The Pan(dem)ic Flu

At the time of this writings, the author is suffering one of the worst post call syndrome in his whole career.

I am recovering from one of my worse call ever. Since the escalation of H1N1 cases on top of new mortality reported on daily basis, my emergency department had faced its hardest time. On the usual daily basis, I am seeing about 100 cases per night shift. Yesterday alone, there is a whooping jump to 380 cases! The card stretched 3 times than our table can accommodate and the waiting time is up to 4 hours. If you take a walk outside my clinic, you might think you had walked into Puduraya or Bazaar Ramadhan. There are seas of people, with all seats occupied and the ‘standing’ seat also taken. People lying on the floor, on the trolley, on wheelchair, in toilet and into the open road outside. During the past 20 years of its service, this is the worst ever ever faced by Emergency department. We had declared a state of ‘disaster’, and channeled doctors, nurses and paramedics from all over hospital to come to aid.

It is safe to say 99% of the case came to hospital for sole reason: to ascertain whether they contracted H1N1.

People are in panic. They fear of H1N1. They want to be sure that what they are having is not this strain. I can’t blame them. The propaganda for this disease is very extensive. I will take time to explain to them and make some facts right. I hope it would help the people who read this article. Yes, it’s you.

While it is true that the Director General (DG) of Health said we should not be less vigilance on this disease, there is a general rule of the thumb that one should adhere before coming to hospital:

1. Please COME to hospital/health facilities if you failed self treatment after 3 days. AH1N1 is a new strain of Influenza virus. Means there is no herd immunity. Means it can and will spread like wild fire. But flu is always self-limiting, that is to say it will resolve within few days of onset. We take a rule of 3 days. So to say, if you are having underlying risk factors such as obesity, pregnancy, underlying heart of lung disease, or any condition that renders your immunity less than ordinary people, you are welcomed to see us earlier.
2. Take adequate water and rest. Yes, it is important but often overlooked steps. Take vitamin C. Take 2 large bottles (3L) of water unless you are told not to. Don’t take too much of carbonated isotonic drink if you are having vomiting as the gas will make you bloat and nauseous.
3. Bring your medications to follow up. It will definitely help us a lot if you can remember what medication you took, but most of the people will describe to me “the white pill” “small yellow tablets”. This is like describing Adam Lambert by telling me he wear a blue jeans.
4. The Throat Swab. I know this is a very controversial issue. Majority of the referral cases from private healthcare to us request us for a throat swab for confirmatory test. This is also a confusing issue. At the early part of the disease, the government requires all patient that came from affected area to be screened from AH1N1 by doing the throat swabs. With time, the disease burden increases to a level that National Lab unable to cope with the amount of throat swabs analysis with the escalating amount of patient. New circulars are out by the minute to limit the screening to high risk patients i.e. pregnant mother, heart disease patient or with other co-morbids. In outbreak cases, for example in a closed compound like a school facility, only a random sample of 10 throat swabs will be taken. So you understand why we as the staff of Emergency department do not take anymore throat swabs; this responsibility is passed to Medical Department specialist and medical officer to decide which cases are severe enough for a confirmatory test. In shorts the throat swabs is a limited test now and NOT done for mild flu cases.
5. Help us to help you. This is my personal opinion. We are seeing at least a 400% to 500% increase in patient a day. My clinic usual closed with 100 patients during a night shift; but in this hard times, the numbers jumped to 400 patients at night time only. The number of doctors are very limited at night, and we are recruiting ‘cold’ department Medical Officers to aid in seeing patients but still average waiting time increase to 4 hours. It does help a lot if the patients behave less hostiles towards the doctors. It is a testing times. No one like it either. Tolerance is the key.
6. Please adhere to home quarantine order. I have few cases in hand that came to us. She was supposed to be in home quarantine as the school closed for a week. Out of her sympathy, she went to visit a sick friend and got fever instead. At this time, the cinema, shopping complexes is full of youngsters that feel that home quarantine is nothing but a scam. Home quarantine is meant for reducing the disease spreading rate. As a general rule, any viral fever should settles within 7 days and by separating the affected and unaffecting, we are hoping to limit its spread till it dies down. There is always a reason for things to be done.

This is both a testing time for us, the healthcare provider and the people out there. H1N1 is hard to control. But we still have to do something. The number of cases is increasing and the mortality increase. However, the rate of mortality remains fairly low. There is no reason to panic. Mostly recovers from H1N1 as a self limiting viral flu. At the same time, we should take precautions as listed in ministry of health guidelines, cheerful and above all: constant vigilance.