We feel that We have to address the most serious issue at hand. Today the most important priority should be given to the H1N1 influenza and how we go about dealing with this. Below is an article from Malaysiakini.com.
The number of reported H1N1 cases could be higher than what is estimated, claimed a virologist from the United Kingdom who urged the Malaysian government to adopt his country’s surveillance system.
Dr John McCauley from the National Institute for Medical Research UK said though it takes time to set up the system, the government should adopt the UK’s “influenza sentinel surveillance programme” to monitor the situation.
“Reported cases of infection are bound to increase but what I am unsure of is whether current figures given are accurate. There can be yet more undetected cases.
“There might be some kind of systematic underestimation of the number of cases. If it is always mild, you can always underestimate the cases you have got,” said McCauley (above).
He explained that under those circumstances some people might not get vaccinated on time. For the vaccination to be effective it has to be administered as soon as the symptoms appear.
Fire brigade approach
He spoke to reporters after delivering a keynote address entitled Pandemic H1N1 – Background and Update at the Kuala Lumpur Convention Centre yesterday.
He said as those below the age of 24, are more susceptible to greater impact from the illness. However, he said, there may a slight degree of immunity for those born before 1957.
He also said that the drugs should only be used in serious cases, this especially so for those not in good health and, pregnant women.
“At the pandemic stage, what you really want the drugs for is to control serious complications arising from the infection,” he said.
Meanwhile, Institute of Bioscience deputy director Prof Dr Abdul Rahman Omar who was also present urged the government to adopt a proper disease control approach.
“We should not practise the ‘fire brigade’ approach but have active surveillance in more places,” he said.
Currently, 51 patients confirmed with the virus, are being warded, with 29 others admitted to intensive care units.
Of the 29, 16 are in the high-risk group with 12 suffering from chronic diseases.
However, from sentinel testing and surveillance by the Ministry of Health the last few weeks have shown that almost 95% of all flu-like illness are now caused by the H1N1 virus. Earlier some months ago, seasonal flu variants caused by the B and other A virus were the main causes, the bug causing most flu these few days is the A(H1N1). This appears to be the case also in neighbouring countries, meaning that the new virus is causing more havoc and symptomatic illness than previous types of flu (which are still in the community).
Because almost every flu-like illness (influenza-like illness or ILI) is due to H1N1, the MOH is now recommending that no testing to confirm this H1N1 will now be offered.
Treat as if this is H1N1 for ILI—symptom relief for mild symptoms (paracetamol, hydration, cough medicines, etc) and self-quarantine, social distancing, be alert for complications.
Most (~70%) do not need any anti-viral medications such as Tamiflu or Relenza. Only severe cases need to be referred to hospital for further treatment.
2) How should doctors decide if a person be given further specific treatment for H1N1?
If after 2-3 days, fever and cough symptoms do not improve, a recheck with the doctor is recommended, especially if there are features of difficulty breathing, severe weakness and giddiness, or, if the following risk factors are present:
- obesity (fatter patients seem to have poorer outcome and more complications)
- those with underlying diabetes, heart disease
- those with asthma, or chronic lung disease
- pregnant women
- those with reduced immunity, cancer patients, etc
- those with obvious pneumonia features
3) Many anxious people with flu-like symptoms want to be tested or treated for suspected H1N1, but are kept waiting or sent home, without being tested. Is this practice right?
There is no right or wrong practice as this outbreak is extensive and is stretching our resources to the limit. This is also the case not just here in Malaysia, but also elsewhere around the entire world!
The recommendation is now not to spend too much time and effort trying to get tested at designated hospitals or clinics—there is probably no need to do so. I have been informed that as many as 1,000 patients queue anxiously at Sg Buloh hospital for testing, due to fear of the H1N1 flu.
So the message must be made clear: Most flu illness do not require confirmatory testing, and are mild and self-limiting. More than 90 percent will get better on their own, with symptomatic treatment—just watch out for possible complications, and risk factors as mentioned above.
