Posted on by Kit

Why is A (H1N1) death rate in Malaysia four times the global case fatality rate?

Health Minister, Datuk Liow Tiong Lai should explain why Malaysia’s A (H1N1) death rate is four times the global case fatality rate.

Malaysia’s death toll from A (H1N1) flu has topped 56 since the first fatality three weeks ago.

Below I have calculated the mortality rates for the following countries, based on reported number of confirmed H1N1 cases, as of 13 August 2009. Some countries like Singapore have ceased to report on total cases, where their current reports are on the number of patients still receiving treatment in hospitals. Some countries have yet to report their most updated total number of cases, hence I have given their numbers as of the date in brackets below. The number of deaths are as of 13 August.

The following are a comparison of Malaysia’s A (H1N1) flu fatality rate with other countries based on confirmed cases and deaths made public yesterday:

Country Deaths Total Confirmed Cases Mortality rate(%)
Hong Kong 4 6,417 0.0623
Indonesia 3 812 (11 Aug) 0.3695
Malaysia 51 2,955 1.7259
Philippines 8 3,207 (30 July) 0.2495
Singapore 10 3,071 (11 July) 0.3256
Thailand 97 8,877 (2 Aug) 1.092
Vietnam 2 1,275 0.157
Australia 102 28,987 0.3519
New Zealand 14 2,984 (11 Aug) 0.469

The influenza A (H1N1) mortality rate in Malaysia is close to 2% instead of the 0.1% to 0.4% as estimated by the Health Ministry. It reflects an unusual phenomenon. Without finding out the crux of the problem, assuming that 5 million of people are infected, probably 100,000 of them will die, instead of 5,000 to 28,000 as estimated by the World Health Organization (WHO).

Full and satisfactory explanations are warranted from Liow.

44 Replies to “Why is A (H1N1) death rate in Malaysia four times the global case fatality rate?”

  2. please don’t blame liow anymore because he’s the one who tries to broadcast h1n1 from the very start because he knew it can kill. somehow, his signals were interrupted by this so called raid yatim and ng yen yen telling the rakyat that there’s nothing to worry about. if talk too much of h1n1, no tourists coming and as of yesterday, rais still says ‘go out enjoy…no need isolate from gatherings. is it because he’s so sure h1n1 stops spreading so is he just PURE DUMP!!!

  5. It seems that Ng Yen Yen is doing quite a good job in tourism. We have a lot of tourists coming from all over the world. Some come from the North on summer vacation. Some come from the South on winter vacation. That is probably why such a Tourism State as Melaka reported a high rate of A (H1N1) virus infestation!

    Perhaps it is time now for us to give priority for tighter endemic quarantine procedures rather than to continue trying to deceive ourselves that tourism income is much more important than the human lives of the Malaysian people.

  6. Datuk Liow Tiong Lai,
    Have your mobilised yet the health quarantine staff from Ministry of Health and deploy them into several international custom and immigration checkpoints at the airports, the sea ports, and the route transport transnational border checkpoints?

    Have you given warning to the public on the necessity to avoid visiting publicly crowded space such as shopping centres in order to prevent widespread of Influenza A (H1N1) virus?

    Have you advised all the school teachers and headmasters to apply for the Ministry’s permission to close down the school as soon as a confirmed influenza A (H1N1) case has been found in the school?

    Have you issued warning to the public on the necessity to avoid visiting patients in the General Hospitals until a later date when the influenza A (H1N1) alarm has been officially removed by Ministry of Health?

    Have you given advice to the human resources managers of all factories and business organizations of Malaysia to cooperate with Ministry of Health to stop the employees from attending work duty once the employees were found to have a suspected symptom of flu, until the flu symptom has already been completely healed?

  7. Why?
    Because we have an irresponsible government. As easy as that. The coming of H1N1 has been known for months. But our government was waiting it out; hoping for some divine intervention to spare our country. These were the months, while inactivity bred death. And why? Because our government, and foremost MoH failed to acquire the necessary means for diagnosis. A colleague of mine had her son down with fever and stuff, went to a government hospital, where they were told, that due to an acute lack of testing for H1N1, they couldn’t. She and her son were to go back, and come back only after 7 days, if the fever persisted. I checked with a doctor today, since I don’t feel well, asking for a test, and was told “no way”, because Malaysia had no resources to do so. Or better, it has the resources, but only very limited. As long as a case is not very serious, with high fever, breathing problems, there is no way to find out. Meaning, the machinery can only move into action, when the patient is relatively close to death. Meaning, there is no way in heaven or in hell, better: no way in Malaysia, to check on the average flu patient. And isolate the beginning cases. Meaning, we have a potential time bomb of infected cases running around, who simply cannot know for certain if they are sufferers; and subsequently be isolated.

