Revisiting the H1N1 scene

When H1N1 cases were first reported, I wrote a post  (Do not be unduly worried) saying that it is impossible to prevent flu from spreading.  I hope I was wrong, but unfortunately, I was proven right. ( That article , I was told, was translated into Chinese  by a Chinese writing  blogger, and I would like to thank him here.)

Flu is one of the most difficult infections to contain. The incubation period is between 2 to 5 days, meaning that it takes 2 to 5 days for symptoms to appear after a person gets infected. But one day before the appearance of symptoms, that patient can already be infectious –meaning that he can transmit the virus one day before he knows that he is down with the flu.

Furthermore, as with most infections, the individual response varies according to the constitution as well as the tolerance of the patient. Some patients can tolerate fever well , and even a temperature of 38 would not mean much to them, but some with even a very mild fever feels very uncomfortable . Some have just mild cough and cold, and may not even be aware that they are sick and may still be moving around in the community since they don’t even know they are sick.

Some have what we called sub-clinical infections, when they do not exhibit  the symptoms of flu but they are actually excreting the virus.. This group may not feel ill at all.

SO with such a wide spectrum, it is impossible to prevent flu from spreading. Not possible in medically advanced countries like USA, UK,  AUstralia, and not in the not so medically advanced countries like Thailand and the Philippines, and not in the in-between group like Malaysia.

I was therefore not surprised that despite the stringent and gallant measures taken by our Ministry Of Health personnel at points of entry as well as in contact tracing, H1N1 flu has spread to the general population.

I was told by a govenrment doctor that from a sampling of a cluster of flu patients, out of 6 with flu symptoms, 5 were H1N1 positive. IN Singapore, one doctor was saying that if you are down with flu symptoms, chances are the flu is a H1N1 flu now.

At this stage, my advice in my earlier article still stands. That is we do not need to panic.  If you are an average person with an average resistance, you will get an average flu, and should recover from it in a couple of days.

BUT,  the onus is on us not to spread the disease to those who have low immunity. So those with flu symptoms should try to avoid contact with people in the high risk groups:  these are people who are very old, very young, with diabetes (especially those not well controlled-they have poor immunity), renal disease , cancer cases, heart failure.. These  are the ones who succumbed to flu during a flu season, and statistics this time has again proven that most of the deaths occurred in this group of high risk patients.

So if you have flu, try to stay at home, and in your room preferably. If you are down with flu but need to go out , wear a mask especially if you take public transportation.

In the west like USA , Australia , you can just call in to tell your employers that you are sick and you are taking a few days off. In Malaysia, you can’t do that unless you have a medical certificate to certify you are sick. Even with the medical certificate, some employers will call up and scold the doctors, accusing doctors of issuing MCs indiscriminately, not knowing that it is actually  good practice to keep a sick staff at home to prevent him from spreading to the rest of the staff, including the boss himself, who might be in the high risk group.

For those in the high risk groups, they should avoid going out.

All of us should clean our hands often and especially before eating and touching our nose, mouth and eyes. If we  have to eat out, make sure we clean our hands before eating, and make sure we wash the chopsticks, spoons and forks thoroughly with detergents before eating– the best way is to pour boiling water onto them after cleaning , like some of the old Chinaman tim sum shops–  and avoiding touching our own mouth, nose and eyes with our hands if we accidentally touch any surface (table top etc) with our hands. One recent study has shown that one of the most contaminated things is the handle of the supermarket push carts. So make sure you wash your hands thoroughly after shopping in the supermarket.

For the rest of us, we cannot do much except to make sure we have adequate sleep and a balanced diet with plenty of fluid intake.

 We need 8 hours of sleep a day for our bodies to function at their best levels. The most important time for our body immune system to rest and rejuvenate itself is 11pm to 1 am, so it would be advisable to sleep before 11pm, and a lot of those who are down with flu are those who either sleep very little or very late. ( The old maxim that ‘sleeping early and getting up early gives you good health’ is very true).

It is impossible for the government hospitals to test every flu-like case for H1N1. A throat swap will cost the government at least 60-80 dollars. A confirmatory test using blood tests (PCR tests) will cost even more, and there are thousands of flu cases a day. So in a mitigation stage like we are in  now, the authority can only test cases who are more serious , those in the high risks groups, or those admitted for serious complications, to confirm whether they are H1N1 cases and to start them on anti viral drugs.

I was also told that the flu medication, tamiflu,  is now controlled by the government. Before , anyone with a prescription can buy. ( Some  pharmacies were selling tamiflu  even without prescriptions, i was told), so for more serious cases, their family doctors would have no choice but to send them to government hospitals (the designated ones).

As I have mentioned, the individual risk is small even if one is down with H1N1, but the absolute numbers of mortality may be high, since in a flu epidemic, most people will be infected at one time or another. Until the herd immunity starts to occur, or a vaccine made available, it would spread in the community and may kill many of those uforrtunate ones with  compromised immunity , the high risk group that I have listed above.

SO it pays to be vigilant but not to be unduly worried!


15 Comments (+add yours?)

  1. Justin Choo
    Aug 01, 2009 @ 15:42:18

    That was a very deatailed advice. Thanks Dr Hsu.

