Between Panic And Complacency

Communicating the risks of infectious diseases as diverse as MERS and hepatitis C may not be easy, but is nonetheless essential.

AsianScientist (Jan. 13, 2016) – About seven months ago, I boarded a plane bound for South Korea to attend the 2015 World Conference of Science Journalists. It was my first trip to the country—and just so happened to coincide with the height of the Middle East Respiratory Syndrome (MERS) outbreak.

Friends and family urged me to reconsider what they saw to be an unnecessarily reckless and foolhardy decision. To state my case, I marshaled facts: the vast majority of cases were hospital-acquired, there was no evidence of community transmission, and the median age of patients affected was 50 years old. Sadly, none of this empirical data was as convincing as the anecdotal evidence of my safe, MERS-free return home a week later.

Not their fault, really. Human beings are just spectacularly bad at thinking probablistically.

Oscillating between panic and complacency

Still, our lagging brain biology is no excuse for public officials to panic and take irrational measures. It is one thing for Seoul residents to start donning masks even though health officials acknowledge that it does not prevent the transmission of MERS and quite another to order the quarantine of zoo camels.

But the 2015 MERS outbreak was also marked by the flipside to over-reaction: complacency. Not taking his voluntary home quarantine very seriously, a 44-year-old South Korean man flew to Hong Kong for a scheduled business trip, despite running a fever. In doing so, he brought MERS into China, gaining the dubious honor of being the country’s first ever MERS case.

Even medical professionals, who might be expected to know better, did not seem to take the threat seriously. An unnamed doctor who had been in contact with a known MERS patient not only continued his work at a large general hospital but also attended public events where large number of people were gathered, potentially exposing over 1,500 people to MERS in the process.

Calculating risk

Truth be told, it’s hard for public health officials to get the message right. Overstate the risks and you might cause the public unnecessary panic, lose tourist dollars and send the stock market into a tailspin. But understating the risks—or worse still, covering them up—could lead to the loss of life and a loss of confidence in the health system.

Take for instance the outbreak of hepatitis C at Singapore General Hospital (SGH) last year, where 25 patients were infected with the disease between April and October. To many people I spoke to it seemed like a non-event; a localized outbreak at a single hospital that resulted in seven or eight deaths. However, a closer look at the biology of hepatitis C reveals why the risk is higher than generally perceived.

First of all, unlike MERS and its coronavirus cousin SARS, hepatitis C is much harder to catch. How much harder? Well, let’s just say that if 100 people were accidentally poked with a hepatitis C contaminated needle only about two of them would develop the disease.

Hepatitis C is not airborne and cannot be transmitted by close contact such as kissing or breastfeeding. According to the US Centers for Disease Control and Prevention, the most common means of hepatitis C transmission is through large or repeated exposure to infectious blood. That such exposure could happen within a large public hospital is itself very worrying, but made worse by the fact that hepatitis C carriers are more likely than the general population to also be carrying HIV.

Another reason people people I spoke to were not that concerned about the SGH hepatitis C outbreak was that they didn’t understand the consequences of developing the disease. Unlike MERS and SARS where an acute infection can lead to the swift and devastating consequence of death, the hepatitis C virus has a much more subtle effect. People infected with hepatitis C may not show symptoms for decades, and even then only present with non-specific symptoms such as tiredness, memory loss and itchy skin.

By the time symptoms appear, however, there is little that can be done for the patient. While a lucky few can successfully clear the virus, the majority of those infected (75-85 percent) will become lifelong carriers of the disease. Over time, chronic hepatitis C infection can lead to severe liver damage, requiring liver transplantation and lifelong follow up care. Eventually, 1-5 percent of those infected with hepatitis C will succumb to either liver cancer or cirrhosis.

So, should I worry?

Thankfully, unless you are an injectable drug user or recent recipient of a blood transfusion or dialysis at SGH, your risk of contracting hepatitis C remains low and is not a reason to start panicking. However, the safety lapses that led to the outbreak, as well as the outbreak of conjunctivitis at a neonatal ward at KK Women’s and Children’s hospital and tuberculosis scare at the National University Hospital, all point to a healthcare system that has let its guard down.

Personally, I hope that these incidents will lead to an improved infectious disease reporting system and a greater deal of transparency in communicating risk to the public. Singapore has previously shown that it has both the will and means to tackle challenging outbreaks and was even hailed by World Health Organization officials as an “inspiring victory” for how it handled SARS in 2003. Although its not be easy to find the sweet spot between panic and complacency, may Singapore do better in 2016.

This article is from a monthly column called From The Editor’s Desk(top). Click here to see the other articles in this series.


Copyright: Asian Scientist Magazine; Photo: star5112/Flickr/CC.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

Rebecca did her PhD at the National University of Singapore where she studied how macrophages integrate multiple signals from the toll-like receptor system. She was formerly the editor-in-chief of Asian Scientist Magazine.

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