All hospitals have to handle H1N1 cases

18 Jun 2009, The Straits Times

Question

Confine H1N1 suspect cases to one hospital

I REFER to last Saturday's report, 'Six more down with H1N1; disease hits young hardest'. I am particularly concerned about the sudden influx of cases that involve young children and their subsequent hospitalisation in KK Women's and Children's Hospital (KKH).

Since the current patterns of serious cases and deaths from Influenza A (H1N1) virus involve primarily young people, those who are pregnant and those with pre-existing medical conditions, it is not advisable to take suspected cases to KKH, nor should confirmed cases be isolated in KKH for treatment. Patients in KKH are mostly babies, young children who are unwell and pregnant women on antenatal follow-up. Distancing them from the virus should be a priority.

I have no doubt about either the high quality of medical care or the excellent infection control measures in place in the hospital. But a single lapse in protocol may prove disastrous. With this in mind, should we take such a risk?

May I suggest keeping the Communicable Disease Centre (CDC) at Tan Tock Seng Hospital as the sole location to convey suspected cases and quarantine confirmed cases for treatment as this may be safer. A paediatrician or obstetrician from KKH can be called on for assistance if necessary.

That way, we would not require two quarantine locations, effectively narrowing down the area in which the virus is known to be present to just the CDC, and we would distance the patients in KKH who are at greater risk of serious complications from HINI.

Reply

Reply from MOH 

Ms Catherine Leong suggested that we "confine H1N1 suspect cases to one hospital" (ST, 16 June) to avoid exposing sick children and pregnant women at KK Women's and Children's Hospital (KKH) to H1N1 cases.  There are merits in putting all infected patients in one hospital.  We adopted such a strategy during the SARS outbreak.

However, influenza outbreak is different from SARS.  First, it is much more contagious and hence we expect large numbers of infected patients. The patient load will have to be shared among many hospitals. If and when the virus spreads in our community, most of these patients will in fact be managed as outpatients by their GPs. Second, H1N1 has caused complications among young people. In New York, half of the H1N1 patients who require ICU facilities are below 20 years of age.  At some stage, paediatric ICU facilities in all our hospitals will be needed to help meet the expected demand.     

All hospitals and clinics will therefore be expected to manage H1N1 cases. We have had a good 6 weeks head start to gear up for this eventuality. The concerns of cross-infection as expressed by Ms Leong can be managed through proper infection control measures.  All suspect cases will be examined in a separate purpose-built isolation tentage.  They will be prevented from mixing with the general patient population. Should they require admission, they will be admitted to the appropriate isolation wards. In the transfer process to the isolation ward, these patients will continue to be isolated from the rest of the patient population.  Staff attending to the patient will be in full protection gear and all appliances used by patients will be disinfected thereafter.

In particular, KKH is an important player in the fight against H1N1 as the virus has caused complications among children and pregnant women. Should such complications arise, the full range of tertiary services in Paediatrics, Neonatology as well as Obstetrics & Gynaecology at KKH will provide the best care possible for such patients.

MOH takes a holistic view of the needs of all patients in planning its emergency measures. As we exercise caution and personal responsibility during this H1N1 outbreak to protect ourselves, we will not neglect the provision of the most appropriate care to other patients.