Spreads easily but not so deadly

(The Star) Instead of being worried, people but should be vigilant and improve personal hygiene to contain the threat of A(H1N1).

SHAMSUDDIN Ali*, a commercial airline pilot, makes regular flights to Australia. As his work requires him to fly to one of the hotspots of the Influenza A(H1N1) pandemic, he can be considered to be in the high-risk category of contracting the disease.

But he says nothing has changed at work.

“They are just like other routine flights. Some airlines have implemented procedures to prevent spread of the virus, but not mine,” he says.

He says there has been no specific directive from his company on measures needed to curb the spread of the disease or to protect themselves from it.

“There is a general poster on what to do, but that’s about it. We (airline crew) have not really been affected, but everyone is worried. Personally, I am afraid and I wash my hands regularly and do what I can to prevent exposure. If I get it, that’s just my bad luck,” he says.

Shamsuddin’s response is typical of most Malaysians. The media has covered the issue so extensively that everybody seems to be an expert on the pandemic. However, there is as much truth going around as there is fallacy on the issue.

While there is cause to be genuinely concerned for one’s health, it is important to be clear on the cold, hard facts.

Dr Christopher Lee, consultant physician and head of infectious diseases at Sungai Buloh Hospital, says the World Health Organisation (WHO) describes the A(H1N1) virus as being infectious but of moderate severity.

“People are easily infected as it is a novel virus and there is no immunity against it. It also spreads quicker than the seasonal flu (influenza),” says Dr Lee.

He says that just like the seasonal flu, the virus spreads through droplet transmissions, but it is not airborne like tuberculosis.

The virus is transmitted among humans by exposure to droplets expelled by coughing or sneezing – either by direct inhalation, or if the droplets contaminate a surface and somebody subsequently touches it and places their hands to their mouth or nose.

Dr Lee says that those within a one-metre radius from the source are most at risk — but that does not mean others outside the radius will not be infected. He adds that the virus is transmitted easily but the mortality rate is low.

According to the latest WHO statistics (as of June 26), there are 59,814 reported cases and 263 deaths — a mortality rate of 0.44%.

This is in contrast to two other high-profile global health threats of recent years. Avian Flu (influenza A(H5N1) had 433 reported cases and 262 deaths; while SARS (Severe Acute Respiratory Syndrome) had 8,096 reported cases and 774 deaths. This shows that there is a higher mortality rate of 61% and 9.6% respectively.

Meanwhile, seasonal flu is estimated to cause severe disease in up to three to five million people worldwide, with 250,000 to 500,000 deaths attributable to it every year (the exact number is not known).

Dr Lee says the elderly and young are more prone to complications if infected with A(H1N1) along with those with co-morbidities such as heart failure, chronic lung disease, kidney failure or those who are immuno-deficient (suffering from HIV).

WHO also reports that most cases appear to have uncomplicated, typical influenza-like illness and recover spontaneously. The commonly reported symptoms include cough, fever, sore throat, malaise and headache.

“So far, most people have recovered from A(H1N1). The symptoms are the same as seasonal flu, and last from one to three days,” says Dr Lee.

Extravagant measures

A doctor who wanted to be identified only as Dr Chew, says although most doctors do not take drastic measures whenever a case comes in, they are aware and cautious of it.

While he believes that the steps taken are necessary, he feels that they are an extravagance and consume resources.

“For example, the area they are housed in for isolation takes up a lot of space, not to mention the cost of protective equipment. There is also a question of manpower because you are taking staff away.”

Dr Chew says these measures are excessive because of the nature of the threat.

“The mortality rate is low, and it is rampant because it is difficult to contain,” he says.

He believes the act of washing one’s hands is very important.

“The simple act of washing hands is the most effective measure to combat A(H1N1). That is what we want the public and all our staff to be aware of.”

A Klang-based doctor, however, does not feel that taking extra measures and precautions for influenza A (H1N1) deprives other patients of care.

“I don’t think it takes anything away from other patients. In certain hospitals, staff are appointed for swine flu cases. The staff have already been identified, and will only be assigned if actual cases come in.”

The doctor says there are usually a few nurses assigned in each hospital and are on call round the clock.

He adds that the personnel who are taking care of A (H1N1) cases will have to be quarantined themselves.

