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The boy who knew too much: a child prodigy

This is the true story of scientific child prodigy, and former baby genius, Ainan Celeste Cawley, written by his father. It is the true story, too, of his gifted brothers and of all the Cawley family. I write also of child prodigy and genius in general: what it is, and how it is so often neglected in the modern world. As a society, we so often fail those we should most hope to see succeed: our gifted children and the gifted adults they become. Site Copyright: Valentine Cawley, 2006 +

Tuesday, April 28, 2009

Swine Flu: is Singapore ready?

Swine flu is spreading around the world. In Mexico it has already killed 152 people (a 50 % jump from the previous tally, on Monday). Cases have been noted in various parts of the world: the USA, Spain, New Zealand, South Korea and Israel. The World Health Organization have declared this a level 4 threat (out of 6 levels). This is the highest they have ever declared, since the system was put in place, five or six years ago. It looks like the world could be in for a rough time. The question is: is Singapore ready?

Singapore has already set up infra red cameras at the airports, scanning arrivals from known infected nations. This is exactly what was done in the face of SARS. Hospitals have isolation rooms available. Doctors and nurses have been trained for this occasion. But is it enough?

I ask this question for a reason, you see, I was struck by something: Singapore has a population of 4.8 million people, yet it has on hand only 500,000 courses of the antiviral, anti-influenza drug Tamiflu. (Figures are from Singapore's daily newspapers...) Thus, in the worst of all possible scenarios, with a virus that is easily transmitted between people, Singapore only has enough drugs to treat 10% of the population. Now, there is a dilemma. Who do you treat? What if those not treated die? Is this the kind of choice we want our Doctors to have to make? The choice of life or death?

It need not be this way. All the rich state of Singapore would have to do to ensure the complete NATIONAL SECURITY of its population, is to have enough Tamiflu stockpiled to treat the entire nation. Sure, it would cost ten times as much...but what is money compared to the deaths of thousands, tens of thousands or hundreds of thousands of people?

Let us look at the example of Mexico, the epicentre of this new disease outbreak. They have had an estimated 2,000 cases. They have also had 152 known deaths. That is a lethality rate of 7.5%. Now, that might not seem much compared to the plagues of history, but in modern times, it is a completely unacceptable, even horrifying, degree of lethality. What is worse to consider is just who is dying. The flu commonly kills the old. Now, while tragic, we all see this as less tragic than the death of the young. The elderly have lived long lives, have had the chance to express their natures, have a career, children and grandchildren and come to understand the world and their place in it. However, this is not so for the young - and the young is precisely who are being killed by the H1N1 swine flu emanating from Mexico. This particular disease loves to take away young adults in their prime, by ravaging their lungs in one last bout of pneumonia. It sounds a terrible way to die...and that way is on its way across the world, even as I write.

So far, no-one outside of Mexico has been killed by the disease. Perhaps this is due to effective treatment being ministered to the victims. However, we should not be complacent because medical infrastructure has inherent capacity limits - and a global pandemic would soon overwhelm that capacity to treat people properly. There could, in a bad scenario, be far too many cases to treat. Many would not receive adequate care...and many would die, therefore. Returning to the matter of drugs: there simply is neither the supply nor the production capacity to meet potential demand for Tamiflu, in the event of a global pandemic. The manufacturer of Tamiflu, Roche, said they could supply an additional 5 million courses to the world, if required. What is that in a world not far short of 7 billion? The stockpiles that exist around the world, of Tamiflu, are adequate for a moderate outbreak - but they cannot meet the needs of a global pandemic. Quite simply, Doctors would have to choose whom to treat, and with whom to let nature take its course: to live or to die - let the virus decide.

We are fortunate that the H1N1 swine flu (a mixture, apparently, of avian, swine and human influenza viruses) is treatable by both Tamiflu and Relenza. Tamiflu has been specifically stocked in Singapore, however, this seems inadequate to me, on two counts. Firstly, different viruses are likely to be resistant to different drugs and there are FOUR drugs available to treat influenza. These are: Symmetrel (amantadine), Flumadine (rimantadine), Relenza (zanamivir) and Tamiflu (oseltamivir phosphate). The H1N1 swine flu is resistant to amantadine and rimantadine, but susceptible to Relenza (zanamivir) and Tamiflu (oseltamivir phosphate). However, it could easily have been resistant, for instant, to Tamiflu, as well - and what good would Singapore's Tamiflu stocks have been then?

