INFLUENZA EPIDEMIC IN SINGAPORE (Statement by the Minister of Health)

The Minister for Health (Mr A. J. Braga): Mr Speaker, Sir, the epidemic of influenza which has visited Singapore has aroused anxiety and I feel it incumbent upon me to make a full statement for the benefit of the House.

As I have already stated earlier, this disease is believed to have originated in Japan and has invaded Taiwan, the Philippines, Hongkong, Singapore and the Federation of Malaya. A characteristic of this disease is its capacity to attack suddenly, although the actual disease is mild, and to extend very quickly. The extreme conditions of overcrowding, particularly in the town, must certainly have favoured the spread. It must also be realised from the epidemiological point of view that the entire island of Singapore is one composite urban unit with denser aggregations north and south of the Singapore River. In consequence, an island-wide spread was inevitable and indeed the spread to the Federation of Malaya was inevitable. In the view of medical experts, it is likely to prevail in an epidemic form until about the end of this month and from daily reports, there are definite signs of a decline and that it is well on its way out.

There is no known preventive or cure for the disease. The only course - which was unthinkable - was to close the port of Singapore and all the ports of the Federation of Malaya and the Siamese border against the entry of any craft whatsoever, and impose martial law to keep people in their homes until the disease had spent itself on a worldwide career. There is no specific cure for influenza as there is none for an ordinary common cold. The number of persons affected by the disease in Singapore and attended to by our medical clinics, and mobile and floating dispensaries totalled approximately 25,000. It is estimated that an equal number have been treated by private practitioners and local medicine men. So much publicity has been given to the epidemic that I have every reason to believe that the number of persons who were actually attacked by the disease and who have not sought treatment would be negligible. Directly it was evident that the disease had attacked Singapore, Government took every possible measure to combat and control it. Briefly, the steps taken by Government were, firstly, my Ministry issued warning and advice through the Press, Rediffusion and the Radio and the personnel of the medical services to the people to keep away from crowds and to rest in bed if the disease was apparent. Secondly, elective surgery was restricted to the barest minimum practicable to make possible the release of medical personnel to augment outpatient services. Further, extra travelling dispensaries were mobilised. Prior to the onset of the epidemic, we had three travelling dispensaries visiting various parts of the island. In addition to this, we had two floating dispensaries doing monthly visits of the islands. On the onset of the epidemic, Government mobilised five travelling dispensaries doing double shifts and the floating dispensaries were put on an emergency basis to visit each of the islands twice a week. The entire staff was stretched to the limit. Simultaneously, the pharmaceutical manufactory immediately increased its production of essential drugs.

The attack of the disease commences with fever, headache, pains in the limbs and back, nausea and sore throat and sometimes accompanied with cough and giddiness and a temperature which ranges from 101 to 102. The duration of the fever is about two days and the patient settles down to normal within four to five days and there seem to be very few complications.

It would appear that four persons might have died of the disease although biological confirmation has yet to be available. Persons diagnosed as having died of influenza depended solely on morbid anatomy. During this period, there were a few other fatal cases in which findings suggest influenza but there were other complications such as broncho-pneumonia, heart disease and nervous manifestations and, in the absence of the virus, it is hardly possible to attribute them to influenza as the causal agent of death. Information from commercial firms is that about 10 per cent of the staff were away at some time or other. The disease seems to have been confined to Asians, Europeans being very little affected. Whether there is an immunity already in the European race is difficult to decide at the moment.

Here, I would like to pay tribute to the excellent team-work and ungrudging service of all members of the Ministry, particularly the doctors, sisters, nurses, dispensers and others who worked throughout - some of them fifteen hours a day on their feet. In paying this tribute, I do so on my own personal knowledge: I visited the outpatient department in the General Hospital and saw the work that was being done there. I have discussed matters with the personnel manning the services and the streamline basis on which they were operating to meet the emergency and I have been given the assurance that there was an adequate supply of drugs. My discussions with all my officers convinced me that the disease is of a very mild nature.