“I don’t think these measures are overboard because we have to be careful. It is very important that we have standby teams if there is an unexpected case. Otherwise, hospital personnel will be untrained on how to handle cases, nor will there be a place for proper isolation,” he says.

He, however, believes that the common cold is more dangerous than A(H1N1).

“A(H1N1) is not fatal if detected early. That is why people are encouraged to come in early to take a test,” he states.

Dr Lee says the current seasonal flu jabs offer no protection against A(H1N1) although there is no harm in taking it. WHO is currently working towards a vaccine which will be ready in four to five months.

However, there have been concerns that the virus — if combined with the much deadlier H5N1 bird flu virus — could claim many more lives.

“The virus can mutate or change,” explains Dr Lee.

He says the current spate of A(H1N1) cases is considered to be relatively mild.

But he notes that all three influenza pandemics of the last century started with a mild wave followed by a much more serious and severe wave of cases.

“All of them followed the same pattern. The first wave was not so severe, but the second wave will come — whether it’s months or years down the road. There are concerns that it will be more serious,” he says.

The last global pandemic was the Hong Kong flu of 1968, which killed approximately one million people. The Asian Flu (1957-58), which originated from China was estimated to have killed between one and four million. And in 1918, the Spanish flu killed some 50 to 100 million people worldwide over the span of a year.

WHO director-general Dr Margaret Chan, however, told reporters recently that the A(H1N1) virus is very stable for now, although it is highly unpredictable and has great potential for mutation.

Government recommendations

The Health Ministry is requesting the co-operation of those studying or coming back from places which have a high number of reported cases (such as Melbourne, also known as the swine-flu capital) to self-quarantine themselves.

“Those who are unwell or show symptoms such as cough or fever are urged to get treatment and reduce their interaction with others,” advises Health director-general Tan Sri Dr Ismail Merican.

Dr Lee says that those without symptoms could still be carrying the virus.

“The virus might be incubating in the first seven days even if there is no fever or other symptoms,” says Dr Lee, adding that such people could unwittingly spread the virus if they go out in the general public.

On Friday, the Cabinet decided that any employee on self-quarantine on suspicion of having A(H1N1) will be given a seven-day medical leave with full pay.

However, Human Resources Minister Datuk Dr S. Subramaniam said in a statement that the medical leave must be obtained from a Government hospital or clinic.

Malaysian Employers Federation executive director Haji Shamsuddin Bardan says that there is no issue if the employee concerned is confirmed to have A(H1N1).

“If this is confirmed by a medical doctor, it becomes sick leave, as stated by law.”

However, he adds that this is a directive, and has not yet been gazetted into law or a regulation.

“We encourage our members to follow the Cabinet directive,” he says.

However, a human resources manager from Petaling Jaya says that the directive places an unfair burden on employers.

He gives an example of an employee who has gone overseas despite the warning of a pandemic.

“It is very selfish of an employee to expose himself to the risk of infection. He should have avoided it completely and cancelled his trip,” he says.

“It doesn’t make sense that the company has to pay for it. In such a situation he should be given half pay during self-quarantine,” he says, adding that there would be no issue if the employee had contracted A(H1N1) while on company business.

Dr Ismail has also advised the public to halt their travel plans to countries which have a lot of reported cases unless it is unavoidable.

As for now, Dr Lee who is also a member of the Global Hygiene Council is advising people not to panic, but to be vigilant and intensify their personal hygiene measures.

“The SARS heightened the personal hygiene of people in Singapore and Hong Kong. Now it is just a habit for them,” he says.

When Wong Jun Ming, an 11-year-old student from SJK (C) Jalan Davidson, went down with a fever and sore throat on Monday night, his father rushed him to the Sungei Buloh Hospital.

Three of his classmates were confirmed Influenza A(H1N1) cases and his father did not want to take any chances.

“The possibility of my son being the next A(H1N1) case could not be dismissed,” reasons Jun Ming’s father, Wong Jee Yai.

He and his wife kept vigil until the test results the next morning showed Jun Ming was not infected by the A(HINI) virus.

The A(H1N1) outbreak has underscored the importance of good hygiene, discipline, and the fact that the public must also be responsible for their own health, Wong says.

Jun Ming has developed some rashes as a result of an allergic reaction to the fever and sore throat medicine he took, and Wong says he and his wife are not writing off the possibility of dengue now.

In the first six months of this year, there have been 23,057 dengue cases and 57 related deaths in the country.