'Providence' to be in Singapore in the thick of Sars

Q: How worried are you about the dengue outbreak here?

It's probably going to be a bad year for dengue. In some ways it's not entirely unexpected. Every few years there's a worse year. But predictions are notoriously challenging and I won't get into the crystal ball business.

Check your house for mosquito habitats. We don't have a good vaccine yet and anti-virals are in trials. So the best thing to do is prevent it.

Q: What about infectious diseases such as the H7N9 influenza in China?

It's early days yet. For something to become a pandemic, it needs to be a novel strain or one where there's very little immunity in the human population.

The more important thing that makes a pandemic is easy human-to-human transmission and right now, that is not the case from all the reports we're getting. We think it's low-risk for a pandemic.

Q: And the novel coronavirus that struck the Middle East?

The coronavirus is another infection that we are watching closely. It was the subject of a great deal of concern because it's the first serious coronavirus since Sars, and in the same family group. We still don't know the reservoir for this thing - we think it's bat origin but don't know if there's an intermediate mammal host that you can catch it from.

But it emerged last September when the haj was about to happen, when two million people from all over the world get together. So if there was going to be an event, it would have happened then. Viruses can and do change, but so far it looks like the risk of transmission and risk to Singapore are quite low.

Q: What would we do in the event of an actual flu pandemic like the 1918 one that killed millions of people?

In 1918, anti-viral drugs and flu vaccines were not very well developed. We have a couple more options now compared to 1918.

Social distancing can make a difference, but the world is a lot more crowded, we live in more urban centres compared to 1918. So there are some plus factors and some negative factors. But we would try very quickly to get a pandemic vaccine out, and governments have been stockpiling drugs and companies have been investing in anti-virals.

Q: What precautions should travellers be taking?

For most people, what we are advising is, if they are to travel to China or H5N1- and H7N9-affected countries, we ask them to please not touch live chickens or ducks. We do advise people to think about getting a seasonal flu vaccine. When people travel, they're often in crowded places and it's easy to pick up respiratory infections. The vaccine is 70 to 90 per cent effective against seasonal flu. If they come back from an affected area with flu, there'll be understandable concern, and we don't want people to get quarantined or end up in hospital for no reason.

Q: Are there countries or conditions you're afraid of?

Not really. One advantage of being an infectious disease doctor is that you spend so much time thinking about it intellectually and knowing the pathogens, you have a healthy respect for them. I'm very meticulous about infection control at work, because it's a duty to your patients to be careful.

Q: You moved to Singapore from the United States just before Sars hit in 2003. What was that like?

The honest answer is I feel like it was providence. We'd moved here partly out of a Christian commitment to serve back in Asia, my father was ill in Malaysia, and I had a Singaporean nephew who was going through medical problems here.

Being an infectious disease doctor...it's like training as a fireman and being there for 9/11. It was incredibly hard but I was grateful to be able to do what I could to help. When we were in China adopting our daughter, we were in Guangzhou in December 2002. Sars started in Guangzhou in November 2002, but we never heard a thing about it. It's scary in retrospect.

Q: How did people react when they found out you were in the thick of the fight against Sars?

At the time, my father had to go through surgery in Malaysia. I went to see what was going on, and was standing by my dad's deathbed with the pastor praying for him when the staff told me to get out because they were worried as I was a Sars doctor.

And at the wake, people didn't want to shake my hand. These were relatives who'd known me for 20, 30 years. I understood that people were afraid and nervous, but it was still hard at the time.

Q: Why were you quarantined for two days?

I caught a cold from my kids. My (then) three-year-old had a 40 deg C fever, so I knew I was going to come down with whatever kids get.

So for the three little ones, mum never came home from work that day. The isolation rooms in the main hospital (Tan Tock Seng) were supposed to be for the sickest patients, and patients who were less ill were isolated in the CDC (Communicable Disease Centre) compound. I insisted on being admitted there instead of the main hospital because I felt that someone else who was sicker needed that bed.

Q: What was the experience like?

Isolation or quarantine takes its toll. The doctor comes in for five or 10 minutes a day, but you have all these questions stored up. So as a doctor myself, I'm busy but I have to try to carve out time because the patient is sitting there waiting for you to come by.

One of the nurses brought me nasi lemak when I was tired of hospital food and I was happy as a clam. It's little things like this that make a difference to people.