Angry Doctor

Monday, May 04, 2009

We are still at...

Alert Orange

And trust me, you don't want us to go to Red.

SMRT's train frequency to be reduced if flu alert hits

SINGAPORE: SMRT said train frequency will be reduced by 30 per cent once Singapore's pandemic alert level hits red. This is because its service staff are divided into two teams to prevent the potential spread of the H1N1 virus.

SMRT has increased its cleanliness vigilance level in trains and buses by more than three times ever since the Health Ministry raised the flu alert to orange.

Public areas are cleaned once every two hours and temperatures of SMRT officers are checked twice daily. There is also a quarantine room for passengers who display flu symptoms.

Ventilation within the trains has been increased, while windows and doors of buses parked at interchanges will remain open.

Temperature of bus captains are also being checked at bus interchanges.

- CNA/so



Yes, reducing the frequency of trains by 30% and therefore increasing the number of passengers on a given train by 43% sounds like a good way to "prevent the potential spread of the H1N1 virus".

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14 Comments:

  • hi angrydoc

    how can we fight the paranoia that comes with swine flu?

    our healthcare delivery system is being messed up - people are afraid to go to hospitals even with severe symptoms. people with chronic conditions will default on follow-up if it proves to be so difficult (and by the patients' flawed perception, dangerous)

    scale that to the whole population of singapore, and goodness knows how many deaths could be attributed to swine flu precautions

    millions upon millions are spent on this swine flu thing that could be better spent on other preventable causes of mortality and morbidity - how about, say, subsidising varicella immunisations? (now that SM goh has it hurhurhur)

    and in hospitals, we are in short supply of PPE, even before the real thing hits...

    how, how, can we fight this?

    -noobie doc

    By Anonymous Anonymous, At May 04, 2009 10:27 pm  

  • I suppose they assume less people will travel if the alert goes to red...

    By Anonymous Ed, At May 04, 2009 11:30 pm  

  • noobie,

    The question you are posing is not a medical question, but one of economics.

    People like to compare deaths due to other causes such as traffic accidents and malaria and whatnot to deaths already caused by H1N1, but this ignores that fact that those deaths occur regardless of H1N1, and what is done to prevent them already represent what we as a society are willing to spend to reduce them. What we are spending to prevent H1N1 deaths is viewed as a separate expenditure, and is kept in a separate account, pretty much like how dessert goes into a different stomach.

    What makes society willing to spend more to reduce deaths due to an epidemic but not deaths due to an endemic disease? That's a question sociologists and economists must answer, but I believe we can gain insights from how we never think twice when we drive on the roads every day, but air-crashes always make the headlines and warrant a documentary series.

    We are familiar with road traffic because we use it every day, while we fly only a few or several times a year. We tend to view road traffic as necessary, but air traffic as discretionary.

    Deaths from road traffic occurs at a low rate every day, air-crashes tend to be rare but claim many lives in one go.

    Air-crashes are so throughly investigated, or perhaps the results of their investigations are so widely publicised, we feel that they are largely preventable. We forget the fact that traffic accidents are also laregly preventable (some people will even argue that there is no such thing as a road-traffic 'accident', only a road-traffic crash).

    These factors in combination lead people to think that epidemics are dangerous but preventable, and so we should do as much as we can to stop them.

    Of course there was also the fact that the Spanish Flu did kill millions of people...

    Anyway, back to the core of your question.

    From a statistical point of view we are quite good at calculating cost-effectiveness. But cost and value are two different things. The cost both in monetary and health terms for smoking may be high, but it is weighed against the value of smoking to the smoker. That is a choice we cannot make for the patient.

    At a higher level the cost of smoking to the national healthcare budget is also known, but to ban it the government must weigh it against the benefits of allowing smoking, and the cost of banning it both in monetary and electoral votes terms. The irony of democracy is that a government may be praised for spending too much on an epidemic that is not, and be condemned for spending the same amount on subsidising HIV treatment...

