theSun | TUESDAY AUGUST 18 2009
news without borders
Fomca to mask suppliers: Time to show loyalty
PETALING JAYA: The Federation of Ma-
laysian Consumer Associations (Fomca)
called on pharmacies and other traders
yesterday to sell surgical masks with
minimal profit or at cost as a national
contribution to fight the spread of Influ-
enza A(H1N1).
“This is the time to show their loyalty
to assist the nation in its battle against
the disease and not to take advantage
of the situation and hike prices,” its
Don’t take the risk,
D-G tells flu victims
by Karen Arukesamy
newsdesk@thesundaily.com
PETALING JAYA: Health
director-general Tan Sri Dr
Mohd Ismail Merican yesterday
criticised those infected with
Influenza A(H1N1) or show
influenza-like illness (ILI) but
disregard the Health Ministry’s
repeated calls for social distanc-
ing.
“We learnt that there are still
many patients, who are infected
with Influenza A(H1N1), who
are not cooperating to help con-
trol the spread of the virus,” he
said in statement.
The ministry urged those
with even mild ILI not to visit
public places, use public trans-
port, or go on tours, to work or
to school.
“Such actions would increase
their own health risks and fur-
ther spread the virus in the com-
munity, especially to those from
the high-risk group,” he said.
“Those with ILI must under-
stand that although mild, the
virus can still be spread to oth-
ers when they cough or sneeze.
Thus they should stay at home
until they do not show any ILI
symptoms.”
He said if they have to do
any important outdoor activ-
ity, they must wear face masks
and practise personal hygiene
throughout the day.
Mohd Ismail reminded those
in the high-risk group for health
complications to immediately
seek treatment even if they have
mild ILI symptoms.
Those in the high-risk cat-
egory are:
» Children below five years
old;
No unhealthy reading on API
KUALA LUMPUR: The air
quality continued to improve
yesterday with no area record-
ing any unhealthy reading on the
Air Pollutant Index (API).
According to the Department
of Environment’s website, as at
11am, 38 of the areas monitored
showed good readings and 12
recorded moderate readings.
Bintulu recorded the best API
reading of 18 and Miri registered
19. The other areas with good air
quality included Alor Star (38),
Bakar Arang (32), Sungai Petani
(32), Langkawi (30), Larkin Lama
(44), Muar (50), Malacca (34),
Nilai (49), Port Dickson (50),
Seremban (47), Indera Mahkota
(42), Kuantan (42), Kota Kinabalu
(36), Sandakan (31), Tawau (42),
Kapit (37), Kuching (28), Sibu
secretary-general, Muhammad Shaani
Abdullah, told Bernama.
Supporting Deputy Prime Minister
Tan Sri Muhyiddin Yassin’s proposal to
make surgical masks a price-control-
led item, he urged the Domestic Trade,
Cooperative and Consumerism Ministry
to gazette the move immediately.
The normal price of a mask is about
50 sen but the price has shot up to RM3
to RM4 each because of the demand.
» Those aged 65 years and
above;
» Children and adolescents
(below 18 years) on long-term
aspirin therapy;
» Pregnant women;
» Adults and children with
asthma, chronic obstructive pul-
monary disease, organ failure,
cardiovascular disease, hepatic,
heamatological, neurologic,
neuromuscular or metabolic
disorders such as diabetes mel-
litus;
» Adults and children who have
immunosuppressant; and
» Residents of nursing homes
and other chronic care facilities.
A seven-month-old boy and a
74-year-old woman are the lat-
est Influenza A(H1N1) victims,
bringing the number of deaths
to 64.
The baby was referred to the
ICU on Aug 7 after having fever,
cough and breathing difficulty
for two days and received anti-
viral treatment the next day.
He also had asthma and
received treatment at a private
clinic on Aug 6.
“He was confirmed to be in-
fected with the virus on Aug 12.
He died on Aug 15 due to severe
pneumonia with acute respira-
tory failure,” Mohd
Ismail said.
