Tuesday, August 18, 2009

Handling The Swine Flu (H1N1): Should We Go The Mexican Way?

(UPDATE : as at 2pm Aug 18 -- H1N1-related deaths, 3 more, bringing the number to 67.)

The statistics of H1N1 deaths threaten to increase. In this current state of affairs, who should we blame?
The health authoritities for not doing enough? Or ourselves, for not doing enough, as well?

Are the health authorities not acting fast enough in the situation, which is an emergency, by any measure.

Should Malaysia go the Mexican way?

"From the moment this so-called swine flu was identified, the Mexican government worked vigorously to contain the contagion — closing all schools across the country, limiting public gatherings and instructing people to wear masks and refrain from greetings involving physical contact. President Felipe Calderón himself led the response, underlining the seriousness of the situation, and that may explain why so many Mexicans have complied. Already, the number of deaths seems to be stabilizing, perhaps indicating that the first wave of this influenza has peaked." -- extracted from This New York Times article.

Mexico’s Deputy Foreign Minister Lourdes Aranda tells Sunday Star in an interview:
"Mexican President Felipe Calderon declared an emergency and ordered the closure of schools, nurseries, universities, theatres and museums until further notice in Mexico City, the world’s most populous city with 24 million inhabitants, to stop the spread of the disease.

The emergency gave the president powers to order quarantines and suspend public events. Football matches in the soccer-crazed nation were played to empty stadiums.

For those who had to go out, wearing mouth masks were a must as “swine flu” fear gripped the capital city.

“The Mexican way of life came to an abrupt halt. Imagine, in a colourful and bustling city, people had to stay home for days. And the president led by example.’

Our Health Minister Liow Tiong Lai has already described the outbreak as a "national emergency". And that's after our Prime Minister Najib Razak said this was a pandemic.

But here's the thing -- Liow said that the government "will only consider declaring a health curfew if the mortality rate goes above 0.4 per cent".

The country's mortality rate for H1N1 is currently between 0.1 per cent and 0.4 per cent.

Any decision to this effect is will teh National Security Council. Liow said it is not up to the Health Ministry.

Liow is aware of the Mexican experience.

But he says, "if everyone plays their role, we should be able to stop the outbreak".

I do understand English. So, my understanding here is that IF we all play our role (which is?), the situation can be arrested. Right?

So, what is everyone's role? The government, the people...

My role is -- and because there is no other official announcement forthcoming -- to make sure I don't contract the disease by washing my hands regularly (with hand sanitizer which I have handy in my handbag), avoiding public and crowded areaand practising social distancing as far as I possibly can, and wearing health mask (I don't always do this). What else, then....?? I could stay home until all this is over.....

Anyway schools are still open. Public and private offices are still open.

So, what's the right decision the government should be taking now?

Should the mortality rate be the only consideration? It's like waiting for more to die before taking the bull by the horns.


Anonymous said...

Read this: "EVERY year approximately 10,000 Mexicans die from the effects of seasonal flu"

I am not surprised if the Mexican health services are more efficient. After all, they have a lot of experience. In the case of Malaysia, we never have such a situation. Deaths from seasonal flu seem to be unheard of.

But of course the govt can’t use this as an excuse.
What can the govt do? Actually a lot:

1. Make the testing procedures more effective and efficient and widespread in the country.

2. Make treatment as easy and as accessible as possible to all members of the public with special attention to those categorized as high risk/ vulnerable.

3. Design a practical and humane quarantine system.

These suggestions require some sort of an overhaul of the health system. It requires the govt to allocate a lot of money (testing procedures are not cheap) and the second suggestion may require an effective and efficient communication system in which the public can call to get advise or treatment, a mobile unit to attend the sick and infected rather than asking them to come to the hospital and inadvertently spread the disease (as currently it takes a long time to queue). For those with mild symptoms, they need to be treated separately – so this requires a separate section of the hospital!

Also a more practical and humane quarantine system has to be developed. The current quarantine system is deeply flawed. For example, the current self quarantine advise is not practical for those living alone and single parents. Imagine if you are a single parent and then you are down with the flu. Can you totally rely on neighbors and relatives to let say bring in food, groceries etc. Can you rely on others to do your children’s laundry etc? Most likely not! In the current situation the health would avoid you and your house.

