A(H1N1): Better safe than sorry
David KL QuekPublished: Jun 30, 2009 6:45 AM | Updated: Jun 30, 2009 12:47 PM
comment There remains much fear that the A(H1N1) flu will continue to spread in Malaysia. Most are imported cases to date, but a steadily growing person-to-person spread becoming a more pronounced reality.
The plan is to try and limit the contagion to as few people as possible and thus perhaps shield Malaysians from the worst aspects of this pandemic's potential lethality and socio-economic perils.
comment There remains much fear that the A(H1N1) flu will continue to spread in Malaysia. Most are imported cases to date, but a steadily growing person-to-person spread becoming a more pronounced reality.
The plan is to try and limit the contagion to as few people as possible and thus perhaps shield Malaysians from the worst aspects of this pandemic's potential lethality and socio-economic perils.
As at June 26, World health Organisation statistics show 59,814 reported cases and 263 deaths - a mortality rate of 0.44%.
This is in contrast to two other high-profile global health threats of recent years. Avian Flu or influenza A(H5N1) had 433 reported cases and 262 deaths; while Severe Acute Respiratory Syndrome (Sars) had 8,096 reported cases and 774 deaths; thus their mortality rates were much higher at 61% and 9.6% respectively.
Contrast this with our resurgent dengue fever; in the first half of the year, there were 23,057 dengue cases and 57 related deaths in Malaysia - i.e. 1 death in 404 cases or a case fatality of 0.25%. Therefore, this A(H1N1) flu has nearly twice the death rate of dengue fever, which must mean that we have to take this very seriously, especially when it is also very contagious.
Although some sceptics including medical doctors, have brought up concerns that perhaps the response to this current pandemic is overblown and exaggerated, the Health Ministry and its director-general (DG) continue to point out (correctly, in my view) that, while this may turn out to be true in the longer term, we just can't simply afford to sit by and let this pandemic go without careful monitoring.
One very important point raised by the DG is that, if and when this pandemic turns out to be truly benign, then all’s well and good.
But consider the converse: if this flu becomes more lethal and many Malaysians die, what then? Will the culpability be equally shared for blame and recriminations? Indeed, will anyone then wish to take the rap, the responsibility?
In neighbouring Thailand, as at today, two among more than 1,000 cases have died, so this is not so benign after all.
In the US, CDC spokesperson and respiratory director Dr Ann Shuchart has stated that perhaps as many as 1 million Americans may have been infected with the virus, but this is, at best a conjecture.
Of the 27,717 laboratory-confirmed cases, about 3,000 Americans have been hospitalised (their median age i s quite young, just 19 years old) and 127 have died. Therefore if we consider just the lab-confirmed cases, the case fatality rate works out to be 0.45% or 1 in 218, very consistent with global figures, thus far.
Let’s do our part
Still, Malaysians are known to be very quick at pointing fingers and apportioning blame and vindictive censure. Many very vocal citizens are often irrationally strident and unforgiving, expecting that any authority or government can or should do no wrong.
Already there is muttering that we have not done enough. A recent letter stated that Singapore's surveillance methods are better and more visible, just because that person and their friends were not screened when crossing over the Second Link into Johor Bahru when returning. Yet they failed to note that the tiny nation-state has more than twice the number of infections than Malaysia, with even greater numbers of local transmission.
Sadly, it's that inherent colour of bias that our neighbour down south is always perceptibly better, whatever the raw unvarnished truth. Thus, although there are some who believe that we have been too cautious, too kiasu (scared to lose) and too kiasi (scared to die) even, there are many others out there who genuinely fear the possibility of a catastrophic contagion that can cripple our nation.
Hence, Malaysian health authorities have very limited options. Rigorous vigilance, close monitoring and being overly cautious might be the more prudent approach - yes, perhaps, this might cost us a bit of time, energy, resources and money in the beginning, but in the long term this would have been worth it. Every life saved, is and should always be a correct public health measure.
The question that begs to be answered is, at what cost? We would all love to know the answer, and perhaps over time and experience from all countries affected, we will be the wiser over time.
It is true that many countries are loosening their surveillance programmes and are moving towards mitigation measures, which will help preserve resources and perhaps offer a more pragmatic approach to the pandemic. Some of these measures are the result of acknowledged failed public containment.
Of course, everyone hopes that this flu will peter out after the initial wave of snuffles and fever subsides, if or when it does. But much remains to be seen, the unknowable remains as unpredictable as ever, and the possible future scenarios range from the most optimistically benign to the most catastrophic.