The second AFPPIX
fatality involved a
diabetic senior citi-
zen, who also had
congestive cardiac
failure.
She was admit-
ted to hospital on
(42), Kemaman (40),
Petaling Jaya (49), Batu
Muda in Kuala Lumpur
(50), Putrajaya (43) and
Labuan (28).
The areas with moder-
ate reading were Kota
Tinggi (52), Pasir Gudang
(53), Kota Baru (59), Balok
Baru (60), Tanjung Malim
(51), Samarahan (52), Coun-
try Heights in Kajang (52),
Kuala Selangor (53), Port
Klang (64), Shah Alam (52),
Kuala Terengganu (54) and
Cheras (52).
An API reading of 0 to 50
is considered good, 51-100
moderate, 101-200 unhealthy,
201-300 very unhealthy, and
300 and above hazardous.
– Bernama
Independence day joy
Muhyiddin had said yesterday the
government was considering making
surgical masks a controlled item to
prevent suppliers from inflating prices.
Muhammad Shaani said priority
should be given to poor schoolchildren,
the elderly and similar vulnerable groups
to obtain free masks.
“People should also be educated on
how to use the mask effectively and to
change it if its soiled,” he said.
INFLUENZA A(H1N1) HOTLINE
» 03-88810200/300
» 03-88834414/415
Aug 10 after she passed out at
home and was reported to have
fever and cough since Aug 8.
She received antiviral treat-
ment on Aug 11 but died on Aug
12 due to severe pneumonia,
and she confirmed positive for
A(H1N1) the next day.
Two hundred and eighty-four
patients are being treated, with
33 in ICU, nationwide.
Seventeen of those in ICU are
from the high-risk group.
Mohd Ismail said immedi-
ate antiviral treatment without
the A(H1N1) confirmation test
is given to people from three
categories:
» Those who show ILI symp-
toms and have high-risk factors:
» Those with ILI symptoms
without high-risk factors but
have high fever (more than 38°C)
for more than 48 hours; and
» Those who go through the
“rapid test” and found to be posi-
tive of A(H1N1) and have severe
symptoms within 48 hours.
Frontliners flop
A(H1N1) test
IT was a simple oral test. What
do the letters and numbers in
“A(H1N1)” mean? The question
was put to Health Minister Datuk
Seri Liow Tiong Lai, a patholo-
gist, two triage nurses, hotline
operators, two doctors and a
government veterinarian. Only
the veterinarian scored A1 in this
random H1N1 quiz.
THE ciphered term “A(H1N1)” has
been the global buzzword in the
last four months. It is on everyone’s
lips but not many know what the
A, H, N and the 1s mean.
If “A (H1N1)” seems to you like
a cryptogram from Dan Brown,
do not fret. Even Health Minister
Datuk Seri Liow Tiong Lai could
not tell off-hand what the letters
and numbers meant.
Liow told me both H and N are
“nucleic acids” and later, in an
sms, his press secretary, Lim Chau
Leng, spelt out what the H and N
actually stand for.
Nobody expects the man in the
street to know its meaning. With
a new virus and new pandemic,
the learning curve for non-medical
professionals will somewhat be
steep and fuzzy.
But as someone who writes
medical stories, I made an effort to
find out because I do not want to
look “stupid” – should a virologist
dip into the nitty-gritty details of
viral aetiology (cause and origin of
disease) at a press conference.
Young men
But can we excuse frontline
climb greased
betel nut
poles to claim HOW A(H1N1) INFECTION HAPPENS
prizes as part
of activities
to celebrate Host cell
Indonesia’s
64th
independence
day in Jakarta
yesterday.
Nucleus Receptor
A special
containing
ceremony, led
sialic acid
by President
Susilo Bambang
Yudhoyono,
medical personnel or hotline tel-
was held
at Merdeka
ephone operators for not “mind-
ing their As, Hs, Ns and 1s” of the
Palace. It was
A(H1N1) pathogen?
witnessed by
I called the Health Ministry’s
the Indonesian
hotline. “I would like to know what
cabinet
ministers
A(H1N1) means, can you help me?”
