Angry Doctor

Thursday, April 17, 2008

Simple Solutions, Hard Decisions

angry doc managed to watch an interesting documentary titled "Five Ways to Save the World" yesterday. The documentary showed some of the hi-tech solutions some scientists have proposed to fight global warming, including a plan to "put a giant glass sunshade in space" that will "deflect a small percentage of the sun's rays back into space", and "artificial trees" that will remove carbon dioxide from the air which can then be buried deep underneath the ocean floor.

The show ended on the note that while all these hi-tech solutions are potentially viable, we already have a solution that is readily available: to reduce our use of fossil fuels.

Which brings angry doc to this news story:

More worrying than Al Qaeda
Pandemic could spark doomsday scenario: Expert
Sheralyn Tay

FORGET bombs and bullets — widespread death and panic is more likely to come from non-traditional sources.

Already, small-scale examples surround us — just look at the ongoing hand, foot and mouth disease outbreak, dengue and the rising cost of rice.

Speaking at the second Asia Pacific Programme for Senior National Security Officers yesterday, award-winning journalist Laurie Garrett (picture) said that a bird flu pandemic could trigger such a Hollywood doomsday scenario.

"Personally, I am a lot more worried about pandemic flu than Al Qaeda," said the senior fellow for global health at the Council on Foreign Relations in New York.

Ms Garrett, the only writer to have won the three Big "Ps" of journalism — the Pulitzer, Peabody and Polk Prize — said a pandemic of the deadly H5N1 strain of the bird flu virus would cause disaster on a scale far bigger than the world has ever known, surpassing even the greatest flu pandemic of 1918, which claimed an estimated 100 million lives worldwide.

Then, the virus' fatality rate was 2 per cent — H5N1 has killed 77 per cent of the people infected with it.

The H5N1 is believed to be similar to the 1918 flu virus, but is considered by experts to be the worst to have ever surfaced, said Ms Garrett, who described it as being able to cause a fatal "thermonuclear" reaction in the body.

In chickens, for example, the virus causes massive internal bleeding, turning the combs on their heads black.

The world is only beginning to understand the problem, she said. For one, countries are still responding only at the local level, said the author of The Coming Plague and Betrayal of Trust.

"We have yet to react on a global scale and global infrastructure is not even there yet," she said. "For example, we don't have the capacity to mass vaccinate the whole population. Just look how hard it is for us to do measles and polio, the routine child vaccinations."

There aren't enough sterile syringes to go around, she added.

Petrol, manpower and other logistical infrastructure are also inadequate to execute mass vaccine campaigns, while containment and quarantine facilities are sorely lacking.

The worldwide shortage of healthcare workers and the lack of understanding about how the disease is transmitted and prevented will only exacerbate these problems.

The solutions to these gaps are multi-level, said Ms Garrett. But some valuable lessons from the Severe Acute Respiratory Syndrome (Sars) outbreak underscore the importance of infection control and preparedness.

"What's already in place on a day-to-day basis for routine threats is important, but will not be able to deal with the flu pandemic," she said.

If countries are unable to respond to small outbreaks, such as a rise in flu cases or dengue fever, the effect of a flu pandemic would be "devastating".

"Much more" is also needed to guide the public health responses, she added. For instance, do masks really work, and is hand-washing the best way to stop transmission?

Ultimately, "low-tech" solutions — basic hygiene, personal responsibility, social resilience and community solidarity — remain critical in the face of disaster, she said.

angry doc is not sure how big a threat bird flu will eventually turn out to be, but as the article mentioned, he can already see the cracks in our walls from the Hand-Foot-Mouth disease (HFMD) outbreak.

Despite having our standing surveillance and notification system (yes, the government knows when you are sick) and our ability to put out information to the public via the mass media, we seem to have difficulty breaking the chain of transmission of HFMD.

