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!