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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