The reason MOH did not announce the Hep C cluster earlier is apparently because there had been no signs earlier to suggest that those cases in the SGH cluster were acute viral hepatitis C. And under the Infectious Diseases Act, only cases of acute viral hepatitis C have to be reported to MOH in 72 hours. If the cases were of chronic instead, then they need not be reported.
And why was it that there were no signs earlier to suggest that those cases in the SGH cluster were acute viral hepatitis C? Because, the cases apparently did not have symptoms — such as jaundice — or a history of exposure to suggest that they were acute.
An MOH spokesperson explained that “As it can be difficult to detect such asymptomatic hepatitis C based on blood tests alone, doctors generally look for a link to an event of relevant exposure, such as current intravenous drug use or a needle-stick injury.” The spokesperson also added that most acute hepatitis C infections tend to not have symptoms.
Yet, notwithstanding these explanations, it seems that a subsequent review did show that the cluster of hepatitis C cases in SGH included some that were acute.
Does the MOH explanation make sense? Is it convincing?
I think it raises more questions instead.
- If the Infectious Disease Act demands that acute viral hepatitis C cases be reported to MOH in 72 hours, it must mean that some thing bad would happen if the cases were not reported to MOH in 72 hours. Yet, our doctors and medical professionals in SGH had to take so long before they could confirm that some of the cases were indeed acute. Even if it is difficult to detect acute hepatitis C, is it not worrying that our doctors took so long to detect the cases? What is the point of having the 72 hours time period if we are so woefully inadequate in detecting acute cases?
- The MOH spokesperson said that one way doctors ascertain if the case is an acute one is to look for links to an event of relevant exposure, including current intravenous drug use or needle-stick injury. But from the reports, it seems that all those who were infected in the cluster were renal patients who received injections. So going by what the MOH spokesperson said, should the doctors not already have enough to go on to ascertain that the cases in the cluster were acute? It is not as if those patients were some John Doe’s that randomly stumbled in off the streets. So what went wrong there? Could something be done to make our doctors and/or hospitals better able to detect acute hepatitis C cases?
- Even if we accept that it was really difficult to detect acute hepatitis C cases, it still begs the question why it took so long to make things known to the public. There were a number of cases from the outbreak that were shown to be acute. When was that ascertained? By 7 September, it was already confirmed that the 21 cases were related. Why did SGH and MOH still have to wait till October to announce? What were the additional investigations that were so important that had to be completed before the announcements? We still do not know.
Even with MOH’s “explanation” of why it took so long before informing the public about this grave incident, there are still many unanswered questions. I hope we get more answers soon.
[Featured image from Wikipedia]