  8. Sorry, off-topic
    From chedet.co.cc

    SCIENCE AND MATHEMATICS IN MALAY
    By Dr. Mahathir Mohamad on August 14, 2009 4:01 PM | Permalink | Comments (0)

    ///1. The Government has decided that the teaching of science and mathematics would revert to Malay in the Government school, with Chinese in Chinese schools and Tamil in Tamil schools. How this is going to help integrate Malaysians I do not know./// — TDM

    A dictionary defines the word ‘integrate’ as to end the segregation and to bring about common and equal membership of the society. It is clear that learning different languages do not contribute to segregation, and when the different vernacular schools teach their students, at the primary level, in the language of their mother tongue, or the main medium of instruction, that would not bring about segregation of the citizens in the country. It is most unethical for a has-been political opportunist to bring in extraneous argument to justify his wrong decision that had caused the sufferings of millions of students.

    ///2. Since then I had conducted a poll on my blog. The result is 84 per cent want to retain English as the language medium for these subjects.///– TDM

    Yes, 84% of the 100,000 that voted wanted English to continue. These are from those or the parents of students who are in the midst of learning mathematics and science in English who wished to have English retained. The government has allowed English to continue for those cohorts so that they would not be affected by the policy change. Najib shows that he has the guts to do not as what Mahathir told him.

    ///3. Admittedly the poll was conducted in the English language and English language speakers might be biased in favour of English. ///– TDM

    Statistics are susceptible to be used for lying, and to project whatever image one has the intention to. When the question asked is either yes or no, the answer can only be the preferred one between the two. Had the intention been to find the truth, the question would have provided different possible choices such as suggested by experts.

    ///4. But some parents and teachers had also conducted a survey and the majority are again in favour of English. A petition to the Prime Minister by parents and teachers was copied to me and they were in favour of retaining English. At least one senior non-Malay politician had left a Barisan Nasional component party and joined the opposition because of the switch back to Malay, Tamil and Chinese. He claimed that he could not afford to send his grandchildren abroad as some who advocate Malay as the medium had been doing.///– TDM

    The parents and students have no problem with the switch back to Malay, Tamil and Chinese at the primary level. They might have preferred to have English at the secondary school level. TDM has either not fully understood the issue or he pretends not to have. If he had made the switch to English only at the secondary school, there would be no controversy now. But he had ulterior motive which he chose not to reveal. Since primary school cannot have a choice of mother tongue teaching of the two subjects in primary school, and English at secondary school, they are willing to forgo the use of English at secondary level.

    ///5. I meet a lot of people at the various forums I am invited to speak. During the usual post-meeting tea most of the participants who got to talk with me, mostly Malays regretted the Government’s decision to use Malay for Science and Mathematics.///– TDM

    That was talk in the corridor of power, but now corridor of powerless. Who cares?

    ///6. The reason that has been given is that Malays, particularly kampung Malays just could not do well when the two subjects were taught in English. If we follow this kind of argument we should also stop trying to get Malays to do business because they really cannot do well in that field. They are best at working as wage-earners, particularly in Government service. We should encourage them not to try to go into business.///– TDM

    Ironically what TDM thought a tongue-in-cheek comment is the only sensible one. Nobody says that Malays cannot do well in business, and it is wrong to say so for two reasons. Malays now do not belong to any ethnic group, anthropologically speaking. People of Malayali race from Kerela of India are good businessman; the descendent of a Malayali in Malaysia is now known as Malay. Arabs are great businessman, and in Malaysia they are now Malays. Indonesians of Java origin, and Bugis are great businessman, and they are called Malay in Malaysia. Who can ever say that Malays are not good businessmen? The government has been utilising the excuse of getting Malays into business for enriching the cronies of the powers-that-be, such as through APs scheme, and discount purchase of equity to attain the 30% participation in the corporate sector.
    The government has no business to be involved in telling how private citizens should lead their life. The job of the government here and elsewhere are to provide the environment for people in pursuit of their happiness. It is for the people to decide whether going into business is a happy thing to do.

