Friday, August 14, 2009

More H1N1 Deaths / The Spread Continues....

...and the Flu is here to stay for at least a year, according to our medical authorities.

Seven more people infected with H1N1 or swine flu have died, bringing the toll related to the virus in the country to 51.

The Health Ministry said in a statement today the seven patients died over the past week and all had other health problems, such as diabetes, hypertension or weak immune systems.

Among those who died are two boys - one aged 4 months, the other 4 years. Malaysia has reported more than 2,250 swine flu cases since May.

As you already know, this is a pandemic. We are no longer in the containment phase, and have moved to the mitigation phase. This means that public health officials have conceded that the H1N1 virus is too widespread to make containment a feasible consideration. It can no longer be contained.
So, local health authorities are now focusing on treating those badly afflicted with the disease.

So, we can't stop the spread. It is now really up to us to make sure that we do not get infected by taking preventive measures and precautions ourselves.
Practise social distancing -- that is keeping a physical distance from other people to slow down the spread.
Avoid crowded places and take better care of our personal hygiene such as washing our hands regularly (with alcohol-based hand sanitizers).

I know we've been deluged with all sorts of materials on the Influenza A and the measures we should take.
Here's just a reminder because a lot of people are still so laid back.

Just the other evening, I was at Rasta in Taman Tun Dr Ismail with a friend to have dinner. After we sat down, the usual bevy of waiters/waitresses descended upon us. Onewaitress (from the nasi ayam stall) was sniffling and wiping her nose with the back of her hands. We didn't realize it at first, until after we had ordered our nasi ayam.
We could see that she was not well. We looked at each other, concerned.

"I think we should cancel our nasi ayam. The poor girl is not well and she's preparing our food," I said.

We turned to look at her and could see that she was wiping her nose with her hand constantly, and sniffling, while dishing out the rice.

Not on, we thought. And canceled our orders. And everything else and quickly made an exit.

For employers:
  • Encourage sick workers to stay home and away from the workplace, and provide flexibility.
  • Encourage infection control practices in the workplace by displaying posters that address and remind workers about proper hand washing, respiratory hygiene, and cough etiquette.
  • Provide written guidance (email, etc.) oninfluenza A (H1N1) flu appropriate for the language and literacy levels of everyone in the workplace. Employers should work closely with local and state public health officials to ensure they are providing the most appropriate and up-to-date information.
  • Provide sufficient facilities for hand washing and alcohol-based (at least 60%) hand sanitizers (or wipes) in common workplace areas such as lobbies, corridors, and restrooms.
  • Provide tissues, disinfectants, and disposable towels for employees to clean their work surfaces, as well as appropriate disposal receptacles for use by employees.
  • One study showed that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface. To reduce the chance of spread of the l influenza A (H1N1) virus, disinfect commonly-touched hard surfaces in the workplace, such as work stations, counter tops, door knobs, and bathroom surfaces by wiping them down with a household disinfectant according to directions on the product label.
For employees:
  • Stay home if you are sick. If you have symptoms of influenza-like illness, stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Keep away from others as much as possible. This is to keep from making others sick.
  • Employees who are well but who have an ill family member at home withH1N1 flu can go to work as usual. These employees should monitor their health every day, notify their supervisor and stay home if they become ill. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitizers* can be used if soap and water are not available.
  • Avoid touching your eyes, nose, or mouth. Germs spread this way.
  • Avoid close contact with sick people. If an employee suspects that they have been exposed to a sick person with novel H1N1 influenza they may continue to go to work as usual. These employees should monitor their health every day and should notify their supervisor and stay home if they become ill.
Lastly, stay healthy, maintain a healthy lifestyle. Remember that out of the thousands who were afflicted, many survived.


Anonymous said...

Do you notice that the number of positive cases and the number of deaths have double since thousands of opposition supporters gahthered in the KL city to demonstrate against ISA?


Unknown said...

"washing our hands regularly (with alcohol-based hand sanitizers)"

I'm starting a pool in the office to wager on whether some dumb "alim" guy tries to get you caned for this, hah!

Anonymous said...

10 deaths in Pune - Mumbai closes down all schools and theaters for a week.
One death in Hanoi, Vietnam closes schools for a day.

