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Brunei's close encounter with fast-spreading flu - 2009 year in review

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  • Brunei's close encounter with fast-spreading flu - 2009 year in review

    <TABLE cellSpacing=2 cellPadding=0 width=550 border=0><TBODY><TR><TD colSpan=2></TD></TR><TR><TD colSpan=2>Brunei's close encounter with fast-spreading flu

    </TD></TR><TR><TD colSpan=2>2009 - YEAR in review

    By Waleed PD Mahdini

    Hand sanitizers, thermometers and facemasks were quickly snapped up as soon as they were restocked in shops across Brunei. Photos: Jason Leong

    In the midst of the recurring flash floods and landslides that were brought on by the long spell of monsoon rains that fell in the first few months of the year, health officials issued risk warnings that were associated with water-borne diseases.

    Accident and emergency rooms in hospitals throughout the country were inundated with patients suffering from injuries sustained by the floods and landslides, as well as those seeking treatment for colds, coughs, fevers and flu that were normally associated with prolonged exposure to the pouring elements.

    On February 25, Brunei's Deputy Minister of Health called out for the need of more joint cooperation in tackling environmental health issues, brought about by the increased risk due to the natural disasters. Interestingly, 12 days earlier, the first alarm bells rang when a 20 per cent surge in flu cases were recorded in the country, which had been attributed to the long spell of heavy rains.

    By March 7, the lingering effects of the Hand, Foot and Mouth Disease (HFMD) were raised once again within the country's borders when the Ministry of Health sounded the alert as 17 new cases were reported within a week's time. The last time that this intestinal virus made its way to the media spotlight was back in January when 11 cases were recorded throughout the month.

    But a world away earlier that month in Mexico, some 60 per cent of the inhabitants of the town of La Gloria, Veracruz were sickened by an unknown respiratory illness that also killed two infants. The Mexican government believed that it was caused by the 'H2N3' Influenza, although one of the cases had tested positive for the A(H1N1) strain.

    By March 17, Mexico recorded the earliest known onset of the case of four-year-old Edgar Hernandez Hernandez that would only later be confirmed as the swine-origin Influenza A(H1N1) virus infection.

    Eleven days later, the United States similarly recorded the first case of a nine-year-old girl in Imperial County, California that would again later be confirmed as A(H1N1).

    By April 6, Mexican public health authorities began investigating unusual cases of pneumonia/influenza-like illnesses after 400 people sought treatment for it - all originating from La Gloria, Veracruz. Six days later, a 39-year-old woman died of severe viral pneumonia in another Mexican city, San Luis Potosi, which was later believed to have been the earliest known fatality related to the outbreak.

    The next day, April 13, another fatality was recorded in the Mexican city of Oaxaca, prompting the Mexican health authorities to inform the American Centre for Disease Control (CDC).

    On April 21, the World Health Organisation (WHO) issued its first Disease Outbreak Notice worldwide, confirming the infection of a number of people in Mexico and the United States by "Swine Influenza A(H1N1) viruses not previously detected in pigs or humans".

    On April 25, under the International Health Regulations, the WHO convened the newly established Emergency Committee, which resulted in the Director General of the WHO to declare a formal "public health emergency of international concern". This resulted in Asia being put on high alert for swine flu amid fears that just like the SARS outbreak, air passengers might spread the deadly outbreak to the rest of the continent, which, in some countries, was still continuing a long drawn-out battle against the avian flu.

    Japan, the Philippines, Singapore, Thailand and Hong Kong closely monitored their respective situations, where 62 people had already died from severe pneumonia caused by flu-like illnesses with more than 1,000 sickened. By comparison, the death toll from avian flu in Asia only stood at 257.

    The following day, April 26, the Sultanate had not yet initiated any on-site surveillance measures at Brunei International Airport.
    An official at the Health Section of the Department of Civil Aviation said: "There are no measures in place as yet with regards to the surveillance and monitoring of the virus. Such a request would have to come from the Ministry of Health."

    That same day, the Minister of Health launched full ophthalmic services at all primary health centres, in a bid to prevent blindness.