    When communications were difficult in the past, the rulers had no clue as to what represent the best government. Now the government has the chance to learn not to repeat mistakes made by others, through meeting their counterparts in other countries. The government can pretend that Malaysia is unique, and that it has done better than others, and pretty soon we only have Zimbabwe in our rank.

    ///7. If we do this then the current anger over the New Economic Policy on the part of the non-Malays would be reduced./// — TDM

    TDM never fails to link his failed policy with another one which Malays love to keep.

    ///8. Similarly with learning English. Malays just cannot learn and speak English. We should stop teaching it so that the language would not drag down the Malays in their exams. We should see better results./// — TDM

    This is usual TDM logic; he will take one example to represent the total. By the same logic, since he can speak and learn English, TDM is not Malay. Would he accept that argument?

    ///9. Malays do best at paddy planting and fishing with rods and net. They should be taught to do this, probably with new technology./// — TDM

    That are skills handed down, and it would be a pity to lose them. Since they do best in those areas, there is no need to teach them. As for utilising technology, people in the field would know how to utilise them to their advantage; TDM thinks that only he knew best.

    ///10. By switching back to Malay, we can expect them to vote for the Government party at the next election. Similarly we can expect at least some who believe their children’s future has been blighted by this decision to think again about voting for the BN./// — TDM

    TDM confirms that he cares only for election results in formulating government policies. He is just a follower then. Or is he an opportunist thinking always about his position, and not the health of the nation? How we wish he had been thrown out in 1987 UMNO election. Malaysia would have been on the path to Japanese success had there been no blackout during vote counting process of the 1987 UMNO presidential election.

    ///11. I cannot read Chinese but Utusan Malaysia kindly translated the editorial in the Sin Chew Jit Poh. The editorial basically said that giving “Ang Pow” would not win over the voters.///– TDM

    Wonder whether it was also translated into Tamil; there would not be a need for Utusan Malaysia, and TDM would learn about it there.

  9. Hi Kit,
    Let me try and shed some like, and to be fair. It is obvious that the reported number of cases is totally wrong. 2,900 cases from Feb till Aug., with globalisation an air travel, is obviously an underestimate. It looks like the initial government strategy of asking for quarantine of cases just made many cases hide and go underground. That is why many countries have stop reporting on the number of cases. By the estimates of expert epidermiologist, the number of cases is probably around 20x that reported. We estimate that there are probably around 50,000 cases. There were 51 reported deaths, but we are awaiting the expert group investigating the deaths. It would appear that not all the ” H1N1 death” was due to H1N1. It was a real assortment. It is something like after 9/11, when all catastrophe was “al-qeeda “. Overall, the estimate is that about less then half the deaths maybe H1N1 caused. In a rather rough guesstimate, the case fatality rate of this H1N1 epidermic is probably about 0.05-0.1%.
    However, it is true that the MOH is in some disarray. Documentations are poor, and facilities are severely stretched.
    You may want to note that this H1N1 crisis is like a stress test for our nation’s acute healthcare delivery system, and we seemed to have failed rather badly.
    If you wish to you may refer to http://www.hmatter.blogspot.com.

  10. Kit,

    Sorry to sidetrack.

    Ronnie Liu’s aide, Wong Chuan How, was harmed by MACC officers and seriously injured his right leg.

    I think you have to voice this out or else the MACC will soon become a licensed gangsters institution.

  11. It appears that the MOH is just fire-fighting without in depth thought or planning to contain the seriousness and medium term of the situation.

    Have the MOH thought of giving vaccination to all the doctors, nurses and staff who are in the front line fighting this disease? This disease is sure to get worst looking at the present scenario and what if the doctors and nurses are down with this disease? When the important front line is gone, there will be no giver of help to those people who are infected. The people who are infected will be getting more and more but the giver of help is getting less and less!

    MOH’s first priority is to provide vaccination to this front line of defense but are they doing it? There are already signs that the doctors and nurses are already down with the disease and many clinics are temporarily closed.

