FOR the first time on Monday, the number of people who contracted the Influenza A (H1N1) virus in Singapore outnumbered those returning from overseas. In a sure sign that the virus is spreading within the community, 17 of the 26 latest infections were transmitted locally. Singapore now has a total of 168 confirmed H1N1 cases, including 41 people who contracted the virus here.

Given the experience elsewhere, Health Minister Khaw Boon Wan said on Monday that Singapore has 'crossed the tipping point beyond which local transmissions will grow rapidly. This may well happen this week'.

Expect many more to fall ill. Expect a few deaths for every 1,000 people with Influenza A (H1N1).

He told a press conference that Singapore was experiencing a third wave of imported H1N1 cases. In the first wave, 26 infected people came from the United States. In the second wave, 56 arrived from Australia. The third wave began last week, bringing H1N1 from Asean countries - more than 30 so far - and this could prove a big wave of infections, he said.

Late last night his ministry announced a new cluster of local infections, at the Fishermen of Christ Church. Ten students who attended a church camp last week are now ill with H1N1 flu. Infections at two other clusters are up - two more at the Riverlife Church, making a total of nine, and one more at the Butter Factory nightspot, for a total of five.

Singapore will recalibrate how it deals with the virus as it spreads in the community, but Mr Khaw said there was no need for people to panic. The alert level will stay at yellow for now, but several things will change.

Temperature scanning at the borders - which picked up one in four imported cases - will continue, but contact tracing of those close to infected individuals will be done on a case-by-case basis, depending on how ill a patient was when exposed to others. Not everyone with the H1N1 flu will be sent to hospital.

Polyclinics and more than 450 general practitioners' clinics have geared up to handle less serious cases, possibly from this week. Earmarked clinics will display a big red check mark, and doctors there will provide patients with antiviral medication and send them home to be quarantined.

Hospitals will concentrate only on more severely ill patients, or those with other underlying medical conditions. 'We need to allow our hospitals to focus on the high-risk cases and not be distracted or overwhelmed by hundreds of mild cases,' said Mr Khaw. All hospitals, not just Tan Tock Seng and KK Women's and Children's Hospital, are already treating flu patients.

Mr Khaw?s advice to everyone: Maintain a high standard of personal hygiene. And those at high risk - such as pregnant women and people with chronic ailments - should take greater precautions, such as wearing masks when going out.

Read the full report in Tuesday's edition of the Straits Times

salma@sph.com.sg