Public bafflement would not have been that serious if the Health Ministry had right from the beginning realised the importance of ensuring and maintaining public confidence in the crisis management of the viral epidemic and demonstrated the ability to understand the concerns of the parents, as for instance, by declaring emergency school holidays for Std. I to III standards in Sarawak in the past two weeks.
Unfortunately, there had been various bunglings and public relations disasters, especially by the Health Minister, Datuk Chua Jui Meng who insisted on monopolising all press conferences from Kuala Lumpur about news about the epidemic in Sarawak and worst of all, his announcement on June 9 that the Health Ministry had identified the viral killer as coxsackievirus B when this was not the case - creating a public credibility gap which had not been narrowed today.
There is not only a public credibility gap in Sarawak, but a public credibility gap world-wide as well. The University of Nebraska Medical Centre, which maintains the only website on the Internet which has a continuous update of developments of the viral outbreak in Sarawak, referred to the "mystery cause" of the 26 deaths in Sarawak, raising the question as to whether they were caused by a virus at all. In its latest update yesterday, it said:
(URL: http://www.unmc.edu/Pathology/Myocarditis/malaysianews.html)
"Thursday, June 19:
"Given that the identity of the virus - if it is a virus - that has caused the pediatric deaths remains a mystery, despite official claims to the contrary, we thought it would be beneficial to point out that a great many viruses have been implicated as causes of myocarditis in humans. The coxsackie B viruses are only the best studied in connection with myocarditis.
"The following list was taken from PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASE, third edition, edited by G. Mandell, R. Douglas, Jr., and J. Bennet (published by Churchill-Livingstone, 1990), by M. Savoia and M. Oxman. On page 722, Table 1 lists the following viruses among the many infectious causes of myocarditis: Coxsackieviruses A and B, echoviruses, polioviruses, mumps, rubeola, influenza A and B, rabies, rubella, Dengue, yellow fever, adenovirus, 2 hemorrhagic fever viruses, varicella-zoster, cytomegalovirus (CMV), Epstein Barr virus (EBV), vaccinia, variola, and hepatitis B virus. There are of course bacterial, rickettsial, fungal and parasitic agents that can cause myocarditis as well.
"We believe it is key to recall that of the many viruses on this list, the only two virus groups that have been demonstrated - either by observation (adenos, CVBs) in patients and experimental animal models (CVBs) - to play significant roles as viral agents of myocarditis in humans are the coxsackie B viruses and the adenoviruses. Both of these are known to be associated with childhood myocarditis."
Yesterday I received an email from an infectious disease physician from Singapore currently doing post-graduate work in the United States stating that Enterovirus 71, Coxsackie A and CVB3 are all members of the enterovirus group of viruses and that the prevention, control and treatment of these viruses is identical according to current expert opinion. Consequently, it is more important to institute and enforce control measures, early detection and management rather than to be obsessed with finding out exactly which species is responsible for the outbreak.
This physician is probably right, but the problem with the Sarawak viral epidemic is that the Health Ministry authorities had lost the first round of the battle when they lost public confidence by allowing a yawning public credibility gap to develop - resulting in an exodus of school children from Sarawak and many of them are still outside the Sarawak state.
The medical officers and personnel, whether in the Sarawak hospitals or in the various research institutes, work their hearts out to try bring the viral epidemic under control, but in circumstances where there is a serious credibility gap, through no fault of theirs whatsoever.
The Minister of Health had announced a website on the Internet to keep the people informed about developments of the viral epidemic.
However, this website had been poorly maintained and anyone who visit it to get advice is likely to be discouraged rather than encouraged. For instance, the webpage on the Health Minister�s daily press releases after he had imposed a clampdown on all press briefings by local medical officers in Sibu, Kuching and Miri and arrogating to himself the sole right to call a press conference from Kuala Lumpur, only carry his press releases for four days, namely June 5, 6, 7 and 9. (http://www.jaring.my/jkns/outbreak/vpr.htm)
What about the Minister�s press releases for the last 11 days - at a period when he is supposed to be the only source of information about the deadly viral epidemic in Sarawak?
Now, a new element has been introduced into the viral epidemic with the announcement that it might not be caused by coxsackie virus B, coxsackie virus A, enterovirus 71 or some other enterovirus, and that it might be caused by an adenovirus which is DNA-based as compared to enteroviruses which are RNA-based.
I wish to repeat my advice to the Health Minister to stay out of the day-to-day management of the viral epidemic, which should be left to the professionals. He should give full support to the professionals and experts to fight the viral epidemic but he should not intrude into the crisis management to the extent of becoming a hindrance and a major cause of loss of public confidence.
I would suggest that the Health Minister turn over the full management of the epidemic crisis to the Health Ministry director-general Tan Sri Abu Bakar Sulaiman, which will be a welcome signal which might go a long way to restore public confidence and remove the public credibility gap suffered by the health authorities in the handling of the viral epidemic.
It is most unfortunate that the viral epidemic and the public relations disaster have clouded a major medical achievement involving Sarawak, as the first clinical tests on humans of a substance derived from a tree found in Sarawak rain forest which could provide a new treatment for AIDS are scheduled to begin in the United States tomorrow.
It has been announced in the United States that Sarawak MediChem Pharmaceuticals, a joint venture company formed by Illinois-based MediChem Research and the state government of Sarawak, Malaysia, had started screening candidates for a 50-patient clinical trial of the substance. The trial of Calanolide A is designed to test its safety and tolerability for humans. The tests will officially begin in the US this weekend and will continue through next year.
Prior laboratory experiments have shown that Calanolide A halts the replication of the AIDS virus in a test tube.
(20/6/97)