As of yesterday’s counting, confirmed local cases have reached 599! This figure is significant because it carries a special meaning. In Chinese, it means “Don’t Play Play!” And the majority of Singaporeans are of ethnic Chinese, so it is even more meaningful. You all see or not? Even the H1N1 virus is trying to send a message to those who think it is just like a common flu virus, to those who take it so lightly, and to those who still go about infecting others without a care even though they know or suspect that they are the carriers of the virus.
The Sunday Times’ headline was “Schools ready to fight flu when they reopen tomorrow”. It then went about trying to convince or assure the parents (readers) that there is nothing to worry about sending their children back to school when it reopens today. It uses the tiny winy sample of a poll of 100 parents to justify its case. Quote:
Bulk of 100 parents polled say they are confident measures will be sufficient. Parents, too, are adopting a calm attitude towards the start of term three. Of the 100 parents interviewed, only 16 said they were worried about their children returning to school. Most parents said they had taken only minor measures to prepare for the new term. 37 parents said they had been telling their children about the importance of hygiene and the need to wash their hands. 9 parents said they had been keeping them away from crowded places. 15 parents were boosting their children’s immunity systems with vitamins, supplements or flu vaccinations. One parent said as long as they maintain their personal hygiene keeping them away from school won’t be necessary.
Schools said they had in fact been gearing up to control the spread of H1N1 even before the June break started. The 50 schools interviewed said they had put in place preventive measures. Raffles Girls’ Primary School has intensified the cleaning of its premises. “The canteen vendors also cleaned up their stalls for school reopening. Special rooms have been set aside for students who may need to be isolated because they are unwell, “said principal Yue Yoke Mun. …
Yes, some schools will also take the students’ temperature twice a day. All measures are in place. Don’t panic. Nothing to worry about. Just keep calm and cool and the H1N1 virus will not dare to infect your precious school-going children. That’s it!
Who are we trying to fool? Can all those silly measures really stop the H1N1 virus from spreading in a tiny congested island when most people either seem undeterred, couldn’t care less to wear a mask, or clearly having a serious lack of knowledge about the virus? Washing of canteens once in a term break can stop spreading the virus? Taking of temperature can stop the virus from spreading? Washing hands one hundred times a day can stop the virus from spreading? Being shy and refusing to wear a mask as a precautionary measure can stop the virus from spreading? With such ingrained attitude, behaviour and ignorance, there is sure to be a surge in infections across the whole island, even spreading into neighbouring Johore, Malaysia, and beyond.
Even advanced countries like the US, Canada, Australia and UK are not able to prevent the spread of the H1N1 virus, which resulted in a global pandemic declared by the World Health Organisation on 11 June 2009. Can a tiny island like Singapore, with indecision being the rule of the day in this Swine Flu episode (upgrading alert state from yellow to orange and then reverting to yellow again, while the infections continue to rise rapidly by the hour), with serious lack of communication between and amongst medical and health care-givers, and with the severe shortage of good and truly professional medical supporting staff, seriously believe it is able to stamp the tide of the spread of this relatively unknown, mischievous and illusive virus?
To begin with, how does the H1N1 virus spread? It spreads through the air we breath, droplets, contaminated surfaces, as well as through contaminated water we drink or use to wash our hands with. And take note that this particular virus has four genes: two from pigs, one from bird and one from human – scientists call this a “Quadruple Reassortant Virus”, which is definitely not the same as the common flu virus at all! Please read my earlier post on “Know Your Flu” and the United States’ CDCP site here for more information.
Officialdom’s mantra about swine flu – “it is mild” – might seem incongruous if we knew the number of children, teens and young adults in ICU beds right now alive only because a breathing machine has taken over for their ravaged lungs.
The heavy reliance on the word “mild “ could be creating a false impression of what is actually going on and what Singaporeans may face in coming months.
If authorities are trying to ensure people don’t panic about the new H1N1 outbreak, they are concerned about the wrong thing. In Singapore, swine flu panic is much rarer than swine flu cases. The problem is not panic or even excessive anxiety. The problem is complacency, both about what is going to happen and about what might happen.
When the new H1N1 virus burst onto the world’s radar, it was, for awhile, the hottest story of the 24-7 news cycle. The long threatened pandemic, it seemed, was finally underway. But instead of the over 60% death rate of H5N1 Avian Flu — seen for years as the pandemic front-runner – the wire was tripped by a seemingly wimpy virus that is causing a lot of flu, but is no viral monster.
In many countries, including Singapore, public health officials have bent over backwards to stamp down anticipated panic. The results? Within a few weeks, most people appear to be convinced the pandemic was (past tense) a non-event, a blip of flu activity over-hyped by the sensationalist media hoard – especially so in Singapore where the alert level was raised from level 2 to level 3 and then quickly revert back to level 2 again, and it stays at this level until today – even though the whole world has raised the alert level to level 6 three weeks ago.
