The haze that’s shrouding Zika

Aug 31, 2016 03.34PM |
 

by Bertha Henson

IF SOMETHING needs to be fixed, it is the public communications of the Health Ministry (MOH). There are just too many information gaps in its Zika narrative for people to exploit.

The key question to be answered is: How did one case of local transmission jump to 41 overnight? On the G website, Factually, an attempt was made to explain this. Here is the chart:

timeline-final
Image taken from the Factually page on the spread of Zika.

 

What it shows is that the G decided to go public only after the Malaysian woman showed up, even though the construction workers had been down with some symptoms earlier and health authorities had been looking into their records. So the Malaysian woman is not the first patient of locally-transmitted Zika, not by a long shot.

What she is: The first patient diagnosed as having locally-transmitted Zika.

So the Health Ministry is right in making this point but how then does it account for why a whole lot of them weren’t diagnosed earlier?

The answer: lack of travel history. So the doctors checked their patients for everything but Zika because presumably the construction workers had stayed put here. There’s the question of whether the travel history only lists places like Brazil but a check of MOH website showed an extensive list, including Indonesia, Thailand and Vietnam. Presumably, GPs would have been informed through circulars.

Never mind that. It’s more than likely that the construction workers never went anywhere but the doctors were alert enough to tell MOH – on August 22 – of a curious spike of fever cases in their Sims Drive area. It might have been different if they actually sent someone to the CDC at that time. When the Malaysian woman turned up at their clinic, with similar symptoms and no travel history, they decided to refer her to the Communicable Diseases Centre.

So, Zika was born…

Then comes the gobbledygook.

 

Garbled communications

Here’s how the MOH released the news of more cases:

The Ministry of Health (MOH) has confirmed 41 cases of locally transmitted Zika virus infection in Singapore. Of these cases, 36 were identified through active testing of potentially infected persons.

Question: What is “active testing of potentially-infected persons”? Basically, it means that those construction workers who could be Zika infected were finally taken to the CDC for testing. That’s how it was discovered that 36 of them had the virus.

Question: Then who are the other five? They refer to the four non-construction workers and the Malaysian woman whose case was announced on August 27, making her the “first” – but we know she isn’t – case of locally-transmitted Zika infection. The four men only started going to the doctor after the news broke on Saturday (Aug 27). So they are “new” cases, rather than “potentially infected persons”. The four, all Singaporeans, either live or work in the Sims Drive area.

The media tried to get the doctors to shed some light but it got garbled.

Here’s an excerpt of the transcript posted by TODAY:

When was the earliest case that Ministry of Health backtracked to?

Dr Derrick Heng (MOH Group Director for Public Health Group): The (earliest) case that we know of was July 31. We would not have picked up on all the cases, (so) we would not be able to pinpoint definitively the first index case (patient zero).

Mr Koh Peng Keng (MOH Group Director, Operations): The first case we knew of was patient A (the 47-year-old Malaysian woman whose case was reported on Saturday). The rest of it we had to work with the GPs, to do a lot of tracking to try and look back.

Dr Heng: We went back to look at people who were part of the GP (cases), and (at the) construction site, the people who had reported symptoms in the past. We took samples… the samples (tested) positive sometime late last night (on Saturday).

Mr Koh: The GP alerted us of this unusual cluster of cases with mild symptoms, it’s only (then) we went back to check… most of them had already recovered. So it was a look back… Initial hypothesis was that it was just some mild viral infection that transmits from person to person. Zika was not specifically suspected at that point when the GP was seeing this group.

 

So we have a date! July 31! What does this mean? Likely, the doctors asked the construction workers when the symptoms started showing and someone had said July 31. Anybody would be thinking: Waah. So long ago ah? What happened to all those precautions? Then comes the standard answer: no travel history.

Now the Malaysian woman was confirmed with Zika on Aug 27, Saturday. In the evening, news that she had Zika was made public. According to TODAY, the construction workers were tested on that day as well and Dr Heng said the samples tested positive “late” that same day. Which led to the question: Why couldn’t all have been announced at the same time?

Dr Heng: We started preparations when the preliminary results (came out). But we had to wait for confirmation in order not to create false alarm.

Okay, that sounds reasonable. There are a lot of people to process after all.

Then comes a question which implied a delay in announcement.

Patient A was at CDC on Aug 25, and it takes about three hours to do the test. So you should have known by that night?

Professor Leo Yee Sin (clinical director of Communicable Disease Centre): Her presence at CDC from the time we received her as a case, to the time she did the blood test, all this is actually a very compressed period of time, including getting her back for further assessment.

But a look at the press statement on Patient A, the Malaysian woman, showed that she hadn’t even seen her GP then. She saw the doctor the next day (Aug 26) and was referred to the CDC where she tested positive for Zika on August 27. It’s a pity that the reporter wasn’t corrected on this and the image we have is a poor woman who seemed to have been imprisoned at CDC for two days.

It’s no wonder that allegations of a cover-up abound. When dates get mixed up and details are missing, it just leads to even more opportunities for disinformation. Political parties are jumping on this issue. And therefore accused of politicising the matter. Those who raise questions are told not to distract the G from the main problem: destroying mosquitoes. Answers can come later, they say.

 

More accurate info, less confusion

There are three camps:

a. those who say this a time for the nation to pull together so no pesky questions please

b. those who say that Zika is such a mild disease so why the fuss?

c. those who say having more information wouldn’t have any practical effect on the spread of the virus anyway

I beg to differ.

In a crisis or medical emergency, answers must be clear and precise. More, rather than less information should be given. And I am referring to confirmed information. It is okay to say that you’ve fallen down on some things, like we never thought of testing the construction workers earlier because we assumed they wouldn’t travel out of the country. Or, we were wrong to tell doctors to look at travel history as an indicator of Zika; being in the vicinity of a dengue hotspot is enough. Or, we don’t know because this is a new virus and there’s so much conflicting information on it.

But please, don’t think that “if we tell you everything, you won’t understand it anyway”.

 

Featured image by Sean Chong.

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