Do not be unduly worried !

(Updated with reply to the first 2 comments):

As a medical doctor with many years of experience, and who has seen tens of thousands of flu or flu-like cases over the years, I wish to reassure the public that the individual risk from dying from H1N1 is very small.

While we should take certain personal precautions like washing hands before eating and keeping ourselves at least 5 feet from those coughing and sneezing, we should not panic as if the world is coming to an end..Unfortunately,  that is the reaction of some .

Looking at the 8 thousand odd cases detected and  with just slightly over 70 cases of death world wide (until this moment), the mortality is less than 1 %. Many cases are likely to be not reported, making the mortality rate even lower.

The noraml flu has a mortality of 1%, which makes this H1N1 flu even milder than the normal flu. If we take out the Mexican death cases, the mortality is even lower. (IN mexico, it was likely that because the virus was first generation virus , it is more virulent, and once it has passed through many bodies, the virus is becoming less virulent).

Why WHO issues the alert is that even though the disease is mild and mortality less than seasonal flu, this flu can spread easily and can cause a pandemic easily, . In the case of pandemic, even though the individual risk of dying is low,  the aboslute number of people dying may be high. Say if 100 million people get the flu, and the mortality being 0.8%, then 800,000 people will die. That is why WHO is taking steps to try to control its spread. But tell me, how to prevent a flu from spreading,? It is almost impossible, it is almost like asking cats not to eat fish.

Another risk is that this H1N1 flu might combines with the virus of a bird flu and becomes a flu virus that can spread easily and  KILL.  SO far, there is no such evidence yet.

So, please do not be too unduly worried about this H1N1. Even if we contract it , it will be like the flu or common colds that we get 2 or 3 times a year on the average…It is defintely not like SARS, where only supportive treatment was  available and the mortality is many many times this H1N1.


Klm, who is familiar to all those who read this blog, has brought up a very good question. What if you are the 1% if you get this flu? I choose to answer here because this is really a big concern.

Firstly, if we take out the Mexican cases (68 deaths in Mexica), the mortality is  much lower  — about 0.125%see below.  (SO far only 7 cases of death outside Mexico, and mostly those with other associated medical conditions). But since we do not know exacttly why in Mexico , the mortality is higher, we have to include the Mexican cases in.

This is the latest from CDC, Atlanta:

  Deaths: Global total of 75 – 68 in Mexico, five in U.S., one in Canada and one in Costa Rica. Officials said Canadian, U.S. and Costa Rican victims also had other medical conditions.

  -Confirmed cases: WHO says 39 countries have reported more than 8,480 cases, mostly in U.S. and Mexico.

Based on the latest, including the 68 deaths in Mexico, the mortality is about 0.89%. ( 75 cases divided by  8480) This is about the risk of dying from  any operation.

(Mexico has 2895 cases latest, so that makes 5585 outside Mexico, and mortality outside mexico is 7 deaths divided by 5585 = 0.125%)

Each year, seasonal flu kills many people (about 1% mortality), mainly those with weakened immune system. . Many of us are inflicted with seasonal flu each year, as travellers from the North and SOuthern hemisphere will bring back the seasonal strains here.

Each years, all over the world, tens of thousands also die from seasonal flu.

 But we are not alarmed because most of us, who had flu,  recovered. It is like driving cars. Each years, tens of thousands die in car accidents, but even if we drive every day to work , we are not alarmed by being at risk of dying from car accidents, because the chances are remote. It is those who have other associated medical conditions which weaken their immune system that are at risk of dying, just like the highlighted statement above from CDC.

But that is not to say that you would not be the one within the 0.89%. Lotteries are so difficult to strike, and yet every now and then , someone will strike. Air travel is safer than driving cars, and yet, once a while , people are killed in plane crashes,

 What I am trying to say is that even though we may be the unlucky one, the chance sof being the unlucky one would not be greater in H1N1 than when we have the normal seasonal flu. Since most of us have flu one time and another and i believe all those who read this blog have all recovered from those flus (dead ones would not be able to read), chances of you dying from another flu is very very small.

In seasonal flu, those who perished,  died from complications: secondary lung infections and pneumonia. If your health is average, your immune system is average, then i can safely bet you would not die from seasonal flu nor this H1N1 flu.

