Public Health: A (H1N1) seen as increasing menace

The Deputy Chief Minister of Sarawak, a large state in Malaysia, has urged students studying in Australia, and especially in Melbourne, to delay their end-of-term return home so as to avoid bringing the A (H1N1) virus back. Tan Sri Dr George Chan Hong Nam said that a substantial number of potential carriers spreading rapidly across the state would create a risk that would be difficult to contain. He feels justified in worrying: the state has only had four confirmed cases - far lower than many similar sized regions - but they all came in from Australia.

He has a point: Sarawak is a major tourist destination - in fact, it has little else to sustain it. The last thing it can afford is a widespread outbreak of anything that would discourage tourists at the start of the peak season. By emphasising that travel to Sarawak is safe, its revenues can be protected, he hopes.

The Malaysian tourism minister said yesterday that some nearby destinations - China, South Korea, Japan and others, had seen a dramatic fall-off in bookings in the past two weeks. Some are as severe as 90%.

Malaysia Airlines managing director and chief executive officer Datuk Seri Idris Jala told travel operators yesterday that perception was oustripping reality and that the current flu is mild compared to SARS with a mortality rate of one in 220 compared to one in twelve in the case of SARS.

But 38 new cases have been reported in Malaysia, mostly around the capital, in the past week. Even so, the total number of cases - 196 out of a population of some 22 million - is a very small proportion of the population.

And Malaysia is not letting up on the message to its people: full pages in newspapers are dedicated to measures to prevent the spread of any infectious disease; the Health Ministry has ordered all government departments to stop using the term "swine flu" because a survey said that many people think they will catch it from pigs - and in a country with about half the population as Muslim, they don't go near pigs so they think they are safe. The opposite side of the coin is that some Chinese think that meat is contaminated. From yesterday, all ministries must refer to Influenza A (H1N1). But the government is concerned about a shift towards intra-community infection and that is behind its continued pressure on the population. It is also running increased campaigns against the aedes mosquito which carries the potentially deadly dengue fever.

To the north of Malaysia, Thailand has reported another two deaths - but its total number is only five.

Further south, in Singapore, the number of deaths is low - but the number of cases has now topped 700 which, given the size of population at just over 4.6 million is statistically much higher than in other nearby countries.

In New Zealand, a country of a similar size population to Singapore but with a massive geographical area, there have been 711 confirmed cases.

Two days ago, Roche Holding AG, makers of Tamiflu, made a statement that the virus was showing resistance to Tamiflu in a case in Denmark. However, this is no cause for alarm as it is normal for isolated cases to be resistant.

In the UK, the government is shaking its head at the stupidity of some parents who are rumoured (on the internet) to be holding "swine flu" parties for their children. The plan is that their little darlings will get a dose in controlled conditions, and so become naturally immunised.

With the WHO confirming more than 70,000 cases and more than 300 deaths, in just two and a half months, there is no doubt that the virus has the capacity to become a serious problem.

Our correspondent might like to think again. Just because he hasn't got it, and his company seems cavalier, clearly does not mean that there is no risk.

It's a risk that can be managed, as the Malaysian experience shows. But it will not be managed if there is complacency.