we could have done better

The H1N1 virus has not changed so far. It is still a mild virus for most of the cases recorded, even though the infectivity is high and the spread is fast, which may not be a bad thing since a herd immunity can be built up fast, like in the case of Australia, even though it is winter, and Melbourne being dubbed the H1N1 capital, there is absolutely no panic and life goes on as usual . As I have mentioned, in Singapore, newsapapers hardly record any news on H1N1 and life is normal and Orchard Road is as busy as ever.

My initial advice still stands that for an average person, even if you get  H1N1 flu, it will just be an average flu for you, just like most of the flus you get year in and year out. But we need to be vigilant not to spread it to the high risk groups that I have listed in my previous articles on this topic.

There is one feature worth noting so far. As in the experience of our countries, most of those who came in with flu are young people, many of them school children. For these young people, we have in recent weeks seen so many cases with high fever, ranging from 38  to 39 degree C, and some even over 39 degree C 39.  Most of the fever subsided within 2 to 3 days, with a few taking one or 2 days extra to get well.  Most of those over 50 , however,  had just cough and cold even though their children may have temperatures of 39 degree, , and hardly anyone had any fever.

This confirms the findings overseas that most of those born in the 50s and 60s have certain immunity to this virus, since even though this is a new mutant H1N1, certain antigens of the virus were still similar to earlier H1N1 infections. I notice even those over 40s do not get high fever; most of them in their 40s just have a mild temperature. And so far, from my info, most if not all of the deaths are those from high risk groups.

We could have handled this outbreak much better. A few things came to mind when i reviewed happenings in the past few weeks.

A few weeks ago, a top official announced that anyone can insist on a throat swab for H1N1 . At that time, only certain designated government hospitals can do this test, and so with this annoucement,  almost everyone with flu like symptoms rushed to government hospitals demanding for H1N1 tests. This resulted in overloading and the health authority at these hopsitals were simply overwhelmed. I heard that those MLTs in IMR worked so hard that they harly had time to breathe..And when heath services are stretched, it is difficult to maintain quality…

In hindsight, the official should have allowed tha doctors to decide , since they are the professionals, whom to do the tests. Not all flu cases required testings; countries like US , UK and AUstralia, where the health care is many times more advanced and sophisticated than ours, did not do tests on everyone. Because that would be a waste of resources, and stretching the already overworked health services even further.

So because our labs and our outpatients cannot cope with the sudden icnrease in cases after the annoucement that anyone can insist on a H1N1 test, the government then issued another statement asking patients to go private clinic to undergo rapid H1N1 testings., without first check the availability of the tests .

However, most of the private clinics do not have this rapid test, since this test has just been brought into the country – (before, no doctors or laboratory is doing any flu detection, since flu is such a common thing and most cases recovered without the need for confirmatoion test)-  and the limited supply cannot cope with the number of actual flu cases. After the annoucement,  most doctors are calling each other to find out where to source for this test. Now , of course, a few companies have brought in some tests, one from Japan and one from Belgium, but the quantity is hardly enough in order to do tests on all flu like cases.

When the death rate started to climb, the minister then announced that all flu-like  cases should be started on Tamiflu early , even  if the flu cases are not confirmed H1N1. The problem is Tamiflu is not easily available, and most suppliers have run out of the original tablets from Roche. A generic version, from India, was available, but the selling cost was pushed up to as high as  the original version, which is ridiculous. All these happened  because of the annoucement made by our officials without first checking the ground availability. 

In other countries, tamiflu is not used to treat mild flu cases, and is used only for severe cases or those high risks cases. If tamiflu is used indiscriminately, resistance is bound to happen, and when that happens, we will have no more weapon to fight future flu which may beuch more virulent than this present one. When the governmnet made these announcement , they failed to realise that most flu cases recover on their own, even without treatment.

Now coming to  the seasonal flu injections. My clinic ran out of stock early last month, and the 3 suppliers (one from UK, one from France and one from Switzerland) all ran out of stocks. Stocks were supposed to come in August but so far none is in sight.  Remember we are not the only country in this world, manufactureres have to fulfilled orders from all over the world and not just Malaysia. Unless we can produce the vaccines ourselves, we depend on the ‘quota’s that these drug manufacturers give us.