Members of this House are, of course, aware that the schools were closed. After consulting my medical advisers and on receiving reports from the Ministry of Education that there was a large number of absentees both of pupils and teachers, I recommended that the schools be temporarily closed with the advice to parents and/or guardians that children should be kept away from crowded places. The reasons for this are threefold: first, large numbers of children travel in crowded buses to and from schools and it is very easy for them to acquire the infection in a crowded bus; second, an infected child would spread to others in the school, persons in the buses and members of the home; and third, the Minister for Education was concerned with the practical difficulty of holding classes without teachers.

In normal conditions, recorded deaths from pneumonia in Singapore rank high in the fatality list. In view of the anxiety created in the minds of the population, it is not unnatural for persons to believe that anybody dying of any respiratory infection must have died of influenza and it is a pity that, in some cases, most exaggerated reports have tended to aggravate the fears in the minds of the people. A glaring example of this is the report on the mercy mission to Pulau Sudong. Following the visit of the mercy mission, it was reported in the local Press with alarming headlines that 300 persons out of a total population of about 450 were down with influenza and that three had died of it but Government was not giving any special treatment or help and that the people were dying of starvation. This, Sir, was a terrible indictment but proved to be a gross exaggeration. It was known to my Ministry at that time that there were only 21 cases with the disease and that none had died of it. On reading this astounding report, I made immediate enquiries. It was then confirmed by the medical officer and the hospital assistants who visited the island twice a week that only 11 children and 10 adults, most of whom were recovering from influenza, were the only cases in Pulau Sudong. There were, in fact, three deaths: one child from convulsions, another child from gastro-enteritis and the third, a woman, from goitre. Not satisfied with this report, I sent two other medical officers with members of the Press in attendance to make a further detailed check. The penghulu's services were specially enlisted to permit the doctors to examine every sick person on the island. The penghulu went hither and thither and eventually brought 51 persons for examination most of whom looked far from ill and were, in fact, in a cheerful and gay mood. Of the 51, there were two new cases of mild infection and a further six convalescents. The remaining 43 intimated that they were going out fishing that night. What was even more surprising, in view of the allegation that most of the population was starving, was the finding that there was not a single case of malnutrition amongst those examined. I would remind hon. Members of the House that those persons examined on that day were persons specifically selected by the penghulu himself as being those most in need because they were either sick or starving.

There was no need to panic and it is further to be regretted that the fear caused in the minds of the people did much more harm than this mild outbreak of influenza really did.

Again, one of the local papers reported that the victims of this disease had to travel from Changi, Katong and Tampenis to the General Hospital and one of these questioned by the reporter was alleged to have said, "We should have our own dispensaries in our areas or quicker attention in the General Hospital outpatient department." I would like, Sir, to remind this House and the people of Singapore that in addition to the services given by the travelling dispensaries in the rural areas and the General Hospital outpatient department, static outpatient clinics and dispensaries are and have been in existence in the following places - and all these have been working full strength during the epidemic:

(1) the Kandang Kerbau outpatient dispensary for women and children;

(2) the Tan Tock Seng outdoor dispensary for males;

(3) the Paya Lebar outdoor clinic;

(4) the Bukit Panjang outdoor clinic at the 10th mile;

(5) the Bukit Timah outdoor clinic at the 7th mile;

(6) the Holland Road outdoor clinic at Holland Village;

(7) the Thomson Road outdoor clinic at the 6th mile;

(8) the Changi Prison clinic for prison staff and Government servants in the area and their families;

(9) the Changi clinic at the 14th mile, Changi;

(10) the Gulega Road clinic at the 9th mile, Changi Road;

(11) the Kampong Batak clinic in the Malay Settlement:

(12) the Kallang outdoor dispensary at the old Kallang Airport site.