    Twenty-four hours later, the WHO issued a statement that "containment of the outbreak was not feasible" and raised the pandemic alert level from Phase 3 to Phase 4. The Ministry of Health then informed the public that hospitals and the airport had been put on high alert for the H1N1 flu, which had already killed 80 people in Mexico.

    All travellers arriving at every entry point in the country would also have to fill in a mandatory health declaration form. That same day, Canada, Spain and the United Kingdom confirmed their first respective cases of the outbreak reaching their shores.
    Israel and New Zealand are added onto the list of countries invaded by the H1N1 the following day.
    Meanwhile, in Brunei, the normal pace of life was rattled when two Bruneians returning from Canada, showing some of the symptoms of the virus, kicked off the local scare as they were admitted to hospital for observations.

    To allay public fears amid increasing concerns that the impending global outbreak was already well underway, the Ministry of Health also announced that one million stocks of the antiviral medicine Tamiflu were readily available in the country. Similarly, two thermal scanners were also operating full-time at every entry point into the country.

    By April 29, the Emergency Committee of the WHO met for the third time raising its pandemic alert level from Phase 4 to Phase 5, confirming the widespread human infection, as Austria and German add to the total tally of nine countries reporting 148 cases of A(H1N1).

    Meanwhile, the US announced its first fatality when a 23-month-old Mexican child who was hospitalised in Texas passed away.

    Incidentally, the health ministers of the 10-member Asean regional organisation agreed to convene a special two-day meeting to discuss a common regional approach to tackling the A(H1N1) virus in Thailand.
    Whilst in Brunei, the Pengiran Muda Mahkota Pengiran Muda Haji Al-Muhtadee Billah Hospital in Tutong was designated as the A(H1N1) quarantine and treatment centre as health officials moved to quickly debunk rumours of A(H1N1) arriving in the country. The officials explained that two sickly patients had tested negative for the influenza and were discharged shortly after.

    Hong Kong was the first Asian country to record a fatality from the A(H1N1) on April 30. Elsewhere, Ireland, the Netherlands and Switzerland fell against what seemed to be the unstoppable spread of the Influenza virus.

    By May 2, Brunei raised the stakes in its preparations against the A(H1N1) virus outbreak as His Royal Highness Prince Haji Al-Muhtadee Billah, the Crown Prince and Senior Minister at the Prime Minister's Office made a working visit to the National Disaster Management Centre (NDMC).

    In trying to boost the confidence of the country, HRH allayed the ever-growing fears by remarking that the previous outbreaks, such as the Avian Flu and SARS, have provided the country with the experience in controlling the risk of the virus from entering its borders and thus decreasing the risks. As the Chairman of the NDMC, HRH also inspected safety measures that had been set up at the Brunei International Airport.

    With the advent of air travel, viruses can now spread across the entire breadth of the planet much faster than ever before and the fact is that the rapid global spread of the virus was indeed attributed to the vast interconnected network of airline travel.

    As the main frontliners in the early monitoring of its possible spread to Brunei, Royal Brunei Airlines, in collaboration with the Department of Civil Aviation and the Ministry of Health, activated its Emergency Plan for handling the A(H1N1), through exact procedures that have been laid down in its operations manual and with highly-trained crew.

    On May 4, 200 British soldiers were quarantined at the hospital in Tutong, when three of them gave off higher body temperatures as they disembarked from a chartered flight from Mexico. After extensive testing on the three, their results showed negative for the A(H1N1) virus but were kept in isolation wards as a precautionary measure, as were the rest of the passengers.

    Elsewhere around the world, 20 countries were now confirmed to have Influenza cases, with 26 fatalities and 1,003 infected.
    That same day, the Minister of Health visited the Health Section at the Sungai Tujoh Border Control Post and calmed public fears by citing that the Sultanate had adequate antiviral doses to cover a large percentage of the population with its one million doses of Tamiflu.

    In addition, the minister said the health ministry was also increasing its own laboratory capacity, stocking up on more Tamiflu and Relenza antiviral doses and had instructed other government agencies to tighten surveillance at every entry point into the country.

