DOH warns of ‘more fatal’ strain


MANILA, Philippines—A 49-year-old woman died of heart attack at her home in Metro Manila on Friday, but a throat swab indicated she was infected with the Influenza A(H1N1) virus, making her death the first in the Philippines related to swine flu.

Health Secretary Francisco Duque III, who announced the woman’s death at yesterday’s briefing, stressed that the death was not caused by the virus but could have been aggravated by it.

The woman’s death and the rise in the number of swine flu cases in the country and elsewhere have prompted the Department of Health (DOH) to gear up for a possible virulent strain of the virus.

Dr. Yolanda Oliveros, director of the Center for Disease Prevention and Control, said a second wave of the virus would take place if the virus mutated into a “more virulent and more fatal” strain.

As of yesterday, the number of A(H1N1) cases stood at 445 after 17 more people, including two foreigners, were confirmed to have the virus.

The World Health Organization has declared a flu pandemic. As of Friday, it said more than 44,200 cases had been reported worldwide with 180 deaths, mostly in Mexico and the United States.

“We would like to emphasize that globally and locally, the overwhelming majority of cases only experience mild symptoms and eventually make a rapid and full recovery, often even without any form of medical intervention,” Duque said.

Of the 445 confirmed cases, 84 percent or 374 have already fully recovered, the DOH said.

Dry cough, fever

The woman came home from work on June 17, complaining of weakness, according to a DOH investigation.

She did not report for work the next day and went into self-medication (taking paracetamol) as she experienced dry cough, fever and chills.

On the morning of June 19, she skipped breakfast. She was restless and complained of difficulty in breathing. She died shortly before a doctor arrived.

Preexisting condition

Duque said the postmortem findings showed that the death was caused by “congestive heart failure secondary to acute myocardial infarction aggravated by severe pneumonia either bacterial, viral or both.”

The woman was also found to have an enlarged liver, spleen and kidney, tumor in the uterus and mild goiter.

“Given the available situation, we cannot conclude that the death is due to A(H1N1). But in other countries which have reported deaths, majority have preexisting medical conditions,” he said.

The woman had not traveled abroad where she could have gotten the virus.

Duque said the DOH would not have known that the patient had the virus had her brother not called him up on June 19 requesting that the autopsy include a swab test for A(H1N1) since the patient had flu-like symptoms before her death.

Nasal-pharyngeal and throat swabs were taken on June 19. The test done by the Research Institute for Tropical Medicine came out positive.

Complicated case

“This is really a complicated case,” Oliveros told reporters at the briefing.

“For the past several days, she was not feeling well because she had several medical conditions and a family [member] claimed that she did not regularly seek medical attention,” she said.

In keeping with its policy on confirmed cases, the DOH did not identify the woman.

Duque would only say that the woman was based in Metro Manila. Her husband and grown-up son have also been tested since they have flu-like symptoms. But the patient’s mother, brother and sister have no flu-like symptoms.

Malacañang sought to downplay the death. “I don’t think that we have to be alarmed considering that the patient died of cardiac arrest,” Lorelei Fajardo, deputy presidential spokesperson, said at the briefing.

The first reported death related to the swine flu virus has prompted the health department to issue stronger warnings.

High-risk groups

Duque said the DOH would be “more aggressive” in targeting patients more vulnerable to fatal flu complications so they would get priority care.

The high-risk groups are those with uncontrolled diabetes, cardiovascular and chronic obstructive pulmonary disease, chronic liver and kidney disease, HIV/AIDS, tuberculosis and other infections; organ transplant recipients; those who are immuno-compromised; pregnant women and the very young (five years and below) and the elderly.

“We want to make it clear that high-risk groups, once they have the flu symptoms should immediately go to their doctor. They should not wait for their symptoms to worsen because they are prone to many infections other than the novel virus such as our seasonal flu strains,” Duque said.

See a doctor

The health secretary said it was prudent for parents to seek professional care for children with rapid breathing, excessive drowsiness or dehydration.

“In adults, chest pain, prolonged fever or labored breathing should prompt warnings to see a doctor,” he added.

Duque said the best defense against swine flu and other communicable diseases was still to boost one’s immune system and to practice good hygiene like proper hand washing and covering one’s mouth and nose when sneezing to prevent spreading respiratory droplets.

“Most people can fight off this virus without special medications or hospitalization. You can stay at home and take supportive care like plenty of fluids, vitamins and bed rest,” he said.

The DOH has discouraged wearing masks in public since the virus is not airborne, and advised that masks should only be worn by those with flu-like symptoms to keep them from infecting others.

Masks are also reserved for caregivers and medical personnel.

In anticipation of a second wave, Oliveros said health authorities were preparing a more intensive response plan to include new “simulation exercises” to determine hospitals’ preparedness.

She said authorities wanted to ensure that basic essential services continue. Companies are encouraged to come up with their respective “business continuity plans.”

“The most important component is risk communication to reduce panic,” she said.

“Second will be health infrastructure to make sure that all our hospitals and health facilities are prepared to address the severely ill cases,” Oliveros said.


Source: Christian V. Esguerra, Dona Pazzibugan
Philippine Daily Inquirer
First Posted 01:01:00 06/23/2009