When the vaccine for the new H1N1 is ready in October, I suspect we will ot be one of the first coutries to get it. The countries that would get it first would be those manufacturing the vaccines as well as those in temperate countries. We may get some initally, but definitely would ot be enough to jab the whole populations. We are so far behind in biotech that to manufacture vaccines would take years if not decades…

In hindsight, we could have handled the outbreak better. This is not to blame our public healthcare workers. They are working very hard- doctors, nurses, MLTs, health personnel- first trying to contain and now trying to mitigate the effects of this epidemic.  They should all be commended. It is the generals that should learn to say proper things and should try to be  informed of  the ground situation,   in order not to cause confusion among the public. 


Earlier articles on H1N1:

Another review of H1N1

Revisiting the H1N1 scene

Do not be unduly worried


8 Comments (+add yours?)

  1. klm
    Aug 21, 2009 @ 14:21:13

    Dr. Hsu

    I read the article “The MMA answers common H1N1 questions” By Dr David KL Quek, President MMA. I think this is another self serving and self justifying comments by the guy.

    I think he is trying to be a politician trying to justify the actions of the Health Ministry, Minister etc.

    What do you say?


  2. Meng
    Aug 21, 2009 @ 15:24:57

    This is happening in almost all the top echelon in this country. ..DPM included. ..saying without checking. What a shame

    Thats the quality we have in the top. In my last visit to singapore I got into a conversation with a man in vivo city. The conversation was centered on the malaysian ministers and this guy practically tore our ministers to bits. Felt shameful..no not a bit for he spoke on the true nature of our ministers.

    What did I say in reply..well malaysian are so used to dishonesty, being cheated, humiliated and thats the way of live.

    What DR Hsu said is correct..in singapore not much news on H1N1 and ppl don’t even bother to know about it.


  3. Meng
    Aug 21, 2009 @ 15:26:11

    Sorry Thats the way of life


  4. Dr Hsu
    Aug 21, 2009 @ 16:39:41


    I have no comment since under Hippocratic oath, we must treat our fellow physicians like our brothers and must not take bad about them.

    But so far, you have been right in most of your observations… And i think you can read between the lines..:)


  5. Enna
    Aug 21, 2009 @ 20:01:42

    Dear Dr. Hsu, thanks for the H1N1 update and all your advice. I found this on the web while surfing for more info.

    Study Suggests H1N1 Virus More Dangerous Than Suspected

    A new, highly detailed study of the H1N1 flu virus shows that the pathogen is more virulent than previously thought…

    To read the full article, please go to:


  6. Dr Hsu
    Aug 22, 2009 @ 13:46:18

    The latest advice from WHO is that healthy people do not need to be given Tamiflu…

    This is what I have been all along telling my readers. An average person will definitely recover from this flu whether given tamiflu or not.

    The indiscriminate use of tamiflu will made the virus resistant and then we will have no weapons to fight the war if the virus turn virulent.. I hope our health authority can realise their mistake in asking all docotrs to start tamiflu on all flu-like cases early.

    It should be reserved for all confirmed cases, and patients in the high risk groups.


    read the excerpts here:
    The latest advice from the WHO said: “Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals.”

    Previously the WHO had said antivirals should be given to patients with “serious progressive illness”. The new guidance is the first time it has specifically advised against otherwise healthy individuals being given the drug.

    The recommendation is based on the conclusion of an international panel of experts that includes representatives from the UK. The advice added that Tamiflu, also called oseltamivir, and the similar drug Relenza, also called zanamivir, should be given quickly to seriously ill or deteriorating patients.

    The WHO guidance said at-risk groups should receive the drugs. “For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir.

    “These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests. As pregnant women are included among groups at increased risk, WHO recommends that they receive antiviral treatment as soon as possible after symptom onset.”

    Some medical researchers have expressed concern about the side-effects of Tamiflu, particularly sickness, nightmares and insomnia in children. A team from Oxford University said this month that children with mild symptoms should not be given Tamiflu and urged the Department of Health (DoH) to urgently rethink its poli


  7. disgusted
    Aug 24, 2009 @ 19:01:46

    Well, this is what you (Malaysians) get when a nutritionist is appointed as Hell minister.

    What you see is what you get.

    A couple of Merry Merry Association guys are just what the Hokkien said, “Ho Lam Pa” to the MCA’s Hell Minister. Normal, it happens before, a Maltom Lam years ago.


  8. cilipadi
    Aug 24, 2009 @ 20:20:33

    Lucky, I can practise my faith without people bothering me.

    Sometime I drink alcoholic drink, not to extent of intoxication.

    Damn lucky lah me.

    siapa makan alcohol, dia kena canned


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