Our resources are limited especially for testing. This is not just for Malaysia, but globally as well. The global demand for test kits and reagents for the H1N1 (PCR) is overextended and are rationed due to this extreme demand.
Some 200 million test kits have been deployed worldwide, but this supply is critically short because of excessive demand, so most countries have to ration testing to confirm only the worst cases, so as to monitor the pandemic better.
4) Are doctors confused as to what to do in this outbreak, especially when they do not have ready access to confirmatory lab tests?
Not really. Earlier on there was some confusion as to what to do next and who to test or who to refer for further testing and admission. Now the rules are clearer.
There is no need to do any testing to confirm the H1N1 virus for any ILI—just assume that this is the case in the majority of cases. Treat symptomatically when symptoms are mild, reassure the patients and ensure that these infected patients practice good personal hygiene, impose self-quarantine and social distancing, wear masks if their coughing or sneezing become troublesome, and keep a watchful eye on whether the infection is getting better or worse.
If there is difficulty breathing and gross weakness, then patients should quickly present themselves for admission. Understandably this phase of worsening is not always clear or easily understood by everyone… But there is not much more that we can do—otherwise we will be admitting too many patients and this will totally overwhelm our health services.
But prudent caution would help to determine which seriously ill patients need more attention and more intensive care. Unfortunately however, there will be that odd patient who will progress unusually quickly and collapse even before anything can be planned – hopefully these will be few and far between.
A more important note, is that all doctors and nursing personnel should be very aware that they too have to take precautions, and employ barrier contact practices, if there are patients with cough and cold during this period of H1N1 outbreak, which is expected to last a year or two. Carelessness can result in the physician or nurse or nurse-aide becoming infected!
5) Are there sufficient guidelines from the Ministry of Health to address this situation?
I think there are sufficient guidelines from the MOH. Although some politicians have blamed the MOH and the minister for being inept at handling this pandemic – in truth this is not the case.
It is useful to remember that this is an entirely new or novel virus, which no one previously had encountered before – thus its infectivity and contagiousness is quite high and almost no one is immune to this virus.
Perhaps, there will come a time when all the resources from both public and private sectors can be put to more efficient use. Some logistic problems will invariably occur, because human beings differ in their capacity to understand or follow directives, whatever the source or authority.
Also patient demands have been extraordinarily high and at times very difficult to meet – every patient necessarily feels that his flu is potentially the worst possible type and therefore requires the most stringent measures and testing.
Doctors are also unsure as to the seriousness or severity of this new ailment – and we are only now beginning to understand this better – so our less than reassuring style when encountering this new H1N1 flu is sometimes detected by an equally anxious patient and/or their relatives.
But there is only so much that we can do under such a pressure cooker of an outbreak which is spreading like wildfire! But nevertheless we should not panic, and remember that most >90% of infected people will recover with very little after effects. Possibly only one in 10 patients develop more serious problems which necessitate hospitalisation.
6) Is limiting H1N1 testing only to those who have been admitted to hospital justifiable?
I have explained the worldwide shortage of such testing kits and reagents. Also it is near impossible to test everyone, the world over. Besides, knowing now that almost all the flu-like illness in the country is due to H1N1 makes it a moot point to want to test for this, especially when most are mild.
The rationale for testing only those who need hospitalisation is to ensure that we are dealing with the true virus, and also help to isolate possible changes or mutations to this viral strain. The MOH is also constantly doing sentinel surveillance (random spot-testing at various sites around the country to determine more accurately the various virus types and spread that are causing ILI)
7) Are we short of anti-virul drugs (Tamiflu, Relenza)? Should I take Tamiflu?
These antiviral drugs were available to most doctors during the earlier scare of the bird flu virus, but now are severely restricted, although some orders are still entertained from individual doctors, clinics or hospitals. Remember that these have been block-booked by more than 167 countries who have been shown to have been penetrated by the H1N1 flu bug.
Our MOH has actually stockpiled some 2 million doses of the Tamiflu or its generic form. In the last inter-ministerial Pandemic Influenza task force meeting, this stockpile will be bumped up to 5.5 million doses to cover some possible 20% of the population.