  12. there seem to be no synergistic working relations between the moh & mot. if the mot is expecting more tourist from countries suspected with h1n1 cases (without prejudice here) then the mot should inform the moh to do something at the entry points. such as airports, bus stations, train stations, seaports (cruises), etc. there must be some plan or blueprint to tackle this in 3-D way. the fire has started but the firefighters are still asleep; that’s what happening in m’sia & we can only expect the fatalities to continue. what is sad is to read of young kids being infected & died. does the moh have no immoral sense at all over the grief of these parents & the paranoia of all parents? it is also insensitive of the moh to put the responsibility of their leadership to the people instead. most parents with the common sense would know what to do. however, there is certain leadership in which the moh has to undertake. do they expect the public to hand out sanitisers on the streets to each other? who has the authority to mobilise health officers to be at checkpoints? what we see on papers are only reported cases. i believe there is at least another 10-20% unreported cases. not to mention schools having to close classes for this reason. if allowed to be reported, i am sure there is not enough room in the papers to put politicians faces on them. it goes to show the priority the cabinet has on this national health threat.

    finally, after hearing from friends, i would like to commend the organisers of the recent fhm2009 in klcc for handing out alcohol-based hand-soap for visitors. look like it takes a chef to know what to do than a nutritionist – what a shame.

  14. 9 to 5,
    To-date there’s no A(H1N1) as yet and therefore the front line health workers cannot be given vaccination.CSL Australia has started
    late July clinical trials on the vaccine for A(H1N1) and it is to be fast tracked to get the vaccine out by late September or early October if the trials go well.The 3 other big pharmaceutical companies Sanofi-Aventis and GlaxoSmithKline have followed suit and
    they hope to get the product out at around the same time as CSL to be on time for the winter in Northern Hemisphere.

  16. On this issue I do not agree that the Ministry of Health of Malaysia has underperformed and many of the criticsm against them here
    are unjustified. First we do not really know the total number of people infected with H1N1 at any particular time as not all patients with flue are tested. If we do not know
    the total number of people infected the mortality cannot be calculated. The number quoted therefore cannot be correct.
    It is therefore not accurate to compare mortality rates with other countries. If the number of people infected is high we would expect the absolute number of death to increase.

    Second H1N1 is a very infectious disease but unlike SARS the mortality rate is much lower and perhaps even comparable to the seasonal
    flu. You have seen countries like Australia, US and UK not paying as much attention to it as we do in this part of the world for good
    reasons. They believe that the infection is very difficult to control and probably also not worth controlling because most of the
    patient who caught the infection almost invariably recovers except for some unfortunately few in the high risk gorup. Look at Singapore. They did everything according to the book. Vacinated their health servants, use tamiflu on anyone with the slightest indication of an upper respiratory tract infection, close all the doors in their hospitals except the main one, screened everybody who comes in and out of hospital and other institution, close their schools for weeks, cut down on extracular activities etc. and what is their situation now? Despite all these effort, they have their fair share of mortality. The lastest publication suggested that more than 90% of their flu cases are H1N1. As a result
    they already dispense with testing for H1N1 and will be standing down sooner than expected. Lets be fair. The Ministry of Health of Malaysia did not over-react and shut down the economy. Other than not makings sure that the country has enough of tamiflu to treat those affected (tamiflu in short supply now), I think they have done a reasonable job.

  17. I will tell you why? Because LKS is just another stupid ignorant idiot who doesn’t do his homework. While all the heath workers are risking their life at the front line, he chose to use this health issue for his political gain so that he can paint the gov a bad image. LKS, if you have a issue with gov, please use other issues like the TBH death to topple the gov, don’t distract the health people from serving the rakyat. This is the LKS’s dirty political trick to the core. Hopeless scum!

  18. If you add all the unreported and missed cases of H1N1, the mortality rate will be much lower. The SIngaporean authority has done a study and noted that 53% of the influnze like illness were actually having H1N1. Thus there will be at least 2-5x more undiagnosed cases. LKS is not really care how many people die, in fact he probably hope that the situation will get worse so that he can ‘hantam’ the BN gov even more.

  19. I see that LKS’s figures for comparisons between countries have been disputed for not factoring ” all the unreported and missed cases of H1N1″ which if they have done so, the mortality rate will be much lower.

    However if mortality rate is lower than what it actually is, it means political pressure is exerted in exaggerated manner on MOH to do more (than less) so that even if LKS is bent on attacking the BN govt on this issue, I don’t see how that can, in fairness, be inferred to imply LKS does “not really care how many people die, in fact he probably hope that the situation will get worse so that he can ‘hantam’ the BN gov even more.” This statement is going over-board.

