Aspiring for the Swine Flu Pandemic Gold Medal?

“You die your own business but don’t say I didn’t warn you lah.”

Today’s (23 June 2009) Straits Times suddenly gives four full-page coverage of the Swine Flu (or the H1N1 Type A Influenza or the American Flu, whichever you prefer), with a full front-page headlined:

H1N1 infections have crossed ‘tipping point’.

The whole message that is given out, to me, in the four full-page coverage (including the full text of the Health Minister’s statement about what the Health Ministry is and will be doing regarding this Swine Flu Pandemic) can be summarised in one sentence:  “You die your own business but don’t say I didn’t warn you lah.”

According to the full text of the Health Minister’s statement on H1N1 yesterday (reported in today’s Straits Times, page A6), the Health Ministry will continue to maintain the alert level at “yellow” (Level 2) “but several things will change.”  And what are these several things that will be changed? They have been spelt out like doing a seven-step foxtrot dance as follows:

• 1. More focused contact tracing.
• 2. Ramping up lab facilities.
• 3. Gearing up all hospitals.
• 4. Refining treatment protocol.
• 5. Special pandemic clinics.
• 6. Adequate supply of vaccines.
• 7. Scientists evaluating genome.

The question we all have to ask ourselves is this: Why are we still maintaining at Level 2 alert while the whole world is supposed to be at the Highest Level of alert (Level 6)?

The Minister also said, I quote:

“There were three waves of exported cases to Singapore. The first wave came from the US. The second wave came from Australia. It is a bigger wave as the volume of travellers from there is bigger than from the US.

The third wave began last week, from fellow ASEAN countries, including the Philippines and Thailand.  This will potentially be a big wave, given our close proximity.” Unquote.

Why was he talking about wave 1, 2 and 3, when actually this is only Wave Number One, of the whole swine flu pandemic?  As forecasted by the WHO experts, the Wave Two will come in Oct/Nov 2009 period, during the northern autumn/winter – to coincide with the peak period of the seasonal flu.

Let us say, he is right – i.e. that we are experiencing the third wave – which means the situation is getting more and more serious, right?  Then, why are we lowering our guard (from yellow-containment to yellow-mitigation)  instead of raising the alert level higher to, say, orange or black?

And may I also ask, when are we going to raise the alert level to its highest level? Waiting for a few thousand unfortunate guys to die first? Please take note that the alert level was raised from yellow to orange on 30 April 2009 (read the CNA report below), but was reverted to yellow a few days after Dr Lee Wei Ling’s letter to the ST Forum was published (see below); and now it remains at yellow, in spite of the 4000 percentage-point increase within one week in local community transmission!

Now, the students are still enjoying their school holidays. When the schools reopen next week, we can all rest assured that the local spread of the H1N1 virus will increase many more folds. Just last week, the number of infected persons was around 17 but by today, it has jumped to 168 – an almost 1000 percent increase.  Just last week, there was only 1 (one) local infection but by today the number of local infections has increased to 41.  That is an exponential increase of more than 4000 percent within six or seven days! And the Health Minister is repeating his favourite mantra: telling us not to panic, to keep our cool. Yes, this is in the tradition of our uniquely Singapore style. We are so cool, man!

The whole world is on full alert and we are still so … so very cool! Or, do we love the yellow colour so much, because it is the colour of gold, that we simply cannot say goodbye to it? In line with our “Economic growth at all costs”? Or, are we so yellow (kiasu) that we must always have the cake and eat it at the same time? In line with our favourite quote “Win-Win Solution”? I don’t really know either. It really baffles me no end. We are unique, one of a kind. Nobody in this whole world can really beat us to it.  May be our Olympic silver medal for table-tennis is not good enough, so we are now aiming for the Olympic Gold Medal for Swine Flu Pandemic, if there is one? Perhaps, we are going to create one just for ourselves only? Remember what our PM said? “Singapore is a city of possibilities!”

According to the World Health Organisation’s  experts, a third of a country’s population can get infected. For Singapore, that would mean over a million people. “Those are frightening figures.  But those are theoretically, potentially possible,” Mr Khaw said. (Theoretically = may not be possible; potentially = highly probable; so what is he trying to tell us?)

Based on the figures from the United States, H1N1 could be almost four times as fatal as seasonal flu – 0.37 percent of those infected have died, compared with 0.1 percent for normal flu.  That means for every 1,000 who fall ill, there would be 3 to 4 deaths.  Therefore, for 1 million Singaporeans infected, there would be 3,000 to 4,000 deaths.

And for a total population of about 5.5 million people, there would likely be 1,800,000 infected.  That means there would be 5,400 to 7,200 deaths. And we are only at Wave One. What will the figures be if the real Wave Two arrived? I am so afraid of the Wave Two materialising that I do not dare to calculate the figures further. What about you?

Do the figures ring a bell?

