Thursday, July 2, 2009

Malaysia: The Epicenter of H1N1 in Asean?

I’ve read in the papers today that till date, we have 196 cases of H1N1. I’ve met a few doctors over the last weekend and one of the topics for discussion was H1N1 in our country. I predicted then to my colleagues that I will not be surprised that the number of cases will go up to 200-300 cases in the next two weeks. The reason is that it is difficult to contain a disease that spread so easily.

Earlier, you will notice of nearly 200 cases, most of it are imported cases. That means we have to be more stringent at the entry point. I wrote in the blog earlier that the temperature of incoming travelers should be taken when they land at our airport and before disembarkation. This is to ensure effective quarantine and contact tracing of people who have come into contact with the H1N1 patient. Whether or not they quarantine themselves according to book, we do not know. As long as there is fever in the plane, then that patient is a suspect until proven otherwise. Passengers around him will have to be strictly quarantined and the quarantine will only be lifted if the suspect turns out to be negative of H1N1 virus. Presently, by the time the suspect disembarks and be sent to hospital, he would have come into more contact with other people. It is difficult to do contact tracing of people who have come into contact with the suspected patient, since it is difficult to remember exactly people you have come into contact with and it may not necessarily be the people known to you.

Presently, we practice home quarantine. To be effective, we need the cooperation of the affected victims that they really stayed in the house without coming into contact with outsiders. Visitors are banned. Hence, it requires 100 percent cooperation and self imposed discipline for members of the family who are affected by the quarantine. At any rate, who is to enforce that members of the family do not break this quarantine? At the moment, it is self-imposed quarantine on those who have just returned from H1N1 affected countries. Whether or not they quarantine themselves, we do not know. There is no stringent guideline or enforcement carried out on those who had just returned from overseas. At the same time, I was told that some passengers who returned from overseas complained that no adequate measures were taken at our airport where there were no hand sanitizing dispensers and some of the health authorities did not wear any face mask or gloves.

However, although the H1N1 virus is highly contagious, it does not have high mortality rate (about 0.44% as of June 26) as compared to SARS that has terribly swarmed the world with mortality rate ranging from 15 to 19 percent. It is true that we have to be very careful and sensitive towards the H1N1 outbreak, but at the same time, we must know how to prevent it the right way. Panicking and overreacting to the H1N1 does not help to prevent the virus from spreading.

Maybe the time has come for us to take rational steps to battle the H1N1 and not overreact to it by closing down shops or even buildings when someone is infected with H1N1 virus. It is highly infectious, yes but not all H1N1 cases bring about mortality. We must ensure that the basic public health hygiene is carried out properly. Cleanliness in public facilities is important. In Hong Kong, all public lifts is sanitized daily and the owner is responsible for maintaining this routine. Proper hand wash with soaps, no sneezing without covering your mouth in public places and the wearing of the right masks are some basic steps to prevent H1N1. The surgical masks will not protect the user adequately from the H1N1. The minimum mask protection will be the N-95 mask. I am given to understand that many people are still not aware how H1N1 spreads.

More could be done by the government to improve on public health and safety. The government should rightly educate the public on the awareness of H1N1 so that they would be conscious about H1N1 and prevent it the correct way. In America, there are detailed advices to members of a family on how to take care of a patient of H1N1 and how to prevent the spread of the virus to the rest of family members. I hope that the public and the government could work together to ensure that this H1N1 be curbed soonest possible.