Right now there is no shortage in the country. It is just that it is not readily available on demand for anyone just yet. The MOH is still of the opinion that this antiviral drug be used prudently and would like to register every patient given this drug.
The private sector on the other hand would like to have a looser control over the use of this drug—but we acknowledge that we should be meticulously prudent in its use. There is a genuine fear that resistant strains to this drug may develop with indiscriminate and unnecessary use—then we will all be in trouble with a drug-resistant H1N1 virus run amok!
Drug-resistant strains have been detected in Mexico, border-towns in USA, Vietnam, UK, Australia even. So we have to be vigilant and closely monitor the situation. Right now, the very limited usage of Tamiflu gives us good reason to be optimistic.
However, because of some unusual patterns of seemingly well people dying or having very critical infections, some people and doctors are wondering if these new strains have already reached our shores… or have we been too late in instituting proper treatment…?
The rising number of deaths to 14 now, is quite worrisome, but our health authorities are watching this development very closely and are also checking the virus strain to see if this has mutated. We can only hope that this is not the case, for now.
8) What are some of the problems faced by doctors in dealing with the H1N1 problem?
It would be good if every medical practitioner keeps a close tab on the H1N1 pandemic, and remain fully aware of the developments and changes, which are evolving daily. Every doctor has to be learning on the trot, so to speak, to keep up with the progress of this outbreak and its management, so that we can serve our patients better.
Logging-in to the internet regularly, for more updated information will certainly help, instead of lamenting that not enough is being disseminated via the media thus far… Every doctor has to be more proactive and practice more responsible and cautious medicine during this trying period which is expected to run into at least one to two years. Importantly look out for lung complications, and the above stated higher risk profiles, and refer these patients quickly for further care.
Easier access to antiviral drugs and their responsible use and monitoring would help allay public fears of delay in treatment, but this should be tempered with care and not over-exuberance to dish out to one and all, the precious antiviral drug, just for prevention—this may be a very bad move which can inadvertently create a worse outcome of drug-resistant bugs.
However, in the light of the very quick deterioration of some young patients who have died, it might be prudent to use antiviral treatment earlier and more aggressively.
We look forward to the specific H1N1 vaccine, when it does come our way, probably towards the end of the year. In the meantime, encouraging those in the front-line, heart or lung patients and frequent travellers to have the seasonal flu vaccination is a useful adjunct to help stem the usual problems from other flu types.
9) Are we doing everything that should or needs to be done?
Yes, if you check what other nations are doing, we are doing relatively well. We are not overstating the dangers and we have been quite transparent on the possibilities of this pandemic. Earlier, many agencies and even the public and doctors have accused us of exaggerating the pandemic, and our response was dismissed as being too much, even over the top! Unfortunately, it was only when some deaths occur that many are now decrying that we have done too little!
Also if you are quite honest about it, just compare with the countries globally, and you will notice that no one health or government authority has got this right, spot on.
We are all learning about this novel flu pandemic, and each country’s response is coloured by its past experiences. In Hong Kong, China, Vietnam, Singapore and Malaysia we have had the SARS outbreak, so we are necessarily more paranoid! Also here the experience is that flu does not usually cause death in our community, unlike the west where seasonal flu kills some hundreds of thousands every year!
So the fear factor for this H1N1 flu is not nearly as great in the west, although it is slowly sinking in that its contagiousness and infectivity is far greater, and fears of its reassortment to a more virulent mutant form is growing, into the so-called second and/or third wave of this pandemic, but we will not know until a year or so down the line.
10) Is the public in general doing enough to help in controlling the outbreak?
I think the public is now reasonably well-informed as to this H1N1 pandemic. Perhaps, they are too well-informed, that they have a fearful approach to this virus. But the proper thing is not too over-react and to panic, although I know this does sound easier said than done.
It is almost a certainty that this flu will spread within the community—in schools, universities, academies, factories, work places, offices, etc. WHO has projected that possibly some 20 to 30% of the population worldwide will become infected by this novel flu bug, after studying various models of spread of past infections—the huge and very rapid spread worldwide is mainly due to air-travel. While older flu pandemics took 6 months to extend to so many countries, this H1N1 flu did so in less than 6 weeks!
