Malaysia: What goes with the H1N1 situation?

I understand that the crowds at our hospitals in Alor Setar have almost returned to normal and are more manageable.. unlike a couple of weeks ago when it was like a mad house. It's the same at the clinics... things have returned quite normal here for now.

So, is the worst over? WHO seems to be of the opinion that a second wave is likely and that the H1N1 strain is now a dominant strain. Which is not surprising considering the wild run that the virus has had here in Alor Setar.

What got me thinking about this issue again is the death of BN's state assemblyman for Bagan Pinang, Azman Mohd Noor. From Malaysiakini, His son Hairol Asfani, 22, said Azman was admitted to the hospital at 3.30am due to fever. The Star has reported the cause of death as blood disorder... (septicemia??) Earlier reports stated that he died of a heart attack.

"He complained of fever but was able to walk unassisted. After the breaking of fast yesterday, his condition worsened and he was unable to walk," he said.

Among his medical history was he had gone for heart bypass but that was in May. And a few days ago, I heard over the news about claims of 3 deaths in Negeri Sembilan which some claim were the result of H1N1. Sounds kinda worrying... earlier a teacher here died under circumstances almost similar to the State Assemblyman. H1N1 had something to do with it? I don't know.

The information from our Health Ministry indicates that the death rate is very controlled now. I don't know whether it is controlled because the health care and public awareness have contributed to it or (more insidiously) because the data is flawed. I've to keep reminding myself that this is Bolehland.... where the perception of corruption, gilaness, scandals, lies is at a high state.

What I do know is we've to be on the lookout for our own good. We cannot quite depend on the gahmen. Life is fragile.. we are very vulnerable...

Mid Term Break

This is one break that I look forward to with a huge relief, not so much of the usual exuberance that comes with the break... More of relief! Cos I don't have to be surrounded by people half my day! This round of flu has made me highly sensitive to coughs, sniffles and flushed faces. Teaching has suddenly become rather dangerous! I have become sensitive to the people who cough or 'sniff' around me! There are a few teachers from the confirmed mortality list and who knows how many other deaths were tipped over by the this virus?

The most recent case to have made the headline.. a Maths and Science teacher, Chai Mee Feng from SMK USJ 12. May she R.I.P. A seemingly healthy and fit 39-year-old teacher. Developed fever and flu, one week later, she had severe pneumonia and multiple organs failure. The authority say she didn't die of H1N1. And if you read this blog post, which I assume is one of her students, they have another teacher by the name of Ms Chow in the ICU. It seems there's another teacher under quarantine.

I don't see the school admin watching out for our welfare.... Don't know what to believe anymore. One day the mortality rate, highlighted translated to a high percentage.. then a couple of days later (after Kit Siang highlighted and questioned it) the number of deaths started to drop but the number of reported confirmed cases begin to rise. At this rate, our mortality rate will surely come down... doing of our own undoing?

But this looks set to stay.... going to be around for a while this flu thing. The spread is too far and wide. And the measures are rather slip shod. A lot of flip-flops too.. one minute, they accuse docs who used the Rapid Test Kit as profit minded. Next minute the DG of Health says the use the Rapid Test Kits is 70 - 90% accurate... but Professor of Medicine and Infectious Diseases Dr Adeeba Kamarulzaman of Universiti Malaya Medical Centre (UMMC), says it only detects 25% of the cases, thereby creating a sense of false security.

This is the time, perhaps we should let the professionals do the running.. not politicians who don't do their homework very well. I could go on to the Fluhalt (generic Tamiflu) which is being used... which the Minister now says should be sold at RM80 per box. The generic company which produces this started charging almost double when the situation got worse... Social responsibility??? What's that? Those private docs who bought it at that price now have to bear the loss... Word on the ground gave the impression that the Flu Halt were going for RM150... more expensive than Tamiflu, the original oseltamivir.

Masks in school... don't think so they do much good. Kids' hands are just too itchy and the mask feels uncomfortable on their faces. And they're uncomfortable.

This was 2 nights ago. I took out a bag of 3-ply masks. Daughter was immediately fascinated by it... and I guess she wanted to try. The novelty of something new I supposed. And being the diplomatic lil gal she is, she told me she wanted to learn how to use it... I said okay and promptly fastened one onto her face.

Before the first minute was over, she was already tugging at it. At the end of the first 5 minutes, she wanted to take it off. I told her she had to learn to get used to it as I heard her school had made school masks mandatory. She went down to get me a cup of water... but when she came up, she was already in tears... from the discomfort of the mask and because I refused to let her take it out! Aiyo! How do you keep the mask on the children's faces? So, for children, we have to physically separate them... right now, the authorities and kiasu parents are doing a horrible job of it!

Anyway, I quote this...

Dr Adeeba also said that face masks were not useful in preventing the spread of the virus but what was important was to practise personal hygiene and observe the quarantine period.

She cited a report by the Centre for Disease Control in Atlanta which says mask-use by either infected patients or health-care personnel does not prevent the transmission of viruses.

"While the mask is effective in preventing those already infected with the virus from spreading it, it actually does nothing to prevent healthy people from getting the disease," said the report.