Hey, I read your other post – you too are avoiding those with flu symptoms!!! Have you ever imagine the feeling of that waitress. You have hurt her feelings. I am sure she did not ask to get the flu! Poor waitress!!!

So in short there are many things that the govt can do. I think the first two is relatively easy provided that the govt is prepared to allocate substantial resources.

The third one is however problematic as it is expected at least 20% will be infected at therefore at any one time there might be a huge number of (suspected) active cases. In this regard perhaps social distancing is more appropriate. Well, I have a lot more to say but perhaps this is not the place to write such a long comment.

Anyway, I do enjoy reading your blog and I do hope you will be blogging more about the swine flu.



thank u for your comment.

about the waitress. yes...of course i was avoiding her, as i would anyone showing flu symptoms. besides, she was wiping her runny nose with the back of her hand, the same hand she was using to dish out the rice (although using the ladle) and the chicken pieces.
yes. i felt sorry for her because her employer (assuming she knew the condition of the waitress) had no sense and made her to work when she was obviously not well. even if she was feeling ok to work, she shouldn't be working given the current health situation. and if she was the one who insisted in working, she should have worn a mask. at the very least.
i wasn't taking chances and so i decided not to have my dinner there.
was i cruel? maybe...but to be kind, so i don't contract any illness and pass it on to my kids.

thanks for visiting.

Anonymous said...

There's a lot the govt can do ... and I'm sure they know what they should do, they're not dumb but just sorely lacking in leadership skills. This is your typical dish of No Leadership served a la Malaysian style. Health Minister says this & that not within our jurisdiction, it's the Director General Merican fella, back & forth. Hello, earth to leaders, can one of you, anyone, take this bull by the horns before we take the gold medal in the global H1N1 death race.

amoker said...

Our mortality rate per infection is already very high and he wants more people to die first before thinking of what is next?

Being prepared is the answer .. in any form. Not having experience before is not an answer. The government hospital are bereucratic about swine flu & people are in q with other potentials.

can tiow describe what happens when we are at 0.4? am sure he can't.

Anonymous said...

Tip to govt -
B4 they take the giant leap of issuing fines of 10k to anyone caught passing the bug, they can 1st take the baby step of say, oh ... perhaps issuing a directive that everyone in the service industry, people preparing and serving food, cashiers at supermarkets... etc. should be wearing face masks (and gloves.)
Yes? No? Do something please. Maybe? Draft proposal & have think tank meeting 1st? Die like, like that.

Anonymous said...

Dear Kak Nuraina,

Thanks for noticing and responding. I have to say that you are so much better than the KKM.

Some time ago (more than one ago), I’ve sent an email requesting for some clarification on one issue with regards to the 7 day quarantine advice for returning citizens. Unfortunately they did not reply even after 3 times I re-send the email.

Basically I asked whether such advice is also applicable for tourists. When the advice first came, it sounds like only citizens returning from swine flu infested countries are advised to practice self quarantine (10 langkah bijak semasa dalam kuarantin). Tourists seem to be exempted. I was thinking that if this is the case, then the quarantine advice is practically worthless as you are only asking for one group of people to practice quarantine whilst letting the others go.

I also would like to know the legal standing of such an advice; given the apparent exemption of tourists from the self quarantine. I was thinking: it is odd for the KKM or Health Minister to invoke Section 12 (1) of the Infectious Diseases Control Act 1988 if locals break or not adhere to the advice when tourists are exempted. If this is the case then the govt and ministry are practicing double standards!

However these questions are now moot. It makes no sense to impose quarantine to returning citizens when local transmissions have surpassed imported cases. In fact as I’ve told you, even the current self quarantine measures are deeply flawed.

Anyway, thanks for replying to my previous comment.


selampit said...

Two days ago I had this conversation with my niece, an undergraduate student at a local university, after I noticed that she started to don a protective mask.

I asked her if she knows the correct and proper ways to wear the mask. Her immediate reply was 'NO'.

She didn't know that once you wear a mask, it MUST STAY WORN. You can't wear it for a moment then take it off, then wear it again. You risk contaminating the mask.

She didn't know that once the mask becomes damp or humid, she must replace it with a new one.

She didn't know that while wearing the mask, she MUST REFRAIN from touching it.