56 deaths in Malaysia .... and counting.

Anonymous said...

What about the role of prophylaxis?

One sure way of preventing any kind of infection is by avoiding the causative agent/s from entering a human body.

In pandemic situations the above condition (free of infection) is almost impossible to achieve no mater how extra careful and knowledgeable any individual has on the whole issue! So what is next?

Yes, people may consider taking prophylaxis. Hopefully some antiviral medication is effective enough to prevent us from getting

The question are:

In the context of H1N1, is the currently available antiviral drugs really that effective as a chemoprophylaxtic agents?

The cost of an antiviral drugs are so expensive as such not many individuals, families, employees or employers can afford it. How to make it affordable?

Suppose chemoprophylaxis really that beneficial in the present stage of pandemic H1N1, is there any practical solution that could be established to reduce the cost of medications (either thru' subsidy and etc)?

If this part of a strategic aspects of combating and mitigating the process of infections by having a broad co-operations of the whole world becoming somewhat cost-effective, can we say that it would contribute significantly towards the noble aim ie that is to rid the world of H1N1?

Thank you,


Anonymous said...


Dalam keadaan darurat, ditimpa bencana atau berhadapan dengan musibah seperti pandemik selesema babi, selain usaha yang disenaraikan oleh puan itu, diharap jangan tertinggal satu lagi aspek yang penting iaitu spiritual.

Aspek spiritual bukan saja penting ketika berlakunya wabak besar Influenza A H1N1, malah sesudah itu. Sekiranya peristiwa Tsunami di Aceh dijadikan analogi, ternyata aspek ini (spiritual) telah banyak membantu para mangsa yang terselamat pada ketika kejadian dan sesudah bencana tersebut berlalu.


Anonymous said...

I feel some among the authorities involved in preventing or rather containing the AH1N1 are lacking big time in their supposed responsibilities.
Just do surprise checks at our entry points like airports.
Personal recent experience proved the absence of any form of scrutiny or effective awareness campaigns/actions.
Even facemasks are purely personal responsibility.
Maybe we should focus more on utilizing the existing government and related agency mechanism to ward of the epidemic rather than the vaccine.
Just do it based on the JE action plan, and get the professionals to do it.
Start with the airports, one of our main entry points. 'TIDAK APA' seems to be lurking at our doors.
The Minister of Health should buck up or risk giving up his portfolio.
What are we waiting for, a disaster kind of situation?


Unknown said...

I saw on tv yesterday an idiot, who was talking about something called 1Malaysia and not actually to my horror because I expected such things from the kind, there were many school kids at that whatever celebration. Some were in mask and many were not and to think that there is H1N1 spreading. What were in the heads of the idiots who organised that stupid gathering.
This is what shits me with our leaders. Do they care? Don't say, that the gathering was planned earlier and precaution was taken.
Hell don't they know that gathering at this time is the most stoooopid idea? Don't they now that getting school children to participate in this stupid gathering is totally irresponsible and definitely unforgivable?

Anonymous said...

When i was in primary school in the late 70s, we have kelas kesihatan. Apparently, most learnt nothing from this subject. People cough openly, throw rubbish every where, spit and clear their nostrils in public, eat and drink in lrt, employ unhygenic foreign workers, etc. Very few wear mask in lrt or shopping complexes. When the govt, via the media started to educate the public on kesihatan matters, it is actually an insult to our people. And rightly so they ought to be insulted, because they don't bother about basic kesihatan matters. The government should start listing dirty areas to the public, for both residential and commercial areas, so that people will avoid these places, and the residents will be put to shame. Municipal enforcement officers should book those who behave unhygenically in public. Aren't they supposed to do that?


Anonymous said...

JUst close all schools..

And ban all gatherings that are not important...

Enough...dont play with people's lives...

These MOH guys are a joke...

selampit said...

Recently Health director-general Tan Sri Dr Ismail Merican told the Malaysian public 'don't panic' following the growing number of deaths due to H1N1.

After all, ONLY two H1N1 patients out of a hundred had died. A lousy mortality rate of 2%.