In the worst case scenarios of course, this outbreak will be alarming—hospitalisations may be required for 100,000 up to 500,000 Malaysians, with perhaps as many as 5000 to 27000 infected patients (depending on the case fatality rate or either 0.1 to 0.5%) succumbing to this illness.
But because we have been monitoring closely and containing the outbreak thus far, with heightened awareness and greater social responsibility, it is possible to ameliorate the infectivity, spread and fatality that will unfortunately accompany this pandemic… Just how successful we will be in limiting these adverse outcomes remains to be seen, but we can be hopeful.
How can the public help? First learn and acquire good personal hygiene. If sick, please be responsible and stay at home, even in your own room where possible, wear a face mask (a cheap 3-ply surgical mask will do, because large droplet spread is the main danger).
Do not go out, practice what is now known as social distancing (about 3 metres from anyone), and be socially responsible, don’t go to public places and infect others – for young people this would be hard, but absolutely necessary – the spread is most rampant in this age group between 16 to 25 years.
When the illness does not go away after a few days or when you are deteriorating, get to the nearest hospital. Most importantly, be very aware and responsible!
Finally, keep abreast of all new developments, because these are evolving all the time. With keen awareness, prudent care, early detection and social responsibility, correct and prompt use of antiviral and other support medical care, and later mass specific vaccination, we can overcome this novel H1N1 flu! But it will take time, patience, public cooperation, much concerted effort and consume great resources.
DAVID KL QUEK is president of the Malaysian Medical Association (MMA).
A television channel reported that officials with the Drug Enforcement Administration were at Dr Conrad Murray’s clinic in north Houston.
Video footage showed two Houston police officers guarding the front door.
Murray was Michael Jackson’s personal physician, and was with Jackson when he died.
Murray, who is based in Las Vegas and is licensed in California, Nevada and Texas, has been interviewed by police but he has not been considered a suspect in the singer’s death.
Meanwhile, investigators in California are also seeking more information from Murray, according to his attorney, Edward Chernoff.
The attorney posted a statement on his law firm’s website late on Tuesday saying investigators from the Los Angeles County coroner’s office have asked for medical records in addition to those already provided by Murray.
“The coroner wants to clear up the cause of death; we share that goal”, Chernoff said in his statement.
“Based on Dr Murray’s minute-by-minute and item-by-item description of Michael Jackson’s last days, he should not be a target of criminal charges.”
Murray has emerged as a central figure in the investigation into Jackson’s death.
The doctor, who had been recently hired by Jackson, was with him in his mansion and tried to revive him.
THIS CENTURY’S longest solar eclipse plunged large regions of Asia into darkness at dawn yesterday, and millions watched the breathtaking spectacle, which will not recur for 123 years.
Lasting six minutes and 39 seconds in some Asian countries, it was visible for over four minutes over India before moving on to Nepal, Burma, Bangladesh, Bhutan and crowded Chinese cites along the Yangtze River, after which it headed out to the Pacific.
“I don’t want to wait hundreds of years to see this again,” said an animated Song Chun Yun, sporting special protective glasses and a new white dress for the occasion in coastal Shanghai, where clouds initially shrouded the eclipse.
Across superstitious India, however, where eclipses are linked with Hindu fables, one of which associate the phenomenon with the demon-dragon swallowing the sun, tens of millions shuttered themselves indoors and abstained from sleeping, eating and drinking – all such activity being considered inauspicious during the eclipse period.
Many Hindus believe the sun’s rays during an eclipse adversely affect newborns, and expectant mothers asked doctors to either advance or postpone births to avoid complications and wretched subsequent karma for their children.
Tens of thousands of Hindus also immersed themselves in the holy Ganges river at Varanasi in northern India, believing it would cleanse their sins and help their souls attain salvation by releasing them from the endless cycle of life, death and rebirth.
“We have come here because our elders told us this is the best time to improve our afterlife,” said Bhailal Sharma, a villager who travelled to Varanasi from central India.