What is needed is for Singapore to stock ALL types of influenza drug, as a precaution against any and all influenza pandemics, which are CERTAIN to come, at some point in time. Not only that, but the stockpiles should be large enough to treat the entire population of Singapore, if need be. The only thing that is needed to ensure this is money - and money is the only thing that is risked. On the upside, Singapore's people would be made as safe as possible from flu pandemics as it is possible to be. This is, in fact, the only wise choice. It is the choice that defends against the worst possible scenario, rather than being optimistic about patient numbers. One must assume the worst in such planning - and the worst is a disease so transmissible that almost everyone gets it. Thus, there should be treatment available for everyone - and in all possible varieties, in case the disease is resistant to several drugs.

Of course, it is possible that there could be a flu pandemic resistant to all drugs...in which case, human civilization could be struck a very hard blow indeed. Let us hope, though, that our luck holds and that at least one of our drugs works, on all future pandemics. Let us hope, too, that we will have had the wisdom to stockpile it sufficiently.

This swine flu may or may not become a global pandemic. It may or may not become a wholesale killer. However, the fact remains that one day there will be a wholesale flu killer of mankind. It is the responsibility of the state - of all states, in fact - to ensure that the national defenses are as strong as possible against such an eventuality (which shall eventually come). The price that unprepared states could pay, is too high to contemplate. In the 1918 Spanish Flu pandemic, some states lost up to 30 % of their people (according to Wikipedia, Western Samoa, for instance lost 30 % of adult men, 22% of adult women and 10% of all children). The most recent estimates of total deaths worldwide are from 50 to 100 million people. This was in a much less populated world of only 2 billion people. Comparable figures for today would be in the region of 175 to 350 million people, were we as badly affected, today, as the world was in 1918.

I hope that the swine flu does not become a global pandemic. I hope further that all states learn this lesson: to prepare for the worst possible scenario, by having enough drugs to treat the entire population of their countries, with all possible drugs: anything less, is dangerous foolishness.

(If you would like to learn more of Ainan Celeste Cawley, a scientific child prodigy, aged eight years and seven months, or his gifted brothers, Fintan, five years exactly, and Tiarnan, twenty-eight months, please go to:http://scientific-child-prodigy.blogspot.com/2006/10/scientific-child-prodigy-guide.html I also write of gifted education, IQ, intelligence, the Irish, the Malays, Singapore, College, University, Chemistry, Science, genetics, left-handedness, precocity, child prodigy, child genius, baby genius, adult genius, savant, wunderkind, wonderkind, genio, гений ребенок prodigy, genie, μεγαλοφυία θαύμα παιδιών, bambino, kind.

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posted by Valentine Cawley @ 9:55 PM 

8 Comments:

Anonymous Anonymous said...

Actually there is no point. My friend who studies biomedical science tells me that it is quite pointless because the flu virus changes so rapidly that there is simply no 1 vaccine to target all the virus. And trying to stockpile vaccines for all the current flu strains is also next to impossible because there are hundreds of them and all are current mutating to fight against our body defenses. So even if we stockpile against 1, this very 1 strain may mutate to render the current stockpile useless.

I read somewhere, that this stockpiling of vaccines by countries is more of a PR exercise than an actual solution; to calm the public and prevent panicky people from making the situation worse.

I think a better solution is prevention in the form of policies to filter out potentially sick people from the population.

11:46 PM  
Blogger Valentine Cawley said...

Thanks for your comment.

You - or your friend - have misunderstood what kind of treatment I am talking about it. Tamiflu and Relenza are NOT vaccines...they are anti-viral medications that interfere with most flu viruses. They are not preventing illness...they are TREATING it. They should DEFINITELY be stockpiled. They are NOT a PR exercise and can greatly reduce the severity of illness if the virus is not resistant to them.

I hope this clears the confusion.

