H1N1 Alert – Why are we so Yellow?


H1N1 Alert – Why are we so Yellow?

Why Still Yellow?In Singapore, the H1N1 alert state still remains at YELLOW. While the number of local confirmed cases of H1N1 infection (at least 800 confirmed cases by now, and at least 502 patients are still hospitalised) has already increased exponentially from tens to hundreds, and very soon will be by the thousands, why is the alert state still remaining at YELLOW? What alert state should Singapore be at NOW, exactly?

Why are we talking about migrating to the MITIGATION Phase? According to the Ministry of Health’s Disease Outbreak Response System, there is no such a phase called MITIGATION.  (See below). Why don’t the ministry strictly follow the system already laid down? How come this magic word suddenly appears?

Accountability, Responsibility and Transparency

It looks like the various authorities are in fact not very serious about preventing the H1N1 virus from spreading and tackling the problem headon. Rather, I feel that they are actually indirectly encouraging people to spread the disease more speedily, much further and wider.

In addition, the authorities also seem to be transferring/shifting their accountability and responsibility to the public and the smaller medical clinics, instead of the hospitals’ senior management and the top leadership.

Today’s Straits Times reports (page A6) also imply that the government is not going to fully monitor and control the extent of infection of the H1N1 disease by saying:

Title: H1N1-ready Clinics to Play a Bigger Role

In a move to mitigation phase, first stop may now not be a hospital.

People suspected of having the H1N1 virus will no longer be automatically sent to the hospital. Instead, those who show symptoms, which include a fever, cough or runny nose, can now be treated at any polyclinic or clinic that has been designated as Pandemic Preparedness Clinic (PPC).

Those with mild symptoms will be treated as regular flu patients, and given normal medicine – not the anti-viral drug Tamilflu. They will be sent home and issued with medical leave. The number of days given will be left to their doctors.

If H1N1 infected victims are going to be treated as regular flu patients, without undergoing the necessary clinical tests, how are we Singaporeans going to know exactly how wide-spread the disease has spread? Perhaps the authorities are trying to dampen the alarming state that the spread of the disease is going to become? But by only testing those the doctors deem as serious cases, many other patients similarly infected by the H1N1 virus are going to be unknown, and therefore their statistics burried under the piles of common flu records. Not ensuring we have the correct data to show us the true picture, in terms of scope and depth, are we not trying to cover up the sheer numbers of infection within Singapore, and therefore give a false picture to the whole world?  Is this a responsible way to deal with a global pandemic disease? Where is the transparency?

Others will be treated on a case-by-case basis, taking into account their risk of developing complications and weighing the risks and benefits of treatment.

Only the more serious victims and those who develop complications will be hospitalised.

This case-by-case basis may lead many patients’ conditions not being thoroughly investigated and their diagnosis backed up with appropriate and proper clinical tests. Thereby, fatal mistakes are made by the doctors because of poor judgment, lack of experience, ignorance, carelessness or wrong conclusion. There have been a few cases where H1N1 infected patients were treated and sent home by their doctors, thinking that their illnesses were mild, but these same patients unfortunately died of the H1N1 infection a few days later. See link here.

Moreover, this approach is, in effect, shifting the accountability and responsibility of the health authorities to the private general-practice doctors at large, and putting the patients’ lives at the judgment of these doctors, who have to make conclusions and decisions blindly, without the necessary facts to back them up. This is like tikam tikam with the lives of the people – playing God at the same time!

The Ministry of Health (MOH) announced this big step towards the so-called mitigation phase in a statement last night. It said the moves are part of its plan to make a gradual transition from containment of the virus to mitigation, during which the focus will switch to treating only serious cases.

What Mitigation?

Who do we mitigate with? With the H1N1 virus? For example, by writing an open letter addressed to “Dear Mr H1N1 Virus,” as  has been done the other day by one of the ST reporters? Will or can the H1N1Virus be so compassionate to heed our plea and willing depart from this tiny dot on the map?

Or, may be we are mitigating with the people, the public, especially the young and energetic youths who like to mix around and go clubing and pubbing every day and night? Will they be so obedient to acede to the government’s plea? Just look at today’s Straits Times (2 July 2009) report on page A6, to see for yourself how many young people are still undeterred making a beeline for the Butter Factory – even though it is one of the very first spots to have started spreading the H1N1 virus – without much of a concern for the H1N1 virus infection at all! Are they following some of the Americans or Australians who deliberately get themselves infected by organising and attending ‘Swine Flu parties’, which has been indirectly recommended by Professor/Dr Lee Wei Ling (daugther of MM Lee) in her letter published in ST Forum several weeks back?

In it s statement, the ministry said: “We are still trying to slow down community spread but have concurrently preparing to manage the disease in a more targeted and risk-stratified manner.”

What the hell does this statement mean? What exactly is the meaning of “targeted”? The virus targets you, not you target the virus! The doctors are not able to accurately assess which patient to target upon because of the mere fact that they do not have enough accurate information about the seriousness of a patient’s infection until and unless they have clinical data to support their analysis and diagnosis. Are we embarking of target practice like in the army – the game of Russian Roulette?

