H1N1 FLU OUTBREAK: S'pore ready for flu patients

May 13, 2009

H1N1 FLU OUTBREAK

S'pore ready for flu patients

No one has H1N1 flu yet, but Khaw unveils action plans, keeps yellow alert

By Bertha Henson, Associate Editor
		Mr Khaw said the alert level will stay yellow even if the World Health Organisation declares a full-blown pandemic. -- ST PHOTO: STEPHANIE YEOW

SINGAPORE has been lucky not to have a single person here ill with the H1N1 flu so far, but it is prepared for that eventuality.

If it happens, the measures taken will include quarantine for those in close contact with the patient, as was done during the 2003 Sars crisis. But there is no need for more drastic steps taken then, such as closing the patient's workplace.

Will stay at yellow even if WHO declares pandemic SINGAPORE lowered its alert level from orange to yellow on Monday once it seemed that the virus was not as lethal as feared. The alert levels go from green to yellow, orange, red and black. Mr Khaw said the alert level will stay yellow even if the World Health Organisation declares a full-blown pandemic or if Singapore has a confirmed case of H1N1 flu. ... more If you get the flu STUDENT: Isolated in hospital while all students and staff of the school are screened. Only close friends, classmates and teachers are quarantined. School stays open. WORKER/HOTEL GUEST: Patient isolated, others screened. Quarantine for worker's close friends, colleagues, bosses and contacts. Hotel guests to monitor their health. No shutdown of workplace or hotel. ... more

This is because the H1N1 virus, while contagious, has so far been mild, with patients who are treated early recovering quickly.

A place would be shut down only if the patient had been cloistered with many others, raising the chances of more falling ill. Such places would include childcare centres and foreign worker dormitories.

Describing what will be done if a student, worker or traveller is diagnosed with the bug, Health Minister Khaw Boon Wan said yesterday: 'We must know how to react to the first few cases. We need Singaporeans to understand our rationale so that there is no misunderstanding or panic when cases do emerge.'

He also cautioned against being fixated on the number of confirmed cases or where else the virus has spread to.

'The public health focus should be on the severity, if any, of the new cases: Do the patients develop complications, pneumonia, severe respiratory failure? Who are those vulnerable to developing complications so that we can focus on treating them early?'

The virus first appeared in Mexico last month and has spread to at least 30 countries, landing in China on Monday and in Thailand yesterday. Most cases have been mild. The United States has eclipsed Mexico as the country with the most cases, but only three people have died there.

The low fatality rate in the US is the reason why there is no move yet to quarantine those arriving from North America, said Mr Khaw.

Likewise, given the mild nature of the virus infecting those who had travelled to Mexico, the Health Ministry is also reviewing the current policy of quarantining those who had been there recently.

http://forums.delphiforums.com/sunkopitiam/messages?msg=28080.130

H1N1 flu watch

May 13, 2009

H1N1 flu outbreak

H1N1 flu watch

PHOTO: AGENCE FRANCE-PRESSE

ALERT LEVELS

WHO ALERT PHASE: 5
Widespread human infection

MOH ALERT SYSTEM: YELLOW

Risk of import into Singapore elevated. Isolated imported cases may occur but there is no sustained transmission.

SUSPECTED AND CONFIRMED CASES

Deaths: Global total of 63

58 in Mexico; three in US; one in Canada and one in Costa Rica. Officials said the Canadian, U.S. and Costa Rican victims also had other medical conditions.

Confirmed cases: Estimated 5,914 in 33 countries, including at least 2,282 in Mexico, 3,009 in 45 US states, and 358 in Canada.

KEY DEVELOPMENTS

Swiss pharmaceuticals company Roche Holding AG says it's donating enough Tamiflu to WHO to treat 5.65 million people. Tamiflu is one of two anti-viral drugs effective against swine flu.

China says it has tracked down and quarantined most passengers who were on flights with the mainland's first confirmed case. The man is a Chinese graduate student at the University of Missouri and became ill while returning to China.

A study published in the journal Science estimates Mexico may actually have had 6,000 to 32,000 cases. It also estimated Mexico may have had 23,000 cases by April 23, the day it announced the epidemic. The study estimates that between 0.4 per cent and 1.4 per cent of swine flu cases are fatal.

WHO says up to 2 billion people could be infected if outbreak eventually turns into pandemic. But WHO flu chief Keiji Fukuda says it's too early to tell how widespread or severe the outbreak will become.

http://forums.delphiforums.com/sunkopitiam/messages?msg=28080.129

Lee Wei Ling: Let it in while benign to develop herd immunity

May 13, 2009
DEALING WITH H1N1 VIRUS
Let it in while benign to develop herd immunity

THE Influenza A (H1N1) virus is rapidly sweeping over the United States, Europe and Asia. It will be impossible to prevent the virus from entering Singapore just by screening those entering here who are ill and/or febrile.

We know that of all the patients who carry H1N1, at least 30 per cent are asymptomatic, and even those who will become symptomatic are infectious for at least the first 24 hours before symptoms appear. However, we are still doing temperature screenings at our borders and other public sites and buildings. A false negative is highly likely and is worse than not screening at all as infectious individuals may then go around thinking that they are well.

World Health Organisation director- general Margaret Chan warns that the virus may well return in a more virulent form after lying dormant in the warm months of the northern hemisphere. Singapore needs to rethink its strategy in this respect while we still have time.

