Zika: MOH under fire for not doing enough

Aug 29, 2016 10.08AM |
 

by Daniel Yap

IT WAS “almost inevitable” that Zika would come to Singapore, said the Ministry of Health (MOH) in April. Now not only is it here, it has spread, with 41 confirmed locally-transmitted cases. Certainly, there are many more still unknown and yet to come.

In fact, its spread had already been happening for a while under our noses. The Zika test takes three hours to show if a patient is positive or negative for the virus. The first suspicion was on Aug 22, when a GP in Aljunied raised the alarm over a series of suspicious cases to MOH. MOH believed it was a mild viral illness, and asked that further cases be brought to the Communicable Disease Centre (CDC). Then on Aug 25, a 47-year-old woman, Patient A, was referred to the CDC and was confirmed to be infected (ST’s report said she went to CDC on Aug 26, Today says Aug 25). All past cases in the area were dug up and tested and it turned out that people were being infected as far back as July 31. MOH announced Patient A on Aug 27. The other 40 cases were announced on Aug 28.

The answer to questions posed to MOH about why two days passed between Patient A presenting herself to the CDC and the first announcement was vague. You can read Today’s transcript here.

Since Zika was “almost inevitable”, and since an imported case had already been reported in May, shouldn’t the ministry already have been expecting to see locally-transmitted cases? Why were blood tests not carried out as soon as the GP in Aljunied reported a suspicious trend of viral infections? Why were blood tests not carried out for all individuals presenting such symptoms – did the ministry have to wait for a trend to develop?

MOH said that since the affected persons did not travel to infected countries, they were considered low-risk. This is why they did not test them immediately. The ministry chose to wait and see. Yet it is known that only one in five Zika-infected persons actually presents symptoms. With confirmed infections in places like Thailand and Vietnam, should Singapore not already have begun to treat Zika symptoms more seriously? Why was an individual’s lack of travel to Zika-affected areas a factor that puts them at low risk?

MOH said that there was no cover up for the rash of Zika infections, a question raised in light of the Hepatitis C outbreak last year. In that case, 16 ministry and hospital staff were disciplined for, among other faults, withholding the announcement of the outbreak.

But it is hard to test for a disease that doesn’t present itself in a very unique way. Sometimes the fever is not present. It is hard, but should MOH have set a higher bar?

Dr Leong Hoe Nam, the infectious diseases specialist at Mount Elizabeth Novena Hospital who diagnosed Singapore’s first Zika case in May, thinks that MOH should have done better.

“Every single mild case of fever, they should have investigated,” said Dr Leong, “It was a chance to break the cycle. Kudos to the GP who picked up the trend. We must remember that Zika is very mild, compared to dengue. Patients may not be sick enough to go to hospital but to the GP instead. So the GP now is the gatekeeper.”

Ms Tin Pei Ling, who is the MP for the ward that Patient A lives in, said, “It would have been most ideal to take a more conservative approach at that point in time, if there had been early suspicion, to check if there were any positive cases. But I suppose MOH would have taken the balanced approach between alarming everyone and doing proper checks.”

Would we have been alarmed? The number of cases, 41, is high compared to other countries in the region. It is low, however, when compared with the more deadly dengue, for which there have been nearly 11,000 cases, of which majority were probably locally-transmitted, since the start of this year.

Perhaps it is time we started acting as if Zika could well have traveled beyond the Aljunied cluster. That’s how it got spread so far in the first place, isn’t it?

 

Featured image from TMG File.

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