All markers indicate that the novel H1N1 influenza epidemic in Singapore is on the wane. Polyclinic attendances for acute respiratory illnesses have declined, the proportion of influenza-like illnesses attributable to H1N1 has fallen, and there are markedly fewer reports in the press.The one question of interest to most people now is whether there will be a “second wave” – particularly one that is caused by a more virulent Mk II H1N1 virus – and how seriously this will affect Singapore. Some local pundits have already suggested putative start dates for the second wave – November (in line with winter in the northern hemisphere) or January 2010 (in line with the start of the school term, when kids returning from overseas holidays will trigger off outbreaks in their schools).
This is a pertinent question, because historically, half of the 20th century influenza pandemics have had second waves that were more devastating than the first, and most pandemics had between three to five waves (the later waves were far milder and resulted in fewer people infected). It would make sense to prepare for a next round of heightened clinic attendances, hospital admissions (and potential bed shortfalls), and media interest.
Most of the local influenza experts I have spoken to have privately expressed the opinion that there will either be no real second wave, or that it will be milder than the current outbreak. This is based partly on historical precedent – all 20th century influenza pandemics have had negligible impact in the second year in Singapore, regardless of impact in other countries. Singapore is also a very small country with no seasons, and the first wave has already resulted in an estimated 15% to 20% (this is based on mathematical models, of course, not real data) of the population – mainly schoolchildren – infected. There is thus a bit of herd immunity, or “firewall” if you like, to limit the spread of newly-imported H1N1.
Time will tell if this is borne out.
This is a pertinent question, because historically, half of the 20th century influenza pandemics have had second waves that were more devastating than the first, and most pandemics had between three to five waves (the later waves were far milder and resulted in fewer people infected). It would make sense to prepare for a next round of heightened clinic attendances, hospital admissions (and potential bed shortfalls), and media interest.
Most of the local influenza experts I have spoken to have privately expressed the opinion that there will either be no real second wave, or that it will be milder than the current outbreak. This is based partly on historical precedent – all 20th century influenza pandemics have had negligible impact in the second year in Singapore, regardless of impact in other countries. Singapore is also a very small country with no seasons, and the first wave has already resulted in an estimated 15% to 20% (this is based on mathematical models, of course, not real data) of the population – mainly schoolchildren – infected. There is thus a bit of herd immunity, or “firewall” if you like, to limit the spread of newly-imported H1N1.
Time will tell if this is borne out.
1 comments:
A recent article in Time magazine about H1N1's "second wave" features a doctor's comment about how containment measures are useless as long as travel remains unrestricted.
Globally speaking, we've already transitioned into the mitigation phase, so isolation isn't an issue. But what happens the next time a new virus emerges?
Back in 2003, SARS arrived at our shores via airplane, but was not highly contagious and managed to burn itself out within a relatively short period of time, thus limiting the number of fatalities.
This year, H1N1 managed to infect over 100,000 people in less than 6 months, but remains relatively benign in terms of overall severity.
Barring the emergence of a truly malignant infectious agent, it's unlikely that future pandemics will trigger outright border closures.
While the Singapore government opted to err on the side of caution during the initial months of the H1N1 outbreak, this contrasts starkly with actions - or rather, lack thereof - taken in other countries, notably the U.S., where flu patients weren't swabbed or quarantined, and were treated like normal seasonal influenza cases.
As long as travel across borders continues, and individual countries' pandemic protocols vary significantly, I see no benefit in quarantine measures, especially those which consume large amounts of resources.
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