And what is the meaning of “risk-stratified”? How are the general practice doctors going to assess accurately the different stratas of risk? What yardstick of measurement are they going to use? We do not have any previous records nor experience in this new strand of virus yet. Guesstimates, probably! I bet 99% percent of the patients will be treated as common flu sufferers instead, and be allowed to go home and infect all the other members of their families, thinking that they are only having a normal cold – nothing serious. Who will be responsible for their deaths subsequently if the cause of death is due to delay in treatment or poor professional judgment on the part of the physicians?

Side-effects on Swine Flu Vaccines

Although the present swine flu vaccines may seem to be effective against the H1N1 virus infections, it reality they are not. There is at present no cure for this H1N1 virus disease. Moreover, there are bound to have side-effects on the health of the victims in the use of certain flu vaccines such as Tamiflu, in the long run.

Watch the following video clips and conclude for yourself.


Very Important Message on Swine FLU!!!



Underlying Medical Condition Is Not Sole Cause of Death.

Though many authorities claim that the H1N1 infections mostly become fatal to those who have underlying medical conditions, this claim in not entirely true. Underlying medical conditions cannot be solely blamed for the cause of death. The H1N1 virus can also cause death to previously healthy and young people too. There are, in fact, many cases of young and healthy persons who, within just two weeks of infection, and though put in ventilators to support their lives, finally succumbed to the disease and died.


If there is going to be a Mitigation Phase, then it is appropriate that the Alert state Black, or at least Alert Red, should be proclaimed – in line with the existing Disease Outbreak Response System. The alert state cannot conveniently remains at Yellow, simply with few modifications. Otherwise, this is a clear admittance that our whole Disease Outbreak Response System is just on paper, not meant to be taken seriously.


Singapore Ministry of Health Disease Outbreak Response System, Definitions

Published on May 01, 2009, 08:06:14 pm.

Definitions for Disease Outbreak Response System

Source Link:

Alert Green

Isolated external or local cases of animal-to-human transmission.

Threat of human-to-human infection remains low. The disease, if any, is basically limited to animals.

Strategy is to step up vigilance and make preparations to meet the potential threat.

Place close contacts of cases under phone surveillance and observe them for flu-like symptoms.

Encourage healthcare workers and high-risk groups to get vaccinated against seasonal flu.

Instruct use of personal protection equipment for those looking after suspect cases.

Advise public to practise good personal hygiene habits and responsible social behaviour.

Alert Yellow

Inefficient human-to-human transmissions of flu caused by a novel virus, requiring close and sustained contact to an index case. Further spread can be prevented through public health measures to isolate cases and quarantine contacts.

Risk of import into Singapore elevated. Isolated imported cases may occur but there is no sustained transmission.

Strategy is to prevent further import of cases, and to ring fence and isolate cases to prevent spread. The focus will be to provide treatment of all cases, and antiviral prophylaxis to contacts including exposed healthcare workers.


Alert Green action apart, institute home quarantine for close contacts of cases.

Institute temperature screening and impose restriction on hospital and clinic visitors.

Restrict inter-hospital movement, except in emergencies.

Healthcare workers to take temperature twice a day.

Institute temperature screening for passengers arriving from affected countries at border control checkpoints.

Travellers from affected countries given Health Alert Notices (HANs) and advised to monitor their temperature daily for 1 incubation period.

Alert Orange

Virus becoming increasingly better adapted to humans but may not yet be fully transmissible , requiring close contact with an index case.

Larger clusters appear in one or two places outside Singapore but a pandemic has not yet been declared. A cluster of cases may also occur in Singapore but human-to-human spread remains localized.

Public health measures such as isolation and quarantine will be effective to break the chain of transmission. Strategy is to contain spread arising from any local cases and break the chain of transmission, while preserving essential services and resources.


Implement “No visitor” rule at all hospitals.

Restrict all inter-hospital movement of patients or healthcare workers.

Set up Flu Clinics at the 18 Polyclinics for assessment and anti-viral treatment of flu-like patients.

Commence antiviral prophylaxis for identified essential services.

Encourage temperature taking at schools and all non-healthcare workplaces, markets, places of mass gatherings etc.

Carry out temperature screening for in-bound and outbound passengers at all air, sea and land border checkpoints.

Consider closing of schools and suspension of public gathering and events.

Alert Red

WHO declares that an influenza pandemic has begun. Singapore eventually also affected.

Higher risk of acquiring the disease from the community once pandemic spreads to Singapore .

Strategy is to mitigate the impact of the pandemic.

All measures taken in Alert Orange will continue to be applied.

Closing of school and suspension of selected events to prevent congregation of large groups of people.

Alert Black

High rates of severe disease and deaths. Emergency measures implemented to bring the situation under control.

Healthcare and social support systems are overwhelmed by the pandemic. Economic activities are severely disrupted.

Strategy is to ensure that medical & public health measures take precedence over social & economic considerations.

Focus is to contain the “damage” and regain control of the situation, Drastic measures like stopping all social events may be implemented.

The majority of measures are as in Alert Red plus the following action:

Suspend all public gatherings, schools and Institutes of Higher Learning (IHL) closures.

Issue advisory to public to stay home or even consider imposing curfew.



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One Response to “H1N1 Alert – Why are we so Yellow?”

  1. Bathroom Vanity Cabinets Adds Class To Bathroom Says:

    […] H1N1 Alert – Why are we so Yellow? « Singapore Trivia […]

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