For the past 2 weeks, I've started 'yelling' at my students who were coughing to wear masks in class... and if they refused to comply I threatened to send them out of my class into the corridors. And I've also started telling my students to distant themselves... not that I succeed each time! *sigh* Plus I seem to be disinfecting my hands all the time at work also....

So, this mid term break is a real welcomed break... fasting begins during the break too! Hopefully people won't be falling sick! Selamat berpuasa....

An update... (25/08/08) From The Star, Ms Chai's death was reported by the Minister of Health and he said she was from a high risk group. I looked at her photos from her students' blogs... either she must have gained lots of weight before she died or everyone of us is also obese. Plus the daily updates from the MOH's own web (for 24/08) page also did not indicate any other underlying probs. And I wonder too how transparent the gahmen has been with the reporting. And today's news too.. the police pooh-poohed the content of the surat layang about the misconducts of a MACC superior in the Teoh Beng Hock case. Tell me..... they grilled him like 'crazy' over RM2500 (was it for the purchase of flags) but treat someone with the RM20 over million mansion with such respect that they find no fault.... something is very wrong. And this is probably just the tip of the iceberg... dig deeper, there will probably be more worms... lots of stinking worms.

H1N1 and School Exams...

You know why H1N1 is having a field day in many schools? Cos it's exam season at school now. Internal exams, mind you. Not the public ones! Student presents flu-like-symptoms; fever, cough, running nose, sore throat. Now what is he supposed to do in this H1N1 season? The DG of Health has said... best to take 7 days off so that others don't get infected. Stay away from others! But do you think this sick fler can do that? Nah!!

What do you think the school heads are telling the students? "Fever also must come school because it's exam. If you don't come, you'll get a zero!" So, students get worried. They go see the doc, take their medicine, suppressed the fever and go to school and infect their classmates. I had a class this morning and coughing and sniffing among students were going off like a symphony! All because the Headmaster and Principals say they must go or else. Ministry of Health and Ministry of Education cannot work hand in hand!

You tell me.. we all crazy or not. If this had been a more virulent strain of virus... most of us would be dead. And exams won't matter to dead people. I wonder whether these HMs and Principals would continue to go to work if they have a fever. And many of them have underlying problems too.

Last week, a teacher in a neighbouring school died and it kinda shook many of us up. He had fever the week before. It subsided and he went to his school's motivational camp to give a talk on his subject. Two days later he was dead... the private hospital he went, but never even managed to get diagnosed, ruled that it was probably a heart attack. Now, this was one of the guru cemerlang... highly in demand for talks at this time of the year... SPM is around the corner. He had been very busy going around. Did H1N1 had something to do with his death? I don't know. But all we know is he had fever and some of the students and teachers who were in contact with him at the motivational camp he attended a couple of days before he passed away have also developed fevers. I think he underestimated what the flu might pushed his body to react.... May he R.I.P.

Later in the day, I read in Malaysiakini that a teacher had died in a prominent school in Subang Jaya. At least the parents are demanding for explanation.... despite denials from the school and all that! Just take a look at measures at schools... they are shockingly lacking; from hygiene to lack of concern from the admin.

Well, this virus kinda punishes your body heavily... you don't get enough rest, I guess it could do you in. Lately, people have been paying more attention to deaths.... not that deaths don't happen everyday. But all of a sudden, everyone is more interested why a person died.... and if fever had something to do with it... then everyone gets more worried. But it still doesn't make them do the sensible thing. Strange isn't it? To be fearful and yet not able to do the right thing? Kinda reminds me of those people who spout holy stuff from their mouths all the time but cannot live up to their 'spoutings'.

It's natural to die... but to die from something preventable like flu... to die because of the incompetence and idiocy of the people who are supposed to know how to make the right decisions.... well, that's stupid right?

So, HMs and H1N1... you see another set of idiocy... It doesn't end there cos when it gets down to the parents, they are also unable to do the sensible thing. They send their children to school in their state of unwell, fever suppressed by panadol to sit for their exams cos they don't want their children to get zero... another set of idiocy.

Then there is another set of parents whose children are sick... they say their children want to go to school... they cannot stop them... two sets of idiocy here; both the parents and kids. Kids; understandable cos they don't think quite straight. Parents don't seem to see that their kids don't think straight these days. I think parents treat kids too much like adults now.... letting them make decisions which they are not ready to make. Between desires and the sensible thing.... which one will a kid gravitate towards?

I'll digress and talk about another set of idiocy.. school trips and camps. Is it wise to have it now? I think not. But there are many who feel that the camps should run as usual... in-house training run as usual... all the congregation of people. Trips too... you put everyone together and infection will spread... again no brainer. Again another set of idiocy.

See? We are all idiots! Idiots cos the sensible and right thing is so clear to see yet we don't have it in us to see to it! The undoing will be our own doing!

H1N1: Our Percentage Is Falling....

I thought I'd better jot this down before I forget. As of today 65 deaths out of 4225 confirmed cases. Just did a quick calculation... mortality rate is now 1.5%, down from the earlier 1.7%. Don't know also whether the upcoming by-election has a hand in this? Come election, gahmen solves everything...

Should this new figure be a cause for celebration? Possibly 80 000 people infected but falling death rates. Our statistics will be catching up (down) with the world statistics soon. Who knows, maybe even get to Hong Kong's 0.3%?

