No blood test for influenza

There is no such thing as a blood test for influenza. If you’ve been searching for one, you can stop.

Influenza is a respiratory disease, so specimens preferred for influenza testing come from the respiratory system: nasopharyngeal swab (from the upper part of the throat behind the nose), nasopharyngeal swab combined with oropharyngeal swab (from the cavity at the back of your mouth), or “nasal aspirate” (translation: “snot”). If specimens from those locations cannot be collected, a nasal swab or oropharyngeal swab by itself will work.But not a blood sample.

You can read the U.S. Centers for Disease Control and Prevention guidance on collecting, storing, processing and testing influenza specimens. Swabs, not syringes.

As a colleague related in his account of being tested for H1N1 last month, Tan Tock Seng Hospital in Singapore took a blood sample from him when he went to be tested for influenza. When he asked why, he was told only that it was ‘to be sure you don’t have anything else.’

If medical personnel draw a sample of your blood for testing, they aren’t looking for influenza. They might be looking for bacterial infections like typhoid or sepsis, viral infections found in Asia like malaria, dengue fever, hepatitis, yellow fever , or some other blood-borne pathogen. They could also be looking for human immunodeficiency virus (HIV), of course, the cause of AIDS.

Unmasking the Truth

Wearing an N95 mask - or any other kind of mask – will not prevent you from getting influenza, and buying multiple masks for each employee in your office as a pandemic preparation measure is wasteful and unnecessary. It will be more effective to get them to wash their hands regularly, because a primary transmission route for influenza is contact with an infected surface.

In an office, masks are for the sick people, not for the well people. A mask will prevent someone in your office who is sneezing or coughing from spraying saliva, “snot” and “germs” on you and your colleagues by trapping mucus inside the mask.  How many sick people do you knowingly let into your office these days? None. You don’t need any masks for them. You keep them out of the office by screening at the building entrance.

How many sick people do you expect to get into your office in the next twelve months? I wrote in September 2006 that my best guess was that about 20% of a company’s headcount, including visitors and vendors, would catch the flu in any one year. Your company could buy masks for those people, I suppose, if you expect all of them to ignore sensible advice and come into the office sick.

Getting tested for H1N1 flu in Singapore

A colleague of mine returned to Singapore on Wednesday, May 27 from Boston, USA, where he’d spent the week between May 17 and May 24. He came back with a cold, a bad one.

He was sure it was a cold, not the flu: his temperature had not gone over 36 degrees C (98 F), he had no fever, no headache, no chills. He had cleared the thermal screening at Singapore’s Changi Airport. But he had a meeting with a client scheduled on Friday, May 29, so he informed the client on Thursday, May 28 of his condition. The client asked him to (quoting the client’s e-mail) “get clearance from a doctor that it is just a common cold, and not something serious” before coming to their office. He called his doctor on Friday morning, 29 May.

This is his first-hand, contemporaneous account of his experience as a suspected carrier of H1N1.

9.40 Call my doctor. All patients who have been to Mexico, USA or Canada and who have any of the flu symptoms, have to go to Tan Tock Seng Hospital (TTSH) by ambulance. [TTSH is Ground Zero for infectious disease in Singapore. It was the focal point for response to SARS, H5N1 "bird flu" and now H1N1 "swine flu". Five TTSH health care workers died of SARS in 2003 as a result of caring for patients.

Is Tamiflu “better” than Relenza?

I can find no clinical evidence that Roche‘s Tamiflu is more effective than GlaxoSmithKline‘s less-prescribed Relenza against Type A influenza like H1N1 and H5N1.

Japanese health inspector in goggles, mask, gloves and gown interviews passengers on a flight arriving in Tokyo from the U.S. on May 2, 2009

I have found abundant evidence, however, that Switzerland-based Roche has run marketing circles around U.K.-based GlaxoSmithKline (GSK) by emphasizing the convenience of swallowing a Tamiflu capsule over the hassle of inhaling Relenza powder.

