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At Large
The ‘disease detective’

By Rina Jimenez-David
Philippine Daily Inquirer
First Posted 22:49:00 05/02/2009

Filed Under: Swine Flu, Health, Diseases

?MY FRIENDS say that when they see me on TV, they immediately get scared because it means there?s another disease outbreak out there,? says Dr. Eric Tayag, director of the National Epidemiology Center, the agency entrusted with tracking and containing infectious diseases, and thus the lead player in the current campaign against swine flu.

So alarming and frightening is the news about this ?novel? virus, so new our bodies as yet have no defenses against it, that there is currently a ?word war? over what to call it. Hog raisers and pork vendors want the media to stop using ?swine flu? because it has allegedly frightened people out of eating pork and pork products, even if humans cannot get this new form of flu from eating pork. Or as Dr. Tayag once told a press conference: ?You don?t see cuts of pork sneezing or coughing, do you??

Do we call this the ?Mexican flu? then? Dr. Tayag, for one, thinks it is unfair since this form of flu may not even have originated in Mexico, although Mexico for now reports the largest number of cases and deaths.

The ?North American flu? then? Well, cases have been reported in New Zealand and in different European countries, so the disease is not confined to that region. Dr. Tayag refers to the disease as one caused by a ?novel swine influenza virus? or NSIV, although the nomenclature is admittedly unwieldy.

But whatever you call it, the disease and other similar outbreaks in the recent past have made this ?a fascinating time? for epidemiologists, says Dr. Tayag.

* * *

A 21-YEAR veteran at the Department of Health, Dr. Tayag spent his first decade in DOH as a hospital-based administrator. He was director of San Lazaro Hospital, which historically has been the country?s referral hospital for infectious and communicable diseases, when he was approached by then Health Secretary Alberto Romualdez Jr., then currently engaged in ?re-engineering? the DOH.

?He challenged me to take on a public health post,? recalls Dr. Tayag, ?to leave the confines of a hospital and go out there and do field epidemiology.? Epidemiologists, says the doctor, are ?disease detectives,? who are charged with tracking infectious diseases and looking for their causes and recommending ways to contain them. ?Foremost in our minds are two questions: Why did this disease develop?? and ?What caused this?? Asked why he took up the challenge, Dr. Tayag says simply: ?It was a chance to work on the number one health problem in the Philippines.?

Also part of his motivation, adds the doctor, was ?the chance to guide decision-makers and policy makers, to encourage them to craft policies and programs based on evidence, and not on assumptions or on a whim.? These days, Dr. Tayag is most often seen on TV beside Health Secretary Francisco Duque, keeping quiet most of the time while his boss does most of the talking, but tackling the more technical, scientific queries from the media.

* * *

The game plan for now, while no case of NSIV-related illness has yet been reported within our borders is to ?detect early and contain immediately,? says Dr. Tayag.

Since the most likely mode of entry is through travelers from abroad, Dr. Tayag cannot emphasize enough the importance of good screening procedures, from thermal scanning to detailed examinations of anyone coming in with the symptoms of flu or even a cold. What happens to a traveler who shows signs of possible NSIV infections? ?Our first priority of course is to treat that person and save his or her life. He or she will be confined in an isolation room, tested thoroughly and treated. Our next priority is to conduct contact tracing, tracking down everyone the patient had been in contact with. We start with the patient?s co-passengers and the crew, tracking them down and monitoring them for any symptoms.? The goal is to identify, examine and then isolate anyone who has been confirmed as infected with the NSIV.

Dr. Tayag also appeals for everyone to be ?responsible travelers,? to stay home if one isn?t feeling well, to use all precautions against getting infected or infecting others, and to fill up the ?yellow cards? as honestly and completely as one can. Only with the right information can health authorities act in the right manner.

* * *

Dr. Tayag also appeals to the public to go easy on oseltamivir or zanamivir, two anti-viral drugs that have proven effective in combating NSIV-related illnesses. The drugs, says Dr. Tayag, ?can delay for up to two days the onset of a full-blown illness,? giving the patient time to build up resistance. But, he says, the ?regular? flu virus is resistant to these drugs, and if taken carelessly, the drugs may no longer be effective should one fall ill with NSIV flu. ?Please don?t misuse [these drugs],? appeals Dr. Tayag, ?have yourself checked first and don?t give the government a hard time, because when an outbreak does take place here, we will need every drug we can get for the truly sick.?

True enough, the night after my interview with Dr. Tayag, news reports said drugstores were reporting that their stocks of oseltamivir had run out.

How exactly does the NSIV kill people? ?Viral pneumonia is always deadly,? says Dr. Tayag. The patient?s lungs start filling with fluid, and ?the body overreacts,? overwhelming one?s immune response because it is unfamiliar with the new invader. ?You can die within five days,? says the doctor.

Fortunately, survival is the prime instinct of a virus, so if its human hosts begin to die too quickly or in such great numbers, the virus will end up causing its own extinction. This is why epidemics and pandemics on their own reach their natural end. Our shared survival is our common goal.

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