Ever since Lim Kit Siang highlighted this figure thingy, the percentage has been inching downwards.... he sure managed to get the Ministry of Health to buck up... either that or our data is not accurate! Some people say all H1N1 related deaths are reported (but our Ministry trying to give a very telus impression). But this is Bolehland. You figure out!

And finally, today the free 3-ply masks arrived at my school for the staff. BTW, our morning assemblies still run as usual. I guess there are some of us who feel that 'lumping' the kids together even with the flu outbreak is too important to give it a miss. Duh! Any brains in it, I wonder.. Virus transmits in groups... assembly is not exactly a smart thing to do. Or they think they can do a hit and run thing... quick assembly, virus no chance to transmit. No brainer!

Update 19/08/09.... read this for the latest mortality rate which is said to be 0.007%. Am curious to know how this figure is arrived at?

What Does H1N1 Tell Us About Our Leaders?

You know in a time of crisis that we are faced with now... one of the things which would make a big difference would be the type of leadership we have.... at every level. So far, this is what I see.

1. Our leaders say the development of human capital is the way forward. What about preserving the human capital we already have? Many doctors, nurses, lab staff, hospital assistants are already stretched to the limit in this current H1N1 epidemic. I find it surprising that not all the staff are given the N95 masks to wear. The 3-ply mask is what's being used mostly as they also are short of the N95 masks. I find it appalling that the heads don't watch out for the welfare of these frontliners. If these frontline workers were to be incapacitated, then the rest of us would be at the mercy of any advancing diseases.
2. Hospital staff are stretched to the limit. Many of them are working longer hours than usual. Soon, many will be without adequate rest which will lower their immune system. These people need to be taken care of. Hire more contract doctors if necessary. Postpone all elective surgeries and other appointments which can wait and channel the docs from the other disciplines to helping their overworked colleagues, especially those in the Medical and Pediatrics. We cannot afford to have them succumb to the disease. Yet such concerted efforts are lacking in many of the hospitals.
   
3. Leaders in the hospital show no seriousness in overcoming the current pandemic. Family members, from young and old walk in and out of the isolation wards. No effort is put into stopping them. Very minimal effort also to get the message across to these kampung folks the gravity of the problem. Everyone wants to play the nice guy. So, rules are bent even when it is detrimental to the public's health. It's as though they are expecting divine protection on all these visitors. Again poor leadership!
   
4. I find it disappointing that a week plus after the statement that some RM2.6 million had been set outside for the purchase of thermometers and masks for schools, we still have not seen them. Most schools are still without adequate protection. And the Education Director General said that students were supposed to wear masks starting from the 11th of August, according to this report from the NST. Why is it taking such a long time for this to be implemented? Temperature taking? I don't see it happening where I am yet.
   
5. Then the leaders inform the public that anti-virals have been made available to the GPs and private hospitals. The real situation is right now even if you have the money, getting a ready supply of the anti-virals would prove to be a tricky affair. It's still best to take your chances at the General Hospitals if you are made really ill by the H1N1.
6. Meanwhile the figures continue to rise for infection and mortality. Instead of organizing political ceramahs, these leaders should be going into the kampungs to giving ceramahs on the importance of practising good hygiene, the dangers of the disease, etc, etc.... Yet we have UMNO trying to organize a 10 000 gathering in Johor... their time and resources would well be used to educate the public on the dangers of this flu.
7. Passing the buck... leaders are quick to claim credit for the good things and also grabbing what they can for themselves and their cronies. Yet in this crisis, I see a lot of passing the blame. They say the medical practicioners are at fault... how can you blame a Medical Officer for missing out on some of the cases if it's the 150th patient he's seeing and going without sleep the night before because he had been working the whole night? What has the 'leadership' done to reduce these overworked docs?
8. You get the impression that the leaders don't know what actually is going on and they seem to be shooting blanks. For example, the DPM said they are considering announcing the hotspots for infection... and a day later he said it wasn't such a good idea. Do their homework first. What hotspot? The whole country is the hotspot. What they do best now is talk and more talk and even more talk? RM3 million has been disbursed for masks, he said. Well, I haven't seen them in my school yet. And neither my son's. Sometimes, I don't know whether they are telling the truth. There are thousands of schools in the country. Who is to know which school has been given masks? Accountability, integrity, honesty... among the mark of good leaders somehow seem to be missing.
   
9. Then the couldn't-care-the-least attitude by some of the docs... many from the other departments prefer not to answer to the 'call-of-duty' as it will also expose them to the hazards of the flu. Many rather be the proverbial ostriches and remain in their corners.... the call the serve is greatly diminished in many younger docs now. Why not? Our education system is to be blamed. Moral absolutes have been bent for years and they are the products of that system.
   

Failed leadership.. that seems to be what we're experiencing for the past years. Decisive, good and strong leadership is something that is so sorely missed right now when we are faced with this tiny viruses which seem to have a mind of their own. If it's a man, you can organize a rally or demo or ceramah to push your agenda. With this virus... tough luck!

H1N1: School Closure A Last Option...

This is from today's NST... Anyway, picture this.