In addition, the City Council maintains three outpatient clinics solely for City Council employees which relieve the pressure on the Government services. Furthermore, our records show that there had been daily attendances at all the clinics mentioned and if it is of interest to any Member of this House, he is welcome to inspect these records. Apart from the Kallang outdoor dispensary which was only recently opened, of which existence the public has been well aware and is prominently situated in the old Airport site, all the other clinics have been in existence for at least one or more years. The fact that these clinics have been well patronised during their existence and during the epidemic is an effective answer to those who might maintain that the people are unaware of them. There are also three clinics for schoolchildren: one at North Canal Road, another at Katong and a third at Paya Lebar. Five thousand schoolchildren attended these clinics up to yesterday.

Instead of the criticisms appearing in the Press and such harebrained suggestions like sending loudspeakers to Chinatown at a time when Government medical services were working at full pressure, had members of the public emulated the splendid example of Mr Richard Lim in organising a special voluntary medical service station at Pearl's Hill community centre and now at Serangoon, it would have served a much better purpose. One sneeze in Chinatown by any person affected in such congested conditions as exist there would result in widespread prevalence. A loudspeaker would only cause more panic and give opportunities to thugs and quacks to make capital out of it, it is, of course, a matter for regret that the outbreak of influenza did cause economic damage and distress to many but I must emphasise that it was absolutely unavoidable and the hazards and distress posed could be likened to a common cold of equal incidence. About nine days ago, I stated that the disease had reached the peak and was expected to decline soon. This was evident by the daily reports and the graphs of new and repeat cases. Today, I am happy to say that the anticipation of the Ministry of Health has been correct, that the disease is well on its way out and I understand that it is unlikely that a person who has been attacked with influenza virus is likely to be attacked again in the same epidemic.

Mr John Ede (Tanglin): Will the Minister state why the radio was not fully used in the early stages of the epidemic to tell the public in simple language what to do and how to treat themselves so as to reduce the pressure on the Government hospitals and the clinics?

Mr Braga: As far as I am aware, the first opportunity to use the radio was taken.

Mr Lim Choon Mong (Serangoon): Mr Speaker, Sir, the Minister informed us that there is no known cure against influenza and that whatever medicine the doctors could dispense would be in the form of aspirin. Why was not aspirin made available to the people of Singapore? A patient going to the hospital-

Mr Speaker: Order. Was that a supplementary question?

Mr Lim Choon Mong: Yes, Sir. I have a series of them.

Mr Braga: I have stated that there is no known cure for the disease but such things as aspirin, A.P.C., Veganin and codeine are all palliatives and they were made available at the outdoor dispensaries and every clinic in Singapore.

Mr Lim Choon Mong: Is the Minister aware, Sir, that a patient going to the hospital may have to wait from morning until quite late in the afternoon, say about four o'clock, five o'clock or even six o'clock before he gets attended to whereas if these medicines were made available, he would then not be subjected to paying high prices to the thugs and quacks as stated?

Inche Ahmad Bin Ibrahim (Sembawang): Is the Minister aware that the death certificates of the three deceased persons mentioned by him were signed by a police constable and is he again aware that the police constable had no medical qualification to ascertain the cause of the deaths?

Mr Braga: I would like to know where the hon. Member got this information from. These islands are visited by the doctors and the hospital assistants and they are perfectly aware of what the patients are suffering from. The death certificates are done after their diagnosis supervision.

Mr Lim Choon Mong: Mr Speaker, Sir, the Minister's goodwill visit to Japan probably has brought back this virus but he must have learned what steps the Japanese had taken when he was in Japan. There was an outbreak there, and furthermore he must have learned what steps they have taken in Hongkong too and I hope that at least Singapore should be benefited in the way of knowing what other countries are doing instead of a just empty goodwill.

Mr Braga: If the Member for Serangoon understands English perfectly, I just said that there is no known preventive against the disease. It is no good kidding the public. If there was a preventive like issuing masks and so forth, we would have done it willingly to factory workers and others but I said that there is no known preventive.