Let's see, Malaysia has a population of roughly 28 million. If we would apply the Health Department's figure of H1N1's mortality rate, approximately ONLY 560,000 Malaysians WILL DIE soon.

So don't panic folks!

AndikaryaMaya at 7:27 asked;

"In the context of H1N1, is the currently available antiviral drugs really that effective as a chemoprophylaxtic agents?

My dear Andi, chemoprophylacic agents and antiviral drugs ARE INTERCHANGEABLE TERMS. They're technically the same thing.

Both Tamiflu (Osetalmivir) and Relenza (Zanamivir) are 'neuraminidase inhibitors' antiviral drugs that can also be used as chemoprophylacic agents.

And since both pharmaceuticals giants 'Roche' and 'Glaxo' refuse to lift their exclusive patent rights to allow other drug manufacturers to produce cheaper generic versions of Tamiflu and Relenza; the word 'afford' is more appropriate than 'effective' I reckon.

Anonymous said...

Good time for all and sundry to stay united. H1N1 proves many things but the most important is, shelfishness do not make any group's survivability any better as compared to others. So let's promote a new thinking paradigm: that anyone's ability to survive is an indirect determinant over chances of the others as well.

Peace :)

Anonymous said...

To "apanama"..when the country moves to the mitigation phase, it means the disease cannot be controlled anymore; there is no need to have airport screening. It is more efficient to divert resources to taking care of the very sick.
Its the same with UK and European airports too.

Anonymous said...

India with a population of close to 1 billion only got 11 deaths so far,Spore only 10 deaths and both countries imported the virus way before us.Their govments dclared emergency closed all schools,cinemas,gatherings etc.We have 50+ deaths already (6th highest in the world!-not bad) and only 1 guy take care (health minister) while the rest pergi bemesra sana sini atau pergi kursus.Clearly nobody give a damn.We should have no problem to achieve our target of 28,000 deaths in less than 2 years as predicted by scientists and take 1st place worldwide.Malaysia boleh!

Anonymous said...

This has been informative, thanks.
Also, major concerns which have to be addressed:
for those who have caught the flu:
- all clinics and many hospitals not testing, only a few hospitals have the facility to test. More centres should be set up with testing facilities! Don't you think?! People are dying because they can't get tested (especially in rural areas) & treated on time. Also heard people are not able to get tested at the hospital - its like you have to be practically dead before they will attend to you.
- test results take 4 days. Medication has to be taken within 48 hours ... do the math here!!
- stocks of Tamilflu has depleted. Even private hospitals have no more stock ... no more stock, can you imagine ... are we playing Russian roulette here?
Can some of you reporters please ask the the Health Ministry what steps they are taking to overcome these problems right now?! It's like we are living in an information vacuum here. They are not releasing any data, no stats, no guidelines, no updates .... it's like we are living in Malaysia and they are living on Mars.
Concerned & Angry Mom

Anonymous said...

Japan & Korea now only got 1 death.Asean countries all below 10 deaths so far.Why Malaysia so many deaths 60? The health minister MUST RESIGN now and let other capable people to do a better job or else we are all doomed in 2-3 years!

Really fed-up

Anonymous said...

Not all who gets H1N1 gets pneumonia BUT all who died of H1N1 gets pneumonia.

So, we should focus on how we can prevent pneumonia if we get H1N1….. not how to prevent H1N1.

For those high risk group, getting pneumococcal vaccination is one of the defense mechanism we could use against dying from H1N1. You might still get H1N1 but at least you have a 30% lower risk of dying from H1N1.

Studies have shown here (,0,6872284.story ) that 30% of h1N1 pneumonia related deaths are due to Streptococcus pneumoniae. Getting yourself vaccinated means you have eliminated 30% of the possible risk of dying from H1N1 pneumonia.

Of course, that does not mean you will not get H1N1 but at least you will not die of it… that’s what everyone would prefers. It’s really not about afraid of getting H1N1, it’s more about dying from it……..

So if the government is serious in preventing H1N1 deaths, all those in the high risk group should get pneumococcal vaccination. Also, please ensure that all clinics are able to administer this vaccination to adults as well and not only to the children….

Karen Lee

selampit said...