    That's the system we work in, noob. We are here to study and present the science of it to people who must make their own choices. Don't think that you can do more, and don't feel that you have to take responsibility for their choices.

    (Yes, I am feeling cynical today.)

    By Blogger angry doc, At May 04, 2009 11:58 pm  

  • Its ME,

    Please do not spam my blog.

    (Yes, I am feeling polite today.)

    By Blogger angry doc, At May 05, 2009 12:00 am  

  • Ed,

    I think you are giving them too much credit.

    If they were reducing train frequency in anticipation of fewer passengers, then the percentage reduction should be a function of the expected reduction. (Or not - since a lower occupancy rate is actually better for infection control.)

    However, the 70% figure is calculated from the premise of a two-team system for the staff.

    In any case, given the amount of contact a passenger has with train staff (drivers and station staff), do you think the risk of a staff-to-passenger spread is higher than that of a passenger-to-passenger spread in a given train trip?

    A two-team system is advocated for most businesses to ensure business continuity so that in case of a spread between staff hopefully only 50% are affected.

    Applying it to a business that will have to adjust its services to potentially result in more people being crowded in a small area for longer may not be such a good idea.

    (Yes, I am feeling unforgiving today.)

    By Blogger angry doc, At May 05, 2009 12:17 am  

  • noobie doc has just lost more of his passion for medicine

    sigh

    -noobie doc

    By Anonymous Anonymous, At May 05, 2009 8:02 pm  

  • noob,

    Those of us with real passion try to make medicine into what we think it should be...

    By Blogger angry doc, At May 05, 2009 9:14 pm  

  • those masks effective barrier against viruses?

    By Anonymous Skeptic, At May 06, 2009 8:47 pm  

  • Good grief. You only have to ask once, Skeptic... I can be a bit slow writing after my evening drinks, you know...

    By Blogger angry doc, At May 06, 2009 9:13 pm  

  • I think we have over reacted to the H1N1 virus. My layman perception tells me it is just another strain of the common flu, albeit a little more, or perhaps just as, lethal. Does anyone know whats the lethality of the "common flu"?

    My own experience of the flu is this: it mutates all the time.

    Why do I say so?

    You see I have not taken any antibiotics for flu since I was in NS.

    It started when I had flu at the start of a company proficiency test. I could not report sick and I slog on through the flu, telling myself to go report sick after the test and take a long MC. The test lasted a week, and when the test ended, my flu just disappeared. It has healed itself. Since then I've always let the body combat the flu without any external interferences.

    And over the years I noticed I had some sort of immunity to some kinds of flu. I can feel fluish in the morning and by the evening it has passed. But there are others that take me longer to heal.

    In particular in a recent one, like some months ago, I had fluish symptoms that lasted for almost 2 weeks. It was hard to go away. My hypothesis would be that I had encountered a flu I never had before.

    The worst case scenario would be spontaneous and simultaneous mutation in several places in the world of a deadly flu virus and before you can raise any coloured flag, the pandemic is upon us.

    By Anonymous Flu Immuned, At May 06, 2009 9:59 pm  

  • Now my brain hurts...

    By Blogger angry doc, At May 06, 2009 10:23 pm  

  • I'm raising the white flag at that comment.

    By Anonymous Edgar, At May 06, 2009 10:31 pm  

  • people shouldn't speculate too much out of their fields

    i don't go around making conjectures on macroeconomics, theories on civil engineering or hypotheses on the adoption of nanotechnology

    likewise, someone without medical training or experience shouldn't speculate beyond what they can understand

    the wisest of men admit that the limits of one's knowledge is very, very limited

    -noobie doc

    By Anonymous Anonymous, At May 06, 2009 10:35 pm  

  • "Now my brain hurts..."

    Actually I haven't encountered the flu ever since I started working with viruses.

    Instead I have been afflicted by this strange desire to take over the world with a huge army of fembots...

    By Blogger Lim Leng Hiong, At May 07, 2009 1:29 am  

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