N95 and H1N1

Please realize that this is not an official advice,
especially the one about face masks or N95.
Most N95 respiratory are designed to filter 95% particulates of 0.3,
while the size of H1N1 virus is about 0.1. Hence, dependence on N95 to
protect against H1N1 is like protecting against rain with an umbrella
made of mosquito net. Tamiflu does not kill but prevents H1N1 from
further proliferation till the virus limits itself in about 1-2 weeks
(its natural cycle).H1N1, like other Influenza A viruses, only infects
the upper respiratory tract and proliferates (only) there. The only
portals of entry are the nostrils and mouth/ throat.
In a global epidemic of this nature, it's almost impossible not coming
into contact with H1N1 in spite of all precautions. Contact with H1N1
is not so much of a problem as proliferation is. While you are still
healthy and not showing any symptoms of H1N1infection, in order to
prevent proliferation, aggravation of symptomsand development of
secondary infections, some very simple steps - not fully highlighted
in most official communications - can be practices(instead of focusing
on how to stock N95 or Tamiflu):
1. Frequent hand-washing (well highlighted in all official communications) .
2. "Hands-off-the- face" approach. Resist all temptations to touch any
part of face (unless you want to eat, bathe or slap).
3. Gargle twice a day with warm salt water (use Listerine if you don't
trust salt). H1N1 takes 2-3 days after initial infection in the
throat/ nasal cavity to proliferate and show characteristic symptoms.
Simple gargling prevents proliferation. In a way, gargling with salt
water has the same effect on a healthy individual that Tamiflu has
onan infected one. Don't underestimate this simple, inexpensive and
powerful preventative method.
4. Similar to 3 above, clean your nostrils at least once every day
with warm salt water. Not everybody may be good at Jala Neti or
SutraNeti (very good Yoga asanas to clean nasal cavities), but blowing
the nose hard once a day and swabbing both nostrils with cotton buds
dipped in warm salt water is very effective in bringing down viral
population.
5. Boost your natural immunity with foods that are rich in Vitamin
C(Amla and other citrus fruits). If you have to supplement with
VitaminC tablets, make sure that it also has Zinc to boost absorption.
6. Drink as much of warm liquids as you can. Drinking warm liquids has
the same effect as gargling, but in the reverse direction. They wash
off proliferating viruses from the throat into the stomach where they
cannot survive, proliferate or do any harm.All these are simple ways
to prevent, within means of most households,and certainly much less
painful than to wait in long queues outside public hospitals

95% of all new cases of flu will be H1N1 Swine Flu

here is new email thats going around at the moment..

To All - some useful information that will help us understand H1N1 better .
----- Forwarded by Prof Dr Hazadiah Mohd Dahan/FPEND17/ UiTM on 12/08/2009 13:25 -----

"Dato' Dr. Mohamed Mahyuddin Mohd Dahan" 10/08/2009 12:02

To Myra Mahyuddin , Kamal Fariz , aniza mahyuddin , phazadiah@salam. uitm.edu. my, Zaleha Jaafar , Zakiah Jaafar cc Subject Fwd: Fwd: USEFUL INFORMATION ON H1NI FLU - From the President, Medical Medical Association

David KL Quek | Aug 7, 09 11:16am



1) Can we distinguish between regular and H1N1 flu, without a lab test?
MCPX


No, the flu is the flu, but there are variations in presentation. Some symptoms such as cough, runny nose, fever, body aches, fatigue, vomiting, diarrhoea occur more or less in every flu patient, but may present differently by different people. Some infected people have very mild symptoms, some in between, and a small minority, probably less than 10%, have severe features including the dangerous pneumonia.

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).

H1N1 Swine Flu: We should declare Curfew. NOW

What this TPM saying that declaring and area as "hot spot" as not practical?

is it becoz " beri kesan negatif apanyer?...lebih baik kita tau mana kawasan panas...orang tidaklah pergi ke situ dan berhati berada di situ? ni tak, rakyat 1Malaysia diutamakan kena H1N1 ke? bodoh punyer TPM."
and "Issue ni tak lah digembar-gembur kan sangat.Nanti menteri yg in-charged pelancungan marah...Skrg ni semua menteri (konon-nya) ada KPI, Kalau pelancung drop, fulus tak mashuk, KPI tak meet, kena drop-lah.."

So out TPM would rather have the whole Malaysia rife with H1N1, and more and more Malaysians succumb to this flu? This is absolutely RIDICULOUS.

..WHEN POLITICAL MADNESS AND LOVE OF WEALTH (if investors knows the full detail they might pull out their money from sharemarket KLSE and share prices will go down..) TAKES PRECEDENT OVER THE WELL BEING OF MALAYSIANS.

