Awareness key to fighting H1NI

The number of confirmed influenza A (H1N1) cases has breached the 3,000 barrier and more people are dying. Is the Health Ministry doing enough to create public awareness of the pandemic? Is there public apathy? ANNIE FREEDA CRUEZ speaks to Health director-general Tan Sri Dr Ismail Merican and Federation of Malaysian Consumers Associations president Datuk N. Marimuthu

Q: Why is the influenza A (H1N1) spreading so rapidly?

Dr Ismail: As the H1N1 is a novel influenza virus, it is expected that the secondary attack rate is going to be high, largely due to the lack of immunity in the general population. Its pathogenicity is not much higher than seasonal flu but because large numbers are infected, larger numbers appear to be falling ill with moderate or severe illness. The majority of the victims are those with co-morbid conditions and risk factors.

Marimuthu: With the symptoms similar to those of a common cold, we cannot know if a simple cough or sore throat is actually the start of an H1N1 infection. It will take days for additional symptoms to surface and by that time the infected person would have spread it around.

Federation of Malaysian Consumers Associations president Datuk N. Marimuthu (left)  and Health director-general Tan Sri Dr Ismail Merican.
Federation of Malaysian Consumers Associations president Datuk N. Marimuthu (left) and Health director-general Tan Sri Dr Ismail Merican.

Other contributing factors are a lack of healthcare facilities and accessibility, which causes many with flu to be refused hospital admittance. To some extent public apathy is also a cause.

Q: Do you think Malaysians are taking the influenza A lightly, especially with regard to personal hygiene?

Dr Ismail: There has not been any in-depth study on hand hygiene practices in Malaysia. However, from general observation, hand hygiene practices, especially the use of sanitisers or hand washing after coughing or sneezing appears to be poor. Education and training on personal hygiene must start from the home, consolidated through pre-school and school years and emphasised right through adulthood.

Marimuthu: For the rural and poor communities, it could well be the lack of, and accessibility to information. Urbanites on the other hand, are swamped with an abundance of information from the web, books, pamphlets and other sources, that could be confusing.

The availability of hand sanitizers in public areas is also critical. At dire times like this, the government must take the initiative to provide hand sanitisers in crowded public places.

Q: Are Malaysians complying with the 10 step-procedure on self-quarantine?

Dr Ismail: This is difficult to determine; there have been reports of people not complying fully with the guidelines. We continue to urge people to take the responsible step of keeping their family, friends and colleagues clear of the virus.

Patients must stay at home, drink plenty of fluids and soup, avoid mingling with others in the house, wear a mask to avoid transmission to household members and, if they need to go out, wear a surgical mask.

They must avoid contact with other people and observe good personal hygiene. While at home, they must watch out for the emergency warning signs of severity, and if they experience any of these, they must seek treatment immediately.


Marimuthu: I believe the public is increasingly aware of the situation and is taking action. However, they must be provided with credible information on what to do, and also the avenues and an enabling environment to do so.

If the employer does not provide additional paid medical leave for those on home quarantine or refuses to halt operations despite having cases, how can those who wish to take action do so?

The 10 steps of self-quarantine must be widely publicised. While the Health Ministry's H1N1 website does have substantial information, it does not visibly and clearly highlight the 10-steps.

Q: What is lacking in efforts to contain its spread?

Dr Ismail: Individual and public ownership of the problem is lacking. Everyone needs to keep themselves informed and educated on the issue so they can take the appropriate preventive measures. Strengthening hand hygiene, cough etiquette practices and appropriate application of social distancing remain key strategies to slowing down the spread until an effective H1N1 vaccine is available.

Marimuthu: There is an apparent lack of inter-ministerial coordination and cooperation. Apart from its impact on health, a pandemic has socio-economic repercussions which fall under the purview of different ministries, government departments and agencies.

Guidelines for school closures, for example, are only being drawn up now after mounting numbers of deaths and new infections, and it's under the jurisdiction of both the health and education ministries.

There must be effective coordination and communication between government organs. Public cooperation is important, too.

Q: Many people with symptoms such as coughing, sneezing and fever are going to work. They mingle with other staff and, worse still, move around freely in public places. Your view?

Dr Ismail: This is of great concern to us in the ministry. We have given enough information in both the electronic and print media about coughing and sneezing etiquette, the importance of staying home if unwell, the practice of strict personal hygiene and the responsibility of wearing masks if they are unwell. We hope everyone takes this advice seriously. They owe it not only to themselves but also to the community at large.

Marimuthu: You cannot blame the people for having to go to work. Though the Health Ministry has issued a directive that employees are to be given paid leave for home-quarantine, compliance with the directive is an issue.

Does the ministry monitor the situation to ensure employers are complying? Or do they leave it to the Human Resources Ministry to follow through?

In some instances, only students are sent home for quarantine but not academic staff. Also, many workers whose wages are paid by the hour can't afford to take medical leave. Organisations have moral and social obligations to their employees to ensure that the working environment is safe.

Q: Has the Health Ministry taken adequate measures to delay the spread of the virus?

Dr Ismail: The ministry has put in place a variety of interventions from public education, improving public hygiene, medical screening and treatment to advice on social distancing.

The situation remains fluid. If necessary, more measures will be instituted. The ministry does not intend to institute drastic measures unless the situation in the country truly warrants it.

We will continue to monitor the situation but we need help from everyone, including other ministries, agencies, the private sector, corporate bodies, NGOs and community leaders.

Marimuthu: The situation and the characteristics of the flu virus itself are changing as we speak, therefore, new measures would need to be in place to prepare for the constant change until the pandemic stabilises and subsides. So far the Health Ministry's measures have been a mixture of proactive and reactive responses. – New Straits Times