That’s the only reason I can imagine why a dose of Tamiflu is two to three times as expensive as a dose of Relenza. A dose of 75mg Tamiflu costs US$5 to US$10 at Internet pharmacies, but a dose of 5mg Relenza costs only US$2.50 to US$3.50. Both require prescriptions.

If the target population covered by your business continuity plan includes a large number of children, you will prefer a Tamiflu caplet that is easier for children to swallow. But, for adults, inhaling Relenza is just as effective, much less expensive, and more readily available than Tamiflu at doctors’ offices and pharmacies in Asia.

If this isn’t a business school case study in the importance of packaging, it surely will be.

Singapore influenza exercise starts August 2008

Singapore’s financial sector industry-wide exercise (IWE) will run from Thursday, Aug 28 to Friday, Sep 11, 2008. There will be three sessions, presumably corresponding to escalating stages of epidemic development, in a highly-pathogenic influenza (HPI) scenario over the two-week period, plus a “practical drill” on Friday 29 August that will require participants to execute HPI response plans at their own facilities.

These are the briefing slides used at ABS’ Apr. 3 announcement in Singapore, and these slides are for the first “communique” briefing on May 7. This slide lists the dates of future briefings and communique’s. The ABS has opened an IWE portal (exercise web site) specifically for the exercise.

• These are the MAS guidelines on pandemic measures for banks, issued in January 2006.

• These are MOH’s recommended infection control measures for workplaces, last updated in May 2007.

• These are the Singapore MOH influenza alert levels (there are five; WHO has six).

The IWE is sponsored by the Association of Banks in Singapore (ABS) with support from the Monetary Authority of Singapore (MAS) and Singapore’s Ministry of Home Affairs (MHA), which includes the Singapore Police and Civil Defence Force (our fire department). Singapore’s Ministry of Health (MoH) will surely contribute, too.

Bengal bird flu presages pandemic

An epidemic of avian influenza in West Bengal, India has the Indian “government in panic mode”, according to the Times of India web site. And with good reason: 15 million of West Bengal’s 80 million people are crammed into its capital city, Kolkata (Calcutta), a petri dish of poverty, pollution, political intransigence and hopeless public health. It is the city where Mother Teresa founded the Missionaries of Charity order.

If the infection reaches Kolkata’s poultry markets, there is a much greater risk of animal-to-human transmission than there has been in Indonesia or Vietnam, where infections of H5N1 influenza have already crossed species from animals to humans.

There have been many more human infections of highly-pathogenic influenza in Indonesia (120 cases, 98 deaths) and Vietnam (102 cases, 48 deaths) than in India. There were three outbreaks of avian influenza in India in 2006, but there have been no human deaths there, yet.

But Kolkata is a whole other miasma of misery. The population density of Kolkata is 24,000 people per square kilometer (62,000 per square mile), the second highest in the world. The population density of Ho Chi Minh City, Vietnam’s largest city, is only 3,000 per square kilometer (8,000 per square mile), a fraction of Kolkata’s. Even the density of Jakarta, Indonesia, at 12,500 people per square kilometer (33,000 per square mile), is just half that of Kolkata.

Singapore Pandemic Exercise

Thousands of innocent bankers could perish in Singapore’s next financial sector disaster exercise in 3Q 2008, when the Standing Committee on Business Continuity Management of the Association of Banks in Singapore (ABS) plans to simulate the late stages of an infectious disease epidemic on the island.

No event in Singapore can be taken seriously until it has an acronym, so an exercise for the Lion City’s entire financial sector is called an “industry-wide exercise,” or “IWE.”

The ABS committee favors a multi-day IWE spread over two (2) weeks. The U.K. ran a financial sector pandemic scenario, “Exercise Winter Willow,” over three weeks from January 30 to February 20, 2007, and a similar exercise in the U.S.A in September and October also lasted three weeks. Members of the ABS committee, who represent big local and global financial institutions, participated in one or both of those exercises and have concluded that three weeks is too long. Senior management loses interest.