Sunday, July 12, 2009

H1N1 Flu: Onwards to Mitigation Phase...

Cumulative A(H1N1) flu cases topped 671 on 11 July 2009: 485 imported and 186 local transmissions. Thus far we've been lucky, there has been no deaths reported in Malaysia. Most of our patients have recovered completely, as detailed by the D-G of Health in NST: Influenza A (H1N1): Nearly all patients fully recovered.

Yet worldwide, the positively-tested H1N1 cases have exceeded 100,000. The WHO reports that some 105,304 cases (an increase of 1,374 cases overnight) with 463 deaths from 143 countries, have now been identified. Although not universally known, the fatality rate has maintained at a remarkably consistent 0.44% or 1 in 227, hardly changed from a month ago.

In the United Kingdom worries are now surfacing as more deaths (up to 14 as of 10 July 2009) from this supposedly benign form of flu have been reported. With 9700 reported cases now in the UK, some 335 people are still hospitalised with some 43 being in critical care. Thus, there are people who fall seriously ill, especially when they also have underlying health problems. With the fall or autumn approaching, there is fear that worse is yet to come.

At the G8 meeting in Italy, US president Barack Obama urged that Americans ramp up preparedness against the A(H1N1) influenza, warning that the virus could return with a vengeance in the fall, that "the potential for a significant outbreak in the fall is looming." He added that "we want to make sure that we are not promoting panic, but we are promting vigilance and preparedness" (AFP, July 10, 2009).

Specific vaccination would be the way to go, but the vaccine only recently developed, is yet to be fully tested for efficacy, but most health authorities believe that this would be the most effective and safe way to combat this community spread of the virus.

In a CrossTalk interview with the NST "Don't sensationalise H1N1 stories", I continue to maintain that we should remain at full vigilance and preparedness, and that what we have been doing thus far, is not alarmist but necessary under the current state of infection of the A(H1N1).

As we progress from containment to mitigation phase, we must urge every citizen to remain calm but responsible so that they can help prevent even greater local spread of the infection. Personal hygiene and even voluntary social distancing is still the prudent approach even if these are inconvenient or costly from a personal or even national perspective.

But we must observe our civic responsibilities and duty if we are to face this pandemic together and come out of this with as little scathing consequences as possible. Unfortunately, the full extent of this influenza outbreak is unlikely to abate anytime soon, with most authorities believing that it would be at least a year or two before this infection makes any meaningful decline to levels of normalcy...

Sunday Star 12 July 2009, highlights a comprehensive and balanced review by Dr Milton Lum (What is an appropriate response?) on the H1N1 pandemic and the difficulties involved in making the appropriate response to this virus in Malaysia.

Clearly no one will have the correct response and there will be detractors that we are either doing too much, or not enough. The uncertainties associated with this pandemic unfortunately have not abated, and might never be known until this pandemic blows over in the next few years... then, and only then will we be enlightened, in hindsight!

What then would the final human toll be? How would Malaysians have fared, and will there be recriminations of having done too little too late, to stem the more unwelcome outcomes? Or, would we then be accused to having alarmingly propagated another Y2K-like non-event?

I think most of us would have preferred that perhaps, we had been judiciously overcautious and that we had mitigated more deaths than would have had taken place otherwise. We'd preferred the inconvenience, the stringent preparedness, until the true benignity or malevolence of this H1N1 pandemic had blown over, even if these measures had cost us a little more, in terms of resources, personal space, and even hard-pressed financial outlay!


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