Sick people waiting for up to 7 hours before being seen by the hospital assistant (HA) or doctors. The docs, nurses, hospital staff, hospital cleaners are too swamped right now... The same patient, after being seen, goes back with the medication. Next day, the patient goes back because the fever is still high. This time, he waits another 6 hours to be admitted... because the queue is long and there seems a shortage of beds. Rooms meant for 4 patients now are filled up by 8. And there are lots of hearsays going around.

And where do most of the infections take place now? One of the places is the school. We're seeing a domino effect.... one student after another, one class after another... and it's compounded by the exam season. The UPSR and PMR trial exams... soon to be followed by the SPM and STPM..... so students are compelled to go to schools, therefore compounding the problem. The virus is having a field day in a field made available by institutionalization.

I've been seeing so many of my students falling sick these past 2 weeks. It does seem so out of control and worrying. They have brought the virus home. I supposed in the next 2 weeks we're going to hear more cases involving the family members...... and this is only from my perspective.... from a small school in the suburbs of Alor Setar. In Labuan, the Health Director says 90% of those infected were students. Well, this is now... in a week or so, it'll be a different group.

A lot of talk about telling people not to capitalize on the current epidemic.. masks going at super-inflated prices, digital thermometers now gone up another notch too, old stocks of anti-virals given an extension of shelf-life... human nature is such that they will capitalize.. no point telling them not to.

So, school closure a last option... there should have been a closure, perhaps at the beginning. Maybe not nation-wide but state by state... school by school just did not do much good. But it is always easier to reflect on hindsight. We always lack the courage to take the drastic measure upfront because of so many reasons. Decisive leadership is something that is very lacking now. The Minister says schools can only be closed if too many students or teachers get the infection... wonder whether the Minister realize also that there are many teachers who have underlying health problems.. and also those who are beyond their first trimester of pregnancy.

Anyway, check this blog if you want to know what is happening around the schools in the country where H1N1 is concerned. It probably contains more info than your mainstream media. By the way you may want to also check this out; from BERNAMA. You'd wonder where our news editors put their brains. Propaganda spin doctors work too when there is pandemic!

Right now, it feels like the virus is on a rampage. True, 98% of the people do recover without the need of hospitalization.... but you wonder how much under-reporting takes place, because this is Bolehland we're talking about. Report too many deaths and the economy might be affected. It all boils down to $$$. Everything can be compromised... just take a read of the PKFZ fiasco.... Ministers, leader of the backbenchers club, MPs... from the left hand to the right hand... and they make it sound so okay. So, take a moment to wonder, would you trust them to do the right things?

My two sen of ramblings... At lunch time today, announcement of another 7 fatalities... that makes it 51 now. BTW, they say it takes 3 weeks for herd immunity to start and 3 to 6 months for this flu to peak. Our Culture Minister also says not to have an alarmist approach to this whole flu thing. Then I'd like him to make visits to the hospitals to see the situation.

The Idiocy Arising From H1N1

38 deaths with 2253 number of cases (yesterday's data at 12 p.m.).... that's the number to crunch for today. And if I do my arithmetic, that means a 1.7% mortality rate. The Spanish Flu had a 2.5%, I think. And with that also it took 50 - 100 million lives. Is that figure big enough? Well, WHO says the worldwide mortality rate stands at 0.7% at last check. Which means that ours is more than double the world body's. Singapore has almost the same number of infections like us but with only 9 deaths, which translates a rather low rate. So what is wrong with our statistics? We over reporting or under reporting? Our health care system not up to par?

And the gahmen keeps saying they have it under control. Information comes sporadically from either the Health Minister... whom some are saying he's very 'soi'(unlucky) and the DG of Health. Not much from the docs on the ground. We surely must be adding on to the world's percentage. And this adds to more paranoia. And we are also denying those who truly need the medical care the attention they need because the hospital waiting rooms are now full of people with influenza-like-illness (ILI). Chaos is indeed reigning cos the hospitals are swamped with people with flu-like-symptoms. *sigh* And the poor staff are all overworked!

In the news today, the PM says they are going to launch full scale education of the public.... when the spread is now swinging ahead full steam. It's a bit late now but I guess something is better than nothing. The PM should visit the GH(s) to gauge the situation...

And schools... let me begin with the ghost called Kiasu (Hokkien for afraid to lose out) who prowl the corridors. You see Kiasu is found in the parents and teachers. Kiasu parents send their sick children to school to sit for the exam. When you explain to them that their kids are infectious, they tell you the exam is very important. As though they can tell the virus what not to do. So their kids go to school because they feel their kids seem to be able to cope with the disease. Even if it's not H1N1, good practice should be the way to go.... but we have this tidak apa attitude.

The idiocy stemming from this... they forget that there are kids who might have underlying problems at school. They forget that there are kids with grandfathers and grandmothers at home who are susceptible to the disease. They forget that there are kids with family members with other underlying problems. No! These Kiasu(s) don't give a second thought to all these. All that matter is their kid can go for the exams/tests!