Throughout the day, Indian television channels relaying the eclipse featured a host of astrologers informing viewers of how it would impinge on their respective birth signs.
A 10-member team of astrophysicists filmed the eclipse from a specially equipped Indian Air Force transport aircraft, while a commercial airline operated a charter flight with seats at 80,000 rupees (€1,159).
In neighbouring Hindu-majority Nepal, the government declared a public holiday, and thousands took the opportunity to head off to bathe in rivers and ponds.
“Taking a dip in holy rivers before and after the eclipse saves and protects us from disasters and calamities,” said Sundar Shrestha (86) – who had come to bathe in the holy Bagmati river with six children and grandchildren – with heartfelt conviction.
Eclipse-viewers in central China were luckier than those in the coastal cities near Shanghai, where overcast skies and rain in some places blocked the view of the sun entirely.
Crowds gathered along the high dykes of the industrial city of Wuhan exultantly waving the sun goodbye as the moon moved directly between it and the Earth, covering it completely.
In ancient Chinese culture, an eclipse was an omen linked to natural disasters or deaths in the imperial family.
– IRISH TIMES-
The century’s longest total solar eclipse began with thousands of skygazers thronging the major sites to catch a glimpse of the rare celestial spectacle.
The Sun rose eclipsed on Wednesday morning at 5:28 am at a local sunrise point in the Arabian Sea close to the western coast of India near Surat in Gujarat.
Time of the eclipse across the country:
- Delhi: Eclipse began at 6.24 am
- Bhopal: Eclipse began before Sunrise; total solar eclipse began at 06:22:11 am
- Patna: Eclipse began at 05:29:57 am; total solar eclipse began at 06:24:37 am
- Varanasi: Eclipse began at 05:30:03 am; total solar eclipse began at 06:24:10 am
- Gaya: Eclipse began at 05:29:34 am; total solar eclipse began at 06:24:26 am
- Surat: Eclipse began before sunrise; total solar eclipse began at 06:21:16 am
- Ujjain: Eclipse began before sunrise; total solar eclipse began at 06:22:51 am
- Vadodara: Eclipse began before sunrise; total solar eclipse began at 06:22:41 am
- Siliguri: Eclipse began at 05:30:26 am; total solar eclipse began at 06:26:33 am
- Darjeeling: Eclipse began at 05:30:35 am; total solar eclipse began at 06:27:01 am
- Sikkim: Eclipse began at 05:30:40 am; total solar eclipse began at 06:27:15 am
Amazing pictures of the eclipse from NDTV.
THE MIGHT OF THE PEN
It will be the longest total solar eclipse of the 21st century, lasting at most 6 minutes, 39 seconds. It has sparked tourist interest in eastern China and India.
The eclipse is part of series 136 in the Saros cycle, like the record setting Solar eclipse of July 11, 1991. The exceptional duration is a result of the moon being near perigee, with the diameter of the moon 8% larger than the sun (magnitude 1.080).
This is second in the series of three eclipses in a month. There was a lunar eclipse on July 7 and now a solar eclipse on July 22 and then a lunar eclipse on August 6.
TO READ MORE GO TO :
In just a little while from now, the longest solar eclipse expected to occur in the 21st century will be visible in a stretch of Asia, beginning in India and crossing through Nepal, Bangladesh, China and part of the Pacific Ocean.
It is a rare celestial event. The solar eclipse that will take place will be a total eclipse of the Sun.
The eclipse will last six minutes and 39 seconds in some areas. The enthusiasts from around the world have descended on the region to view the event by land, sea and air.
A solar eclipse occurs when the moon passes between the Sun and the Earth so that the Sun is fully or partially covered. This can only happen during a new moon, when the Sun and Moon are in conjunction as seen from the Earth.
While large parts of central and eastern India will see a total eclipse, other parts of the country will experience a partial eclipse. The big worry, however, is that the monsoon clouds could play spoilsport.
