Monday, June 29, 2009

H1N1 (aka American flu) - time to end the confusion, MOH

I have been trying to give the MOH the benefit of the doubt with regards to the H1N1 thingy because it's just been such a difficult position for the Ministry to be in. But day by day, its indecisiveness is getting more and more disappointing and frustrating. And the growing public confusion is worrying.

Where are we now, and what is the real strategy with regards this infection? Do we take this seriously not not?

The MOH website doesn't contain much more than the latest stats, and an uninformative statement - "Though the number of infected cases has increased, the severity of the disease remains relatively mild. .... Singaporeans should carry on with their usual activities whilst observing good personal hygiene at all times. If unwell, they should see a doctor, stay away from work, school or crowded places, and rest at home." helpful lor. If it's 'relatively mild' why this concern about staying away etc etc...?

The Straits Times today quotes an unidentified spokesman as saying "We are now preparing to manage the disease in a more targeted and risk-stratified manner".

Ummmm....that's even less helpful I am afraid.

And neither is the ST report from that interview, that Singapore is preparing to switch to the mitigation phase of dealing with the H1N1. Whatever that means. I mean, we are either containing or mitigating... being told that we are preparing to move to mitigation is like saying we want to be there, we should be there and we are going to be there. But where are we exactly?

Clearly the public is confused. And I really don't blame them.

Do we need to still control movement / contact and do voluntary home quarantine? Are all these temperature monitoring really necessary? There is just such a confusing array of containment strategies out in the schools and workplaces, that even more puzzling when you consider we are actually moving (preparing to switch?) to mitigation.

If we are not going to treat all H1N1 cases, and we are not going to swab all flu cases, why do we need, as the spokesman said, to "call 993 for an ambulance" if travelers get flu-like symptoms within a week of return from affected countries?

If the MOH wants the public to be participatory and to be engaged in the management of epidemics/pandemics such as this, information and instructions must be clear and unambiguous. Why do we keep fueling this paranoia if we are really not going to do anything substantive about it?

And we are really not having that clarity of mission at the moment.


singaporegirl said...

Giga, I sense n sympthise with yr frustration. The Govt is sending conflicting signals, perhaps because it doesn't want to spoil the fun/mood of the upcoming F1 and the current AYG? Guess we shld do wot NEH says, don't keep asking what if, what if. Just live with what is...

gigamole said...

Hi AuntieL,

Yeah, we should all just live with what is...

'cept that we really don't know what is at the moment do we? Are we in containment mode or not? Are we in mitigation mode or not? Saying we are transitioning really doesn't make sense, and clearly doesn't help people live with what is...

Also, for some reason the MOH top brass have all gone quiet, and are choosing to speak through "spokesmen". PS and DMS are nowhere to be seen. I wonder what's happening?


angry doc said...

Well, today's circular clears things up a little.

gigamole said...

Yep. The relevant explanation is pasted here for your general info:

9. Currently we are in transition and not in the mitigation phase yet. We are still trying to slow down the community spread specially as schools have just re opened. We should however start preparing to manage the disease in a more targeted and risk-stratified manner. For example we have allowed our hospitals to use their discretion and not swab cases where the risk of Influenza A (H1N1-2009) is assessed to be low and not to hospitalise very mild cases but to place them on home quarantine orders. There will therefore be occasions when some of your referred cases may appear to receive different treatments in different hospitals. We seek your understanding on such apparent anomaly.

10. Similarly, medical clinics should start to introduce the following risk stratified measures (please refer Annex A for guidelines on patient management):
a. All clinics must have stringent triage procedures to separate patients with ILI from those without ILI to prevent cross infection.
b. Based on our latest bio-surveillance data of 5% (where only 1 in 20 patients with ILI would have Influenza A (H1N1-2009)), we would not in general recommend that patients with ILI be treated with Tamiflu. Doctors should therefore carefully consider the risks and benefits of antiviral treatment for each suspected Influenza A (H1N1-2009) patient in deciding whether to proceed with anti-viral treatment1.
c. Most suspected Influenza A (H1N1-2009) patients can recover at home2 with the advice to return if still unwell or to call 995 if condition deteriorates (e.g. becomes breathless) and needs urgent medical attention.
d. The duration of medical leave for suspected3 cases should be 7 days for adults and 10 days from onset of symptoms for those below 13 years to cover the infectious period.
e. Pregnant women, immuno-suppressed persons and renal dialysis patients are at much higher risk of influenza-related complications. For all such patients with symptoms of ILI, please contact their primary specialists for advice on further management. When the patients do not have a primary specialist, please arrange with a relevant specialist to assist in the management.

Anonymous said...

Common cold symptoms = running nose, sorethroat, cough, fever etc

Flu symptoms = Common cold symptoms + lethargy, malaise, bodyache, headache etc

Am I right?

I don't understand the use of "flu-like symptoms" and "influenza like illness". How does one define flu-like symptoms? Why not just call flu symptoms?

To the layman this may add to the confusion.

gigamole said...

Well...the common cold and 'flu' do share considerable overlap in terms of symptoms. Flu does tend to be a bit more severe, febrile and with body aches. But yes, common cold symptoms (runny nose, cough, sore throat) would be consistent with mild 'flu-like' symptoms. But I wouldn't diagnose 'influenza like illness' unless there was a significant fever.

What this means practically is that :
a] unless we have a positive H1N1 test, we'd be hard put to clinically separate the real H1N1 from a whole coterie of similar symptomologies;

b] Now that we are not routinely swabbing for H1N1 diagnosis, don't take the offical infection numbers too seriously;

c] H1N1 is already among us, and we don't really know how prevalent it is in the community. It is not that common now, but clearly will soon become very common.

Common sense hygiene is important; and we shouldn't be paranoid about it. Just be watchful from the point of view of people around you who might be vulnerable or at risk patients.

Otherwise the disease is really pretty mild, and in my mind less dangerous than the common flu.