deaths out of more than 7,000 confirmed cases - a mortality of 1.61 per cent.
The most recent World Health Organisation data showed that H1N1 has infected nearly 40,000 people worldwide and caused 167 deaths, giving an overall mortality of 0.4 per cent.
In the 39 days since the first H1N1 case was detected here, there have been 1,003 confirmed cases in Singapore and no deaths so far.
It is obvious the H1N1 virus is highly infectious but it has thus far not been more severe in its effects than the seasonal flu. And yet there has been near mass hysteria here, perhaps aggravated by MOH's initial approach.
Its reaction was perhaps shaped by anticipating what the public expected the Government to do. Thus it may have felt it necessary to demonstrate to the public that the Government has taken all the necessary steps to protect their safety and health.
It is like the witch-doctor who performs the rain dance: He may not actually believe that the dance will bring rain, but he performs the dance nevertheless because that is what he thinks the tribe wants and expects from its witch-doctor.
The more logical thing to have done would have been to explain to Singaporeans that the H1N1 virus in its current form is mild. Apart from pregnant women, children younger than two years old, diabetics, people who were immuno-compromised and obese people, the H1N1's effect on otherwise healthy people will be no different from the seasonal flu. This message could have been emphasised while alerting Singaporeans to the possibility of the virus mutating and becoming deadly. If that happened, we would have to adjust our response. But until then, we need not over-react and overstretch our resources.
MOH's latest approach centres on Pandemic Preparedness Clinics (PPCs). These are primary health-care providers which form a vital part of the ministry's Flu Pandemic Response Framework.
PPCs are supported with personal protection equipment and Tamiflu. All polyclinics are part of the framework. Being islandwide, PPCs will help ensure effective assessment and treatment of people with flu-like illnesses.
Doctors should exercise judgment in prescribing anti-virals like Tamiflu, taking into account patients' risk of developing influenza-related complications, the prevalence of H1N1 in the community and the risks and benefits of treatment. There has already been one H1N1 patient in Japan who did not respond to Tamiflu. It is well known that a significant proportion of influenza viruses - but not H1N1 yet - has become resistant to Tamiflu.
It is good that MOH has finally stepped down its procedures against H1N1. But temperature-taking is still being carried out. I wonder how many confirmed H1N1 cases were detected by thermal screening, and how many false negatives there have been. The manpower devoted to thermal screening, and the inconvenience it has caused the public, are significant.
We can be better prepared by studying the pandemics of the 20th century. All three major pandemics of the last century were characterised by multiple waves. For instance, the lethal Spanish flu wave in the autumn of 1918 was preceded by a first wave in the summer that led to substantial morbidity but relatively low mortality. Recent studies suggest that these early mild outbreaks partially immunised the population.
We do not know yet whether another wave of H1N1 will hit us. If it does, the next wave is likely to be more deadly, if history is any guide.
The writer is director of the National Neuroscience Institute. Send your comments to [email protected]
Sure, save some $ for my shopping trips! *hee*hee*