  21. Should this be done?

    //Deadly flu: Gov’t told to declare emergency
    Aug 14, 09 12:18pm
    PKR vice-president Dr Lee Boon Chye today reiterated his call to declare emergency for the A(H1N1) outbreak.

    He pointed out that since the first imported case on May 15, 2009, the total numbers of infected patients has surpassed 2000 with 51 deaths as of yesterday. //

    Is this true with Deputy MOH from Sabahkini?

    From: Omar Kadir

    Dear friends,

    Words around that the Deputy Health Minister, YB Datuk Rosnah Shirlin Abd
    Rashid (MP for Papar) is tested positive with Swine Flu H1N1. It seems only
    yesterday that she and the Director General of Health were reported in the
    mainstream media telling the public not to worry! Do not panic! We have the
    problem under control!

    pw: S. A jean

  23. I entered Johor Bahru late last night around 11pm because of a meeting with my relatives. As I had been saying, the scanning of all the human traffic entering into the Johor Bahru CIQ is only for vans and buses passengers. In other words, they believe that humans driving the buses and vans as well as everyone in cars, MPVs, bicycles, tricycles and motorbikes are immune to A (H1N1).

    Well, I had complained it before but last night was the best. The human scanning stops already by 11+pm. In other words, any human beings traveling into Johor Bahru at the late nights and perhaps until early morning are also immune to A (H1N1) virus. It is incredible! Sometimes even if the two cameras scanning us are placed there, the people sitting there are either looking elsewhere or even not present!!!

    The point I want to make here WHAT’S THE POINT? If you want to do it, do it seriously and wholeheartedly! If you can’t, don’t do it at all! It is a waste of time, money and energy. Those ‘health officials’ or nurses are just there to enjoy air-conditioning. There is no point doing the scans since the system is so flawed! It is extremely pointless! Argh, I can’t stand them! (knocks head on the wall! They are killing my intelligence! Please HELP!!!)

  24. SocratesPlato what they’re doing is perfectly sensible, if they are to do screening at all. No screening is probably not politically viable. Total screening is also not viable – we do not live in concentration camps that can be sealed off from contact with each other. Furthermore, you can be infected with H1N1 and show no symptoms.

    Their point, presumably, is to catch some decent-sized proportion of all travellers and make an inference from those statistics as to the likely size of the problem. Why pay someone to capture statistics after 11pm when the traffic is much lighter?

    There is nothing that can be done to prevent the transmission of H1N1, unless you intend to stay in your house for the next 5 years, or wish (as some other commenter proposed) to allow BN to pump bleach into the air for 5 years. You can slow the transmission of H1N1, but it is my strong suspicion that slowing it would only make the pandemic last longer, and likely have little effect on the total fatalities.

    A thought just strikes me that slowing the pandemic may mean that more people are unexposed by the time a vaccine is ready. As AhPek points out, there currently is no vaccine. As far as I know, the Malaysian government has no plan to obtain it? Perhaps MM has cautioned against falling for another Jewish trick. Some countries (the UK is one) have commited to buying sufficient vaccine for every citizen. That’s a lot of money. By the time the vaccine arrives, many citizens will already be immune through exposure.

    Has somebody done the maths to see what the cost of a total vaccination program would be, and what the financial benefit? Are Malaysians actually worth it? This isn’t a bad exercise for PR to work through. If they’re faced with a similar emergency on their watch (in some happier future) I wonder what they will do different?

  25. You cannot compare by % anymore because all countries have stopped testing for H1N1 due to the sheer number of infection except in serious medical cases & death. Therefore all % numbers are now WRONG.

    The only accurate % that we can use now is number of deaths over the number of the population, and the number of deaths relative to countries nearby.

  26. Ronson’s point is spot on – although it does rely on reliable diagnosis of H1N1 as the cause of death, particularly in cases where there were underlying health problems. It may also be timely to remind everyone that the % by population is very low, compared to many other killers that we don’t worry will happen to us. Someone from the USA’s Centre for Disease Control noted:

    “20,000 people die from novel 2009-H1N1 and everybody wants to wear a mask. 9 million people die from AIDS and no one wants to wear a condom.”