We should stop temperature screening, which is ineffective for picking up infected subjects. When the pandemic started, there was a concern that it could be a virulent disease which makes sense for countries to err on the side of over-cautiousness and adopt stringent measures to prevent its spread. The situation has since changed as we learn more about the H1N1 virus. �It appears to be highly contagious, but with low morbidity and mortality. �

One possibility suggested by some doctors, including specialists in infectious diseases, is to freely open our borders, allow the relatively benign H1N1 to come into Singapore and allow our people to develop herd immunity. This way, if or when the virus mutates and turns virulent, our herd immunity may better protect us from a serious epidemic. In my view, there is merit in this idea. Continuing with the present strategy may invite more risks.

Professor Lee Wei Ling

http://forums.delphiforums.com/sunkopitiam/messages?msg=28080.128

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

http://forums.delphiforums.com/sunkopitiam/messages?msg=28586.1

Reducing train frequency because of H1N1? That’s ridiculous!

Reducing train frequency because of H1N1? That’s ridiculous!

According to CNA, SMRT said train frequency will be reduced by 30% once Singapore’s pandemic alert level hits red. This is because its service staff are divided into two teams to prevent the potential spread of the H1N1 virus.

This is the most ridiculous excuse I’ve heard to reduce train frequency! Does SMRT realise what’s going to happen if train frequency is reduced by 30%? Crowds will swell on the platforms and stations, and the trains will be packed even fuller with people (as if they aren’t already). That would surely be a formula for an even more rapid spread of the flu, should anyone of the 8 persons per square metre of train space happen to sneeze or cough.

I know many organisations, particularly government and government-linked ones, have plans to divide into two teams if the situation gets severe, but this is not something that essential services companies should do — or at least it should not affect their operations to such an extent.

Do you hear of Singapore Power, PUB and the police telling us that our electricity, water and security forces will be cut by 30% if the alert level hits red?

Nice try at cost-cutting, SMRT.

http://forums.delphiforums.com/sunkopitiam/messages?msg=28408.1

SMRT's train frequency to be reduced if flu alert hits red

SMRT's train frequency to be reduced if flu alert hits red
By Kheng Siong & Lynda Hong, Channel NewsAsia | Posted: 04 May 2009 2123 hrs

	Photos 1 of 1 > " onclick="Next();" src="http://www.channelnewsasia.com/images/butt_next.gif" type="image" width="18" height="15">

SINGAPORE: SMRT said train frequency will be reduced by 30 per cent once Singapore's pandemic alert level hits red. This is because its service staff are divided into two teams to prevent the potential spread of the H1N1 virus.

SMRT has increased its cleanliness vigilance level in trains and buses by more than three times ever since the Health Ministry raised the flu alert to orange.

Public areas are cleaned once every two hours and temperatures of SMRT officers are checked twice daily. There is also a quarantine room for passengers who display flu symptoms.

Ventilation within the trains has been increased, while windows and doors of buses parked at interchanges will remain open.

Temperature of bus captains are also being checked at bus interchanges.


- CNA/so

http://forums.delphiforums.com/sunkopitiam/messages?msg=28408.2

The Risk of Disease on a Very Crowded Little Red Dot

The Risk of Disease on a Very Crowded Little Red Dot

May 1, 2009
H1N1 outbreak
Orange alert in S'pore
Measures to fight swine flu shift into higher gear; One-week quarantine for those who return from Mexico

By Bertha Henson

EXPECT to have your temperature taken when you attend big events, and to be asked for your contact details when you enter office buildings.

Such procedures at schools, workplaces and hospitals will start now, as Singapore moves into 'orange' mode in its five-colour alert system, which progresses from green through yellow, orange, red and black.

It might well move to red soon, said Health Minister Khaw Boon Wan on Thursday, as he detailed more stringent measures to combat swine flu.

..... As for those contemplating a trip to Mexico, the epicentre of the swine flu outbreak, and affected areas in the United States such as New York, California, Texas and Kansas, the plea from Mr Khaw is: Don't.

So far, Singapore has been lucky not to have been invaded by the virus, he said, 'but I think it will not be long before patients or even deaths start to occur here'.

'In South-east Asia, we are the most globalised country, so the first cluster of cases in South-east Asia may very well emerge in Singapore.'

The problem isn't merely that we are the most globalised country in Southeast Asia. The problem is also that Singapore is the second-most crowded country in the world.

And why is Singapore the 2nd most crowded country in the world? It's mostly because of the government's hare-brained plan to deliberately bump our population up to 6.5 million (by inducing a huge influx of foreigners onto our little island).

Such a plan has numerous implications. One implication is the greatly increased risk to the health of the general public. Here's an excerpt from one of my own posts, which I had written more than a year ago:

Incidentally, I've often wondered whether the government has really considered the potential health implications of its ambitious population plan. I'm referring to the government's plan to increase Singapore's resident population to 6.5 million people (mainly by importing more foreigners).

There are plenty of reasons why we should be cautious about such a plan. One reason is that we live in a time where mankind seems to be constantly threatened by the likes of SARS and bird flu.

Squeeze 6.5 million people together on a little red dot. Make it the world's most densely populated country. Every day, pack a great number of citizens like sardines into the public transport system. What do you get?

Potentially, a great recipe for a massive epidemic .....

Unfortunately we are led by buffoons. They actually seem to believe that 6.5 million is some kind of magical number, at which Singapore's population will thrive, and below which we are doomed to failure.

This, of course, is pure nonsense. Economic success is far too complex to be reducible to a single figure, and depends instead on a wide range of other variables.

It is interesting to recall that Singapore's best economic years (when we were regularly achieving double-digit annual economic growth) all happened in those times when our population was just around 2.5 million. In other words, about half of what it is today.

http://forums.delphiforums.com/sunkopitiam/messages?msg=28080.68