Wednesday, June 24, 2009

Much ado about nothing? Influenza A (H1N1)


These are scary words and since April 2009 the world has been truly and thoroughly scared. The Centers of Disease Control and Prevention (CDC) in the United States noted

On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway.

More than 70 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.

WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus.

The World Health Organisation (WHO) latest update June 24 states that there are 55,867 cases and 238 deaths. The first death in Asia occurred last week.

MANILA, June 23 (Reuters) - The Philippines closed down the lower house of Congress for five days on Tuesday and sent about 3,000 workers home after cases of influenza A (H1N1) were reported in the offices, officials said.

A 49-year-old woman who died last week from symptoms exacerbated by the flu was a staff member on a congressional committee, said Ramon, a doctor and deputy secretary-general of the House of Representatives.

The mode of transmission is by coughing and sneezing and contact of articles touched by infected people.

So Malaysia, as is the rest of the world is closing down schools and starting to quarantine travelers.

I want to raise two questions here:

(1) For a pandemic, aside from being a good traveler, it does not seem to be extra virulent or particularly dangerous. Most people infected by the virus recovered. If we take the number of confirmed cases and the number of deaths, we have a mortality rate of 0.4%. That is not exactly a killer like SARS.

(2) The spread is by contact, sneezing and coughing which is extremely difficult to control. Often many others would have been exposed long before the infected are traced by health officers and quarantined.

To the first question, should we panic? Or is there a need to panic? Apparently the panic is driven more by the media hype and the health authorities than what the plain facts warrant.

The second question addresses our present health measures. Trying to contain this infection is like trying to catch the wind. It is obvious that quarantines and closing of schools, factories or congress will do nothing to stop the spread. So why are so many countries and health authorities, not to mention a certain health minister and a deputy prime minister spending so much money and effort to catch the wind? Wearing face masks and giving influenza vaccine is known to be not effective prevention against influenza A (H1N1).

I will suggest that instead of instilling panic in our populations and wasting valuable resources in isolation and quarantine, we should

(1) allow the infection to spread. People over time will develop immunity to it. We call this herd immunity.

(2) focus our resources on treating those who became really sick due to this virus. There are anti-viral agents which are effective against the virus.

(3) educate the population about personal hygiene, especially hand-washing.

Following the news about the pandemic of Influenza A (H1N1), I wonder if the response is more political, emotional and knee-jerk rather than evidence-based medicine. It did take our mind off the world wide financial crisis.


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Blogger Paul Long said...

What you say makes sense to me as here in NZ, some are projecting numbers as high as 1 million will be infected.

But some who have the flu say while their body aches etc, the aches from a normal flu were far worst.

I think medical authorities here are slowly coming to their sense by now trying to just focus on cases that are serious. Fact is that many recovered quite naturally.

Perhaps the fear is more of a possible mutated version of the flu virus? But then again, why panic the general population over a remote possibility which has not come to pass?

Two days ago my son went to his school nurse because he had an upset stomach. She found he had a slight fever and I was called to take him home and he was warned not to come back to school if he even had a slight fever or risk being fined $500 if caught.

So I took him home, he took 2 panadols, slept an hour and later that evening went to work (part time job) with a 5 hour shift! He was fine and is still fine.

5:23 AM  
Blogger Alex Tang said...


Home quarantine do not always work. As highlighted by the local Malaysian newspapers, will the self-quarantine workers get paid?

Also to be considered is that when they are quarantined, who will get their food for them?

11:49 AM  
Anonymous Anonymous said...

You may find this ted blog informative - I think we are fortunate to have a very infectious but mild strain - almost a natural vaccine except it could mutate.

Question if the counter intuitive method is to hold selective and exclusive" flue parties to create buffer herd immunity. Maybe churches might be a natural inoculation center because of the herding behavior of our worship - similarly the other book based religion........journeyman

1:54 PM  
Anonymous journeyman said...

You may have problems accessing this is a better link

Hope this helps in the management of fear and dread. Just commonsense and alot of grace! Shalom

2:05 PM  

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