    Speaking to the media about the official decision to quarantine the 200 passengers, the minister re-emphasised that it was now a standard WHO requirement in light of the unstoppable scourge of the A(H1N1) rampage across the world.

    But one issue that was highlighted was the fact that the country still did not possess the necessary laboratory expertise, capability or capacity to conduct its own verification, as the ministry still had to rely on sending the samples overseas.

    The US confirmed its second fatality with a pregnant 33-year-old woman. Her eight-month-old baby was delivered by Caesarean section, whilst the mother was in a coma and on life-support. The A(H1N1) virus now spanned 20 countries affecting the lives of 1,124 people worldwide.

    May 6 saw the Minister of Health visiting the hospital in Tutong to specifically inspect the isolation wards and the medical staff procedures in treating the contagion.
    Asean health ministers met in Bangkok together with their counterparts from China, Japan and South Korea and deliberated upon a joint strategy to tackling the A(H1N1) virus, which was expressed through a joint declaration.

    The Deputy Minister of Health visited the Serasa Ferry Terminal the following day urging the public to play an equally vital role in ensuring that the country remain safe from the probable outbreak of A(H1N1).

    Meanwhile, thousands of flyers and posters carrying information and the dangers of the virus were distributed to schools nationwide. Elsewhere in the country, the Suri Seri Begawan Hospital in Kuala Belait geared itself up for the oncoming arrival of the A(H1N1) virus.

    The Deputy Minister of Health continued his programme on May 9 by visiting a hospital in Temburong.

    That same day, he also visited the Immigration Control Posts at Puni and Labi to check on the nationwide surveillance network, as well as the Bio Medical Science Laboratory in the capital that were manned by virologists and medical laboratory officers.

    On May 11, the Jerudong Park Medical Centre introduced mandatory health screenings at its premises.

    Whilst it began to sink in that despite every best effort in protecting the country's borders from a breach by the unstoppable spread of the virus, health and education ministry officials began drafting up standard guidelines for all academic institutions in the country.

    By May 14, the Ministry of Health announced the establishment of seven sub-committees as part of its H1N1 preparedness plan that encompassed surveillance, control and prevention, technical support and logistics, medical case management, media and public relations, infection control, as well as laboratory support and manpower. At the same time, the health minister also warned the public against flu complacency by reminding them that the precautionary steps taken by the authorities to detect suspected cases were not 100 per cent effective.

    A day later, Malaysia confirmed its first case of H1N1 from a 21-year-old male student returning from the US, making it the 34th country to have been hit by the virus. Indonesia also confirmed its first H1N1 case with another passenger returning from the US.

    However, within just a span of 24 hours, the number of infected cases jumped to 7,520, a thousand more cases compared to the previous day.

    Twenty-four hours later, Brunei stepped up its precautionary and surveillance measures at all of its entry points as it braced for the inevitable when Malaysia confirmed its second H1N1 case.
    The total number of infected cases saw another leap to 8,451 people in 36 countries, in just a span of 24 hours.

    On May 18, Brunei's Minister of Health joined other health ministers and representatives from 193 countries in Geneva for the 62nd WHO Assembly to discuss vaccine preparations and other preventative measures against the new flu strain.
    Japan closed down 4,043 schools nationwide in a preventative move to protect its schoolchildren from the virus, as its confirmed number of cases rose to 163, the fourth largest figure in the world infection table.

    The Deputy Minister of Health continued with his surveillance rounds on May 21, this time to the Kuala Lurah Control Post by taking a closer look at the thermal scanning facilities and isolation rooms.

    As a way to provide the latest information on the situation, the Ministry of Health set up a hotline (145) and issued current updates on its web site.

    A nurse checks a girl's temperature at a hospital

    On June 11, citing a significant transmission of the virus, the WHO declared the first flu pandemic of the 21st century and raised its alert level to 'Phase Six' - the highest ever - confirming that the flu pandemic was well underway worldwide. The fatality tally reached 145 with 29,699 infections across the globe.

