Saturday, August 22, 2009

Malaysiakini: Prognosis: Flu to last for a year, mostly mild

Prognosis: Flu to last for a year, mostly mild
Aug 22, 09 3:30pm
Malaysian Medical Association (MMA) president Dr David Quek estimates that the current H1N1 pandemic plaguing the world is expected to run for another year or two.

Quek, however was quick to say that the majority of cases would be mild and it was those in the high risk group that needed to be cautious.

Speaking to Malaysiakini, he said "Every doctor has to be more proactive and practice more responsible and cautious medical professionalism during this trying period, which is expected to run into at least one to two years."

Doctors, he said have to be acutely aware that the initial symptoms could deteriorate into something more serious.

"Doctors must assiduously look out for lung complications, quickly identify high-risk profiles and refer these patients promptly for further more specialised care."

When asked if the medical profession's governing body was not doing enough, the MMA president said "Most of our doctors are actively engaged in looking after many flu-like illness patients. But they find many constraints due to lack of access to specific treatment modalities."

He said that the lack of available and reliable testing and difficulty in confirming such illness as A(H1N1) flu compounds the situation.

Many patients demand to know for sure if they have the flu but the doctors are thus left quite alone to fire fight angry and worried patients with very few resources or reassurances or specific therapies.

He said that it was the Ministry of Health, (MOH) that takes the lead in such matters but it needed the cooperation of all sectors to handle this situation.

While the MOH comes out with the guidelines and policies, implementing it on the ground required all parties to come together.

"The main 'leader' is of course the Ministry of Health (MOH) but the rest of us have to join forces with them to come up with a contingency plan. It is becoming increasingly clear that this is no easy task, and translating policies down to proper and appropriate practical responses and ground-level implementation can be challenging, and would be less than clockwork precision," he said.

Keeping abreast critical

Quek also advised doctors in the private sector to keep themselves updated and not just depend on official handouts as these may be late filtering down to the ground.

"It would be good if every doctor keeps a constant and close tab on the H1N1 pandemic and remains fully aware of the developments and changes, which are evolving daily. Every doctor has to be learning on the trot, so to speak, to keep up with the progress of this outbreak and its management, so that we can serve our patients better.

He said that "logging to the Internet regularly for more updated information will certainly help, instead of lamenting that not enough is being disseminated via the media thus far. Every doctor has to be more proactive and practice more responsible and cautious medical professionalism during this trying period."

Doctors he said "must assiduously look out for lung complications, quickly identify high-risk profiles and refer these patients promptly for more specialised care.

Quek called for an easier access to antiviral drugs and their responsible use and monitoring to help allay public fears of delayed treatment.

But, he warned that this should be tampered with care and not with over-exuberance "in dishing out to one and all."

"There is genuine fear that the precious antiviral drug might be used indiscriminately, just for prevention - this would be a very bad move, which could inadvertently create a worse outcome of drug resistant bugs," Quek said.

Self-qurantine and common sense

He said that in the light of the very quick deterioration of some young patients who have died, it might be prudent to use antiviral treatment earlier and more aggressively.

While there is no specific H1N1 vaccine as such, he expects one to be available by the end of the year.

"We look forward to the specific H1N1 vaccine, when it does come our way, probably towards the end of the year. In the meantime, encouraging those in the front line, heart or lung patents and frequent travelers to have the seasonal flu vaccination is a useful adjunct to help stem the usual problems from other flu types", he said.

In a wide ranging interview, Quek said that most of the affected cases would be mild ones and strongly advised those exhibiting flu symptoms to self-quarantine to help curb the spread of the disease.

As a cardiologist, he said that he had a patient who came to see him and was coughing. When he asked her to take a weeks's quarantine, she was reluctant despite him giving her a medical certificate.

"I informed a young coughing patient who came to my heart clinic that she should probably come back later when she was better because her complaint was not serious. But she was incensed and was upset when I told her to self-quarantine for at least one week. She flatly refused although I was willing to give her MC (medical certificate) for the week."

The patient, he said, was actually exposing the others who were in the high risk group with heart ailments.

Quek concluded by said that the people should join forces with the authorities and medical personal to help in curbing the current pandemic by looking out for the tell-tale signs in both themselves and their loved ones.

Taking proper and commons sense measures, could go a long way, he says, in helping curb the H1N1 spread.

Below is the full text of a question-and-answer session with Malaysian Medical Association president David Quek, who has been keeping a close eye on the H1N1 pandemic.

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