(Latest Update: As of 24 June 2009, the total number of infected cases has increased to 220 persons – from 168 – an increase of 52 victims or 31% within two days.)

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Singapore raises swine flu pandemic alert from yellow to orange

By Hoe Yeen Nie,Channel NewsAsia, on 30 April 2009.

SINGAPORE: The Health Ministry (MOH) has sounded the orange alert for the Mexican swine flu pandemic, moving one notch up from yellow the previous day. So far, there are no confirmed cases here.

Singapore is also imposing a home quarantine order on those who have recently travelled to Mexico.

The move comes after the World Health Organisation (WHO) raised its pandemic alert phase from level 4 to level 5 on Thursday.

According to Health Minister Khaw Boon Wan, it is only a matter of time before the Mexican swine flu strikes Southeast Asia and its first case could well be in Singapore – one of the region’s most globalised cities.

When that happens, Singapore should not be “shocked into panic or inaction”. He said the country must be prepared for a long fight, with a very different type of enemy.

“We must not be trapped into a SARS battle mindset. As I said yesterday, we are fighting a new war. What worked during SARS may not be effective or even necessary this time round,” he cautioned.

Mr Khaw also advised hospitals and Singaporeans against going into “overdrive” in their precautionary measures, lest they “exhaust themselves” even before the first wave of swine flu strikes.

MOH has said it would escalate the pandemic alert to red, should the global situation deteriorate.

Under the orange alert, infection control measures will be stepped up further. Temperature screenings and checks for flu-like symptoms will be mandatory at hospitals, and patients will be allowed only one visitor each time.

Hospital staff must also wear full protective gear in all areas with patient contact.

“All of us are participants in this war. We are not just bystanders watching the developments,” Mr Khaw said.

MOH is imposing a seven-day home quarantine order on those who have travelled to Mexico in the past week. They will be monitored for symptoms of the H1N1 virus and should symptoms develop, they will be referred to the Communicable Disease Centre (CDC) for further assessment.

The health minister said arrangements would be made for non-residents to put up in chalets or hotels and to undergo phone surveillance for symptoms of swine flu.

If it is found that other countries, besides Mexico, are exporting cases, MOH may also impose similar conditions for travellers returning from those areas.

While Mr Khaw cautioned against complacency, he said Singaporeans should not get unduly stressed over the situation.

“For healthy Singaporeans or those who have not been overseas recently, get on with your life! Go out! Exercise! Bicycle! Brisk walk! Go dancing, whatever! We all know when you’re active and have enough sleep, you’re at your top form; you’re less likely to get flu,” he urged.

Of the 22 cases referred for medical assessment, one is still pending lab investigations. The rest have been cleared of swine flu.

MOH said 19 have been tested negative for Influenza A, while two are tested positive for the usual circulating strains of Influenza A.

For more information on Mexican swine flu, members of the public can access MOH’s website at www.moh.gov.sg or call its hotline at 1800-333 9999.

Source link:

http://www.channelnewsasia.com/stories/singaporelocalnews/view/426089/1/.html

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Lee Wei Ling: Dealing with H1N1 Virus – Let it in while benign to develop herd immunity

Source: ST Forum May 13, 2009 (which is now deleted, for reasons best known to the ST Forum editors, but a copy of which was already made before it was deleted and now appended below for your reading pleasure.)

THE Influenza A (H1N1) virus is rapidly sweeping over the United States, Europe and Asia. It will be impossible to prevent the virus from entering Singapore just by screening those entering here who are ill and/or febrile.

We know that of all the patients who carry H1N1, at least 30 per cent are asymptomatic, and even those who will become symptomatic are infectious for at least the first 24 hours before symptoms appear. However, we are still doing temperature screenings at our borders and other public sites and buildings. A false negative is highly likely and is worse than not screening at all as infectious individuals may then go around thinking that they are well.

World Health Organisation director- general Margaret Chan warns that the virus may well return in a more virulent form after lying dormant in the warm months of the northern hemisphere. Singapore needs to rethink its strategy in this respect while we still have time.

We should stop temperature screening, which is ineffective for picking up infected subjects. When the pandemic started, there was a concern that it could be a virulent disease which makes sense for countries to err on the side of over-cautiousness and adopt stringent measures to prevent its spread. The situation has since changed as we learn more about the H1N1 virus. It appears to be highly contagious, but with low morbidity and mortality.

One possibility suggested by some doctors, including specialists in infectious diseases, is to freely open our borders, allow the relatively benign H1N1 to come into Singapore and allow our people to develop herd immunity. This way, if or when the virus mutates and turns virulent, our herd immunity may better protect us from a serious epidemic. In my view, there is merit in this idea. Continuing with the present strategy may invite more risks.

Professor Lee Wei Ling

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Read also the numerous responses to Lee Wei Ling’s forum letter by MOH and others here, here, here , here, and here.

May all beings be well and happy to live and to love, to progress and to prosper in health, wealth and good wishes.