A month ago, I posted in my blog that the H1N1 would spread rapidly in Malaysia. It started off with imported cases. It is now local infection that accounts for more than 50% of the total 1200 cases reported. This is to be expected since the local infected cases become the source of local transmission. I have always felt that we are not stringent enough in picking up imported cases at the point of entry.
Since it has a low mortality rate, there is a tendency by healthcare providers and also patients to treat it like common flu. Out of the 1200 cases, we have 4 reported cases of death. So far, the mortality rate is 0.5 percent. With such low mortality, there’s a tendency to let our guards down and throw cautions to the wind. However, I am glad to note that the Director General of Health seems to be very committed in this battle against the H1N1. However, like all infectious disease control, it involves many healthcare providers, what we call the chain of command from the nurses, doctors, lab technologists and etc. The lack of sensitivity and commitment by any of the healthcare providers would render the whole effort to contain the transmission a failure.
What was puzzling is that the Minister of Health one and a half months ago said that the Ministry has ordered H1N1 vaccine to be given to healthcare providers who are front liners. In fact, the H1N1 vaccine is now on trial. So I wonder how he ordered one and a half months ago! Maybe the healthcare providers in Malaysia are part of the H1N1 vaccine trial on human being.
Most of the patients who succumbed to the H1N1 infection seem to have underlying illness, which rendered them more prone to death. The pregnant, the elderly, the very young age group and those with underlying illness seems to be the high risk group. Pregnant ladies are four times more prone to infections.
I am surprised about the death involving a 42 years old man reported in the papers yesterday. This is a classical case of lack of awareness by the attending doctors. This patient falls sick on 6th July. After a series of visits to clinics and finally private hospital, the diagnosis was made only on 22nd July. By then, it was too late. We lost a middle-aged man in his prime of life. One can speculate that if the diagnosis was made much earlier, he could be saved. A total of 16 days were wasted and all we need was the patient’s throat swab. I wonder why after seeing so many doctors, none of them even give a thought to the H1N1 despite batteries of test and a declared pandemic by WHO. Doctors can only make a diagnosis if they keep in mind diseases which becomes the current epidemic. Hence, many doctors also failed to make a diagnosis for dengue until it is too late. There should be no excuse since there is enough publicity to alert doctors that the H1N1 and dengue fever is staring at us everyday. Maybe practicing doctors should attend a refresher course to remind them to think of these 2 diseases. A late diagnosis would be fatal for both dengue and H1N1.
While the H1N1 is highly infectious, one should not lose track of dengue fever which is endemic in this country. With the epidemic going on, I will not be surprised that the number of death this year may be more than 120 cases. The number of dengue cases recorded could also be more than 50,000. Both the figures are the highest ever recorded in this country. It is an achievement of which we are not proud of.