Gov't against disclosing H1N1 hotspots

Aug 15, 09 3:39pm

The government has decided against releasing information on Influenza A(H1N1) hot spots in the country, with Deputy Prime Minister Muhyiddin Yassin saying it was not a practical idea.

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• 

  by fantastic4 - an hour ago

  This episode always remind me whether our leaders actually think through the issues before annoucing or commenting to the media. This is certainly not the first time. Flip-flop policies seems to be the trademark. Many examples, like Education policies, internet censorship and then this ? Don't they think before they talk ???

• by concerned - 2 hours ago

  It's like not telling you where there is a minefield and letting you walk into it.

• 

  by Suhakam - 2 hours ago

  Sometimes I wonder whether the government is really serious in tackling the H1N1 problem. The increasing death toll is extremely worrying.

• 

  by Lin Wen quan - 2 hours ago

  Trademark of Malaysia Boleh - first deny then cover up and let the people go about their business in blissful ignorance. With already so many reported deaths, we are now talking about ordering additional the antiviral drug, Tamiflu. In Australia, at the first sign of an imminent outbreak of H1N1, all hospitals were issued Tamiflu as a standby measure. It looks like the drug house producing Tamiflu is obliged to entertain our order when H1N1 is now more or less a global curse and therefore immediate supply may be a problem. The moral is 'Take care of yourself and don't expect the government to take care of you'.

• by Mykern - 2 hours ago

  If a certain area is declared H1N1 free, then people may go there and inadavertantly infest it .... thus spreading it.

• 

  by Dennis Madden - 2 hours ago

  ... or maybe they dont even know where the hot spots are

• 

  by David Yau - 3 hours ago

  Flip flop again... always engage brain before opening mouth lah!

H1N1 Swine Flu: We should declare Curfew.

This morning i got this forwarded message.
Basically healthy body, and fitness, and lots of Vitamin C.
On the "what should be done" side, I believe that we should declare curfew, yes CURFEW.

No one shall get out of their house. Need food? The army of volunteers shall deliver to front gate, and "NO CLOSE CONTACT" either.
Then the curfew shall last at least 2 weeks. Businesses, shops, school and all other least necessary services shall close.

This virus spread through human contact, or close human contact. If there is less human contact, we shall be able to arrest the spread of this virus.

We should keep in mind, at the moment there is no vaccine in the market yet.

Here is the email that has been going around..

Latest info pasal H1N1(pengalaman family pesakit)-penawar Insya'Allah
> JUST 4 INFO... SEKADAR FORWARD UNTUK SEMUA MUNGKIN BERGUNA
>
> JUST A SMALL BUT MEANINGFUL INFO FM ME TO YOU AND YR FRIENDS....MY PERSONAL
> EXPERIENCE OF H1N1 SINCE IT PRACTICALLY HIT US LIKE A TIME BOMB.....
>
> My staff was crying herself sick on Tuesday morning...was told that her son
> was confirmed of H1N1 in his Uni at Kangar, Perlis...worse was that when he
> was bedridden 2 days the warden didnt even bother to sent to hospital till
> his dad came fm KL and with his friends assistance brought him to GH
> Kangar....
>
> No one bothered in the hospital and he was put in the normal ward for
> another 2 days!!! (imagine the amount of people he has infected!!)
> .....after 2 days and his eyes were turning yellow and saliva greenish...he
> was put in quarantined room...
>
> Called his mom to say...minta maaf and ampun la dosa dia, etc...she
> practically fainted just telling me the story.. cant do much cos she x have
> enough money to go to the north with the father...
>
> First thing we did was made her call the hospital and insist that they sent
> him to Sg.Buloh Hospital or any other hospital in KL since they seemed to be
> more alert and more equipt...they refused of course...so I sent her off to
> Kangar the same day to solve the problem.
>
> Whilst this was happening, SUBHANALLAH, I had a call from one Ustaz who was
> in town to "help cure" another H1N1 child in Shah Alam.....and was told this
> simple prescription by him.....of course kena redha pada ALLAH and niat
> dengan sesungguh nya...selawat 3x....
>
> *EAT MINIMUM 6 GREEN APPLES A DAY AND FRESH ORANGE JUICE** *
> for those with sore throat please blend the apples and keep on taking till
> your fever disappear and yr symtoms are gone....I cannot explain it but the
> child in Shah Alam was ok too after taking this tip....
>
> ALHAMDULILLAH. ..my staff's son was given the apple juice for the whole day
> on Monday/Tuesday and dengan kuasa ALLAH he was out of the fever yesterday
> Wednesday... .she called me and was crying on the phone to say that her son
> was out of ICU and was able to eat normally...all these happened within just
> 4 days today (thursday 6 august)...
>
> This is just to share with my fellow sisters and brothers and hope this
> small info could assist others as well, INSYA'ALLAH! !!!!!!!!! No harm in
> trying and kuasa ALLAH anything can happen!!!!