H1N1 FLU CHECK STRATEGY: SOCIAL DISTANCING AS A CHOICE

By Alan Ting

KUALA LUMPUR, Aug 11 (Bernama) -- The spread of Influenza A(H1N1) may well
depend on how quickly we can shut down schools, day-care centres and public
gathering spots temporarily, and whether people are willing to stay away from
their neighbours.

Malaysia has recorded 1,983 cases, but the fatality rate is alarming with 32
deaths so far.

Some world health experts have suggested that "social distancing" could be
the main strategy to curb this contagious flu outbreak by at least half.

However, they believe that more wide-ranging steps affecting the entire
community are necessary if the isolated clusters of infection expand to become
a widespread outbreak, where person-to-person transmission in the community is
virulent.

In such a scenario, public health officials will be called upon to enact
voluntary plans that can keep people away from work, out of school and in
their homes for as long as it takes to quell the threat of infection.

This seems to have happened now in this country where Influenza A(H1N1) has
become widespread, affecting the community, with no more isolated clusters of
infection like previously.

Therefore, social distancing seems to be inevitable but there is still many
considerations as the health authorities continue to monitor the situation,
apart from already implementing some additional measures.

But the question is, whether these additional measures are adequate to
contain the number of fatalities because the spread has already reached the
community level involving person-to-person transmission.

The authorities are discouraging public gatherings but have not banned them
as they feel that such a measure is not required at the moment.

There are some evidence that big gatherings of people encourage the spread
of flu, and limiting such gatherings can be an effective preventive measure.

There is a big difference between recommending limited public gatherings and
enforcing a more specific and uniform requirement.

In making a decision to close public gathering places, the impact on the
economy, education, and access to food, water and other necessities need to be
balanced with the ability to effectively protect the public through such means.

During the 1957-1958 pandemic, a World Health Organisation (WHO) expert
panel found that the spread within some countries followed public gatherings,
such as conferences and festivals.

This panel also observed that in many countries the pandemic broke out first
in camps, army units and schools, suggesting that the avoidance of crowding
might be important to reduce the peak incidence of an epidemic.

During the first wave of the Asian influenza pandemic of 1957-1958, the
highest attack rates were seen in school-aged children. This was attributed
to their close contact in crowded settings.

A published study found that during an influenza outbreak, school closures
were associated with significant decreases in the incidence of viral respiratory
diseases and health care utilisation among children aged 6-12 years.

Given a pandemic strain causing significant morbidity and mortality in all
age groups and the absence of a vaccine, WHO consultation on priority public
health interventions before and during an influenza pandemic concluded that the
authorities should seriously consider introducing population-wide measures to
reduce the number of cases and deaths.

This include measures to reduce mixing of adults (close workplaces and
discourage mass gatherings).

The measures are intended to slow down the spread of the disease over the
next several months until a vaccine effective against the new strain of the H1N1
swine flu has been manufactured and distributed.

WHO has said that the earliest possible the vaccine can be available is
towards the end of this year.

In the 1918 flu pandemic, social distancing worked as it reduced infections.

Cities that closed schools, churches and theatres during the early months of
that deadly plague had 50 per cent less death rates than the cities that imposed
such measures later or not at all, according to a 2007 paper led by Marc
Lipsitch, a professor of epidemiology at the Harvard School of Public Health.

In facing the H1N1 outbreak, the government officials in Mexico, for
example, now have even emptied museums, closed schools, cancelled sports events
and advised churches not to hold services for several days, and urged members of
the closed-knit society to avoid customary social greetings and kisses on the
cheeks.

This has to some extent successfully reduced infections and contained
the outbreak, where the virus was first detected in April, a report said.

So far, the Malaysian health authorities have not warranted widespread
social distancing to contain the spread of the disease.

But this may change dramatically as we face the reality of the increasing
number of fatalities over the past few days and the figure increasing day to
day.
-- BERNAMA