Then teachers tell the sick children.... "Come to school, take the exam. You can go back immediately after the exam." I wonder whether the school has this special ability to stop the virus from finding new hosts. Idiocy arising from H1N1... parents and teachers. Hello! Don't these people read the WHO recommendations... and that the kids are infectious for up to 8 days! In Singapore, they automatically hand you a 7 day leave if you balik from overseas or exhibit any symptoms! That's how serious they take this pandemic! We treat this pandemic as if we are taking a stroll in the park. We don't bat our eyelids when 10 month old babies die because of the flu, or 20 year old seemingly healthy college kid is found dead in his hostel because of the flu. It's a good opportunity to teach social responsibility... not just I want.. I want mentality. But we don't bother...

Kiasu is followed by another ghost called Kiasi (afraid to die). You see this Kiasi Ghost will take the sick child straight to the doctor after the exam to be treated for the fever which of course will naturally rise after a couple of hours of exam (when the fever is suppressed by the medicine)... body already stressed by virus... stress some more by the exam. Then the Kiasi will ask the doc, "Doc, you think my child can go for her exam?". Doc says better rest.. Then the Kiasi says.. "But exam very important. Maybe I send her and pick her up immediately." And the school complies, even encourages it.... sick children come to school, other children become sick. If that is not another idiocy... then what is! Exams won't matter to dead children, you know!

Civil society?? Still some way to go! Kiasu, Kiasi.... we used to laugh at the Singaporeans. We are no better than them! Look at their figures.. only 9 dead compared to ours. And their infection started way earlier than ours... H1N1... It has really shown us what idiots we can be! I am ranting and raving a lot on this, I know.. but really beh tahan at our lack of responsibility and the lack of social responsibility!

Anyway read this pekeliling from the Pengarah Kesihatan.... arahan dan nasihat sudah diberikan tetapi nampaknya ramai yang tidak kisah! And they don't want to close schools cos ini akan menganggu proses pengajaran & pembelajaran. Look what the Mumbai authorities did. Read here. Even the ghost of Kiasu is in our gahmen. Let's hope Kiasi come visiting next. Then maybe they'll start thinking about closing the schools to break the cycle of infection. Thankfully, H1N1 has not been that virulent.

There are plenty more idiocies... demands that workers be paid full if they fall sick. Small industries cannot afford that. Banks whose workers want to don masks but not allowed by the management because it is seen to drive the customers away. I supposed they think their staff should gadai kesihatan (nyawa) for them.

Oh ya! Sick secondary kids skip school but then go for tuition. Why? Cos school can afford to miss but tuition cannot. So, in the end, H1N1 becomes an excuse not to go to school, just a mere excuse cos they still go around not giving two hoots whether they infect others. It gets a little depressing seeing all these from us, the so-called civil society!

A little social responsibility from everyone... that would probably work well... think a little more for those around you; that also would probably work.

Update 14/08... this is from The Star. The mortality rate stands at 0.1%, says the Minister of Health. How did the people at the Ministry come up with that? Isn't 0.1% the mortality rate of normal flu? Did the statistics improve so much in the last two days? Did we have a huge spike in the number of infected in the past 2 days? Or this is just.... Malaysia Boleh at work? Anyway, check out the comparison of mortality rates in our neighbouring countries.

Why H1N1 cannot be contained?

In the first place, should H1N1 be contained? Should it be allowed to run its course? .... since many people laugh it off as just another harmless flu.

Well, schools are hotbeds for infections, and a very conducive one, if I may add. Confined and cooped up together for more than 6 hours together, it's not hard to see how infectious diseases can have a field day. Everyone rubbing shoulder (as in literally) to spread the disease! And kids are least likely to stay clear of each other.

So in a pandemic such as the one we're in.. our educational institutions would be the hotbeds for them to spread. Alor Setar has not been spared from the H1N1 spread too. The hospitals are full... the clinics too. People are worried. I am too. This wave of infection came about after the higher institutions closed due to H1N1. And the fully infectious people were sent home, back to their kampungs. The virus travelled with them. That helped sped up the infection rate. What were the people up there thinking?

Plus at some schools the measures just don't quite measure up. Students who are sick are not checked for their temperatures... the MOE's promise of gadgets to check temperatures still has not materialized. In some cases, the sick students are just left to mingle with the well ones. Masks are encouraged in some schools but students are not taught how to use them properly... in the end, the masks become a source of infection as well; as happened during the SARS outbreak. And you cannot expect small kids to use the masks and not be scratching their noses. Somehow the nose seems to itch a lot when you don a mask.

In my school, the absenteeism rate has been quite high... add that to the fact that the recalcitrant students are taking this opportunity to skip school, it's hard to know the actual figure. But going by just where I am and also those schools that I know of... I'd say many people are sick. I've not seen so many students falling sick at one time.

And how to contain too also when parents are more concerned about their children sitting for their tests (it's test season now). So, those with sick children let their children go to school. You know what they say... never mind, send them for the exam then we take them back. Even when their children are sick, education comes first! Can you beat that? Another Malaysia Boleh! We 'perah' our kids to the limit also? I find it so prevalent in my gal's school. Exams are like do or die thing. We are selfish cos we do not think that our children may cause other kids to fall very sick.....

