Swine Flu : Senarai Perlu Faham dan Buat

"Ustaz, saya tak puas hati betul dengan keluarga si X, dah tahu dia tak sihat janganlah datang ke program kita, sekarang saya pun dah selsema ini" Rengus seorang di klinik, kebetulahn bertemu seorang ustaz.

"Heh, sebab anak kamu, pembawa wabak, sekarang ni satu pertiga seokolah kita sudah kena selsema babi, lain kali kalau dah ada symptom, janganlah datang ke sekolah!" kata seorang guru dengan wajah menyinga kepada bapa seorang murid.

"Alahai macam mana ni, tak boleh diri dekat sangat dengan dia ni, dia tengah selsema rupanya, nanti kalau aku jarakkan diri dia terasa pulak" Monolog hati seorang apabila kawannya mengatakan dirinya sedang selsema dan punyai symptom selsema babi.

Itu mungkin beberapa dialog yang semakin popular di ketika ini. Jika tidak dilafazkan sekalipun, ia mungkin sahaja bermain di minda dan hati. Bolehkah kita sedemikian? Apa lagi senarai perlu faham, perlu dan jangan buat di ketika ini?

Wabak swine flu atau selsema babi semakin dahsyat menyerang manusia. Sebelum ini manusia diserang oleh krisis ekonomi hasil tangan mereka sendiri, kali ini krisis bersambung dan berganda dengan serangan krisis kesihatan, juga hasil tangan manusia.

Manusia yang kerap bertukar menjadi bongkak dan angkuh dengan pangkat, kuasa dan harta kini mula menjadi kecut dan takut. Di United Kingdom, pihak kerajaan dan media sering mewarwarkan bahawa swine flu tidaklah berbahaya, ia juga digambarkan sama seperti selsema biasa seperti selsema di musim sejuk yang akan kebah dalam beberapa hari. Ia dikuatkan lagi apabila semua individu yang meninggal dunia akibat swine flu di sini, mempunyai pelbagai penyakit serius yang lain. Keadaan ini menjadikan rakyat UK juga biasa dan hampir tiada dilihat sesiapa memakai ‘facemask' di jalanan sepertimana yang terdapat di Mexico dan Malaysia.

SELSEMA BABI DI UNITED KINGDOM

Namun beberapa hari ini kerisauan sudah mula menjengah di minda kebanyakan rakyat UK akibat kematian seorang kanak-kanak yang sihat akibat swine flu. Ia juga sudah mula merebak dengan makin meluas di United Kingdom sehingga dijangkaan di akhir bulan Ogos, dijangkaan lebih 100,000 orang akan menghidapinya setiap hari.

Hari ini, jumlah mereka yang selsema dan disyaki swine flu di UK semakin bertambah, warga Malaysia di Leicester khususnya dan UK umumnya, juga tidak terlepas dari symptoms swine flu. Semua mula berasa risau tetapi jika sebuah negara maju seperti UK dan USA serta Eropah juga masih terkial-kial, tidak mempunyai penyelesaian rawatan, bagaimana pula nasib negara sedang membangun seperti Malaysia atau Negara-negara lain yang masih mundur.

Media di UK mewarwarkan bahawa dijangkakan vaksin khas untuk virus ini akan berjaya dihasilkan sekitar bulan hadapan. Vaksin ini juga diwartakan akan diberikan kepada seluruh penduduk United Kingdom, dimulakan dengan warga kesihatan di hospital, diikuti golongon berisiko tinggi seperti pesakit athma, diabetes, jantung dan sebagainya. Namun begitu, semuanya masih kabur dan tidak pasti.

Ubat khas seperti anti viral seperti Oseltamivir (Tamiflu) dan Zanamivir (Relenza) hanya boleh diperolehi oleh mereka yang telah menjalankan ujian darah dan disahkan memang dijangkiti swine flu, namun demikian di UK, ujian tersebut sudah tidak lagi relevan kerana jumlah pengadu sudah terlalu ramai. Malah penghidap symptom juga tidak digalakkan hadir ke GP lagi, cukup sekadar kuarantin diri di rumah dan mengubat diri sendiri.

