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Dr Lim Chien Chuan (Photo - Terry Xu)

Clinic that raised the alarm: Zika-infection is easily written off as mild fever

Dr Lim Chien Chuan, who have been serving as a General Practitioner (GP) at Sims Drive Clinic for 16 years, was one of the three doctors who referred their clinic's patients to Communicable Diseases Centre (CDC)at Tan Tock Seng Hospital under the assistance of the Ministry of Health (MOH) which led to the discovery of the first locally transmitted Zika infection in Singapore.

The two other doctors at the clinic are Dr Chi Wei Ming and Dr Tan May Yen.

According to the press release by MOH, the first patient who is a 47-year-old female Malaysian residing at Block 102 Aljunied Crescent, developed fever, rash and conjunctivitis from 25 August. She visited a GP on Friday (26 August) and was referred to the CDC, where she was tested positive for Zika on last Saturday (27 August).

Dr Lim noted to reporters in an earlier interview on Monday, that it was difficult to notice trends among their patients, because he, Dr Chi and Dr Tan are rarely on duty at the same time.

The clinic had begun seeing as many as 10 patients a day with mild fever, rashes and joint pains just two weeks before they informed MOH about the matter. Prior to this, the clinic was seeing only two or three cases.

Dr Tan drew attention to the “sudden spike” in the cases and further suspicions aroused when the patients were tested negative for dengue, chikungunya, measles and rubella.

Dr Lim said that the clinic contacted MOH on last Monday (22 August) and the CDC asked the clinic to send samples for testing on Tuesday (23 August) which eventually resulted in the discovery of the first patient.

Dr Lim is unable to provide information of whether the workers were from his clinic as MOH does not get back to the clinic on whether their patients have been tested positive for the Zika infection. However, he did share that the clinic referred another five patients with the same symptoms for testing just on Monday itself.

The only difficulty that he brought up is that although patients do agree to go for testing, but the doctors cannot be sure if they would be physically present for the testing.

Identifying the Zika infection

The problem with identifying the Zika infection is that doctors would likely write the patient's sickness off as a fever as majority of them would have their fever subsided by the time they visit the clinic. And prior to the clinic’s referral of patients to MOH, there has been no awareness among the GPs that they had to look out for Zika infections in patients who have showed signs of the infection but had not travelled in recent days.

But the infection is not to say undetectable as Dr Lim pointed out that the fever will come with rash and painful joints. The rash will come about on day two, day three upon infection and it is itchy.

According to Dr Lim, some patients will also have meningitis as a result of their infection.

There is a guideline issued for GPs, before any referral is made to the CDC so that the GPs will not over diagnose or under diagnose.

Back when the clinic had its earlier suspicion, the doctors could not test the samples because of the lack of access to the labs. But from today (29 August), GPs can now send the samples to CDC for testing if it meets the criteria.

People with symptoms should not panic

Dr Lim said that people need not worry if they take necessary precaution. If they show symptoms of the infection, which would be mild in most of the cases, they should just visit their GPs to be sure.

Pregnant ladies need not panic over any symptoms and should visit their obstetrician for medical consultation and advice.

Dr Lim believes that with the appropriate vector control, he is confident that the situation can be brought under control.

When said that it is the credit of the doctors for highlighting the first case of infection, Dr Lim said that “This is just our duty” and added that he believes that other doctors would have done the same.

sims drive medical
Clinic that referred the patients to MOH for suspected cases of Zika infection