截至目前,我国A(H1N1)型流感的确诊病例已高达196宗。我预测在未来两周内,国内的确诊宗数将增加到200至300宗。原因是要控制易扩散的疾病并不容易。


目前的近22宗病例当中,绝大部分为进口感染。这表示我们必须加强入境关口的检测程序。我曾在部落格中强调,所有航空搭客抵达降陆后,必须在下机前接受体温测量。这么做是确保有效隔离和追踪曾与A(H1N1)流感病人接触的人士。因为我们无法确定有关人士是否根据程序完成自我隔离。因此,航班中若有人发烧,将被视为疑似病例而须接受隔离检验,曾与发烧病患接触的搭客也须被严格隔离,直到报告证实呈阴性为止。目前,所有疑似病患下机后,将被送往医院进行隔离和检验,病人在整个过程中或与许多单位接触,而使当局的追踪工作趋难。


此外,当局也实行居家隔离。我们需要相关病人及家人的充分合作,在隔离期间居家不出,谢绝访客,以免让其他人感染。这样,居家隔离措施才能奏效。还说回头,我们要如何确保有关病人和其家人严格遵守有关措施呢?谁由执行监督?截至目前,我们尚未有完整的隔离及执法指南,予从国外回国的人士。与此同时,我被告知一些搭客投诉我国机场的防疫措施不足,例如没有洗手液及一些卫生官员没有戴口罩和手套。尽管H1N1型流感能迅速传染,然而其的死亡率仍偏低,截至6月24日只有0.44% 。当年肆虐全球的非典型肺炎死亡率高达15%至19%。在这关键时刻,我们需谨慎面对H1N1型流感,更重要的使要懂得正确的防范方法。


也许我们应采取更理智的步骤控疫,而非反应过敏地将每一间出现感染病例的商店甚至整座大厦关闭。H1N1型流感能传染人,但并非所有病例能致命。我们首先要确保基本的公共卫生,公共场所厕所的清洁卫生最为重要。在香港,多有大厦业主将负责和维持大厦内的公共电梯每日进行消毒。


使用肥皂或其洗手液清洗双手、勿在公共场所张口打喷嚏以及戴对的口罩,是基本的防疫措施。要严防感染H1N1病毒,必须要使用N-95口罩。手术用途的一般口罩无法发挥上述功能。我所了解的是,很多人至今尚未意识H1N1病毒的传播途径。


政府应该提高公共卫生和安全,包括加强H1N1流感的教育及提高公民意识,让他们掌握正确的防疫方法。例如美国,当局甚至为人民提供照顾H1N1流感病人以及防控疫情传播给家人的详细劝告。我希望我国人民及政府当局能携手合作,尽早把疫情控制。

6 comments:

Malaysia said...

Doctor,

Your article Malaysia The Epicenter of H1N1 in Asean come at the right time and truly caught our attention while browsing the internet.

As concern civilians, we agree "More could be done by the government to improve on public health and safety". Usually, unfortunately and sadly health campaigns don't run long. We wonder why? The best education is via schools and leaders in education must integrate a portion of weekly schedule to health and hygiene. Headmasters under the Ministry of Education also play a role to consistently promote health and hygiene and of course current issue i.e. H1N2. One day I overheard a small girl age 5 asking her dad, whether there would be a H1N2. It may sound funny, but the little girl stirred some thought in us, as parents and responsible citizens. If we are not changing our mindset and paradigm about health and hygiene, there would be more horrifying viruses to come. And mind you, viruses mutates into 'stronger' and 'clever' forms. Think about it.

Last but not least, as long as we stay and share the planer earth, our common home, we must never say we don't care. We must change our mindset. This is our earth. This is our home. We are owners and will care.

God Bless.

Signed by an ordinary person on the street.
Alexander.


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shan said...

Chief your alarmist trait is getting the better part of you Sir.

Malaysia said...

As per your H1N1 topic which is so striking, our first concern is fast tracking and treating the disease. Are these properly mapped out, spelled out and explained to the public? The press should have a column on health and hygiene and put up a hotline for H1N1, dengue enquiries, etc. What are the steps to be taken when we encounter the problem? Common sense tells us, TV announcements (that last 30 to 60 seconds) is definitely not sufficient without hard copy print in the local newspapers.

Our second concern is prevention. The common saying, "Prevention is better than cure." Are the borders nothern, western, eastern and southern gates being closely guarded and monitored? Supervision of these officers in charge must be done regularly and strictly.

