What the press conference on Zika infection told us and did not

In the press conference on Sunday held by Ministry of Health (MOH) and National Environment Agency (NEA), we are informed about the current situation of Zika infection in Singapore, which is 41 confirmed cases of Zika infected patients and we are not told about a lot more by the ministry.

So far what we know from the press conference on Sunday (28 August) is

• 41 confirmed cases of Zika infected patients (out of 124 tested)
• 34 had already recovered from their infection, meaning they were infected much earlier

In its earlier statement on 27 August informing of the first confirmed infected patient, also known as Patient A, MOH said that it has alerted all General Practitioners (GPs) around the patient’s home and workplace to be extra vigilant and to immediately report patients with symptoms associated with Zika virus infection to MOH.

Minister for Health, Mr Gan Kim Yong went on say, “...We do expect more cases to emerge over time partly because the active testing that we are now carrying out at areas of concern have new cases emerged, therefore we have instructed GPs especially in the affected areas to look out for potential suspect cases.."

MOH in its statement also said that it is also carrying out Zika testing on others living and working in the Aljunied Crescent/ Sims Drive area and other areas of concern who have symptoms of fever and rash.

MOH further added that as an added precaution, all suspect cases of Zika virus infection will be isolated while awaiting confirmation of the blood test results.

Mr Gan Kim Yong also said that part of the reason that MOH has discovered more cases is because it has now gone back to the cases that were seen before by doctors. They were not suspected to have Zika, because they have no travel history and so on.

The statements provided by MOH are somehow troubling, given the following reasons.

1. Its effort to discover more patients is currently focused on the areas near where the infected cluster is located and Singapore is a small country where people can easily travel from one place to another.
2. That the test conducted to confirm the first patient, a 47-year-old female Malaysian may be different from the test conducted by GPs. Bearing in mind that the 40 other patients found infected were only discovered after MOH did a check on past cases.
3. MOH is only telling the GPs in the region of the first patient or the cluster to take note. This mean that it is possible that other cases in Singapore will likely to be also written off as just a fever and the patients will just recover from it such as the 36 cases.
4. Previously before this announcement, there is no instruction of isolating suspected cases because there was no doubt about the possibility of a Zika outbreak in Singapore.

Rather than to say that there is a cover-up by MOH, it seems more like a case where the ministry was caught with their pants down with the first case of Zika infected patient and then scrambled to see if there are any other patients with the same issue.

Questions that MOH had not been asked by the media which can shed more light on their preparedness on the Zika infection.

• How dangerous does MOH feel the Zika infection to be in relation to the Singapore population?
• What measures have been put in place to inform GPs to take extra care in testing for patients with symptoms of Zika infection?
• Given that MOH had only given the instructions to the GP around the first patient's home on 27 August. Why wasn't it done earlier and why are the instructions not given to all GPs around Singapore?

So far, all signs would indicate that MOH did not make much effort in ensuring the patients infected by the Zika infection would be promptly detected by their GPs. This is especially telling from Mr Gan's comment about patients were not thought to have Zika because they had not travelled abroad.

Mr Gan then somehow covered his ministry well from further cases of infections by saying that the MOH expects more infected to be discovered in time to come. So who can the public find responsible for the Zika outbreak if it does get out of hand like the dengue fever that has stuck with Singapore for the past few years?

What else did you learn from the press conference? Below are the questions and answers published by TodayOnline

Q) When was the earliest case that Ministry of Health backtracked to?

Dr Derrick Heng (MOH Group Director for Public Health Group): The (earliest) case that we know of was July 31. We would not have picked up on all the cases, (so) we would not be able to pinpoint definitively the first index case (patient zero).

Mr Koh Peng Keng (MOH Group Director, Operations): The first case we knew of was patient A (the 47-year-old Malaysian woman whose case was reported on Saturday). The rest of it we had to work with the GPs, to do a lot of tracking to try and look back.

Dr Heng: We went back to look at people who were part of the GP (cases), and (at the) construction site, the people who had reported symptoms in the past. We took samples...the samples (tested) positive sometime late last night (on Saturday).

Mr Koh: The GP alerted us of this unusual cluster of cases with mild symptoms, it’s only (then) we went back to check....most of them had already recovered. So it was a look back...Initial hypothesis was that it was just some mild viral infection that transmits from person to person. Zika was not specifically suspected at that point when the GP was seeing this group.

Q) Saturday was confirmation that the woman (patient A) had Zika. But you had preliminary results, did you start looking before Saturday, or did you only start work on Saturday when you had confirmed results?

Dr Heng: We started preparations when the preliminary results (came out). But we had to wait for confirmation in order not to create false alarm.

Q) Patient A was at CDC on Aug 25, and it takes about three hours to do the test. So you should have known by that night.

Professor Leo Yee Sin (clinical director of Communicable Disease Centre): Her presence at CDC from the time we received her as a case, to the time she did the blood test, all this is actually a very compressed period of time, including getting her back for further assessment.

Q) The first case was announced on Saturday, and it jumped to 41 cases. Could the MOH have announced all these cases earlier?

Health Minister Gan Kim Yong: Part of the reason that we have discovered more cases is because we have now gone back to the cases that were seen before by doctors.

They were not suspected to have Zika, because they have no travel history and so on. Now that we know there is a case ...we’ve therefore gone back to all these cases that were surfaced before, and checked their blood tests, and that’s why we have discovered more cases, as a result of the first case.

So out of the 41 cases, I think some 36 cases were a result of this active testing of the patients who were in the areas of concern, whom we felt there was the potential they would be infected by Zika. Then we went back to relook at their test results. Some were even retested to determine whether they were infected by Zika.

Q) Why did it take two days before the MOH announced patient A’s case?

Mr Gan: Some required double confirmation. So first we tested them on the urine test...various steps of testing.

Q) So it’s not like you knew about it earlier, but was keeping quiet about it?

Mr Gan: No, of course not.