In the meantime, we can only help by assisting the ministry to abide by the continually updated measures that are being rolled out daily. At very least, we can help by mitigating against the careless spread of this quite contagious virus, by scrupulous hygiene measures, and where necessary, by applying strict self-quarantine, if and when, we are possibly infected.
Let's do our civic duty and be responsible and good citizens.
DR DAVID KL QUEK is president of the Malaysian Medical Association.
The plan is to try and limit the contagion to as few people as possible and thus perhaps shield Malaysians from the worst aspects of this pandemic's potential lethality and socio-economic perils.
As at June 26, World health Organisation statistics show 59,814 reported cases and 263 deaths - a mortality rate of 0.44%.This is in contrast to two other high-profile global health threats of recent years. Avian Flu or influenza A(H5N1) had 433 reported cases and 262 deaths; while Severe Acute Respiratory Syndrome (Sars) had 8,096 reported cases and 774 deaths; thus their mortality rates were much higher at 61% and 9.6% respectively.
Contrast this with our resurgent dengue fever; in the first half of the year, there were 23,057 dengue cases and 57 related deaths in Malaysia - i.e. 1 death in 404 cases or a case fatality of 0.25%. Therefore, this A(H1N1) flu has nearly twice the death rate of dengue fever, which must mean that we have to take this very seriously, especially when it is also very contagious.
Although some sceptics including medical doctors, have brought up concerns that perhaps the response to this current pandemic is overblown and exaggerated, the Health Ministry and its director-general (DG) continue to point out (correctly, in my view) that, while this may turn out to be true in the longer term, we just can't simply afford to sit by and let this pandemic go without careful monitoring.
One very important point raised by the DG is that, if and when this pandemic turns out to be truly benign, then all’s well and good. But consider the converse: if this flu becomes more lethal and many Malaysians die, what then? Will the culpability be equally shared for blame and recriminations? Indeed, will anyone then wish to take the rap, the responsibility?
In neighbouring Thailand, as at today, two among more than 1,000 cases have died, so this is not so benign after all.
In the US, CDC spokesperson and respiratory director Dr Ann Shuchart has stated that perhaps as many as 1 million Americans may have been infected with the virus, but this is, at best a conjecture.
Of the 27,717 laboratory-confirmed cases, about 3,000 Americans have been hospitalised (their median age i s quite young, just 19 years old) and 127 have died. Therefore if we consider just the lab-confirmed cases, the case fatality rate works out to be 0.45% or 1 in 218, very consistent with global figures, thus far.
Let’s do our part
Still, Malaysians are known to be very quick at pointing fingers and apportioning blame and vindictive censure. Many very vocal citizens are often irrationally strident and unforgiving, expecting that any authority or government can or should do no wrong.
Already there is muttering that we have not done enough. A recent letter stated that Singapore's surveillance methods are better and more visible, just because that person and their friends were not screened when crossing over the Second Link into Johor Bahru when returning. Yet they failed to note that the tiny nation-state has more than twice the number of infections than Malaysia, with even greater numbers of local transmission. Sadly, it's that inherent colour of bias that our neighbour down south is always perceptibly better, whatever the raw unvarnished truth. Thus, although there are some who believe that we have been too cautious, too kiasu (scared to lose) and too kiasi (scared to die) even, there are many others out there who genuinely fear the possibility of a catastrophic contagion that can cripple our nation.
Hence, Malaysian health authorities have very limited options. Rigorous vigilance, close monitoring and being overly cautious might be the more prudent approach - yes, perhaps, this might cost us a bit of time, energy, resources and money in the beginning, but in the long term this would have been worth it. Every life saved, is and should always be a correct public health measure.
The question that begs to be answered is, at what cost? We would all love to know the answer, and perhaps over time and experience from all countries affected, we will be the wiser over time.It is true that many countries are loosening their surveillance programmes and are moving towards mitigation measures, which will help preserve resources and perhaps offer a more pragmatic approach to the pandemic. Some of these measures are the result of acknowledged failed public containment.
Of course, everyone hopes that this flu will peter out after the initial wave of snuffles and fever subsides, if or when it does. But much remains to be seen, the unknowable remains as unpredictable as ever, and the possible future scenarios range from the most optimistically benign to the most catastrophic.
In the meantime, we can only help by assisting the ministry to abide by the continually updated measures that are being rolled out daily. At very least, we can help by mitigating against the careless spread of this quite contagious virus, by scrupulous hygiene measures, and where necessary, by applying strict self-quarantine, if and when, we are possibly infected.
Let's do our civic duty and be responsible and good citizens.
DR DAVID KL QUEK is president of the Malaysian Medical Association.
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