Lee Wei Ling criticises Health officials

May 8, 2009
FIGHTING INFLUENZA A
Tackling it better

MUCH has been said about this new variant of Influenza A (H1N1) virus. In brief, it seems to have started in Mexico but spread rapidly throughout the world, especially in the Americas.

As a doctor observing how our health-care system responded to this potential threat, I have several points to make from which we can learn to better tackle the next outbreak of H1N1 or other novel infectious diseases.

First, protecting Singapore from H1N1 must be an all-or-none approach. The present approach is illogical: People from certain countries or regions that have shown significant human-to-human transmission are not allowed into Singapore, or if they have already arrived, are quarantined; yet people from other areas where there is human-to-human transmission are allowed to enter freely. The latter group will bring in H1N1 and waste efforts to protect Singapore.

Second, standard operating procedures cannot be transferred automatically from one medical illness to another. In Sars, there was some logic in using fever to screen for patients who were infected because when they were infectious, the fever had already started. Even then, there was a huge proportion of false positives leading to futile investigations and anxiety.

With H1N1, the situation is worse. More than one-third of people infected have no fever or other features of flu. Of those who will eventually develop fever and symptoms and signs of flu, they are infectious yet appear well on the first day of their illness.

This leads to a high percentage of false negatives, which is worse than not having tested these people because they now have a false sense of security and hence are likely to spread their infection even further.

We must not dismiss H1N1 just because the morbidity and mortality seem mild compared to regular flu.

We should heed World Health Organisation chief Margaret Chan's warning: 'Flu viruses are very unpredictable, very deceptive...We should not be over-confident.'

I agree and would rather the Health Ministry err on the side of over- cautiousness, so we expend a few million dollars rather than relax because Mexico declared it was winning the battle against this new strain of H1N1, and later suffer unacceptable loss of lives.

Prof Lee Wei Ling

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