    …and presumably the same people who are worried about H1N1 smoke, eat fried / salty / sugary food and ride motorbikes without helmets.

    I still think it wouldn’t hurt for DAP to publish their own H1N1 advice. A set of crude (but not bad) diagrams / no more than 50 words of english as a single A4 poster would do. Just to demonstrate they have a response and that they can make it available. I would *cough* copy *cough* the best *cough* bits *cough* from another *cough* country’s *cough* advice *cough* if I were you. You can’t provide vaccines, so handwashing, resting, plenty of fluids and fever reduction, an emergency number or two and a box to write the nearest doctors’ phone numbers in would be better than nothing.

  27. Whilst I agree with you that using mortality figures from now on would not be useful,YB is not entirely wrong though since his figures are figures over the last 3 months the disease has been raging.His comparison is a good indicator.We do know no figure from any country over the last 3 months can be said to be absolutely accurate,there is bound to be under-reporting for obvious reason but these figures (again over the last 3 months) cannot be out by 10% to 20%.Say in Malaysia’s case we assign 20% inaccuracy,the actual figure infected would then be 3594 instead of 2995 and the mortality rate would be 1.4% instead of 1.7%. If we think that Australia’s data collection is more efficient,assign 10% inaccuracy to the figure above the number of infected in Australia would come to 318857 and the mortality rate of the disease is 0.32%
    instead of 0.35%.If we then do a comparison between Australia and Malaysia ,Malaysia’s death toll rate resulting from with these adjusted figures is 4 times higher!

  29. Orang Rojak, don’t waste your energy advising this LKS, his intention is to become 1st chinese deputy prime minister. The higher the death toll, the more bullet he can criticise the BN gov. LKS is not interested in helping the MOH spreading the advise, he is more interested in making Liow disappear from political scene.

  30. is to become 1st chinese deputy prime minister
    I don’t want to go all ‘The Nut Graph’ on you, but I think his aim (if he has one so specific) is to be the first ‘Malaysian’ deputy prime minister – one picked on grounds of suitability for post rather than race. If he wanted to be a Chinese Minister, surely he would have emigrated from his home nation to China by now?

    I would have thought such a goal might be served just as well by leaving an incompetent Health Minister in his post and demonstrating how it should be done to show the MOH effort in a bad light – no? My mistake. We all make ’em!

  31. nckeat88 :
    Orang Rojak, don’t waste your energy advising this LKS, his intention is to become 1st chinese deputy prime minister. The higher the death toll, the more bullet he can criticise the BN gov. LKS is not interested in helping the MOH spreading the advise, he is more interested in making Liow disappear from political scene.

    Hi nckeat88, you mean that by making Liow disappear, LKS can become Deputy Prime Minister? You must be kidding. And if LKS wants to become first Deputy Prime Minister, what’s wrong with that? Is it a crime?

    LKS has given much of his life to Malaysian politics. And should anyone qualify to become first Deputy Prime Minister, it should be LKS and no one else. You think MCA Presidents are better? Name me which MCA President qualifies? Lee San Choon, Lee Choon Toi, Ling Liong Sik, Oh Kuei Tau, who? Or Koh Tsu Koon who can only swallow his pride when someone tore his portrait and stepped on it as if it is some caterpillar?

  32. nckeat88,
    First what is wrong if LKS wants to expose that Liow is not running his Ministry
    well? Is he spreadin untruths with his tabulations of mortality rates drawn up?
    Secondly if he has ambition to be DPM,what is wrong with that? Is he not qualified to be one or is he born with the wrong skin and thus cannot be one?
    You enlighten us pleas!

  33. YB Kit,

    Perhaps the press release from Singapore’s Ministry of Health, as shown below, will enlighten you on the political correctness to stay away from talking about comparative figures among many countries.

    “Press release from Ministry of Health, Singapore

    Managing Influenza A (H1N1-2009) (8 July)

    Influenza A (H1N1-2009) has become endemic among global communities. Yesterday, the World Health Organisation (WHO) informed that countries are no longer required to submit regular reports of individual laboratory-confirmed cases and deaths to WHO.This is because the reporting of such numbers is no longer a useful monitoring tool. WHO has also decided that it will no longer publish the global tables showing the number of confirmed cases for all countries.

    With this decision by the WHO, MOH will not be able to compile an accurate list of Influenza A (H1N1-2009) affected countries. We will accordingly remove the list from the MOH website.”

