I refer to the recent press statement by Deputy Prime Minister Tan Sri Muhyiddin Yasin who stated that “Even if I am Health Minister, I cannot guarantee your safety” regarding the novel influenza, H1N1. The flu has thus far claimed 13 lives. Although it has a predilection for the infirm, immuno-compromised, in the pregnant and those with underlying diseases, the patients who have died thus far in Malaysia does not reflect this scenario.
The symptoms of novel H1N1 flu virus are similar to the symptoms of seasonal flu which include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue including diarrhea and vomiting. In seasonal flu, risk factors are similar except that in novel influenza H1N1, patients aged 65 and above appear to be protected. But as evidenced in Malaysia, H1N1 has killed patients in the age range of 6 to 51 years with the majority being less then 30 years old. This “common cold” kills. And it kills the young – meaning healthy young adults who generally take flu less seriously.
The DPM and the Health Ministry has taken this entire disease lightly, just like what they did with dengue. H1N1 had been festering in Mexico for probably months if not years as a result of poor hygienic standards and surveillance before it blew out in the open in April this year causing the country to shut down. By June it had killed 80 people with almost 80% of deaths being in the range of 20 to 50 years with most of the deaths being between ages 20-29 years. By July the death toll stood at 125.
The Mexicans at that point in time could not differentiate how many of these deaths were actually attributed to seasonal flu as compared to the novel H1N1. They really didn’t know what hit them in the beginning. But since then the WHO and CDC (Center for Disease Control, US) have stepped in and issued various guidelines to stop this virus in its tracks. Malaysia has the benefit of hindsight and must use it effectively.
In its latest bulletin, the CDC has clearly outlined the role of early diagnosis clinically and also with the help of Rapid Influenza Diagnostic Tests (RIDT) which have varying degrees of sensitivities but a high degree of specificity. These tests only tell you whether you have Influenza A or B. Period. It has it’s limitations but it helps the frontline doctor, the General Practitioner (GP), thus far largely ignored by the Ministry of Health, to come to a diagnosis as results are available within 30 minutes.
The CDC has issued a very common sense approach to treating the disease. If the test is positive and the patient’s symptoms don’t improve with usual anti-flu measures and there has been a history of contact and/or is at high risk, antivirals such as Tamiflu and Relenza which kill the bug are prescribed. If there is a need for additional testing then the far more accurate but expensive real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) test for the virus is carried out.
But what we witness in Malaysia is an MOH policy where victims are to be sent to Government General Hospitals, specifically Sungai Buloh Hospital, based only on clinical suspicion. We would be no better than the Mexicans in April when they too didn’t have a clue as to whether it was seasonal or novel H1N1. Logistically, our government health infrastructure will not be able to handle the thousands of young, worried, flu patients who flock to emergency departments throughout the country wanting to know whether they have H1N1 when clearly testing by the Ministry’s IMR is limited to only 200 cases a day.
There are a lot of patients who are going to have their diagnoses missed who may develop the virus’s dreaded respiratory complications if this is allowed to carry on. The Ministry’s hospitals should be reserved for serious cases. Tan Sri Muhyiddin must re-look the Ministry’s policies and rein in the help of the thousands of GPs or Government Health Clinics to whom many of these patients first flock to. He has to quickly move now to make available at least the RIDTs and antiviral medication to these frontline doctors. Failure to respond effectively is going to cost this nation more deaths than it necessarily should.