Better safe than sorry
The response to the influenza outbreak among children in Hong Kong is much more than just dealing with a 'flu scare': it is a dress rehearsal for the real thing. Many people may see the early closure of primary schools, kindergartens, special schools and nurseries for the Easter break as an overreaction to panic among the parents of young children attending the schools where outbreaks have occurred. But the government's decision to shut the schools, clean them thoroughly and use the time to let the influenza virus burn itself out is a wise move.
The very best outcome is no outcome at all. In other words, one where nothing happens: the outbreak fizzles out, children go back to school after Easter and parents, grateful to have them finally off their hands, start to wonder what all the fuss was about.
Managing or suppressing an outbreak of an infectious disease is a bit like housework. No one notices all the work that goes into keeping a house clean and tidy. It is only obvious when dirt and spills have not been wiped up, dishes have not been cleaned, the rubbish hasn't been thrown away and the place begins to smell.
Likewise, effectively quashing an outbreak involves clearing the disease from vulnerable members of the population by closing institutions susceptible to outbreaks, cleansing potential infection sites and removing the virus by not giving it a chance to jump from human to human during its natural cycle (the school closures will cover double the natural cycle).
With flu cases rising in Guangzhou (there have been well over 100, also mostly among schoolchildren), the pressure to stop the outbreak before it gets out of hand is even greater. And, if the best result is achieved, nothing will happen: Hong Kong will, once again, survive a potentially serious infectious-disease outbreak; the house will remain in order.
However, that is only the best outcome. There is another very good reason for closing the schools. Right now, nobody is 100 per cent certain that the only thing going on here is a rise in flu cases, something we expect to see at about this time every year. Severe acute respiratory syndrome, which also arrived in early March, taught us some very painful lessons, ones that we would be foolish to forget.
Young children do die from infectious diseases. A sudden rise in temperature can send some into lethal convulsions. Others, who may have had their immunity weakened by an earlier infection, other medical conditions, fatigue - or are simply genetically more susceptible to particular infections - may be rapidly overwhelmed by an infection that causes few problems in other children.
But the cases involving the sudden death of a child, following the rapid onset of a flu-like illness, must be investigated. And if, in the worst-case scenario, it turns out to be a variant of influenza - one to which we have no immunity, and one which is particularly virulent among young children - not closing our kindergartens and primary schools would have been a disastrous decision.
If this turns out to be the case, what should we do? Besiege doctors and pharmacists, asking for Tamiflu? Definitely not: this is the worst thing people could do at this stage.
For one thing, Tamiflu has some unpleasant side effects, the most serious of which are neuropsychiatric problems - delirium and depression - in children under 16. For instance, in Japan, between 2000 and October 2006, 16 children died after taking Tamiflu, the health ministry reported. For this reason, children should never be given the drug unless they are in hospital or under very close medical supervision.
Pregnant women should not take it either, as it is not clear whether it is safe for the unborn baby. Other side effects include nausea and vomiting and rare, but life-threatening, allergic reactions.
Second, there are signs that Tamiflu resistance is emerging in some countries. So far, this is not a problem in Hong Kong because use of the drug has been carefully controlled. But, if the entire population started taking Tamiflu pills at the first sign of a sniffle, we would not only have a large number of people suffering unpleasant side effects, we would also end up with a drug that could do nothing for those who really need it. So, resist the urge to hoard, powerful though it may be, and ignore all those know-it-all aunties, neighbours and friends. If they are such experts, why are they not assisting us in the hospitals and clinics currently swamped by people in serious panic mode?
And, finally, we come to the last good reason for closing the schools. During Sars, much of the damage was done not by the virus itself but by the panic it engendered. Panic disrupts societies, destroys economies and leads to ridiculous behaviour. If taking concrete action like closing the schools can halt the rising tide of panic, yet another excellent outcome has been achieved. As health secretary York Chow Yat-ngok noted this week: 'This is not just a decision on public hygiene, but also one concerning public sentiment.'
There is a risk, of course, that concrete action like this will fuel the panic, as parents see the decision as hard evidence of a serious outbreak and, thus, one to be feared.
But, in this instance, the authorities are damned if they do, and damned if they don't. Let's hope that, eventually, actions will speak louder than words.
Margaret Cheng is a Hong Kong-based medical writer