So, those who are not sick catch the infection from the sick ones. The teachers also sow ignorance... cos they ask the sick kids to come to school to take their exams; how to contain? The vicious cycle perpetuates itself because of our kiasu-ness; all for the fear of missing out tests, that their kids are losing out. Wonder, wonder.... but while wondering I've decided to take my lil one out from school for a while. It's a difficult decision as it will affect her overall position... and she'll probably drop to a worse class.

And the increasing death toll (the DG says that is also expected to rise given the high number of those down with pneumonia in ICUs all over the country) does seem to paint a rather worrying picture. Today it stands at 32. Of course there are other diseases which kill but right now this cloud seems bigger. And also natural disasters. The Typhoon Marakot in Taiwan in one blow buried more than 500 under a mudslide. More lives lost there in couple of minutes than a month of H1N1!

Anyway, H1N1 can't be contained as long as we have this tidak-apa attitude. Either that or we wait for the virus to run its course... that's from my narrow viewpoint! BTW, the Chinese government says if there is a second wave, it'll most likely hit next August. Beats me how they came up with that assumption. Maybe they know something we don't.

H1N1... It's Everywhere!

Picked this up from Malaysiakini... according to the President of Malaysian Medical Association, 95% of the influenza-like-illness (ILI) is now due to the H1N1. Question is whether it's the AH1N1. H1N1 is everywhere! And the MOH has also announced that they will not be reporting the number of infections anymore. Another sign that the virus is out of control.There is nothing much the authorities can do to contain it.

This is a rather interesting video which I came across. It is a bit over-sensationalized but it's also rather informative. It was done in response to the H5N1 or avian flu. And oh! Might I also add that it can be rather depressing as well. But I believe we need to understand what we might be up to. And also the adage prepare for the worst, hope for the best.

After all, the Spanish Flu (1918) came in 3 waves and the first wave was relatively mild. The second wave, however, was so lethal that it together with the subsequent 3rd wave (all over a period of 18 months) took tens of millions of lives worldwide. Some estimates put the figure at 80 - 100 million people. It was a flu with a profound virulence; one could die within hours of being struck by it.

We do not know how to handle a pandemic like this, despite the advance technology that we have. Our greed stops us from taking drastic actions to stop the virus in its track. According to the CDC page a person can remain infectious for 8 days or more, 1 day before the onset of fever some more. Sometimes I think, we beget our own destruction cos we don't seem able to make decisions to save ourselves.

What have our authorities done? Basically they've been trying to placate the people. First they say, everyone can ask for a swab to be done. Then they said no. It's just not possible. We've been reading about 1000 people waiting to see the doctor (get their swabs done) at the Sg Buloh Hospital. Don't think so they can cope. So, they tell the people it's okay to go to the GPs....

More recently they said Tamiflu will be supplied to the doctors... Indiscriminate dispensing (which the private practice is apt to do) will only render it useless in time to come. In Mexico and Canada can be bought over the counter it seems. Anyway, with the mutation that is likely to happen as with all the flu viruses, it remains to be seen whether Tamilfu will work. Our DG seems to be making statements like a politician... first no rapid test... now encourage the use of rapid test kits; swinging back and forth. Wonder whether he's eyeing a career in politics and now he's practicing.

Anyway... 95% of flu-like-illness now seems to be caused by the H1N1.... only let's hope there are no other ensuing (and profoundly virulent) waves coming next, if it's the A(H1N1) they mean.

Update (9/8/09): Death toll at 26.These coming from earlier deaths which were not confrimed. And which also means that the number is most likely higher than what is stated.

More on H1N1...

Schools have obviously received instructions from higher authorities regarding this matter. So this morning, an announcement was duly made requesting teachers in their respective classes to send students with symptoms of flu to the office. The reason was so that letters could be issued to them to seek treatment at the hospital.

By the end of the school day, we had sent around 20 students home or to the hospital. I went to pick son up later at his school and he told me that they sent back more than 40 students! Theirs was more stringent. Those with only cough were sent back too.

My school is a small school... around 700 students. So, I was kinda surprised to find that on a given day, so many are actually sick. And today also happened to be a day with high absenteeism rate because it is the last day of the week and that there are some who are not well. Flu season to blame or H1N1 or fruit season???

With one student in the hospital still under observation, I guess you could say that many of us are rather concerned. But I am also aware of the fact that so far there are many other diseases which kill more than H1N1... diseases like diarrhea in Africa which claim more lives every year, the common flu which takes 250 000 - 500 000 lives each year. What I also do know is this... the pharmaceutical companies (face masks), vaccine companies (new H1M1 vaccine to hit the western market in October), anti-viral (Tamiflu) companies are making killing themselves! Sometimes I wonder, isn't a little panic like this good for their business?

Plus I think we are basically quite clueless as to how to deal with something of this magnitude... in the morning I had the privilege of watching one of my bosses at work. You know how she checked their temperature? She stood in front of them and touched each student's forehead with her hand... One of them could have just coughed right into her face... guidelines if there are just don't seem to register...

Infectious Disease and the Malaysian Mentality

It's flu season... this season, we've a new 'kid' in town - the H1N1. It's one of those topics that creeps into conversations now. Though the seasonal flu kills more than it, we still do not know exactly how lethal it might be.