    I believe there are other much more useful issues to be focussed upon in relation to the H1N1 pandemic. Let’s check out the news as reported by Channel News Asia on 15 August 2009. http://www.channelnewsasia.com/fluoutbreak/

    “Singapore’s Health Ministry has announced that it is making the transition to the mitigation phase, so those with flu-like symptoms may see polyclinic (operated by Singapore Government) or pandemic preparedness clinic doctors, who will make a preliminary assessment. They need not call 993 for the special ambulance.

    Only severely ill or high-risk patients will be tested for the H1N1 flu virus, and hospitalised if needed. Those with mild symptoms may be sent home and if necessary, prescribed anti-viral drugs.

    The World Health Organization’s (WHO) pandemic alert level remains at the maximum level of six. ” (Channel News Asia, 15 August 2009)

    The basic regular personal hygienic practice is still the best way to fight H1N1. In fact, Tamiflu is no panacea to influenza A (H1N1) symptom. Many other conventional anti-flu drugs may be useful in mitigation of the fever, cough, and lethargy caused by influenza. If the suspected Influenza A (H1N1) symptom patients are able to consult an experienced doctor at the clinic, their lives can easily be saved, unless they are already infected with a complication of other fatal sickness or are at the chronic stage of terminal illness. When God created H1N1, the solution to the symptom caused by it had already been provided by God in our body. We just have to be cautious and be always prepared to love ourselves as well as we love our neighbours. If we are able to keep a healthy body by regularly watching our food hygiene and personal health with adequate of sleep, God will most likely allow us to build up a natural immune system in our body in order for us to produce adequate antigen in our body to fight against H1N1 virus. Therefore, it is important for all politicians to encourage people to lead a healthy life style in order to fight against H1N1 pandemic.

  34. I really shake my head in disbelieve to hear that ‘hotspots’ for H1N1 might be announced. This is a typical third world thinking mentality. I wonder why in other developed nations, qualified medical doctors are the ones giving announcement and details about H1N1 but in our countries, politicians are the ones making the announcement. Sometimes I wonder if they even know what they are dealing with.

    I have a son who is only 5 and he is a chronic bronchitis sufferer. We live in Kota Kemuning and we experience hazy conditions EVERYDAY. My son’s like is at stake! And so are many other asthmatic patients, chronic bronchitis patients, young children with low immune system etc.

    Each day I will search all papers hoping to get some leads as to how I can build as many defence mechanisms as I can for my son…. And all I get is the feeling like I am searching for answers in a dark room, totally helpless and in despair.

    Then, one good Samaritan gave me a very important lead which might perhaps save my son’s live and I am sharing this with as many people as I can.

    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 (http://www.latimes.com/features/health/la-sci-pneumonia4-2009aug04,0,6872284.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….

  35. “So if the government is serious in preventing H1N1 deaths, all those in the high risk group should get pneumococcal vaccination.” (karenleehs)

    As far as I know, pneumococcal vaccination has been promoted regularly by a phamaceutical trading company in Malaysia on farmed animals, not through injection but through nose spray dosage. However, this vaccine as promoted by the company is said to have an acting period of only 7 months. After seven months, a repeated dose is required on the farmed animals. The recurring costs can be a heavy financial burden to the farmers. Therefore, many farmers refuse to use this vaccine!

    The Americans may produce another type of efficacious vaccine called “pneumococcal polysaccharide vaccine”. Generally the vaccine should be a single lifetime dose, as there is a high risk of side effects if repeated. I wonder whether MoH has any plan to import such a vaccine from the United States.

  36. MoH will vaccinate Malaysians? All 27 million of us for an infection with a really low mortality rate? Do you all realise that we have about 15 fatalities on the road a day and this has been going on for years?

    Let’s get real. SARS was bad but it was contained as people really got serious about it. Heck, Genitng Highlands was dead when it happened. For AH1N1 we are not serious. Malaysians are still enjoying, going out of the country to bring it back even. The DCM of Sabah’s son brought it back to Malaysia when he went on holiday.

    We are a selfish nation. We do not care to take the necessary precautions. We know about it so we need to act upon it.

    My friend is well educated, well brought up. He got a high fever for a few days and was unhappy when his sister with a newborn told him to move out to their apartment.

