H1N1: Better to err on side of caution (ST 3 July)
July 3, 2009
TWO VIEWS
Better to err on side of caution
By Jeremy Au Yong, Political Correspondent
ALTHOUGH some may complain about what they see as over-zealous measures to contain the H1N1 virus, the fact is that this level of response is exactly what Singaporeans expect – in fact, demand.
Beyond the clear public health issues at play, there are equally important, though much less discussed, political considerations at work.
Take it all together and there is a strong case to be made that Singapore’s response to the outbreak is exactly what the doctor, and the people, ordered.
In recent weeks, there has been a growing chorus of those criticising the tough measures rolled out to contain the H1N1 flu outbreak. The Government, they say, is overreacting, treating the mild flu like the severe acute respiratory syndrome (Sars).
National Neuroscience Institute director Lee Wei Ling, an outspoken critic, at one point suggested opening up Singapore’s borders to build up herd immunity to the disease while it was still relatively mild. More recently, she called the continued use of temperature screening a waste of resources.
Meanwhile, others have pointed to how governments in some parts of the world have downgraded their alert levels once it was clear the bug’s potency was limited.
The Australian government has ended mandatory quarantine, thermal imaging at airports and compulsory testing. Those with flu-like symptoms will no longer be tested for H1N1. While those who are sick are ’strongly advised’ to stay home, they will no longer be forced into quarantine.
Japan has decided to stop counting individual infections. Instead, it is going to focus on early detection of group infections.
In the United States, it has been business as usual from the start, despite it being next door to H1N1’s Ground Zero – Mexico. There are no temperature checks, no quarantine orders and no tests.
Why then, does Singapore still count, screen and quarantine?
Though there is a discernible easing into a lower alert level, Singapore still takes more precautions than most other countries. This is even while ordinary Singaporeans seem to be caring less and less about the disease. Some even joke that they would not mind catching it, if only for the week-long quarantine, and others talk about organising flu parties to catch the disease.
Many regard it as no more potent than the common cold. At any rate, they argue that with 878 cases already reported here, the disease has shown that it cannot be stopped.
From the public health point of view though, there are clear reasons why Singapore must maintain some level of vigilance.
One is that much is still not known about the virus. The H1N1 virus remains elusive and mysterious. Nobody knows when or if it will mutate, and what it will mutate into. Call it a known unknown which can mutate into an unknown unknown at any minute.
Doctors and scientists have had only two months to examine the bug, and while the Genome Institute of Singapore found that the virus has mutated only slightly, there is no telling how much it can change further.
At a press conference last month, Dr Lyn James, the Health Ministry’s director for communicable diseases, sounded a warning against being too cavalier, saying: ‘It is wiser not to underestimate the virus, because we are still in the early stages of the outbreak.’
Until the disease is properly understood, precautions have to be taken, just from the health perspective.
As for temperature screening, while it may miss some who show no fever, it has also caught others who proved to have the bug.
The bigger point about the H1N1 measures, though, is political.
The question to ask is this: If the Government uses a relaxed approach, and things suddenly take a turn for the worse, would it be blamed?
If there is a sudden fierce outbreak in schools, if the virus mutates into a more deadly strain or if Singapore registers its first fatality, what will the public reaction be?
There will almost certainly be a public outcry if the Government had not rolled out measures to deal with this flu.
There is no saying that there will not be an outcry still if, say, some schoolchild dies from H1N1.
As political analyst Eugene Tan from the Singapore Management University, says, it can be likened to a terrorist threat: ‘The population will grumble at some of the measures but accept the necessity albeit grudgingly. If such measures are not in place and an untoward incident happens, blame will fall squarely on the authorities. In fact, despite the measures, blame will still be pinned on the Government if something untoward happens.’
In a sense, the reaction is spurred by the people. One wonders if the Government might have been prepared to do less about the disease if there had not been so much expectation.
Singaporeans demand firm government action in response to each crisis, and the Government knows it must deliver just that.
A laissez-faire attitude towards contingencies – whether terrorism or health epidemics – is not what the people elected this Government for. This is one government that has honed emergency planning to a fine art, with periodic exercises to prepare officials, relevant organisations and members of the public for a range of emergencies.
In the case of H1N1, Health Minister Khaw Boon Wan has even made it his job to talk to the private sector about the impact of the virus on business operations. Also, the Health Ministry has been urging companies and other organisations to use the current situation as an opportunity to test their business contingency plans.
To top it off, there is the matter of timing. The H1N1 flu outbreak has come at a time when Singapore is entering a busy period. Numerous high-profile international events are either already here or about to be staged.
Right now, the Asian Youth Games are ongoing. After that comes the Formula 1 night race in September and the Apec Summit in November. The international spotlight will be on Singapore during these events. Any shortcomings in the way the disease is handled could adversely affect Singapore’s reputation.
Says Mr Tan: ‘The Government certainly does not want to be in a position where it is accused of being lackadaisical in managing the H1N1 threat.
‘Imagine the damage it would do to our economy if tourists stayed away. Now is the time to inspire confidence that Singapore is on top of the threat so that prospective visitors can plan their trips in full confidence that they are not leaving themselves open to greater threat than is acceptable.’
But that does not mean H1N1 measures are politically self-serving. Political aspects may be taken into account, but political expediency does not factor in.
In other words, this is not scare-mongering, as that in itself carries a cost.
As Mr Tan says: ‘The precautionary measures, over and above what the World Health Organisation recommends, involve a heavy cost to all parties. They stretch our health-care resources and could deprive us of the ability and resources to respond effectively in the face of a real and present danger. So politics cannot be the reason.’
In the end, however one feels about the current response, one thing is clear: This is one situation where a little bit of extra precaution, a little dose of Singaporean kiasuism, would not hurt.
If anything, this is a good practice run for when a bigger crisis occurs.
jeremyau@sph.com.sg
Beyond the clear public health issues at play, there are equally important, though much less discussed, political considerations at work. Take it all together and there is a strong case to be made that Singapore’s response to the outbreak is exactly what the doctor, and the people, ordered.
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