    Bruneians, meanwhile, were advised to postpone all unnecessary travel overseas, especially in the run-up to the second term school holidays. But flu or no flu, many Bruneians remained calm in the face of the storm that was to come and did not heed the professional medical advice and instead, chose to go spend their holidays abroad.

    The Minister of Health pointed out that although the country was still at 'Level Five', as no cases had yet been detected and tests on the 68 suspected cases reported so far still yielded negative results, he warned: "Our concern is that it may come to Brunei anytime."

    On June 18, two Bruneian brothers were confirmed to be infected with H1N1 as they arrived in Jeddah, after a night over in Kuala Lumpur and were duly interned at the King Faisal Hospital in Mecca, where they were said to be responding well to anti-viral treatment.

    Two days later, after dodging earlier viral epidemics, the bubble burst. A 19-year-old student returning home from the UK for the holidays found himself with flu-like symptoms 12 hours later, before health authorities confirmed him positive with the A(H1N1) virus.

    The Ministry of Health urged the public to remain calm. Family members who had come into close contact were duly tested that yielded negative results, prompting the ministry to ascertain that the virus must have been contracted whilst the student was still in the UK.

    Due to this latest development, coupled with the pandemic nature of the virus spreading, the ministry determined that all incoming air passengers may be checked and not just passengers from infected countries as it had previously been doing.

    Twenty-four hours later, a 16-year-old girl is also confirmed with the H1N1 virus, after returning home from abroad. The Ministry of Health traced all of her other close contacts and quarantined everyone suspected to be at risk.

    Malaysia closed down its first school due to H1N1 contamination and Singapore braced for a community spread of the virus as 23 new cases were reported.

    On June 22, four more students - all aged between the ages of 11 and 20 - returning from abroad were all tested positive for the virus. The fears had then become a positively tangible reality when in Malaysia, a second school was closed down just 24 hours after its first closure.

    A day later, a four-year-old girl became the latest patient to be infected with the H1N1 virus, after she returned from her family holiday in Malaysia.

    On June 25, in a further preventative bid to limit the spread of the contagion, the Ministry of Education and the Ministry of Religious Affairs supplied schools nationwide with 1,000 thermometers and 10,000 facemasks.

    On June 29, school reopened and teachers were instructed to check the temperatures of every single student and staff before they entered the premises.

    By now, the total number of infections in Brunei rose to 18, seven new cases alone recorded in just one day, which were later confirmed to have been 'close contact' cases with earlier carriers of the virus returning home from affected countries.

    Whilst fewer travellers passed through the Kuala Lurah Control Post bound for neighbouring Limbang, many families headed off for Miri, via the Sungai Tujoh Control Post, to catch flights to Kuala Lumpur, which was to have a further effect on the spread of the virus in the coming weeks.

    By June 27, seven more new infections were recorded in Brunei, bringing the total to 25. Around the world, 238 deaths had been recorded due to H1N1 with 55,867 infections reported.

    Four more cases were confirmed positive with the infection, bringing the total to 29 the following day, as the Ministry of Education announced all schools nationwide to be closed for an extra week as a precautionary measure. The Ministry of Religious Affairs ordered all religious schools to close for a week.

    On June 29, three more confirmed cases brought the total to 32. The Ministry of Religious Affairs held mass Hajat prayers at the Jame 'Asr Hassanil Bolkiah Mosque and urged all mosques and prayer halls all over the country to perform the Hajat prayers and recitals of the Qunut Nazilah.

    Meanwhile, facemasks and hand sanitizers were sold out throughout the country in a positive indication that the public were now well aware of the dangers and risks of H1N1. That same day, the total number of fatalities reported worldwide climbed to 263 with 59,814 infections.

    Ten confirmed cases were recorded on June 30, bringing the total number to 42.

    His Royal Highness the Crown Prince and Senior Minister at the Prime Minister's Office, as the Chairman of the NDMC, attended a special meeting with the rest of the council to discuss the plans and preparations in tackling the current H1N1 outbreak.

    What was previously the nation's worry has now become a reality where the Sultanate is not exempted from the threat of the virus, pointed out HRH.