    I had to literally force him to go to the GH for testing. Well it was not AH1N1.

    Here are some quetions we need to ask:

    i. sre the people dying coming from urban or rural areas?
    ii. Do these people know about AH1N1 and how serious it is now?

    If not then the ministry is really at fault but if its URBAN and they know … then sorry la.

    We are too lackadaisical … A simple mask will cut down the risk of infection by a lot. This is just nature’s way of culling the human race.

  37. karenleehs, please google news on H1N1 because our local news on H1N1 is hopeless. As a matter of fact, recent news from the UK is that Tamiflu is not effective in children under 12 and you’re right about the pneumococcal vaccination.

    A point to ponder, many countries first infected with H1N1 started treating infected high risk groups with Tamiflu even before confirmation of H1N1 infection as delay could cause death. Here, it seems it is only now that they are implementing this SOP. The policy makers here take no cue from what is being done overseas and thus are just reacting instead of being proactive.

  38. I think the very 1st thing to do is to increase the number of hospitals or clinic equip with the equipment or processes or facility to examine H1N1 disease throughout the country, This is the most basic thing that the Ministry of Health (if not then Hell) needs to do. Once the patient is identify with H1n1, immediate proper treatment will be treated instead of assuming it is a normal flu.

    As can see, the general hospital is packed with people,simply due to lack of such facilities to help patient re-confirm the illness apart from the hospital.

  39. Cause -Effect

    In those days, when the KL General Hospital was built, nobody knows why we need such a big hospital

    except for those families strickened with Dengue fever, dysentery, typhoid ,small pox,yellow fever , leprosy prevalent in those days.

    It was one of the best hospitals of good medical management in SEA….yes SEA.

    Now it is still the best but of the wrong order.

    because of lowstandards in the supports such as nurses, who are relatively not very different from maids on their idea of everyday hygiene

    because we have either trained the wrong people for these jobs or promoted the wrong person for the job, so who can save us now.

    Even the best doctor will not be able to help, we can brag and brag all day till kingdom comes.

    When there is trouble in the streets, the politician quickly takes charge.
    When there is trouble to everybody health the politician takes charge
    When there is trouble in the economy, the politician takes charge
    When there is trouble in schooling the politician takes charge.

    Where are all the DG, are they doing their job or just seriously creating and maintaining their job.

  40. The mortality rate of SARS is 20%,Nipah Virus is 40% and A(H1N1) is 0.5%.However there is one big difference and that is their transmission rate.
    The transmission rate of both SARS and NIPAH VIRUS is very low cos their transmission hasn’t come up to person-to-person transmission yet,and that is why both SARS and NIPAH VIRUS are not classified as pandemic!Thus in terms of containment,they are much,much easier.
    If we take Spanish Flu,both its transmission rate and mortality rate (said to be 15% to 20%)
    are very high.Death toll is said to be 50 million and even as high as 100million according to some sources.It raged for about 2.5 years before it petered out.Asian Flu petered out after 1plus year.A(H1N1) has so far been termed mild both by WHO and US CDC and if it doesn’t mutate,we probably has hope that it should peter out in less than a year from now.
    The Ministry has failed in one important aspect of educating the public in a big way on such sensible,simple and practical step as the first line of defence against getting infected ie washing one’s hands thoroughly
    and often,wearing mask in public places at all times plus avoid touching one’s mouth,nose or eyes.If it can be carried out effectively,the number infected has to drop.
    Pneumococcal vaccination comes in as an added defence mechanism especially for people with underlying medical conditions. People with underlying medical conditions
    usually are the people who die when infected
    since, in their case,pneumonia will set in as complication to kill them.

  41. in the beginning of the outbreak, every single case of h1n1 positives were counted, including healthy contacts of sick confirmed h1n1 patients. thus the Case Fatality Rate (google it) was more likely to be correct.
    however, later, since the advance to the mitigation phase, it was impossible to count all the cases, and only the moderately-to-severe sick cases of h1n1 who were admitted to hospitals, were counted.
    this being the case, the CFR is not going to be accurate, since the denominator is grossly undercounted, while the numerator ie deaths, are counted accurately.
    imho, the MoH had itself to blame, for continuing to put the “number of cases” count tally up in its website, knowing that this figure is inaccurate. WHO and CDC had stopped counting a long time ago, since they understand that it was not going to be accurate.

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