PENGALAMAN KE KLINIK

Pengalaman beberapa warga Malaysia mempunyai symptoms swine flu ke GP (Klinik awam) tidak begitu menggalakkan, sambutan para doktor juga amat dingin malah doktor kelihatan amat bimbang dan mengarahkan segera pengadu untuk keluar melalui pintu lain dengan alasan agar tidak bercampur dengan orang ramai.

Ramai yang kurang senang dengan keadaan ini, tiada ubat yang diberi oleh pihak doktor, tiada prescription untuk antiviral, tiada ubat batuk, dan sebagainya, hanya nasihat untuk mempertingkatkan penjagaan kebersihan, mengunci diri di dalam rumah dan minum air banyak.

Ramai yang sedang menghadapi selsema, batuk dan demam di United Kingdom ketika ini, tetapi kebanyakannya tidak pasti adakah ia swine flu atau tidak, kerana ia benar-benar seperti selsema biasa, yang mana ia biasanya berulamkan batuk dan sekali sekala pening kepala akibat membuang hingusan dan demam singkat. Padahal semua yang disebut tadi adalah symptom-simptom selsema babi, itulah juga info yang terpapar iklan dan poster symptoms swine flu, ia juga tidak jelas.

SENARAI PERLU DAN JANGAN

Apa yang perlu dilakukan kini? Saya bukan doktor namun beberapa nasihat berikut mungkin boleh difahami dan dihayati sebaiknya, moga kita dapat memanfaatkkanya:-

1. PENYAKIT BERJANGKIT & IMANI QADA' QADAR.

Perkara utama bagi semua umat Islam, jangan sesekali lupa atau ‘terlupa' bahawa semua bakteria, virus atau apa jua makhluk yang membawa mudarat ini terlepas dari kekuasaan Allah swt.

Jikalau kita menelurusi hadis Nabi s.a.w, kita akan dapati anjuran Nabi s.a.w untuk berhati-hati apabila bercampur dengan pesakit kusta dan sopak. Sudah tentu anjuran Nabi itu terpakai buat semua jenis penyakit yang diiktiraf boleh merebak dan ‘berjangkit'. Hadis berikut amat jelas :-

لا عدوى ولا طيرة ولا هامة قال له رجل : أرأيت البعير يكون به الجرب فتجرب الإبل ، قال : ذاك القدر ، فمن أجرب الأول ؟

Ertinya : Tiada jangkitan, tiada sial dan tiada hammah (satu kepercayaan jahiliyyah iaitu burung yang kononnya tercipta dari tulang mayat dan hidup lalu membawa sial kematian), maka seorang lelaki berkata : Apa pandanganmu jika seekor unta yang mempunyai penyakit lalu terkena unta yang lain?. Nabi menjawab : Itulah taqdir Allah, (cuba fikirkan), dari mana pula yang pertama mendapat penyakitnya? ( Riwayat Ahmad )

Allah swt mengingatkan :-

مَا أَصَابَ مِن مُّصِيبَةٍ فِي الْأَرْضِ وَلَا فِي أَنفُسِكُمْ إِلَّا فِي كِتَابٍ مِّن قَبْلِ أَن نَّبْرَأَهَا إِنَّ ذَلِكَ عَلَى اللَّهِ يَسِيرٌ

Ertinya : Tiada suatu bencana pun yang menimpa di bumi dan (tidak pula) pada dirimu sendiri melainkan telah tertulis dalam kitab (Lohmahfuz) sebelum Kami menciptakannya. Sesungguhnya yang demikian itu adalah mudah bagi Allah. ( Al-Hadid : 22 )

Berbekalkan ayat dan hadis di atas, Islam mengajar kita agar melihat ketentuan Allah swt sebagai asas, sebelum melihat kepada soal sebab dan musabbab atau sunnatullah (hukum alam).

Walaupun demikian, Nabi s.a.w juga mengingatkan :

فِرَّ من المجذوم فِرارَك من الأسد

Ertinya : Larilah (jauhilah) mereka yang berpenyakit kusta sebagaimana kamu lari dari singa" ( Riwayat Al-Bukhari)

Manakala di dalam sebuah hadis lain :-

لا يُورِد مُمَرَّضٌ على مُصَحٍّ

Ertinya : Janganlah orang yang sakit bercampur dengan mereka yang sihat (Riwayat Muslim)

Mungkin ada yang terfikir wujudnya pertentangan makna di antara hadis berkenaan qadar Allah swt dan saranan menjauhi pesakit berjangkit.