    Reiterating the need of the current national 'Pandemic Influenza Plan' to be increased and strengthened by taking into account the rapid proliferation of human-to-human infections and the potential to further spread into a community outbreak, HRH emphasised that it posed a security threat to the safety of its citizens.

    The Ministry of Health called on the public and private sector to provide stable disease control protocols and procedures such as providing hand sanitizers at every premise, stressing the need for every member of the public to perform and maintain good hygienic protocols and responsible health protection in fighting the virus.

    The following day, July 1, the Minister of Health called a media briefing saying that it was not necessary to live in fear and that there was no cause for panic as 24 new cases were recorded - the highest increase in a single day - bringing the total number of infections to 66. The day confirmed that the pandemic was here to stay.

    The health minister also informed the public of the first possible case of a community transmission, when a 15-year-old girl contracted the virus, without having left the country or come into close contact with the other cases.

    The Tutong hospital was looked into as being mobilised as the full isolation centre for the H1N1 virus and management cases also came under review for mild cases to be treated at the homes of the respective infected cases to ensure no further close contacts would be transmitted with patients of chronic diseases and pregnant women.

    However, national celebrations continued unabated such as the hoisting of the giant national flag at the Taman Sultan Omar 'Ali Saifuddien in the capital and in all the other districts that day, with little regard for public safety by the authorities.
    On July 2, a 12-year-old girl became the first victim to succumb to the Influenza A(H1N1) virus, recording the country's first fatality.

    However, the Ministry of Health was quick to explain that she had also suffered from autoimmune hepatitis, end-stage liver failure and pneumonia, which left her frail body's defence system unable to counter the deadly disease.

    Twenty-seven new confirmed cases brought the total to 93 with the numbers likely to increase, the ministry added, prompting the public to wear face masks as they went about their daily lives.

    The Ministry of Health also focused on hoteliers and staff of the Ministry of Industry and Primary Resources with an update of the virus and in particular calling on the cooperation of hotels to provide face masks, hand sanitizers and the setting up of health teams to prepare standard operating procedures for suspected cases of H1N1, emphasising that it was the social responsibility of their guests to help prevent the further spread of the virus by informing the local authorities and that hotel managements should also prepare their own transportation for any suspected guests to hospitals and health centres.
    Citing the increase in the number of infections, the Ministry of Health warned that there could be a shortage of resources to send ambulances.

    The elderly and pregnant women were also advised not to undertake the Ummrah and Haj pilgrimages this year amid the growing H1N1 concerns.
    But were all the medical advice and precautions being heeded by the Bruneian public?

    For some, the answer was yes. But for many more, the extended school holidays and the fact that it had just been payday clearly became too much of an excuse not to go out unperturbed.

    Many families continued to amass at commercial centres across the country, with young children in tow, despite the fact that many amongst them had just returned home from affected countries and should have initiated some social responsibility by committing themselves to self-quarantine at home for at least a week, as advised by the health authorities.

    Nevertheless, national, social and community gathering continued on in complete disregard of the repeated warnings, which had obviously fallen on deaf ears.

    On July 3, eight new cases brought the total to 101 confirmed infections. The Ministry of Health again advised the public to reduce social activities, by avoiding crowded places, community gatherings, shopping centres, markets, food stalls, restaurants, cinemas and swimming pools.

    Hand sanitizers, thermometers and facemasks were quickly being snapped up just as soon as they were restocked in shops. This prompted some private institutions, such as the Bank Islam Brunei Darussalam to take on some social responsibility by distributing face masks to the public at all of its premises nationwide.

    That same evening, the Ministry of Education held special prayers asking for the country's protection against the H1N1 virus.

    By command of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam, on July 4, the Minister of Home Affairs announced that in view of the outbreak and continuing spread of H1N1 in the country, as a sensible and precautionary measure to mark the monarch's 63rd birthday anniversary celebration, all national and district level activities were to be postponed, with the exception of the mass prayers on the evening of July 14, much to the relief of the general public.