And this another interesting piece of news from mainstream papers. It seems the Deputy Education Minister says students will have their temperatures checked before entering classes... Interesting to see how this develops cos the politicians seem to be releasing 'tak boleh pakai' statements all the time... to show that they are on top of things.

I think it's a good thing to have... this temperature check thing. But I really wonder whether we have the will to see to it. The times when we are likely to see things being done is near election time. Roads get done, street lights get fixed, longkang(s) get cleaned, halls get built, all the 'rakyat-based' things get done. Anyway, I await the execution of this latest 'decree' from the venerable politician.

We're having another round of hand-foot-mouth outbreak again in Alor Setar too. This is the second time this year. We seem to take things lightly. Many parents still send their children to nurseries and schools even though their children are not well. They need to work, their children need supervision. You have working mothers pulling their hair now cos Indonesia still hasn't lifted their maid ban to Malaysia. Childcare is a problem and contributes to the spread of infectious disease! So.. infectious diseases spread unabated. Right now, those of us with younger children tend to be more worried as H1N1 is also around. Those with underlying health problems are more susceptible, we have been repeatedly reminded. Sometimes, ignorance is memang bliss.

Back to H1N1 in season... we tell students not to go to school if they are not well. Some are ill, have flu-like symptoms. Guess what? They still show up at school. At a time when most of us are more jittery, we still get such people who seem to take all these very lightly. So, how can we ever hope to contain all these outbreaks... Lucky us this H1N1 is not as virulent as SARS... dread to think whether we could cope if it had been that virulent. The Nipah outbreak doesn't count as it was not highly contagious like SARS or H1N1.

So, what is the Malaysian mentality with this regard? I dunno... sometimes I think we have this 'what will be will be' way of looking at things... and that we feel that things will take care of themselves.... which they do eventually. Depends on which and whose angle you are looking at it from!

H1N1... Malaysia Entering Mitigation Phase

Last count 8 deaths, including a 51-year-old teacher... and countless infections. I've ceased to believe the number given out by the MOE. The situation was never in control... not even since the first day the 'swine' flu landed in Malaysia.

A friend of mine was in one of the flights with the initial infected... she, being dutiful called the Airlines to inform... anyway, they must have lost the flight passenger list or they just couldn't be bothered. When she told them where she was sitting, they told her they are not sure where the infected was sitting... and anyway, they were only going to quarantine those seated within 3 rows of the infected. See the gaps in the info? Not sure but got quarantine. They didn't think she was seated anyway near the patient. And they didn't even check. That's another Malaysia Boleh for you... but in the papers, they tell you everything is under control.

The gahmen was clueless how to handle this thing.... Our newspapers may give glossy reports of how our gahmen is on top of things but most of their reports tak berapa boleh pakai very often. The hands that control the newspapers and the gahmen agencies are also helpless against this unseen tiny virus. Anyway, those hands are too busy trying to hang on to power! Hence, you have the DG of Health (that Merican guy) saying one thing and his political master (that Liow fler) saying another.

Tis a losing battle we're up against...now it's the little wars we're fighting and we've to win these wars! At school, students are reminded to stay at home if they are not well. Well, they are still coming to school. How to contain? Rumour has it that a neighbouring school near mine has a confirmed case... I wonder if they are going to close the school for a week.... Schools are hotbeds for infectious diseases. 30-40 people cramped within 4 walls with poor ventilation due to curtains hanging everywhere, which incidentally are also wiping cloths... another good place for the germs to hang on; close proximity of the institutionalized form and institutionalization by law (7.40 a.m. - 3.00 p.m.)... H1N1 is a lost cause here.

We have entered the mitigation phase which means that the disease can no longer be contained. Resources are now supposed to be channeled towards mini containments and contingency plans. The virus is out in the community, at large. It's no longer confined to small groups which makes containment possible.

In Alor Setar yesterday, one could sense some panic. People are going to see the docs at the slightest feeling of unwell. Read this for the why. Concerns are arising as there seems to be more deaths from this flu worldwide. There is always the worry that the worse is yet to come. This is yet another site for good information. Check it out! Also a good read... this will explain why WHO is concerned about H1N1.. Spanish Flu.

But if any country which might at least contain it somewhat... I think it's our tiny neighbour down south, the land of kiasu and kiasi. Then again, it has also moved into mitigating the disease but they are mitigating it quite successfully. Because of the experience with SARS they are not afraid to be decisive.

So, looks like H1N1 is set to rampage in Malaysia. Take the necessary precautions! Mitigation becomes easier if each one of us play our roles.

H1N1 has finally landed... in Malaysia

So, we are finally on the H1N1 map - 2 confirmed cases. Problem is it's flu; I guess everyone becomes a suspect the minute they start to have flu. The gahmen says we are prepared... they say they've given out the instructions to those in the health services, both private and public, that they've mechanisms in place, experience from SARS and Nipah, etc, etc...

The thing is, talk to any private practitioner and they'll tell you also that what they know, they get from the mass media or internet. The gahmen has not really done the briefing or whatever they say they have been doing. They give us the impression that they are on top of things... and lull us into complacency as a result cos we think someone is in the know when they actually are not.

