Plug the gaps and restock

Khaw: How Singapore can learn from the experience so far

by Neo Chai Chin

05:55 AM May 13, 2009

THE Influenza A (H1N1) virus creeps closer to Singapore, with Thailand reporting two cases yesterday. And while no cases have been reported here so far, it will take a full year - as the virus evolves and moves from the northern to southern hemisphere and back again - before Singapore can "decide if we can relax", said Health Minister Khaw Boon Wan.

Yesterday, he unveiled his Ministry's three-part game plan for the coming weeks and months, while stressing the likelihood that "H1N1 is going to be here with us permanently; it may not simply disappear like Sars".

First, the Government is replenishing stocks of personal protective equipment, as well as Tamiflu and Relenza antiviral drugs - and the private sector is strongly urged to follow suit.

General practitioners (GPs) and companies who did not stock up on these essentials and had to scramble, "learnt the hard lesson of being caught unprepared" when Singapore moved to Orange alert two weeks ago, said Mr Khaw.

On the "grumbling" about a shortage of N95 masks and Tamiflu, Mr Khaw said GPs "are supposed to have stocked up during peacetime". They should, for that matter, take advantage of the window of respite now when stocks are more readily available.

Second, the Ministry of Health (MOH) will do a post-mortem and plug holes in its flu plan - particularly, the gaps in the response of the primary healthcare sector that were exposed by the H1N1 alert.

For example, the MOH will tighten its communications system with GPs by ironing out technical problems and getting their updated mobile numbers for SMS updates.

Third, teams of public health experts and scientists will be sent to "battle-scarred" affected countries in North America to study their experiences.

'Don't play with Singaporeans' lives'

What of recent suggestions that Singapore allow the virus to enter in order to build some herd immunity? Or to adopt an all-or-none approach in tackling the virus - quarantining all visitors from affected countries, for example?

The MOH does not consider countries like Spain and South Korea as affected countries because the human-to-human transmissions have not reached a sustained level of community spread, said Dr Lyn James, director of the MOH's communicable diseases division.

The five deaths reported outside Mexico have been of people with underlying medical conditions, she noted.

Mr Khaw said that while it was okay to experiment with immunity as individuals or family units, he could not risk lives when there remains incomplete information about the virus.

"I don't think we should play around with Singaporeans' lives in such a casual manner," he said.

And as the world slowly uncovers more about H1N1, the public's focus "should not be over the number of new cases" but the severity of these cases, he said. "Do the patients develop complications, pneumonia, severe respiratory failure? Who are those that are vulnerable to developing complications, so that we can focus on treating them early?"

Singaporeans should also not be alarmed to see more people down with flu - the seasonal variety kills 600 here yearly - as flu season in Singapore peaks at mid-year and again at year-end. Mr Khaw gave the sombre reminder that we should "expect some deaths due to H1N1 at some stage".

"Last week, I did a house-to-house visit in Sembawang," recounted the Minister. When constituents were asked if H1N1 concerned them, "all said they were not worried" - a response that, in turn, made him "very worried".

"While I appreciate the confidence of my residents, such a high expectation that we can keep out H1N1 is unrealistic," he said, urging Singaporeans to maintain good personal hygiene and, if they are sick, to avoid crowded places and to see a doctor.

Meanwhile, life must go on: Families who are going on holidays abroad in June should avoid affected countries, check the Ministry's website for updates and take the usual "commonsensical precautions".

From TODAY, Singapore – Wednesday, 13-May-2009