During the last serious outbreak in 2000, the government had to close down all "childcare centres, kindergartens, enrichment centres, play groups, wading pools and play areas" for a duration of 16 days. While it is not proven that this action directly contributed to controlling the outbreak, it did end soon afterwards.

angry doc thinks it reflects poorly on us as a society that it takes a government action to enforce something which seems like common sense - keep your children at home during an epidemic.

angry doc remembers patients whose parents were more worried about them missing their lessons or exams in school, or arrangements for childcare while they are at work than the public health implications of HFMD, and who would pressurise doctors to give their children the 'all clear' note to return to school, while they still had their ulcers and rashes. angry doc understands their anxiety and concerns, and realises that they stem from an unforgiving system where things are expected to function at peak capacity, leaving little room for occasional illnesses which are actually life's normal occurrences. Still, at the end of the day it is a decision that must be based on one's sense of proportion and social responsibilities, and so angry doc must salute parents who make that decision to voluntarily keep their children away from school during such epidemics.

On the same note, angry doc wonders if the solution to the feared bird flu pandemic may lie in a simpler if more painful decision to end large-scale poultry farming*, instead of a more hi-tech but less certain one like mass vaccination with a yet-unproven vaccine against the disease, as is being undertaken now. Of course, there is no reason why we can't pursue both approaches at the same time - who know? the Japanese may be the ones laughing when the pandemic does strike. If an effective vaccine is found, it will only be part of the solution - making enough of the vaccine and getting it to all those who will need them is another problem to be tackled. And if an effective vaccine cannot be found before the pandemic, then we will perhaps be remembered as the generation who lost so many of their own because of their unwillingness to renounce a steady supply of fried chicken.

* - According to the WHO site "[t]o date, most human cases [of bird flu] have occurred in rural or periurban areas where many households keep small poultry flocks" and not in large-scale poultry farms as angry doc thought. angry doc apologises for the error.



  • A sobering reminder that humankind's old nemesis - infectious diseases - is far from being defeated.

    Also curious the inclination to believe that some high-tech solution or heroic effort can save the world when everything goes wrong.

    By Blogger Lim Leng Hiong, At April 17, 2008 7:06 pm  

  • When dealing with potential problems like an extinction-level asteroid collision, technology is probably our best bet. For things like global warming and epidemics, it might be surer in the medium term to make the painful decision to forgo some of the things we have come to take for granted.

    By Blogger angry doc, At April 17, 2008 9:37 pm  

  • Somehow I feel that the public and perhaps even the government is not really aware of the extent of damange a pandemic can inflict. I can't imagine the scenario where our already highly congested hospitals have to deal with even more patients from a pandemic.

    By Anonymous Edgar, At April 18, 2008 12:44 am  

  • No need to apologise, doc, you did not err. Avian flu ripped through the commercial poultry farms of Holland in 2003.

    Four months, 30m dead chickens and 1 dead vet later, the Dutch brought it under control. History doesn't record whether the vet was angry or not but I imagine he can't have been too gruntled.

    In the absence of an effective vaccine, keeping the flocks indoors away from any possible contact with wild fowl vectors would seem to be the best bet, NOT doing away with large-scale poultry farms. Which does not mean we should allow the horrors of battery farming to be resurrected of course.

    The other advantage of indoor flocks is ease of culling of an entire affected flock, if necessary, by pumping CO2 into the barn. That segues neatly into a global warming rant which I shall refrain from for now, you'll be pleased to hear.

    By Blogger geriatric_eunuch, At April 18, 2008 5:21 am  

  • "When dealing with potential problems like an extinction-level asteroid collision, technology is probably our best bet. For things like global warming and epidemics, it might be surer in the medium term to make the painful decision to forgo some of the things we have come to take for granted."

    True, but what I mean is that to me, true heroism is the effort to monitor a problem and defuse it before it spirals into a huge mess. This sort of "routine" vigilance is often taken for granted.

    A common tendency to see heroes only when chaos has arrived (eg. war, disaster, pandemic), the sort of heroes that the public adore the most. But not every crisis has a happy ending.

    By Blogger Lim Leng Hiong, At April 18, 2008 12:44 pm  

  • Eat less chicken and more vegetables. You get just as much proteins from vegetables, if you eat a wide selection.

    Less chicken required, less poultry farmers, less birds reared in close proximities, viola, less avian flu virus.

    By Anonymous Anonymous, At April 23, 2008 1:35 pm  

  • It's sad really with all the technological advances we have, we still can't maintain a good quality of health all over the worlds.

    By Blogger askgreg, At April 30, 2008 2:21 pm  

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