Even the US is having a hard time... my conclusion ... since both the confirmed cases came on the same plane from the same place. How did they get on board of the plane? Airport scanners? I thought they say those scanners are supposed to single out those people with fever? Doesn't seem to be so, it seems. I wonder whether the front line people have been given their flu jabs (which actually don't protect against this strain) as announced earlier?

H1N1 doesn't seem to be that lethal as thought to be but WHO worries that it'll mutate. All this promiscuity, the hopping around... viruses mutate to survive! Think Spanish Flu! Anyway, this flying swine flu has landed... mutation of swine, bird, human and what-have-you-not combi. Kinda reminds me of the mutation that Ben goes through in Ben 10. He did 'mutate' to become stronger, didn't he? ... whacked all the aliens and send them running away with their tails between their legs and all that!

Add that to the way our politicians handle things and how our professionals have also started handling things ala-politician style... God help us if it breaks into an epidemic in our country!

H1N1.. epidemic, pandemic??

This is another bolt to jolt us... the last jolt of this like was during the SARS outbreak, about 6 years ago. I remember canceling a trip to the Lion City that year. Fear was everywhere! This round, Malaysia still hasn't reported any case yet, hence maybe many of us might still feel it's not our problem. But it has arrived in Asia, identified in Hong Kong 4 days ago.

This a false sense of security. All it takes is just one case and all hell will break loose here too. Avian-swine-human.... if you think we humans are so connected, that privilege is also shared by the animal kingdom with us. All this mingling of the virus has created a super virus that can kill us. (See, even in the virus world, intermingling of viruses from different animals create stronger offspring... in the human world marriages within family members have been suspect of 'inferior' offsprings. One of the reasons for surnames for the Chinese is so that there is no such union. Very pantang for both of same surnames to marry!)

Anyway, back to the flu virus story. It's something like this.. pig flu virus and human flu virus meet. Result... a super mutated offspring which kills. Same thing happens to bird flu virus and human flu virus ...another super mutated offspring. Then these 'supers' intermingle with each other and we get another super duper flu virus... either way, we humans as well as the animals are screwed. But the thing is as long as the virus doesn't jump from humans to humans, it can still be contained. Cos the host dies, the infected also dies. And the virus 'dies' with them.

The problem starts when the super duper virus survives this jump and starts to hop from one human to another human, sometimes becoming stronger in the process, then we have a pandemic in the making. That was why the Spanish Flu could kill so many, estimated around 50-100 million. And also why when the Nipah virus struck the villages in Negeri Sembilan in 1999, while dangerous,did not turn into an epidemic or pandemic cos the virus died with the host and 'infected'. The Nipah virus originated from the fruit bats... then it infected the pigs, dogs, cats... probably with some mutation along the way too.. and then down the chain to the humans. But it did not jump from one homo sapien to another.

I don't know whether this is panic or opportunity - the gahmen announced that it will give 200 000 frontliners (docs, immigration officers, customs) flu jabs. Some drug company will be making a kill. My imagination ran a little wild the morning I read the piece of news. You know, in this world where greed seems to rule, what is to stop drug companies from starting epidemics or pandemics to make a killing (the $$$ kind)? Sounds kind of morbid and heartless, I know. I think I probably read too many thrillers! But it's a scary thought.

Meat producers, especially pork, on the other hand have been putting pressure for this swine flu to be renamed. After all it's a strain of a 'mixed-union' - bird-swine-human. So WHO has re-designated H1N1 to be known as a strain of Influenza A. Some countries, like Egypt have gone on a pig-cleansing zealousness. They're culling all the known pigs in the country. And it's creating tensions between the Muslims and the non-Muslims. I supposed the next time they have a dangerous bovine disease like the Mad Cow Disease, all cows should also be culled. I feel sorry for the animals.... Man disagree, and they become sacrificial pawns. There is this suspicion that back in 1918, during the Spanish Flu, we may have passed the virus to the pig.

Anyway, all these flu viruses.. they are relatives of each other, though not entirely same. Swine flu basically means there're more swine 'components' in them. Avian flu means more bird 'components'. But there is a strong likelihood that they've intermingled with each other. Scientists aren't too sure. There're no clear trails. This particular virulent strain that is tormenting the world now may not even have a swine component! These viruses are smart! They mutate, remember? 8(

World history is dotted with such pandemics. Russian Flu, Spanish Flu, Hong Kong Flu, SARS and now the Mexican Flu. Scary cos now that we, humans congregate in huge numbers in our creation called the city. Theoretically, a whole city of millions can be wiped out in weeks! Then we read about 1st wave, 2nd wave... lull before the storm kinda thing. Flu viruses also attack in waves. Add that to our kind of mobility now, it can really spread like wildfire. We should be careful.

And why should we be really worried about this most recent one?? Cos the subtype responsible for the Spanish Flu is the same one that is creating the current havoc - the H1N1. And there are some reports stating that our authorities say our flu vaccines also has protection for H1N1 but the thing is other countries have not made this claim. We seem to be the only country in the world in possession of this vaccine which can prevent this flu... don't tell me this is another Bolehland announcement by some want-to-score-points politician? How come there're no reports of such a vaccine being put in place as a prophylactic measure in those countries with cases now? The flu would not be so feared by now too! But WHO went into Pandemic Alert Level 5 ....that's one level below global pandemic. Fodder for thought.