The operator said: “Oh, it is a flu.”
and foreign
I told her it is not a flu but the
delegates and
name of a virus that causes a “kind
diplomats.
of flu” and that it is a novel, para-
doxical bug that is mild and yet a
serial killer that “kills” selectively.
“I want to know what the A, H,
N and the 1s mean.” She put me on
hold and I overheard her asking a
male colleague, who replied: “Mana
aku tau?” (How do I know?)
Then the male voice came
on the line: “Hello sir, I am Hafiz
Mohd, actually ah ... they are just
letters to differentiate the strains
of the many kinds of flu viruses.”
When I asked what the A, H,
N and the 1s mean, he replied:
“They don’t have any significant
meaning, sir.”
Nice spoken English but a face-
saving lie. I asked if a doctor was
available. He told me there was
none and I thought it was a little
odd. The hotline – a substantial
facility of our National Influenza
Pandemic Preparedness Plan
(NIPP) – was operating without a
doctor within reach!
If we can’t even get our basics
right, how can we “NIPP it in the
bud” when a pandemic dawns
upon us?
When the Health Ministry’s
frontliners “boo-boo” it could
have serious consequences. What
if someone calls to say he or she
is experiencing adverse reaction
such as an episode of psychosis
(cases have been reported) after
taking a dose of the anti-viral drug?
Will those manning the hotline be
3
Comment
by Joseph Masilamany
able to handle such a crisis in the
absence of a doctor?
A call to a private hospital
in Selangor revealed that the
pathologist in attendance was
not familiar with the initials of
A(H1N1). She said: “Oh dear ... my
microbiologist is on leave but I can
send you some literature which
will help you.”
I called the same hospital’s
emergency room, requesting to
speak to a triage nurse. The nurse
who answered said she did not
know the answer, and passed the
phone to a doctor (Dr H), who gave
the most ludicrous definition: “A
is for America, H is for hemisphere
and N is for north.”
Dr H spoke so professionally
that, for a split second, I thought
another novel virus was circulat-
ing the globe!
I enquired about the two 1s,
but Dr H, so enthused with his
knowledge of the influenza, con-
tinued: “As the strain originated
from America and since America
is in the northern hemisphere, it
was named “A(H1N1).”
What a hogwash from Dr H at a
time when the swine flu is spread-
ing rapidly.
If the doctor does not un-
derstand the letters and digits
of A(H1N1) or the seasonal flu
Neuraminidase
(the attack commando who strikes
at the cell’s defence platoon)
Haemagglutinin
(the foot soldier
secures a territory
in the host cell
by binding itself))
VIRUS
Neuraminidase
A(H3N2), how has he been treat-
ing cases of the common flu all
this while?
To treat cases of seasonal flu, it
is imperative for a doctor to know
what strain he is dealing with and
only then will he be able to match
and prescribe the right antibiotic
to the corresponding strain.
A government veterinarian,
who asked to be identified as Dr
K, came out “tops in the class”.
He said all influenza strains are
classified as A or B. “In A(H1N1), A
refers to the influenza category.
“The H is haemagglutinin, a
surface protein that binds the
virus to the host cell that is being
attacked. N stands for neuramini-
dase, an enzyme that penetrates
the host cell.
“Both H and N are present in
the cell membrane of the viruses.
There are 16 kinds of H and only
nine kinds of N. And that is why
we have the numerical digits in
influenza strains.”
The bracketed letters and
numbers refer to the specific
strain or sub-type of the category,
Dr K explained.
In a nutshell, the Hs and Ns are
blueprints that help to fingerprint
the emerging strains and that is
how viral types are identified and
named.
Imagine H to be a foot soldier
who has secured a territory (host
cell). Now imagine N to be the
attack commando who strikes
at the cell’s defence platoon and
conquers the territory. An infec-
tion has now taken place. And we
call it A(H1N1) infection.
A major public education
campaign to create awareness of
A(H1N1) is in the pipeline. It will be
good to have a separate campaign
for frontliners, too.