So what’s the real H1N1 mortality rate in Malaysia anyway?
posted in - Nation, - Palmdoc |Headlines in Sinchew are screaming Whose fault is it that leads to the high mortality?
The influenza A (H1N1) mortality rate in Malaysia is close to 2% instead of the 0.1% to 0.4% as estimated by the Health Ministry. It reflects an unusual phenomenon. Without finding out the crux of the problem, assuming that 5 million of people are infected, probably 100,000 of them will die, instead of 5,000 to 28,000 as estimated by the World Health Organization (WHO).
As of August 16th, the death toll is 62. The problem about working out the mortality rate is that the true denominator is not known unless ALL suspected ILI (Influenza Like Illness) cases are tested with confirmatory PCR tests. At the moment, confirmatory testing is done only in patients ill enough to be hospitalised, and not done for the much larger number of patients seen in the OPD and GP practice. The vast majority of these patients will have mild disease and these are not included in the denominator.
One cannot take a denominator of so-called “confirmed cases” of about 3000, and deaths about 60 making the “death rate” 2%.
Actually Sinchew had it right but still concluded it wrong:
The Health Ministry believed that the domestic confirmed cases are far lesser than the announced (sic. should be “true” not “announced”) amount, and said it should be multiply by 20 to get the correct data. But if we compare it to other countries calculated based on the announced confirmed cases, their rates are still lower than ours.
So if the actual number of domestic cases is 20 x 3000 = 60,000 then the death rate is 60/60,000 which is about 0.1% making it similar to other countries (0.1-0.5%).
It’s difficult to compare with other countries too since their policies for testing may be different and the number of unreported and unconfirmed cases highly variable.
Perhaps if there are more cluster sample studies from both Outpatient and Inpatient patients with ILI we’ll get a more accurate picture.
I don’t think it is correct to blame the Government or the MOH for the pandemic was inevitable. A large part of the responsibility lies in the public who needs to practice good hygiene and responsible self-quarantine when having influenza. The MOH H1N1 management guidelines should also suffice for now but we should remain flexible and be prepared to adapt as the need arises and as the pandemic evolves.
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August 17th, 2009 at 10:34 am
Well said Palmdoc. I share your views.
Must blame be assigned everytime a crisis breaks out? What about a little introspection and ask ourselves if we’ve done the responsible thing in our own capacity – like self-quarantine if you’re having mild ILI or practising good hygiene not just to protect oneself but to minimise transmission to another person? I’ve lost count over the number of times I got assaulted by projectile droplets from people totally clueless about good cough etiquette.
I also agree that it’s difficult to compare mortality rates between countries because the rate of detection might be different as we all obviously adopt different testing guidelines. In my unit alone the criteria for testing changes every other day!
August 17th, 2009 at 10:37 am
One issue the Star brought up – if the Malaysian Government had been/will be as aggressive as the Mexican government, could we/can we stop H1N1 in it’s tracks earlier?
Will the Malaysian public be able to put up with such aggressive measures?
How Mexico licked the flu
August 17th, 2009 at 11:19 am
Even with the aggressive moves, the Mexico still have hundreds of death. Education can only do so much but human behavior is notoriously difficult to be altered. Just like HIV, you can advise condom but small head still takes over the big head. H1N1 is a new disease, the management is based on past experience of seasonal flu and thus guidelines changed many times in relatively short period.
August 17th, 2009 at 5:39 pm
not to be dismissive, but merely requesting for a proper perspective…
is there any record of how many people die of the seasonal flu in mexico each year, and how the present h1n1 compares with the previous seasonal flu?
August 17th, 2009 at 7:58 pm
i think Mexico facing H1N1 would be equivalent to darurat.
i think we’re progressing to that state of health emergency.
anyway, it just believe, the major person to be blamed is the general public, who severely lack of civic-mindedness
August 17th, 2009 at 8:35 pm
http://www.cdc.gov/flu/about/disease/index.htm
Every year in the United States, on average 5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from flu complications, and; about 36,000 people die from flu-related causes.
If this statement is correct, H1N1 is no where near the seasonal flu.
August 18th, 2009 at 2:28 pm
Since Mexico has a population of only about 100mil, compared to USA’s 300mil, if we were to compare the number of deaths due to seasonal flu, Mexico would be expected to have a third of that of USA’s ie 12,000 deaths annually, or about 1,000 per month (although, since being “seasonal,” they would probably not be the same each month). Thus, the Mexican deaths attributed to H1N1 would not seem all that bad.