Any country without proper vision, strategies can become an epicenter of H1N1.

A note of thanks to Doctor Chua for timely tips and observation on the current situation.

With much concern,
Dennis
Process Architect
www.IklanMalaysia.net

Malaysia Classifieds

Anonymous Says said...

Personal hygiene starts from home. But if the home does not know how to teach that, than people who know about healthy living should teach those who do not know how to. The very important contacting point and at times, it can be the first contacting point is between the schools and the pupils. The teachers do not have to spend a long time giving health education. 5 minutes per week may be. Impromptu advise may be. Posters may be. After all these years, we still have dirty wet toilets. We still have dirty coffee shops. We still have dirty streets. Until when ?
Malaysia is promoting tourism. You cannot stop people from coming in. You cannot stop people from going out.
Then a fever does not mean it is one of the cases. Sometimes the impression is as if Malaysia is trying to get attention from the world but this is a wrong kind of attention.

Low C. W. said...

just some simple thought :
1) Create more nice and interesting theme song in all langauages and air it more frequently to create more public awareness.
2) Print some massage with interesting and easy to understand picture on those household glossary product which every woman and children will notice.

my cup of TEE said...

H1N1, I am infected, Why MOH don’t care about me?

By Gavin Tee

Unfortunately, I have a friend who was unfortunately infected with H1N1 virus . The frightening issue is she need to wait frantically for two days just to get the assistance from Ministry of Health .

This friend of mine went to Singapore last week to attend an international forum. Participants came from all over the world including Mexico, Australia, Philippines.

When she returned to Malaysia by flight after the 2 days seminar, she found herself came down with the symptoms suspected of H1N1. She quickly went to Government Hospital requested for a H1N1 check up and was informed that result will only churn out in 48 hours . She was asked to wait at home , and the bad news was finally delivered to her that she has contracted H1N1 after 2 days. Though she was stunt and upset, she immediately offered to report to hospital for treatment and quarantine.

“Okay, I will drive to hospital now”

“No, No, No! you are not allowed to do so, please stay at home, we will send the ambulance to pick you up.”

And she waited nearly two days for the ambulance. This 2 days waiting was an unbearable and horrible experience. Being a H1N1 patient already makes one so helpless , she or he will expect the hospital to act immediately , not wondering whether she has been forgotten .

Since she was diagnosed with H1N1, she duly informed the hospital on the persons that had been in contact with her in Singapore. Phone numbers of these persons were passed to the health department for further action.

Again her friend has been waiting for days and nights, which sadly to mention till today no one has called them. Her friends merely wanted to know what to do next. Instead she made the initiative to call the hospital helpline, and more upsetting to find no one was picking the call.

I told her no need to complain or rather to hope to get help. As there was one lady who had undergone H1N1 test but had to call few times to find out the result. She was lucky or rather unlucky that somebody on the other end finally picked up the call and found out that she was H1N1 positive. I do not know whether will she get informed if she doesn’t call.

We deeply appreciated the effort undertaken by the Health Ministry to fight H1N1. However, if the medical officers do not perform their duty in more responsible manner , I wonder, will our country be able to win the war of H1N1?

Who really don’t care? Ministry put the blame on people do not alert. They claimed the people are not co-operative. They have forgotten there are the servant of the people in Malaysia.

I had once made a remark that Malaysia will be badly hit by H1N1 when I came back from a trip to Australia a month ago, as I found the way government’s attitude in dealing with the problem was rather RELAX (“ tidak apa” attitude ) .

Last month, when I was in one of the Hospital for an ECG heart test, I found there were many patients coughing in the public and no medical officer seemed to care about it. And the hospital also did not monitor the public body temperature , unlike our neighboring country Singapore where all visitors to the hospital had to go through temperature screening .

What if I say, the number of cases of H1N1 in Malaysia will reach 1000 in 2 weeks time, would you think so?

Note : my friend was finally “TAKEN AWAY” by the ambulance after a long waiting. It was however within 48 hours.

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