It is when your resistance are compormised, such as patients on immune suppression drugs, renal dialysis, patients weakened by other disease such as cancer, old people with poor immune resistance, the premature babies etc will die from the normal seasonal flu, or this flu,  outside of Mexico. (The Mexico pattern where younger people died is still a mystery, but very likely to be due to the virulent first generation virus eliciting a strong immune reaction from those who died.   This pattern is not seen now showing that the virulence of the virus is diminishing, and it has now act more like a common seasonal flu).

That is why WHO has advised the drug companies to stick to producing vaccines for the normal seasonal flus, because if not, more people will probably die from the seasonal flu rather than this H1N1 flu.

So while i cannot rule out totally whether you will be the 0.89% , chances are you will not die from it if you are an average person. 🙂


19 Comments (+add yours?)

  1. klm
    May 18, 2009 @ 13:11:57

    Dr Hsu. Somebody said the fatality rate is very small, just 1%. What happened when one is the very small statistical minority? 🙂


  2. Fi-sha
    May 18, 2009 @ 13:48:51

    Hi Dr Hsu. Thanks for the advice. But I was thinking along the line like Mr KLM – what if?

    p.s. if you have time sir, can you enlighten me on my worries here :


  3. Dr Hsu
    May 18, 2009 @ 14:13:34

    klm and Fisha, pls read my reply in the updated main article. I decided to post the reply there as more people will read it there.


  4. shoushudao
    May 18, 2009 @ 15:53:41

    Dear Dr, thanks for the good piece.
    I regularly read your blogs. This is
    the first time I write a comment.


  5. Fi-sha
    May 18, 2009 @ 16:02:12

    Dear Dr Hsu

    merci be coupe!


  6. Dr Hsu
    May 18, 2009 @ 16:13:55


    welcome. It is my duty as a doctor to let people see the true picture and not be gloomy about this thing.


    Thank you for commenting, pls give more input.


  7. pilocarpine
    May 18, 2009 @ 17:23:25

    i’d link my entry on A(H1N1) in pregnancy to your entry, dr hsu..

    i hope you don’t mind…

    because I guess too many people just panic… and fear…


  8. pilocarpine
    May 18, 2009 @ 17:26:55

  9. Nick
    May 18, 2009 @ 18:29:01

    Thanks Dr. Hsu for the assurance. I will take it at full value because of your reputation and expertise as a practising GP. But I need to get an answer from you. Before this news broke about swine fever, do we get H1N1 virus in our country? In other words, when we fall ill due to common cold and show flu symptoms, could some of those cases have been due to Influenza A?


  10. Dr Hsu
    May 18, 2009 @ 21:02:51

    yes. Although many majority of the so called ‘flu’ cases are common colds and not caused by influenza viruses, we do have influenza cases. Influenza is always endemic, meaning cases occur but not on an epidemic scale.. This is especially true in December to Feb during the Northern hemisphere’s winter, when many of our travellers do bring back the viruses home., and June to August when travellers to Southern Hemisphere like Australia and Nz bring back the Southern strains flu.

    As I have said, flu is endemic and and is so common that most of us at one time or another would have got it, but severity varies. ANd since most flu strains are variants , there is a certain amount of herd immunity among the people. Meaning even whena new variant strain occurs, we may have certain amount of immunity against it and so even if we fall ill, we do not get the full blown severity.. And virulence tends to taper after spreading from one person to another..

    Having said all these, old people especailly bed ridden old people, people with compromised immunity , patients on immune suppression drugs and so on, they can die from even the normal flu, and they constitute most of the cases of the 1% mortality..The cases are most severe in cold temperature, because extreme of temperature can lower our resistance..

    So the risk is not individual, but rather that of apandemic, whenthe absolute number of people dying may be high since in a pandemic, large number may be infected, and even a small mortality rate can translate into a high absolute number of death as I have explained.

    I stand by my statement that if you are an average person without any associated medical problems, you will not die from H1N1.

    That is also why in AUstralia and NZ airports, you do not see medical personnel wearing space suits and masks to welcome visitors.They do have health declaration forms, and they have thermal screening , but I do not see anyone wearing masks in Adelaide, AUckland airport as wella s Melbourne airport where I transited to NZ.. This is probably because they are so used to seasonal flu and they understand this H1N1’s cases are mild outside of Mexico. They are screening cases more for prevention of occurrence of a pandemic..


