SINGAPORE: The outbreak of COVID-19 infections that started in Wuhan, China and has now spread to almost 30 other countries including Singapore could follow the same trajectory seen in the H1N1 influenza outbreak in Mexico just over a decade ago. It could fade into something less sinister later on, said infectious disease experts.
In early March 2009, Mexico experienced outbreaks of respiratory illness and increased reports of patients with flu-like symptoms in several areas of the country.
This new human H1N1 strain, which originated from swine flu in pigs, swept across the world and by the World Health Organization’s (WHO) estimate, was responsible for more than 18,000 deaths globally in the 2009 pandemic.
JUST ANOTHER FLU BUG
WHO declared the virus a public health emergency on Apr 24, 2009. Four days later, Singapore raised its Disease Outbreak Response (DORSCON) from Green to Yellow. This was raised to Orange on Apr 30, when the WHO raised its pandemic alert level from phase 4 to phase 5.
But it was not until May 26, 2009 that Singapore saw its first case of H1N1, 15 days after the Ministry of Health (MOH) revised the DORSCON alert back down to Yellow. A 22-year-old undergraduate returning from New York had developed symptoms on the flight and later tested positive for the virus.
The outbreak in Singapore peaked in Aug 2009, and the country saw 18 H1N1 fatalities in that year. By the time the DORSCON alert was lowered from yellow to green on Feb 21, 2010, about 415,000 people islandwide had been infected with the virus, with most experiencing mild illness.
“Everyone then realised that it was just another flu bug. The initial deaths in Mexico were not seen in Singapore. Very surprising,” said Dr Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Novena Hospital.
“Now when you revisit Mexico, the same virus circulates there, but it doesn’t kill that much.” This is because the threat of H1N1 eroded over the years, he added.
And the same is likely to happen for COVID-19, said experts CNA spoke to.
VIRUSES BECOME MILDER OVER TIME: EXPERTS
Professor Tikki Pang, visiting professor at the Lee Kuan Yew School of Public Policy under the National University of Singapore (NUS) said the coronavirus causing the COVID-19 outbreak is likely to stabilise and eventually disappear from public consciousness.
“This is the historical pattern of past pandemics, and happens because the virus ‘burns out’ and runs out of people to infect as a result of many factors,” said Prof Pang, citing warmer temperatures, better public awareness and public health measures.
“There is a possibility that the virus could mutate into something more ‘sinister’, (that) spreads faster (or causes) more severe disease, but, so far, we have not seen any evidence of this happening.”
According to Dr Leong, there are four circulating coronaviruses that cause the common cold, and one of them periodically causes severe pneumonia.
“I believe they came into existence much like the current COVID-19. It killed many people and virology or technology was not sufficiently established then to identify the cause of the illness. But it became attenuated with time,” said Dr Leong.
“COVID-19 will go the same way. What we need is time for it to accumulate mutations, and it will become milder.”
According to Dr Leong, there is a “natural tendency” for viruses to mutate to something milder.
If the virus is too pathogenic and it kills its host, it is unable to continue spreading. But if it is mild, it can continue to propagate and pass on to other individuals, eventually picking up mutations that reduce the virus’ ability to cause disease, said Dr Leong.
He noted that increasing awareness of H1N1 treatment and availability of vaccines also contributed to the threat fading.
According to experts, H1N1 is currently a dominant flu strain in Singapore, although this may vary between seasons, and flu vaccines provide immunity against it. Countries in the region face a similar situation – Taiwan’s Centre for Disease Control said earlier this month that 56 patients there had died of H1N1 flu virus-affected respiratory failure in the past three months.
In the years following the 2009 pandemic, H1N1 became less common globally, but has been on the increase in recent years, said Professor Clarence Tam from the Saw Swee Hock School of Public Health, NUS.
“This is likely because, after the pandemic, many people were infected with H1N1 and developed immunity against this influenza strain, so the virus couldn’t spread as easily,” said Prof Tam.
“But we know that immunity against influenza is short-lived, and as the level of immunity drops in the population, more people are now becoming infected with this strain again.”
Dr Leong said: “It becomes another flu bug. And it helps with the fact that Singaporeans cannot distinguish between flu and the common cold, making the concept of flu in Singapore much milder.
“People soon became complacent of H1N1. But, some lethality maintained. If there is a bad case of influenza in the intensive care (unit), it would usually be a H1N1 (case). But overall, we see less and less of a problem.”
“The transmission mechanism of COVID-19 is different from SARS. In fact, the transmission mechanism is closer to H1N1 or influenza,” said Mr Wong.
Researchers at the National Centre for Infectious Diseases (NCID) have confirmed this, he added. Researchers found that, like influenza, COVID-19 is infectious when symptoms are mild.
Because of this transmission mechanism, COVID-19, like the flu, can spread “quite quickly”, said Mr Wong.
“With our mild symptoms, we sometimes let our guard down – we continue going out even though we don’t really feel well, and that’s how the virus transmits,” he added.
Mr Wong also said it was “a matter of time” before “a lot of people around the world” will be infected with COVID-19.
Citing the widespread community transmission seen in the 2009 H1N1 pandemic, Mr Wong said: “We’re not saying that this will happen for COVID-19. It’s a different disease than H1N1 so the patterns of transmission and the number of people contracting the disease will be different,” he said.
“But because the transmission patterns are similar to H1N1, we should be prepared for a scenario where you get wider transmission around the world.”
Prof Tam stressed that even if the risk of mortality from a virus is low, it can still cause a large number of deaths if it spreads easily, citing the current COVID-19 outbreak as an example.
“The available data indicate that this new virus is not as deadly as SARS, but spreads much more readily from person to person. Consequently, the number of reported deaths has already surpassed deaths from SARS in less than two months,” he said.
“The same applies for influenza viruses. Even though the proportion of all influenza cases that succumb to the disease is low, an estimated 300,000-500,000 people worldwide die each year from influenza.”
Adding that it is “difficult to predict” whether the COVID-19 will take the same route as the H1N1 pandemic, Prof Tam said: “The concern is that if current efforts to contain the virus aren’t ultimately enough to stamp out human transmission, it could spread rapidly across the globe causing many more hospitalisations and deaths before a vaccine can be developed or enough immunity builds up in the population to bring the epidemic under control.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
