The Haze and PSI

Another spate of deaths to ponder on. It’s unthinkable that 19 people in Indonesia have lost their lives due to the haze. For PSI levels to soar all the way to 2000, suffocation is probably imaginable. Here in Singapore, a PSI of 300 could mobilize mass-closure of schools, sending parents scrambling for urgent makeshift childcare arrangements on breaking news as such. People who run outdoors on a regular basis have to scale back on outdoor activities. For three months the country was shrouded by a choking smog blanket, while the mask-manufacturing companies were making a quick buck cashing in on the public anxiety over the PM 2.5 particles.

PM 2.5 sized particles are the main culprit in a haze, as they breach the respiratory tract’s natural defenses, penetrating deeply into the alveoli of the lungs and possibly entering the bloodstream. These particulates can enter air-conditioned buildings through the fresh air intake and by infiltration through openings and gaps. These particulate levels indoor can accumulate to unhealthy levels, resulting in undesirable health effects on the occupants. Therefore staying indoors or working out in a gym is not a complete respite from the air outside. The brunt of the haze is borne by people with existing health conditions, such as asthma or pre-existing chronic heart diseases.

The PSI (Pollutant Standards Index) measures air quality and determines the severity of a smoke haze. It takes into account the concentration levels of 6 pollutants listed below, with the spotlight on particulate matter (PM2.5).

  • Particulate matter (PM10)
  • Particulate matter (PM5)
  • Sulphur dioxide (SO2)
  • Nitrogen dioxide (NO2)
  • Ozone (O3),
  • Carbon monoxide (CO)

I was fortunate to have been overseas for two weeks to avoid the start of the haze. This picture looks misty and somewhat blurry because I was caught up in the clouds near the peak of some snow mountain in Yunnan, taking in the crisp air.

Near the peak of Yulong Xueshan in Lijiang, Yunnan, nestled among the clouds at 3 degrees celsius.

Upon landing in Singapore, I was greeted by a dense smoke stench and a visibility challenge, an albeit unpleasant one, that looked like this:

PSI at 371 on 20th June Credits : The Straits Times

The haze was still hovering over Singapore’s skies during the F1 World Championships.  I tried to take a picture of the Marina Bay skyline overlooking the race track but the fog somewhat got in the way of taking a good panorama, with the 24-hr PSI at 66-69, within the moderate range. I tried my best to get a shot atop the Singapore Land Tower at the 42nd story but the picture quality did not turn out too fantastic:

View from rooftop of Singapore Land Tower on 2oth September

These few months have seen a fluctuating PSI, bordering around the unhealthy range of 101 – 200, at times closing up to 300. The PSI even shot up to above 400 on one night in October. Changing directional wind patterns and increased rainfall typical of the end-of-year season temporarily stopped the haze. On one of the good days after the haze abated for a consistent few days, the skies and scenery around Bishan Park looked like everything was back to normal:

Clear skies.
Family day out.
Every cloud has a silver lining.

For now we can hope for favorable wind directions and wetter weather from now till the end of December.

This annual ordeal has brought us to the realization of Singapore’s vulnerability. Despite petitions to the Indonesians to promote sustainable farming in place of slash-and-burn crop cultivation, which causes the haze, it has persisted for years. While NEA is currently working with ASEAN to combat the haze problem, more strategic decisions have to be taken for the common good of its members. A transboundary problem should involve all members in haze-management affairs to tackle a recurring environmental problem.

Economic costs, such as the loss of businesses, tourists and healthcare costs, have been incurred. The Haze Subsidy Scheme has been implemented as a result, which subsidizes treatments for haze-related illnesses like asthma, bronchitis and conjunctivitis for low-income earners, old folk and persons below the age of 18. It was recorded that in 2013, 500,000 SGD worth of subsidies were given out for haze-related treatments.


Hepatitis C

Hepatitis C, a lesser-heard variant of the Hepatitis virus umbrella, has been making the waves in the medical circle here. Less than 1% of the Singaporean population is affected by it, in contrast to Hepatitis B, which affects 1 in 35 Singaporeans. To date, 25 patients admitted to SGH between April and June had been diagnosed with the same family of Hepatitis C virus. Eight patients have died, with five deaths linked to the virus.

Hepatitis C is a virus that causes liver inflammation, which can lead to chronic hepatitis, cirrhosis and liver cancer. It is primarily spread through contact with the blood of an infected person. In this saga, it was purportedly spread through multiple-use medical vials, though allegations have not been confirmed. Sufferers of Hepatitis C are vulnerable to other strains of the hepatitis virus like Hepatitis A and B. There is no vaccine for Hepatitis C.

Though the outbreak happened earlier this year in April, SGH told MOH of the news in end-August, and MOH only released news of the outbreak in October. The information lag does raise eyebrows on their response to management of the outbreak. What exactly was done that resulted in the spread? Who are the persons accountable for the way medication is dispensed (multiple-use vials)? Why was news of the causalities held back so long? The consequences could have been mitigated if the situation was dealt with earlier.  Important questions were not addressed clearly. The authorities responded with a string of neutral statements, reiterating their stance on taking the situation seriously through thorough investigative work.

In the aftermath of the outbreak, some measures have been put into place.

An independent review committee has been set up by the government to look into the findings of its investigations but concrete conclusions or statements have not been made known to the public. International experts were too roped in to provide analyses and interpretation of the findings. One of the recommendations include extending the screening to verify if precautionary measures put in place in the wake of the outbreak had been effective. The hospital had originally screened only patients who stayed in the renal wards between January to June. Thus, SGH took further action to screen more patients, 849 of them, for the Hepatitis C virus, of which 777 tested negative and 3 positive, with the remaining 69 test results pending. SGH staff were also screened for the virus, and were given the all-clear.

Kidney dialysis centers across the country were reminded to use dedicated dialysis machines and stations for those with Hepatitis C. Dialysers and bloodlines (dialysis tubes) are not be shared among renal patients and can only be used once and discarded. Some dialysis centres like the National Kidney Foundation (NKF) have also separated Hepatitis B and C patients at separate centres to prevent cross-contamination.

Hepatitis C can be cured with early detection and appropriate treatment. However for 10% of those infected, the virus continues to live in the blood, which could lead to problems like liver cancer or cirrhosis. Hepatitis C if left uncured, is reminiscent of a life sentence, where patients are bound to a lifetime of symptom-regulatory medication to keep afloat relapses.