Hakikatnya, tiada kontradiksi di antara satu sama lain, perlu difahami bahawa orang Arab di zaman Jahiliyah percaya tubuh orang sakit akan automatik memberi kesan buruk yang pasti kepada tubuh orang yang sihat tanpa mengira sebarang sebab atau taqdir[1]. Atas sebab itu hadis menyebut hadis pertama, namun dalam masa yang sama tidak menafikan jangkitan dari berlaku. Oleh itu, dalam konteks ketiga-tiga hadis di atas, mesej yang disampaikan oleh baginda Nabi s.a.w adalah :-

· Menafikan kepercayaan silam bahawa tubuh orang sakit PASTI AKAN memudaratkan yang sihat, justeru di dalam Islam, tidak boleh diiktikadkan sedemikian.

· Membetulkan kefahaman semua bahawa hampir setakat mana pun kita dengan mereka yang sakit berjangkit, semua masih tertakluk kepada kekuasaan Allah swt untuk mendatangkan sakit itu kepada kita atau tidak.

· Membetulkan kefahaman ummat bahawa sakit yang mungkin kita alami tidak semestinya datang dari orang sakit yang kita temui. Justeru, jangan mula salah menyalahkan di antara satu sama lain.

Hasilnya, Islam tidak menafikan wujudnya kebolehjangkitan tetapi hadis itu disebut dalam konteks dan objektif yang disebutkan di atas. Kebolehjangkitan adalah termasuk di dalam perkara sunnatullah (hukum ketetapan alam), cuma umat Islam perlu memahami ia tertakluk di bawah izin Allah swt. Pastinya, di musim berlakunya perebakan wabak seperti selsema babi ini, tidak mudah untuk mana-mana individu yang terkena dan belum kena untuk meyakini kuasa Allah. Itulah sebenarnya salah satu ujian Allah swt untuk hambaNya, mendatangkan bala sebagai ujian, tapisan iman serta mengingatkan hamba kepada kekuasaan penciptaNya. Hanya merkea yang beriman mampu melakukannya. Semoga kita terdiri dari golongan itu.

2) JANGAN TUDUH SESIAPA SEBAGAI PUNCA

Jangan menuduh sesiapa sebagai penyebab anda terkena selsema ini, jangan juga marah kepada sesiapa. Ini kerana kita tidak akan mampu mengetahui secara pasti dari manakah kita mendapat virus tersebut. Ini kerana virus selsema boleh sahaja datang dari tombol pintu pejabat yang kita pegang, pintu kereta, teksi, mouse computer, key board dan sebagainya. Mungkin terdapat indidivdu lain yang bersin lalu tangannya memegang keyboard, pintu atau berjabat tangan dengan anda sebelum tangannya benar-benar bersih dari virus.

Mungkin sahaja kita ingin meyalahkan seseorang yang bersin di hadapan kita atau duduk di sebelah orang selsema di dalam train atau bas, namun diingatkan sekali lagi, kita sama sekali tidak boleh pasti, kita mendapat selsema dari orang terbabit, besar kemungkinan virus itu telah kita dapati sejak di stesyen bas lagi. Perlu difahami juga, jarak tebaran germ dari seorang yang bersin secara terbuka adalah sekitar 10 kaki jaraknya. Justeru, JANGAN SALAHKAN SESIAPA dan yakinlah ia takdir Allah swt untuk menguji kita.

Cuba lihat petikan video ini :

3. ELAK KELUAR DAN MASUK DARI KAWASAN SESAK DAN WABAK

Elakkan bercampur di temat awam tanpa keperluan yang mendesak dan adalah baik jika dapat sentiasa membersihkan setiap apa yang ingin kita pegang di temat awam. Mungkin sahaja semuanya telah dicemari oleh virus selsema babi tadi dan sedang menunggu orang menyentuhnya sahaja.

