Thursday, August 13, 2009

H1N1 opinion: Whose fault is it that leads to the high mortality?

Whose fault is it that leads to the high mortality?

The influenza A (H1N1) mortality rate in Malaysia is close to 2% instead of the 0.1% to 0.4% as estimated by the Health Ministry. It reflects an unusual phenomenon. Without finding out the crux of the problem, assuming that 5 million of people are infected, probably 100,000 of them will die, instead of 5,000 to 28,000 as estimated by the World Health Organization (WHO).

If we compare to other countries, we can see the inadequacy of prevention and control in Malaysia. Vietnam reported 1211 confirmed cases with one death and the mortality rate of 0.08%. While Hong Kong reported 5991 confirmed cases with four deaths and the mortality rate of 0.067%. Australia reported 27,663 confirmed cases with 95 deaths and the mortality rate of 0.34%. Even Singapore that found death cases earlier than Malaysia, reported only nine deaths.

The Health Ministry believed that the domestic confirmed cases are far lesser than the announced amount, and said it should be multiply by 20 to get the correct data. But if we compare it to other countries calculated based on the announced confirmed cases, their rates are still lower than ours.

"Many people complaint that government hospitals have been reacting too slow to the influenza..."

Why was our death toll increased to 44 people within three weeks after the first death case reported on 22 July? And why are we having over 200 new cases each day, causing the epidemic to fall out of control?

Such a high mortality rate might be caused by a variation of the virus, weak immune system of Malaysians, poor public health system and ability to deal with an emergency. The former two causes have very low probability. If there is a variation or a new virus, the Health Ministry would have recognized it through the autopsy reports. And no matter how weak is the Malaysians immune system, it would not have killed six to eight people every day. The key should be the public health system and the mobility of medical personnel.

Hong Kong, Japan and Australia no longer take the quarantine measures, but they are still having a low mortality rate because of their sound public health systems in which their medical personnel treat the high-risk patients first.

Many people complaint that government hospitals have been reacting too slow to the influenza, including spending a lot of time waiting for tests and long testing time. Many patients might have missed the golden time for treatment during the waiting period and died.

In addition, during the early stage, the government treated the epidemic with neglect, low efficiency and it did not see it as a serious infectious disease. If the government has held a large-scale awareness and hygiene campaign, including stopping assemblies, the epidemic would not have lost control.

The people lost the sense of crisis because the government did not propagate it through the media at that time as they took into account the impact of it on the national economy, especially on tourism.

Such a serious epidemic has tested Prime Minister Datuk Seri Najib Tun Razak’s governing philosophy of “people first, performance now”. The government must take urgent measures and emergency means, including having early school holiday and a general mobilisation of medical resources, to prevent the spread of the influenza. Any hesitation will further push up the death toll. (By LIM SUE GOAN/Translated by SOONG PHUI JEE/Sin Chew Daily)

( The opinions expressed by the writer do not necessarily reflect those of MySinchew ) MySinchew 2009.08.13

1 comment:

Cyberdoc said...

The rate is determined by positive screening cases(denominator). If many are missed the rate goes up. First the sensitivity of the PCR can miss cases. Second there is already a 20-30% who may not have fever and missed. WHO is no longer interested in reporting cases except if it an index case in a new country.
So is the rate real?
As the virus has gone into the community and there is no real way of knowing the denominator maybe a surrogate such as state population or country population can be taken??? Then you can compare vs. other countries.
This is a novel virus which is highly infectious and most likely with (thank god currently) a low mortality as mentioned. It is very unlikely that Malaysia has a higher rate...but the rate the information is released is another hypothesis.