However, it is true that vaccines can become less effective because of the changing of a virus...but they may still provide some protection, if the virus doesn't change too much.

6:34 AM  
Blogger Indiana said...

Interestingly the WHO figures say only 7 have died from Swine Flu, the rest are (until confirmed) likely to be a normal number for flu deaths in Mexico at this time of year.

So who to believe?

1:54 PM  
Anonymous Anonymous said...

I supposed the government is being optimistic, relying on the "defenses" at the airport to ensure that nobody brings in the swine flu. Hence the decision not to stock up on the medication yet.

I certainly hope the virus doesn't come into Singapore. Considering the population density, all it takes is one infected person in a train to cause a outbreak.

2:45 PM  
Blogger Re-minisce said...

For a self-proclaimed scientific prodigy your piece is oddly unscientifically and somewhat clumsily worded; i'll assume this is because you wrote it for the layman.

Some of your points have merit, and tamiflu (and other drugs in its class) may well prove important in the immediate future if this pandemic fails to be contained.

One has to take into consideration that stockpiles expire; drugs are usually good for up to four or five years.

If you're looking to stockpile every last known antiviral agent in existence, at levels approaching an entire population... and if that stockpile has to be repurchased every five years, you're talking about an expenditure that would probably exceed this country's national reserves.

You should also look into just how much an individual treatment costs; antiviral medications for HIV for example can be in the thousands - per course.

You should also consider that antiviral medications do not limit the spread of the virus, they alter its natural history in the patient, and, hopefully, prevent it from killing him or her.

The appropriate primary response to the problem of a pandemic is one of containment; the real issues at hand, which you can't see as a layman - are how flawed our ability to contain the spread of these viruses is, and the real danger here is of complacency, of medical staff, administrators, and politicians.

Don't focus on media reports about tamiflu; look into factors like whether it makes sense for medical staff to wear N95 masks, while patients' relatives are free to wander into hospitals wearing surgical masks that don't contain viral spread, and patients themselves aren't wearing any form of barrier protection. Other flaws exist in the system which ought to be looked into; sadly all the media hype is about drugs, and the only winner here is going to be Roche.

go figure.

9:12 AM  
Blogger Valentine Cawley said...

I find your evaluation odd. Of course, I have to write for the layman...otherwise the piece would be closed to them. To write otherwise, would be to be deliberately obtuse.

I am aware that drugs have lifespans and that they need replacing. I am also aware of the cost...which is nowhere near as great as you seem to think. A course of Tamiflu was, in one article I read, quoted at being around 100 dollars, per person. Thus stockpiles of drugs ARE affordable, for entire populations, for all developed countries...if they wanted to implement them. Several types of drugs could be stocked to allow for possible resistances and replaced every, say five years, for less than one hundred dollars per person per year. That is not a lot for a nation like Singapore to afford.

I am also aware that N95 masks are the only ones likely to be effective in interrupting spread of the disease...but assuredly there are not enough to go around.

Yes, you are right that containment practices can help. Reducing crowds and large gatherings such as schools, churches and the like can, if implemented nationwide result in reductions of transmission of up to two thirds (though half is more likely owing to non-compliance issues).

HIV drugs are expensive...but anti-influenza anti-virals are not. There is no real excuse for richer nations not being able to cover their entire populations in the event of a pandemic.

Yes, Roche will benefit...but then so will those saved from dying by its drug, Tamiflu.

Thanks for your comment.

10:36 AM  
Blogger riverman72 said...

The UK is already stockpiling masses of the Tamiflu ani-viral and our few confirmed cases are responding well to treatment.

The infected here are recovering. We can only pray that this will not be as bad as people fear.

10:30 PM  
Blogger Valentine Cawley said...

Hi Indiana,

Mexico attributes its 176 deaths (and counting) to Swine Flu because of a strange characteristic: the people dying are young and previously healthy. This is a different pattern to normal flu that takes the elderly and youngest children.

The figure 7 from WHO was the number of deaths that had actually been confirmed by laboratory testing...this is going to be a vast underestimate of the true number, since the other tests have not been done, yet the deaths show unusual characteristics.

Thanks for your comment.

2:14 AM  

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