Saranan pencegahan ini sesuai dengan hadis di atas dan juga tindakan Nabi yang tidak berjabat tangan dengan seorang lelaki kusta dari rombongan Bani Thaqif di ketika sesi berbai'ah (janji taat setia). Yangmana Nabi saw diriwayatkan berkata yang ertinya : "Pulanglah, kamu telah pun dikira berbai'ah" (Rujuk Sohih Muslim)

Nabi s.a.w :-

إذا سمعتم بالوباء بأرض فلا تقدموا عليه ، وإذا وقع بأرض وأنتم بها فلا تخرجوا فرارا منه

Ertinya : Apabila kamu mendengar terdapat wabak di satu kawasan, janganlah kamu memasukinya, dan apabila kamu wabak berlaku di satu kawasan, kamu pula berada di sana, janganlah kamu keluar dari kawasan tersebut untuk melarikan diri. ( Riwayat Al-Bukhari dan Muslim)

Mungkin akan adayang tertanya-tanya mengapa dihalang mereka yang sihat untuk kelaur dari kawasan wabak, apakah justifikasi arahan nabi sejak 1400 tahun yang lalu ini. Jawapan diberikan oleh Dr Muhammad Al-Bar (merupakan seorang doktor pakar perubatan dan ahli Majlis Fiqh OIC), beliau menegaskan terdapat individu yang tidak jatuh sakit dengan sesuatu jenis virus, manakala sebahagian lain jatuh sakit. Mungkin sahaja yang keluar ini sihat, tetapi tubuhnya sedang membawa virus dari kawasan wabak, hasilnya, ketibaannya di tempat baru menyebabkan penyebaran berlaku kepada penduduk setempat dan pasti akan ada sebahagian yang boleh jatuh sakit dengan virus tersebut.

Selain itu, kemungkinan juga individu yang sihat ketika keluar itu, belum terkesan lai dengan virus yang berada di dalam tubuhnya. Ini kerana sebahagian virus memerlukan beberapa masa dan tempoh untuk membiak dan mengganggu kesihatan mangsa. Hasil dari semua kemungkinan ini, Nabi s.a.w sejak beribu tahun silam, tanpa ilmu mikrobiologi telah mampu memberikan satu peraturan yang bertepatan dengan penemuan sains. Itulah ilmu yang datang dari pencipta sekalian alam, Allah swt.

Dengan fakta ini, kita tidak akan sama sekali mampu meneka siapa yang menjadi punca pemindahan virus kepada tubuh kita, kerana bukan sahaja individu yang sedang sakit dan selsema sahaja yang berpotensi, malah mereka yang sihat juga terdapat kemungkinan menanggung virus yang sama dan memindahkannya kepada kita melalui sentuhan dan sebagainya. Itulah takdir namanya dan kita diarah untuk berusaha sedaya mungkin dan redha serta sabar apabila diuji.

3) SEKATNYA DARI MENJADI PENYEBAR

Jikalau ditakdirkan kita tergolong dari mereka yang sedang diuji dengan selsema babi ini, pastikan sedaya upaya kita tidak menjadi sebab untuk merebaknya virus terbabit di kalangan awam. Justeru itu:-

· Tutup mulut dan hidung dengan tisu atau kain semasa bersin.

· Sentiasa basuh tangan selepas memegang hingus, hidung atau selepas bersin di tangan, gunakan sabun atau apa-apa jenis sabun antibacteria.

· Kurangkan berasak-asak di tempat awam, kerana peluang pemindahan virus boleh berlaku dengan lebih besar. Namun takdir Allah mendahului segala-galanya, jika telah ditakdirkan, seseorang yang mengunci diri di dalam gua batu sekalipun pasti akan kena, mungkin melalui virus yang dibawa di atas badan semut yang memasuki gua itu!.

Kesemua tindakan dan usaha pencegahan adalah wajib kita lakukan menurut hukum Islam, kerana menyebabkan kemudaratan kepada orang lain adalah diharamkan.

4) CADANGAN PEMULIHAN : SARANAN DOKTOR DAN USTAZ

Bagi tujuan pemulihan, perkara biasa yang disarankan oleh para doktor adalah :-

· Makan vitamin C dengan kadar lebih banyak dari biasa.

· Minum air dengan kuantiti yang banyak, lebih banyak dari biasa.

· Boleh mengambil (kecuali kanak-kanak bawah 5 tahun) ubat demam atau batuk yang biasa atau juga paracetamol dan pain killer seperti ibuprofen untuk melegakan beberapa symptom. (Rujuk doktor anda terlebih dahulu).

· Ambil cuti dan berehat sehingga sembuh.