The Sri Lankan government claims that, after its military victory against the Liberation Tigers of Tamil Eelam, which was fighting for an independent homeland in the island’s north-east for the Tamil minority, Tamil “terrorism” has been crushed, and that the outlook for the country is rosy.
In reality, Sri Lanka’s problems have gotten worse. The need for international action against the crimes of the regime is more urgent than ever.
This year, the regime’s genocidal war on the Tamil people killed more than 30,000 Tamils this year. This occurred after the government removed international witnesses.
“Genocide” is defined by the United Nations Convention on the Prevention and Punishment of the Crime of Genocide as an act committed with the intent to destroy in whole or in part a national, ethnic, racial or religious group.
More than 300,000 Tamils have been incarcerated in what are essentially concentration camps set up by the government in the north. A well-functioning defacto state in the Vanni region, four large districts administered by the LTTE for more than a decade, has been decimated.
Democracy in Sri Lanka has been dismantled and a politico-military dictatorship established.
More than any other country, China has assisted Sri Lanka militarily and economically. The quid pro quo is the establishment of a major naval facility in Sri Lanka. This will help supply oil to China from the Middle East and safeguard the movement of manufactured goods from China to the West.
China has also started a coal-powered power plant in the island’s north-west. Eighty families of fisher people in the area have been evicted. The government claims they are “illegal residents” because they live in huts.
A US$500 million “soft loan” has been granted by the Export and Import Bank of China.
TO READ MORE:
Below is a list of ten of the most popular reasons given by conspiracy theorists who believe the Apollo Moon landings that began 40 years ago were faked.
1) When the astronauts are putting up the American flag it waves. There is no wind on the Moon.
2) No stars are visible in the pictures taken by theApollo astronauts from the surface of the Moon.
3) No blast crater is visible in the pictures taken of the lunar landing module.
4) The landing module weighs 17 tons and yet sits on top of the sand making no impression. Next to it astronauts’ footprints can be seen in the sand.
5) The footprints in the fine lunar dust, with no moisture or atmosphere or strong gravity, are unexpectedly well preserved, as if made in wet sand.
6) When the landing module takes off from the Moon’s surface there is no visible flame from the rocket.
7) If you speed up the film of the astronauts walking on the Moon’s surface they look like they were filmed on Earth and slowed down.
8) The astronauts could not have survived the trip because of exposure to radiation from the Van Allen radiation belt.
9) The rocks brought back from the Moon are identical to rocks collected by scientific expeditions to Antarctica.
10) All six Moon landings happened during the Nixon administration. No other national leader has claimed to have landed astronauts on the Moon, despite 40 years of rapid technological development.
What do you think? Were the Moon landings faked? What evidence is there to support or defend your view?
Civil defence officials in New Zealand have issued a tsunami warning after an underwater earthquake measuring 7.8 on the Richter scale.
By Paul Chapman in Wellington
The Pacific Tsunami Warning Centre in Hawaii said the earthquake in the seabed, 100 miles west of New Zealand’s South Island city of Invercargill, “has the potential to generate a destructive tsunami that can strike coastlines in the region near the epicentre within minutes or hours”.
Whether the earthquake, which struck at 0922 Wednesday GMT, had actually generated a tsunami was not known. But the Centre issued a warning based on evaluation of the seismic event.
Civil defence emergency procedures were activated in Southland, New Zealand’s most southerly region, and coastal residents were asked to stay tuned to their radios.
The earthquake’s power makes it one of the largest in the world this year, compounded by the fact that its focal depth was less than five miles below the earth’s surface.
An aftershock measuring 6.1 on the Richter scale struck about 20 minutes later.
The quake was felt strongly by residents in Dunedin, Invercargill and the ski resort of Queenstown. It was also felt as far away as Wellington in North Island.
People ran from restaurants in Queenstown as buildings shook, and lights and phone lines went down.
Simon Darby told the New Zealand Herald that a rumble in the ground led him to run outside his house in the lakeside town of Wanaka.
“It must have lasted about two and a half minutes. I lived in Tokyo for three years so I know what large quakes are like. This was easily the longest and biggest I have ever felt.