She didn't know that the mask she was wearing is a single-use mask and CAN NOT be recycled like a male bachelor's seluar dalam.

She didn't know that she must tie the mask securely to minimize any gaps between the face and the mask.

And she's an undergraduate student who is TRAINED to do researches for her thesis and such.

And WHO stresses that incorrect use of protective masks actually increases the chance of spreading infection.

And wearing protective mask is just one aspect of prevention.

p/s: Surgical masks are NOT 100% effective, since the H1N1 virus which is just 80 to 100 nanometers in size, can easily pass through such barriers. The most effective is a special mask called an N-95 respirator.

Wait a minute, WHAT THE HELL is an N-95 respirator?

wishediwaswrong said...


Like you, I'm stumped at the suggestion by the MOH minister that the public should do their part to arrest H1N1 influenza pendamic. Exactly, what's our part other than to see to our personal hygiene and, to the best of our ability, social distancing?

Now let's look at what the authorities have done or failed to do.

Instead of educating the public on the seriousness of the flu they decided to play it down lest we lose tourist dollars. Instead of investing in additional (to the meagre three for the whole country)throat swab machines, they went for the sans test option.
Instead of quarantining school children who caught the flu, they closed schools and allowed the infected to move around unchecked. Instead of issuing brochures and pamphlets and publish information on the do's and dont's they just rely on MOH minister's press conferences which had little educational value. Instead of taking control of the situation, they pass the buck to headmasters to determine whether or not and when to close schools without so much as to provide guidelines and criteria therefor.

And when things don't look too good for the minister to face media cameras the government scare the public with RM 5000 fines for things the public is not too sure about.

What had happened to the-buck-stops-here credo and the people-first, action-now mantra of 1Malaysia?

We've learnt that Iran had decided to prohibit their pilgrims from performing haj this year for the greater good of the ummah. Knowing that social distancing is humanly impossible during the haj, the least the Malaysian govt. can do is to convene a meeting of the fatwa council for guidance of our to-be pilgrims so that later, on hindsight, we wouldn't have to regret that we'd failed to turn the last stone.

Anonymous said...

Don't paniclah,nothing onelah.It will go away itself onelah.Just pretend nothing is happening.

gram.kong said...


Below was my last paragraph of my article 'H1N1: Something Gone Terribly Wrong'that I wrote on 13 August.

'At 44 deaths the Malaysian government should announced red alert before it's too late.We should take cue from Mexico City where the city virtually shut down, closing restaurants, cinemas, sport venues and other public places in a bid to contain the disease'

The Malaysian government is acting irresponsibly by not taking drastic step to contain the disease.The public are not making an effort to protect themselves because of our government apathy.

This kind of pandemic is seasonal and the best way to contain it is to stop the contagion from spreading and the only way is to discourage people from going to crowded public places.

By now Malaysia should be on red alert.I wonder whether the government understood the seriousness of the pandemic.

Atat said...

Dear Nuraina,

I posted a comment on the H1N1 a couple of weeks back when the girl died at the Melaka hospital. I was near the ICU ward because I had a relative warded there.

I took my father to a General Hospital located in a different state last Monday - no difference.
H1N1 suspect are still being treated in the same place as the ailing senior citizens and children.

I was worried sick taking my dad to the hospital but he was so ill, I had no choice and I definitely risk exposing him to the flu. He can't walk, I had to get the wheel chair (and it did not look clean). The seats in the hospitals did not look clean as well and since H1N1 suspects are all placed in the same area this contact issue cannot be addressed proper.

This is my view: Remove the daft Minister and the DG and find someone better to do the job!!!

Really, what did the Govt. do to ensure we are safe. Many people do take precaution - many can't breathe behing the mask also - I can't as well (but since the virus is not airborne but could be transmitted from airborne droplets from sneezing and coughing I don't understand the greater advantage one gets from donning the mask) and many do wash their hands and try as best to keep themselves clean but still one can do only so much but the Government must do something and not just give live chats -talks.

For children at school this is diffcult and teachers risk being expose since they come in contact with hundreds of school children, people working in the service sectors are expose because you can never be too sure of the person coming to seek service.

I am terribly sorry but I am very angry - if there is any move to demonstrate for better action from the Government - this I will march the streets.

I think Chua Soi Lek would have done a better a million times better!!