Ditambah pula dengan nasihat dari para ilmuan Islam:

· Yakinkan diri dengan kesembuhan, sebutkan kata-kata yang baik untuk diri seperti yakin diri akan sembuh segera dan sebagainya. Selain itu, jangan pula mencerca dan memaki hamun semasa sakit. Hal ini disarankan melalui hadis :-

لا عدوى ولا طيرة ، ويعجبني الفأل قالوا : وما الفأل ؟ قال : كلمة طيبة

Ertinya : Tiada jangkitan (tanpa izin Allah) dan sial, dan aku suka kepada sikap Al-Fa'l, Sahabat bertanya : "Apakah Al-Fa'l ?"

Nabi menjawab : "Kalimah yang baik (sangka baik untuk sembuh)

· Berdoa agar beroleh kesembuhan dan doakan orang lain agar turut kuat dan sembuh dari jangkitan selsema babi ini.

· Bersangka baik dengan Allah dan serahkan urusan kepada Allah swt. Iaitu jikalau telah terdapat ahli keluarga yang dijangkiti dan amat sukar untuk mengelakan diri dari bercampur dengan mereka. Dirwiyatkan di dalam sebuah hadi, Nabi meletakkan makan di dalam satu bekas bersama pesakit kusta lalu berkata :-

كلْ باسم الله توكلاً على الله وثقة بالله

Ertinya : Makanlah dengan bacaan Bismillah, bertawakkal kepada Allah dan berikan kepercayaan ( sangka baik) kepadaNya: (Riwayat Tirmizi dan Ibn Majah, namun menurut analisa, hadis ini dinilai lemah)

· Jangan sesekali putus asa jika ditimpa penyakit ini.

Firman Allah swt :

وَإِذَا أَذَقْنَا النَّاسَ رَحْمَةً فَرِحُوا بِهَا وَإِن تُصِبْهُمْ سَيِّئَةٌ بِمَا قَدَّمَتْ أَيْدِيهِمْ إِذَا هُمْ يَقْنَطُونَ

Ertinya : Dan apabila Kami rasakan sesuatu rahmat kepada manusia, nescaya mereka gembira dengan rahmat itu. Dan apabila mereka ditimpa sesuatu musibah (bahaya) disebabkan kesalahan yang telah dikerjakan oleh tangan mereka sendiri, tiba-tiba mereka itu berputus asa.

Sekadar itulah yang dapat dikongsikan buat masa ini, semoga semua kita dapat menghadapi saat sukar ekonomi dan kesihatan ini dalam keadaan yang jitu dan teguh iman kepada Allah swt.

Akhirnya hayatilah kata nabi ini

عجبا لأمر المؤمن ، إن أمره كله له خير ، وليس ذلك لأحد إلا للمؤمن ، إن أصابته سراء شكر وكان خيرا له ، وإن أصابته ضراء صبر فكان خيرا له

Ertinya : hebat dan amat mengkagumkan sifat orang beriman, semua urusannya memberinya kebaikan, dan tiada perolehinya kecuali dia adalah mukmin, iaitu apabila ditimpa kebahagian dia bersyukur, maka ia perolehi kebaikan (hasil syukurnya dia), dan apabila ia ditimpa keburukan, ia sabar dan baginya kebaikan juga (Riwayat Muslim)

Sebarkanlah artikel ini di merata tempat, semoga ramai beroleh manfaat dan terpandu untuk menentukan iman, minda, hati dan sikap yang betul.

Sekian.

A(H1N1) flu: Updates on 10 FAQs

Dr David KL Quek, President MMA

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

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 per cent, 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 per cent 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 per cent) 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:

1. obesity (fatter patients seem to have poorer outcome and more complications)

2. those with underlying diabetes, heart disease

3. those with asthma, or chronic lung disease

4. pregnant women

5. those with reduced immunity, cancer patients, etc

6. 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 Sungai 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 per cent 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 (more than 90 per cent) 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 which have been shown to have been penetrated by the H1N1 flu bug.

Our MOH has actually stockpiled some two 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 per cent 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 the US, Vietnam, Britain, 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 are 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 20-30 per cent 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 six months to extend to so many countries, this H1N1 flu did so in less than six 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 5,000 to 27,000 infected patients (depending on the case fatality rate or either 0.1 to 0.5 per cent) 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 three-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 three 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 and 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.

Dr David KL Quek is president the Malaysian Medical Association.