Wednesday, August 19, 2009


Letter to editor – The STAR


Dear Sir,

I am writing in support of the statement given by Dr C.Lee that appeared in the STAR 19th Aug 2009. “Expert: case fatality rate not that high “. What Dr Lee said is true.

However, there is a problem.

A H1N1 is a very infectious disease. It spreads by droplet spread and so it is easily transmitted. The DG of Health calls it a high attack rate. For a country of 27 million, struggling with this crisis since April 2009, and with national and international transportation being so widely used, for such an infectious disease, 4,200 reported cases so far is a severe under-reporting. There are probably 20x that number of cases out there that are not reported. Because of this issue of under-reporting, many countries have stopped trying to report the number of new cases.

Unfortunately, 67 have died. This is regrettable. But if you were to be objective, 67 deaths, out of possible 70-80,000 cases, give a death rate of 0.08%. Still a bit higher than the usual seasonal flu death rate of 0.04%, but surely not any where near panic proportions. A closer look at the deaths revealed that 80% were A H1N1 associated, or were incidentally found to have contacted the virus, the virus by no means causing the death. We can call this A H1N1 associated death or death with incidental A H1N1 infection. So, if the certification of death is proper, it may be that only 15 deaths were actually due to A H1N1, giving a fatality rate of 0.02%.

The flu itself is usually a mild disease in the majority of cases. From all available clinical epidemiological evidence, the bulk of patients dying in flu pandemics are from secondary bacterial pneumonias. This has been shown to be the case in all flu epidemics and pandemics.

To consolidate measures that are already in place, it would be wise for the MOH to restrategise and put into effect mechanisms for the prevention of secondary bacterial pneumonia. This should include a national level SOP whereby all affected patients with secondary bacterial pneumonias would be immediately triage for intensive tertiary level care.

There is no cause for panic. We should all be vigilant, because there is a very infectious disease in our midst. We should exercise good personal hygiene, now and at all times, even after this crisis. If you are not well, as always, seek medical advice. There is certainly no need to panic and there is no national emergency here.

There is already too much misinformation and misperception of the situation out in the lay media without having to distract the public with the hype about national emergency.


Dr Ng Swee Choon

Committee member

Medical Affairs Committee,

Federation of Private Medical Practitioners’ Associations Malaysia.

1 comment:

Karen Lee said...

Dear Dr. Ng...
Can i seek some clarification? For a person who is on the high risk group, would you recommend pneumococcal vaccination?

Those who had H1N1 and recovered, what sort of medication were given?

Did they take the usual medication for cough and running nose like
1) anti histamine eg Polaramine or Loratadine or Zyrtec?
2) bronchiodilator eg salbutamol (Ventolin) or combivent, inhale or oral?
3) something for the phelgm eg Rhinithiol or mucosolvent?
4) steroid for the inflammation of the lung eg prednisolone or seretide?

(these are the usual medication i have to give my 5 year old child when he has bronchitis....)

It's important to know what are the care they have taken after they got infected so that we know what to do.....

What about those that died? Did they know the medication required to take?

Thanks for your feedback.....