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Monday 23rd April 2018

Singapore revises bird flu plan

11th October 2006

11102006_Singapore400.jpg Three key changes are being made to Singapore’s response to a possible bird flu pandemic, based on lessons learnt from the preparedness exercises Sparrowhawk 1 and 2 conducted earlier this year.

Speaking at a flu pandemic training session for voluntary organisations, the Minister of State for Health Heng Chee How said the first main area of improvement is the line between government polyclinics and GPs.

Also reviewed is the work of public and private hospitals in an outbreak. Previously, government-backed restructured hospitals were to manage all flu patients who required hospitalised care, while non-flu patients would be referred to private hospitals. But the exercises showed it would be very difficult fully and effectively to segregate such cases in a pandemic, and both public and private hospitals will be required to manage both.

Initially, the plan was to centralise treatment at the city-state's 18 polyclinics. But most Singaporeans consult their family doctors in the private sector for acute illnesses like influenza, and the government's preparedness exercises showed that with some coordination it should be able to organise more than 1,000 GP clinics to provide primary care to the community.

Under the new plan, all hospitals are to have a dedicated group of staff or an ‘infection control response team’. According to Mr Heng, the training exercise highlighted that it was impractical to expect that all staff have the same level of readiness and training and to be able to sustain a high level of readiness over a prolonged period of time. Instead, hospitals will maintain and roster a team of dedicated health-care workers who are very well versed in the handling of infectious cases.

Central to the plan is the concept of a three-pronged or ‘3P’ approach involving the Public, Private and People sectors in the event of a pandemic. As a result of the exercises, inter-agency, cross sector collaboration was now well in place border agencies, healthcare institutions and security agencies were ready, Heng said.

The government is stressing the importance of continued training and practical exercises to prepare against bird flu, rather than just planning on paper and ‘hoping the telephone numbers will still work when they are actually needed’.

In June this year, the World Health Organisation (WHO) reported evidence of the first human-to-human spread in Indonesia, where a child who was thought to have come into contact with infected poultry, infected his father. It was a confirmed human to human transmission, but no further spread outside of the exposed family was documented or suspected.

To date, the H5N1 virus does not infect humans easily, and it is very difficult for the virus to spread from person to person.

But all influenza viruses have the ability to change, and scientists are concerned that the H5N1 virus could mutate, infect humans and spread easily between them, thus causing a worldwide outbreak of the disease.

Currently there is no commercially available vaccine to protect humans against the H5N1 virus which has affected 251 people with 147 deaths in ten countries.

Should a pandemic hit Singapore, the Ministry of Health (MOH) says it will be able to vaccinate the entire population, 4-6 months after the new flu strain is confirmed.

Lim Kok Peng, Deputy Director for Contingency and Scenario Planning, MOH, on obtaining the vaccine, says “We are not first in line, but we are not last.��?

The MOH also predicts that any outbreak would enter Singapore from beyond its borders and could reach Singapore within days or weeks of emerging, with two or more waves lasting about six weeks each, in the same year.

The nation will rely on Tamiflu as a form of prevention of the spread while a new vaccine is being developed, but even this will face increased resistance. According to the MOH, an outbreak of bird flu will be more infectious than Severe Acute Respiratory Syndrome, or SARS, with an incubation of seven days.

It is estimated that some 11,000 people in Singapore could be hospitalised during the first wave of the outbreak, should it occur.

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