  11. Dr Hsu
    May 18, 2009 @ 21:11:40

    pls feel free to link this..


  12. Disgusted
    May 18, 2009 @ 21:12:16


    You are right, “Man acts, God disposes”. I believe in the 1 per cent “upstairs. Said and done on the law of the average, I believe a person’s birth and death do lies “upstairs.

    When the right time comes (meaning the visa of permanent migration), no amount of medicine or hole can hide or prevent a man destined to migrate.



  13. cilipadi
    May 18, 2009 @ 21:49:49


    You were practising as monk before and you know the 1% better than anyone of us.

    But there is somebody is even better than you that he can predict ‘for sure’ and decided not to contest. Would we see this somebody not contesting also in Perak fresh election, if any? Good idea also right? Can save a lot of people’s money.

    siapa makan cili, dia rasa pedas. Somebody?


  14. batu giant
    May 18, 2009 @ 22:52:33

    Thanks Doc for your valuable information.


  15. Disgusted
    May 18, 2009 @ 22:56:30


    Sometimes we have to watch out very carefully “the type of logic or grandfather’s excuse” by BN politicians. Brandied around and sounding as though all of a sudden, “by-elections” have become a “waste of public funds.”

    But I gathered the NEP had leakages or wasted hundreds of billions ringgit since it was introduced without achieving its specific objectives.

    But a simple logic would be millions of ringgit would be “circulated” to schools, for road developments, shops, hawkers, from the kacang putih man to the restaurants, hotels….etc, but suddenly the “wiser man” (compared to me, you said) considered a wastage of public funds.

    Even the Elastic Commission makes money through deposits. So where the money flows….to wastage?

    One word describe the no contest, in Singaporean language, “kia su”. The BN has been suffering from the stink of humiliation.

    Maybe they are too full of “smacking” from voters and face-saving gesture. The old horse will “bark” again in reaction to the no contest. Saying it is to save public money is just bulls**t.

    The scenario or decision would be different, if BN thinks it can win the Penanti seat. But there is no trumpeting of arrogance.



  16. cilipadi
    May 18, 2009 @ 23:18:46


    Somebody does it as if he knows well about Sun Tzi Art of Wars. This art of wars was designed on level ground, fair and square basis. In Malaysia, can?

    Let’s enjoy their acting. Meanwhile, see how they do next.


  17. kittykat46
    May 19, 2009 @ 10:16:04

    Agreed with you, Dr. Hsu
    Apart from taking sensible steps for hygiene, we shouldn’t be unduly worried.

    I personally know a case of a person who died of complications arising from common flu. The person had recently been hospitalised for some other illness, overall in weak health. She caught a case of flu, unfortunately led to a serious infection in the lungs. Died of pneumonia. It came as a shock to me that even today, with antibiotics and all kinds of modern medical treatment, pneumonia can still kill.

    For most healthy people, the common flu is nothing more than an uncomfortable inconvenience, but its worth remembering that under some circumstances, some people do die from it, or indirectly from related complications.


  18. anon
    May 19, 2009 @ 10:36:51

    Dear Dr Hsu

    I recently heard an internet radio program based in the US on an interview with a Dr Henry L Niman, a researcher in virus and its recombination. His website is as listed below.

    The one point that I can gather from this interview is that of a calm understanding of the whole issue of how the current influenza outbreak is happening and to take a calm precaution over the issue. In it he also calmly explained that this type of virus has been around for the past ten years and not to be irrationally worry.

    I believe there are other experts that you know of who can help the general public gain a calm understanding about this whole issue of viral pandemia.

    I got a download of the internet radio interview at rense dot com.



  19. monk
    May 19, 2009 @ 13:02:51


    Life can be naturally sadistic. I mean, Man’s “wander-ful” progress, lightning speed communication, “zooming here and there like popular “Flash” of the comic icon.

    Bigger planes with airbus and towering planes loading up to 500 passengers. And it helps this sadistic trend when an epidemic breaks out, quarantined…can you imagine the enormous implication and consequence when 500 passengers sitting inside an enclosure with someone unknowing suffering from some extremely contagious disease.

    So much for the future to ponder upon !



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