Concerned & Angry Mom at 6:46

You are right to be concerned and angry.

Presently, if you suffer from mild symptoms of influenza and pay a visit to a nearby local Hospital, you have to WAIT HOURS at the outpatient waiting area before you get to see the doctor. If you suffer from 'mild' H1N1, then you would 'kindly' unknowingly spread the virus to those who sit near you every time you cough or sneeze.

There is NO PROVISION for a separate outpatient unit for those who seek treatment for influenza in government hospitals to minimize the rate of infection.

When you finally get to see the doctor, he or she would probably run basic tests (blood pressure reading, point flashlight down your throat etc)and probably ask you one or two questions.

Then you will probably be given a prescription of a moderate-spectrum antibiotic such as amoxycillin (to combat secondary bacterial infections) and antihistamine. And yes, cough syrup.

Then most likely, you leave WITHOUT any serious test performed on you.

No specimen obtained from you (nasopharyngeal or orophayrngeal swabs), so that they could at least run rapid influenza diagnostic tests (to detect influenza viral antigen).

You see, you must exhibit severe symptoms to get a special treatment, such as signs of respiratory distress in children (rapid breathing, seizures, excessive sleeping, skin and lips turn blue).

In adults, pain in the chest and abdomen, shortness of breath and dizziness.

Hospitals after all, are bound by the TRIAGE rule, which is a process of prioritizing patients based on the severity of their condition.

As our good doctor2008 at 9:38 wrote;

"It is more efficient to divert resources to taking care of the very sick."

Man reality SUCKS.

Anonymous said...

I don't think the Goverment is interested in stopping the pandemic or knows what to do.
They are too busy trying to wrest opposition rule states like selangor and kedah.

My brother in law and five of his classmates in a university up north had fever and nobody offers any help.

They went to a Goverment hospital and guess what, tempreture were taken and some medications were given and then they were send back to their dorm. no proper test were given.

Some of their classmates who were down with fever refuse to go to the hospital because they were afraid of being quarantined.

And yes, they all had the symptoms HINI and we advice them to go to a private hospital immeadiatly... the rest refused and only two of them went to a private hospital for further tests...

I hope the authorities do something before more death occurs...

Anonymous said...

Mr Health Minister Liow & Director General Merican PLEASE resign, both of you failed to put into action preventive measures early,now its too late,many of us may die

Anonymous said...

Selampit said...

"chemoprophylacic agents and antiviral drugs ARE INTERCHANGEABLE TERMS. They're technically the same thing."

I am not very sure about that but why don't we look at it this way:

-there are few different groups of antiviral drugs but then not all are suitable for TREATING human's infections. Meaning, not all of these antiviral substances would be classified as a chemotherapeutic agent.

-By right, any of the antiviral agents could also be used for preventing the viral infections. However, due to suitability factors, only a few of its are useful clinically as a prophylactic agent.

Aspirin is not an antiviral drug. Same thing goes to Fansidar. Yet both of them can be used as chemoprophylaxis in certain diseases. Nonetheless, being a good therapeutic agent not necessarily mean it is a good chemoprophylactic agent.

"Both Tamiflu (Osetalmivir) and Relenza (Zanamivir) are 'neuraminidase inhibitors' antiviral drugs that can also be used as chemoprophylacic agents."

Yes, both of them got a proven therapeutic record as far as the seasonal flu is concerned. But then is there any concrete proof that either one of it is an excellent anti infective drug against H1N1?

Therefore, without having sufficient knowledge about therapeutic efficacy of the Tamiflu or Relenza in the context of H1N1, how could epidemiologist be able to postulate convincingly that they are a reliable prophylactic agents for H1N1?

"And since both pharmaceuticals giants 'Roche' and 'Glaxo' refuse to lift their exclusive patent rights to allow other drug manufacturers to produce cheaper generic versions of Tamiflu and Relenza; the word 'afford' is more appropriate than 'effective' I reckon."

During a pandemic, many a thing is possible. In fact a generic version of Tamiflu by the name FluShot have already appeared on the market. Notwithstanding some grousing about a costly Tamiflu in amongst the meager states, yet the generic version still not that cheap, bro.