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The Singapore Model on SARS
From: Dave Farber <dave () farber net>
Date: Thu, 27 Mar 2003 19:43:36 -0500
------ Forwarded Message From: The.Wallstreet.Journal () central cis upenn edu Reply-To: Sg_Review () yahoogroups com Date: Fri, 28 Mar 2003 00:32:53 +0000 To: dave () farber net Subject: [Sg_Review] The Singapore Model on SARS REVIEW & OUTLOOK A new type of atypical pneumonia dubbed Severe Acute Respiratory Syndrome continues to spread globally, with 1,316 cases and 48 deaths reported so far, most of them in China and Hong Kong. Despite the fact that health care professionals are practicing rigorous isolation techniques when they treat known or suspected victims, the disease is causing tens of new victims to fall gravely ill every day. It's now clear that early guesses about the pathogen's infectiousness were too optimistic, and that means more stringent measures to contain the outbreak are now justified. Yesterday, doctors in Hong Kong announced that 14 people in one apartment block appear to have contracted SARS from another resident, who in turn got the disease from visiting his brother in hospital. The new victims live on different floors, meaning that they probably got the disease by inhaling small amounts of virus in airborne water droplets, perhaps left in the air by the "index patient" when he coughed in the building's elevators or lobby. Also this week it emerged that 10 members of a tour group contracted the disease after taking the same flight as an infected person. And the earliest source of the Hong Kong outbreak was a medical professor from mainland China who transmitted the disease to six other people staying on the same floor of his hotel last month. All this suggests the pathogen, probably a virus, does have the capability to keep spreading through the community by casual contact, even though it isn't as contagious as common strains of influenza. If SARS does continue to spread at an increasing rate, it could overwhelm hospitals. The disease is extremely virulent; around 25% of patients require intensive care, and even with that care about 4% of them succumb to the disease. Combine that with the fact that health care workers have been catching the disease from patients and it's easy to see how hospitals could soon not have enough healthy workers or equipment to handle the influx of new cases. That could then increase the mortality rate. That is especially a concern in Hong Kong, where hospitals are already overstretched and the number of cases increased by 25 on Tuesday and 29 yesterday to a total of 300 confirmed cases still showing symptoms. You would think this would scare governments into taking decisive action. But so far that hasn't been the case, except in Singapore. For the last month, Beijing has insisted that the initial outbreak in Guangdong province ended in mid-February with a total of five deaths. Then this week it admitted that the death toll was much higher, and cases were still occurring. Yesterday, the official death toll in China stood at 34, including three deaths in the city of Beijing, the first deaths outside Guangdong. But the government still seemed to be trying to suppress information in order to avoid alarming the public. Not only did it take four months for Beijing to request help from the World Health Organization, but it is still hampering the international body's work by not allowing investigators to work in Guangdong province. In Hong Kong, there has been much more transparency about the number of cases and their details, but officials have also been trying to play down the problem, perhaps to minimize the economic impact to the tourism industry. Secretary for Health, Welfare and Food Yeoh Eng- kiong reassured the public that the disease was not spreading within the community, a statement that we now know was premature. Schools are being closed only after a student comes down with the disease, despite alarm among parents. There is no plan to create a quarantine system to ensure that family members of patients don't spread the disease further. This failure to act in a resolute and timely fashion has created distrust of the government. Singapore, on the other hand, has been both transparent and proactive in fighting the spread of SARS. Although there have only been 69 cases and one fatality in the city state, much fewer than Hong Kong, it has taken several decisive steps. The government closed all schools and designated the Tan Tock Seng Hospital to handle all cases and closed it to other admissions. It has also forcibly quarantined 841 people who had exposure to the victims; those under a quarantine order can't leave their apartments for 10 days under penalty of a $2,832 fine. Such an approach has some drawbacks. Governments need to educate and encourage their citizens to seek medical attention promptly if they display the symptoms of SARS. Singapore may have created a disincentive for people to come forward, since they may fear that if they turn out to just have some milder disease, they could unnecessarily inconvenience many of their friends, family and colleagues who have to spend time in quarantine. The resulting delay in seeking medical treatment could then end up increasing the number of people infected. Moreover, in Hong Kong doctors say that the number of people exposed could be more than 1,500, making quarantine difficult. Nevertheless, the risks of doing nothing are becoming unacceptably high. Hong Kong and China have a responsibility to try to contain this disease before it possibly causes a global pandemic. The closure of schools at least temporarily seems like a prudent measure, since children are often a pathway for the spread of disease and their less developed immune systems are more vulnerable. Singapore's approach of dedicating certain medical facilities to treatment of SARS is also prudent. It may be necessary to restrict visits by family members in order to stop this route of transmission back into the community. And finally, a system of voluntary quarantine could be created, perhaps including an economic incentive. Those who have been exposed should at the very least be asked to stay home from work for seven days, the maximum incubation period, and wear a mask if they have to go outside their apartments. We've sometimes been critical of Singapore's degree of protection of civil liberties, but when public health is seriously threatened, as is now the case, it's difficult to find fault with a quarantine. In fact it is a valuable experiment to see if this is an effective way to contain the disease now that isolation measures within hospitals have proved insufficient. If only Hong Kong and China would take SARS as seriously. Updated March 27, 2003 ------------------------ Yahoo! Groups Sponsor ---------------------~--> Make Money Online Auctions! Make $500.00 or We Will Give You Thirty Dollars for Trying! http://us.click.yahoo.com/yMx78A/fNtFAA/46VHAA/34fwlB/TM ---------------------------------------------------------------------~-> To Subscribe to this news group, send an e-mail to: Sg_Review-subscribe () yahoogroups com To unsubscribe from this group, send an email to: Sg_Review-unsubscribe () yahoogroups com If you would like to learn more about the Sg_Review group,please visit http://groups.yahoo.com/group/Sg_Review Your use of Yahoo! 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- The Singapore Model on SARS Dave Farber (Mar 27)