H1N1 flu (Swine Flu)

For all those worrying and panicking about H1N1, there is an excellent letter in today's Star and Sun , Aug 21 2009.
Take note of the bits I've highlighted in red.

For those of us from Western countries that have winter, we know that the annual death from flu in winter is always high, much worse than the comparatively few deaths caused by H1N1.
And a friend made a good comment  about the number of road deaths in Malaysia, an average of 17 a day, =  6205 death a year. So the 68 deaths (at the moment) from flu pale into insignificance ! 

STAR

No cause for panic

Friday August 21, 2009

No cause for panic

I AM writing in support of the statement by Dr C. Lee “Expert: case fatality rate not that high” (The Star, Aug 19). Although what Dr Lee said is true, there exists the pressing need to restrategise and implement mechanisms and Standard Operating Procedures (SOP) for the prevention of secondary bacterial pneumonia.
A(H1N1) is a very infectious disease. It spreads by droplet spread and is easily transmitted. The director-general of the Health Ministry has called it a high attack rate.
For a country of 27 million people, struggling with this crisis since April 2009 and with national and international transportation being so widely used, the 4,200 reported cases so far for such an infectious disease is severe under-reporting.
There are probably 20 times that number of cases out there which are not reported. Because of this issue of under-reporting, many countries have stopped trying to report the number of new cases.
Unfortunately, 68 have died in Malaysia. But if you were to be objective, 68 deaths out of a possible 70,000 to 80,000 cases will give a death rate of 0.08%. Still a bit higher than the usual seasonal flu death rate of 0.04%. However, surely it is not anywhere near panic proportions.
A closer look at the deaths reveal that 80% were A(H1N1) associated, or were incidentally found to have contracted the virus which by no means caused the death. We can call this A(H1N1) associated death or death with incidental A(H1N1) infection.
So, if the certification of death is proper, it may be that only 15 deaths were actually due to A(H1N1), giving a fatality rate of 0.02%.
The flu itself is usually a mild disease in the majority of cases. From all available clinical epidemiological evidence, the bulk of patients dying in flu pandemics are from secondary bacterial pneumonias. This has been shown to be the case in all flu epidemics and pandemics.
That is why we need to consolidate measures that are already in place. This should include a national-level SOP whereby all affected patients with secondary bacterial pneumonias would immediately triage for intensive tertiary level care.
There is no cause for panic but we should all be vigilant because there is a very infectious disease in our midst.
Good personal hygiene is crucial, now and at all times, even after this crisis.
There is already too much misinformation and misperception of the situation out in the lay media without having to distract the public with the hype about a national emergency.
DR NG SWEE CHOON,
Member of Medical Affairs Committee,
Federation of Private Medical Practitioners’ Associations Malaysia.

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