When we’re told that swine flu is mild, we don’t think, “It will infect a half to a third of the world population and kill a few million people, mostly young people, before it’s over.” We think, `It’s like having a bad common cold.”‘
Well, swine flu isn’t over yet. In fact, it is just starting to pick up speed. It is extremely infectious, even five days after a patient is already put on proper medication and isolated and enclosed within the CDC. And it is definitely not like a bad common cold sweeping across the tiny island of Singapore!
Officials and experts seem to be having a hard time trying to strike a balance in their messages to the public — unclear what they are dealing with now and what it might become. I think the problem is we don’t know how to paint this picture properly, because it is perfectly true that most cases are mild and Singapore has not experienced any death arising from the H1N1 virus YET. But it does not mean that we should not worry about it.
The regular common flu, as anyone who has had it knows, is no easy walk in the park. And with this new H1N1 flu virus, a small subset of people get very, very sick and also die. Their lungs are overwhelmed by an aggressive viral pneumonia described as looking like a “white out” on an X-ray. A number of hospitals in other countries are struggling to keep these people alive at a very high cost!
Generally, much younger than the typical hospitalised flu patient, many of these people have been on ventilators for weeks. Every day, officials in some part of the world announce that a 15-year-old boy, or a 24-year-old woman or an otherwise healthy pregnant woman in her third trimester has lost his/her life in the battle against this H1N1 flu virus.
“When you look at those things then you begin to say `Well, is it really accurate, is it really fair to say that this is a mild phenomenon?”‘ said Dr. Keiji Fukuda, the World Health Organisation’s top flu expert.
Fukuda and his team have been warning, for some time, that the unusual age pattern of severe cases, the odd out-of-season spread and the fact that the virus is killing some previously healthy young adults makes the term MODERATE a more appropriate severity assessment, instead of the words “Mild”, “Relatively Mild”, or “Usually Mild”.
That pattern, seen in previous pandemics, makes flu watchers sit up and take notice. “What it really leads you to conclude is that, Boy, we’d better watch this pretty carefully,” Dr Keiji Fukuda added.
There still isn’t a good estimate of the percentage of total swine flu cases that becomes gravely ill, or the percentage that succumbs to the virus’s onslaught. Currently the numbers may seem small – 25 deaths in Canada, 127 in the U.S., 263 worldwide. (This swine flu death toll has already overtaken that of the bird/avian flu.) As a human pathogen, this virus is still a baby, despite its rapid global spread. It is still growing. The fact remains that no one really knows what it is going to be when it grows up.
Some things are clear, though. Since most people seem to have no immunity to the virus — some people over 60 may have some — huge numbers will probably catch this flu over the next couple of months. In a relatively tight time frame, a lot of people will come down with the flu — far more than would be seen during a regular common flu year.
To understand that impact, think back to primary school arithmetic. If the denominator (the total number of cases) gets substantially bigger, the total number of people falling gravely ill or dying (the numerator) will rise sharply, even if the proportion of severe cases (the percentage) does not change.
And sheer numbers could make the outbreak get very nasty, very fast.
Several centres in other countries are already struggling under the load of critically ill patients during this period of northern summer, the season when flu viruses do not transmit as efficiently as they do during the cold winter months. What will happen when the northern winter arrives? Will Singapore’s hospitals and clinics be able to cope?
“If this is as bad as it’s going to get, this is still not going to be a cakewalk,” says Dr. Michael Osterholm, Director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
“We still have relatively few people in the population getting sick. We don’t know – 10 per cent? 5 per cent? We don’t know yet.”
“If, in fact, we are stretching our medical resources, particularly in the pediatric community, people will start to die with higher frequency with the same disease spectrum if care is compromised and we can’t get every kid on a pediatric vent(ilator),” Dr Michael Osterholm warns.
Even if the disease severity does not change but in a few weeks time we will see more and more people getting sick at the same time, and we will be in trouble. Add in the potential for this virus to mutate and cause more severe illness, what will the outcome be? Will it be good? I don’t know how people can still sit down and say `Oh, this is mild. Don’t worry. Don’t panic!”‘
The danger is that the constant refrain that swine flu is “relatively mild” may be keeping people who are becoming severely ill from seeking care as soon as they should. Young people, who are unlikely to go for a vaccination for the common flu – may decide they do not need to bother when H1N1 flu vaccine is ready. By that time the H1N1 flu virus will have declared its own victory.
Unfortunately, I think the number of deaths in the end is going to be high enough that people will get the message and generally will go for their vaccinations. Don’t Play Play!