    As I said before, man is not very clever and cannot win over nature. When you find a cure for one sickness/disease, another two will emerge, and others will mutate, just like politicians.


  2. cilipadi
    Aug 01, 2009 @ 16:53:00

    How come your Merican DG cannot explain so well?

    How come your DVD doctor ex-hell ministry so quiet on this?

    How come your Yen Yen lady doctor still in the kitchen cabinet not bother to explain, but let her non doctor hell ministry to run here and there?

    How come your old goat doctor doesn’t talk about H1N1 flu, instead, like to play up racial sentiments?

    How come your advice is so good, yet your gomen don’t choose to adopt your advices?

    Who is the good doctor? Who are the lousy ones?

    Lousy doctors only good in politics, not public health …..

    Good doctor makan cili, lousy doctors rasa pedas.


  3. DG
    Aug 01, 2009 @ 17:43:04

    Doktor, is it true by drinking cooling stuff can help prevent flu ?


  4. Dr Hsu
    Aug 01, 2009 @ 18:14:41

    I am not a herbalist so I would not comment. But certain herbs are known to have certain anti viral property, like “Jin Yin Hua” literally mens ” gold and silver flower”. BUt how much to take , pls ask your sinseh herbalist.


  5. iamyuanwu
    Aug 01, 2009 @ 21:47:27

    Some have claimed that H1N1 is most severe amongst those with mature immune system (the young adults), it kills via ‘cytokine storm’ (overreaction of the body’s immune system).
    I read it from wikipedia from a friend’s leads.

    I just want to know what do you think about this, because it does sounds a bit absurd to me.


  6. Dr Hsu
    Aug 01, 2009 @ 22:00:37

    FOr this infection, the older people seem to experience a milder version when compared to seasonal flu . This has been attributed to partial immunity that those older people acquired in the past H1n1 epidemics…YOuger people who have not gone through those epidemic seem to have a more severe infections, but even so, most recovered.

    As to those who died, apart from the initial clusters in Mexico (mainly young people and nobody knows why), the later mortality mainly involved those with co morbid features such as impaired immunity.

    BUt don’t forget, even when the average old people get milder version of disease , many of the old people in the high risk groups died.. And most people in the high risk groups are older people, not the average young and fit young adults.


  7. DG
    Aug 01, 2009 @ 23:50:52

    Doktor, thank you . I will check it out.


  8. Clarence
    Aug 02, 2009 @ 06:07:30

    Thank you Dr Hsu for your excellent article and advice. This information should be shared widely with family and friends.

    If I may, there is one more thing to add.

    There is an important group of people who is also at very high risk. These are women who are pregnant, especially those in their second and third trimester. US Health authorities have recently reported that 13% of those who died from the A(H1N1) flu in the US were pregnant women.

    The report said that a pregnant woman have lower immunity as it is Nature’s way of preventing her body from attacking the fetus. Pregnant US women are now in the top category to receive the A(H1N1) vaccine when it is available in October 2009.

    So, let us all be mindful of our pregnant spouse, sisters, relatives, and friends and advise them to follow Dr Hsu’s advice to remain uninfected.


  9. julian
    Aug 02, 2009 @ 11:10:48

    went to your country last month and passed some idiots sitting behind monitors (supposed to check visitors who had high body temps?) damm they were too busy talking amongs themselves.
    thats why your country is going down the drain


  10. shoushudao
    Aug 02, 2009 @ 21:30:34

    Dr Hsu,
    if I may add, appropriate exercise on
    regular basis should also help.


  11. Dr Hsu
    Aug 02, 2009 @ 21:49:05

    yes, you are right. Pregnant ladies are at high risk. The risk is at least 4 times higher. Especially those who have co morbid disorder like diabetes.

    Yes, exercise done moderately will help, as mentioned in my earlier post.

    However, if a person is down with cough and cold, even if no fever, do not do strenous exercise as it may precipitate myocarditis….


  12. Atila
    Aug 03, 2009 @ 02:31:54

    Dr. Hsu
    thanks for the info in your write up. You tell the truth better than the DG Health in Malaysia.

    Please, I need your advise.
    I go for evening walks 45minutes for 3-4 times
    a week at Botanical Gardens. Around 4pm onwards, you have more people at the garden.

    Would you recommend me to put on face mask although its open air environment?


  13. peng
    Aug 03, 2009 @ 15:43:13

    Dr. Hsu, thank you for your objective and honest take on H1N1. This is what people need to know – to be better advised, so that we can do our part, instead of panicking and reacting with fear.


  14. Trackback: we could have done better « Dr Hsu ' s Forum
    Sep 10, 2009 @ 16:16:39

    Dr Hsu, We are Eco-Verde Pte Ltd (SG) and is in the business of disinfection, decontamination and mold removal / prevention services, would like to share with you our services. So that if you find it good, you will recommend it to your followers. send me an email and i will send you our MSDS and more information of the chemical that we use. We are currently on 24 hr standby for our HSA (Health Science Authority), our 48 post offices and soon will be disinfecting for our NEA (National Enviroment Agency) We are also the principal disinfection company for this year’s national day parade, and had recently disinfected the Selangor Sultan’s home.


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