    The Municipal Department also conducted H1N1 inspections at hotels and restaurants in the capital as 23 new cases were reported, bringing the total number in the country to 124.

    Elsewhere around the country, there were similar scenes of frantic cleaning activities at schools as teachers took extra precautionary measures in preparation for the reopening of schools the next day.

    As schools reopened, the total tally climbed to 142 confirmed cases. The temperatures of every student and pupil were taken nationwide before they would be allowed into school premises. But there was the expected drop of attendance that very first day, especially amongst kindergarten children.

    Attendance at schools were still being affected, especially by unconfirmed rumours of H1N1 being discovered as a result of the temperature checks and monitoring at schools.

    Profiteers were also reported to be taking advantage of the huge demands of face masks and hand sanitizers by increasing their prices in many shops around the country, with absolutely little that the public could do about it, let alone the government authorities that had no such measures or regulations to control market prices of goods in the country.

    The following day, the Ministry of Health signed an agreement with Singapore's Specialist Training Committee on Emergency Medicine to ensure that more local doctors would be trained to become Specialist Emergency Physicians in order to be internationally accredited as specialists in Emergency Medicine.

    The health minister also confirmed to the public that Brunei Darussalam was now in the queue of countries waiting for the H1N1 vaccine.

    In an unannounced visit to the NDMC on July 14, His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam spelt out his displeasure and disappointment on many recent issues and events.

    With regards to the invasion of H1N1 into the country, His Majesty questioned why the Ministry of Health had just limited its actions to advising the people where "clearly the most important preventative measure was to temporarily prevent Bruneians from travelling to the affected countries.

    The monarch pressed on with his annoyance why nothing was carried out or thought of until a Prime Minister's Office circular was issued on July 9.

    But His Majesty's main displeasure was why government ministries and departments continued to send their officers and staff abroad including to some of the affected countries, even though the officials in question had themselves requested they be refrained from travelling abroad in their hopes of preventing the further potential contamination to other staff or their family members.

    "They travelled because there were no instructions yet. This is what I did not want to hear.

    "Heads of departments work just like a robot with no discretion or common sense. They just wait for instructions. If there is no instruction, they will not take steps even though they are mandated to make these considerations and take logical steps, especially when it concerns the safety and welfare of their people," berated His Majesty to the assembled gathering of ministers and senior government officials.

    His Majesty also asked why more prayers were not recited as spiritual protection is an advisable option when "we are running out of options particularly when physical control seems to be ineffective as H1N1 cases continue to rise".

    "Do you have to wait for my personal order to do all these?" fired off the monarch to all his ministers.

    That same day, the Ministry of Health stopped publishing the numbers of new infected cases, citing the WHO monitoring requirements, as 34 new cases were reported. With regards to the technical glitch surrounding its H1N1 hotline number that was reported on July 10, the ministry announced the activation of a second hotline number.

    Many parents expressed their disappointments and concerns with religious schools as they just began to start H1N1 screenings within their premises.

    A day after Singapore recorded its first fatality from H1N1 and with 24 new confirmed infections in the country, the Ministry of Health's H1N1 committee published excerpts of a series of Questions and Answers with the public.

    On July 27, the State Mufti launched a book on H1N1, entitled 'Swine Flu: Strengthening the Truth of the Al-Quran'.
    The 92-page book listed out that most of the major diseases that have claimed the lives of millions of people over the years have originated from pigs.

    But despite the lack of resources and the unavailability of the vaccines towards the end of the year, when H1N1 first landed on the country's shores in June, Brunei's efforts in containing the Influenza A(H1N1) virus had gone beyond what the WHO had been recommending in its efforts to protect and minimise the further spread of the virus.

    The Regional Director of the WHO's Western Pacific Region, Dr Shin Young Soo praised Brunei for its sound healthcare system. "I knew that even before I arrived here. However, I think that your system is more than meets the eye. Your healthcare system is ideal and what the government provides for its people is one of the best in the world," said Dr Shin. Meanwhile, the health authorities urged the public to stop circulating baseless and unfounded rumours.

    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela