120130 the sars experience

The SARS Experience

From Global, Public Healthcare

Policy and Communication

perspectives

Annita Mau

30 January 2012

annitaskmau@yahoo.com.hk

A long holiday (a few months before summer

2003)?

Special Administrative Region = Hong Kong

SAR

Severe Acute Respiratory Syndrome

What is SARS to u?

The family of the 774 fatalities all over the

world?

The family of the 299 fatalities in HK?

The 8096 people infected all over the world?

The 1755 people infected in HK?

What is SARS to…

As a Chief Public Affairs Manager in the

Hospital Authority working among front line

healthcare workers, mass media, general public,

key opinion leaders, government, clinicians,

patients, management …

It is a trauma

What is SARS to me…

What SARS is to me is not important

What SARS is to HK Government, and

Governments all over the world, and World

Health Organization (WHO) is

What SARS is to public healthcare system is

Why?

We don’t want to repeat our mistakes

But…

Major events from end 2002 to July 2003

Lessons learnt

We will go through

16 Nov 2002

45 year old man in Foshan City, Guangdong (GD) becomes ill, with fever and respiratory symptoms, retrospectively identified as the first SARS case

Nov 2002 to Jan 2003

numerous flu cases in GD ~~~rumours start to spread

20 Jan 2003

GD CDC invites China CDC to provide guidance

30 Jan 2003

Mr ZZF, 44, hospitalised in GZ, passes on the virus to 50 hospital staff and 19 relatives

Chronology

11 Feb

GD health authorities report an outbreak of atypical pneumonia that has sickened 305 people

11 Feb

Hong Kong Department of Health (DOH) closely monitors the situation, finds no unusual pattern of flu-like illness. A working group is formed to step up surveillance and advise on pneumonia cases

14 Feb

Ministry of Health of China informs WHO that the GD outbreak is coming under control

21 Feb

index case Prof LJL of the Metropole Hotel

outbreak arrives from GD, an international

spread of virus begins, hospitalised 22 Feb

26 Feb to 2 Mar

index cases hospitalised in Hanoi, Singapore,

Beijing

4 March

index case Mr CT of outbreak at Prince of

Wales Hospital (PWH) hospitalised

10 March

outbreak at PWH begins

12 Mar

WHO issues first global alert about cases of atypical pneumonia

19 Mar

link to the Metropole Hotel is identified

22 Mar

Amoy Garden index case hospitalised

22 Mar

Coronavirus is identified as possible cause of SARS by the University of HK

27 Mar

DOH legislates SARS as a statutory notifiable disease by revising the Quarantine and Prevention of Disease Ordinance

31 Mar

Amoy Garden residents (109 hospitalised)

quarantined under DOH’s exceptional order to

isolate all residents of Block E for 10 days

1 Apr

Amoy Garden residents evacuated

2 Apr

WHO issues travel advisory for HK and

GD: postponing all but essential travel

(most stringent travel advisory in 55-year

history)

3 Apr HK

Government announces school suspensions

7 Apr

WHO reports three types of tests for SARS

10 Apr

HK Government announces home quarantine of household contacts of SARS patients

11 Apr

HK Government announces close contacts of SARS patients bared from leaving HK during quarantine period

16 Apr

WHO confirms that a new form of

coronavirus is the cause of SARS which is

officially named SARS-CoV

16 Apr

a WHO team in Beijing, China attends a media briefing, the media are frustrated by the lack of information from the Government amid fears of a larger outbreak in Beijing

20 Apr

Chinese officials (Health Minister Zhang Wenkang and Beijing Major Meng Xuenong) are fired for downplaying SARS

Beijing starts more accurate daily reporting of cases, and reports 295 previously unreported cases.

16 May

The Health Minister of Taiwan and Director of Taiwan CDC resign over criticism of its handling of the SARS outbreak

21 May

Singapore devotes a TV channel exclusively to news on SARS

23 May

WHO remove its travel advisory for HK and GD which have successfully contained SARS outbreak

23 June HK is declared SARS free

July

HK Secretary for Health, Welfare and Food and

the Chairman of the Hospital Authority resign

Does the story end there?

What did we learn from SARS?

SARS was the first emerging disease of the age

of globalisation

Before time of international travel, it would

probably have remained as a localised problem

Virus travelled around the world on passenger

jets make the disease one of the 21st century

Prompt and clear travel guidance is needed

Public health is a serious business

People and products travel vast distances in an instant, threats to health, whether real or imagined, can be economically disastrous

A clearly reasoned, well planned, and effectively managed and publicised response to such threats is important in mitigating the damage to the economy, and public confidence in Government

Risk communication policy, strategy and tactics

have to be in place and reviewed all the time

SARS: new disease, unknown virus, no treatment

New virus and disease can be found again

Impact on public policy

In health

Training and expertise in barrier nursing and

hospital infection control are deficient

Building of infection control facilities

Healthcare workers, management, and policy

makers have to stay alert

Food trade, animal husbandry and market

practices

Central culling

Environmental consideration and measures

Air flow, wind direction, sewage

Partnerships worked, but the partners need to

clarify and agree on their relative roles

Governments: legislation, drastic and decisive

measures

Country CDC’s collaboration with WHO

Human rights issues must be attended to

There should be international standards for

the carefully considered use of

countermeasures against communicable

diseases, such as accessing police databases

and imposing quarantine, community

surveillance

Transparency is the best policy

Diseases do not observe international borders

World community expects accurate, complete, and timely information

We expect government to provide transparent, up-to-date information about communicable diseases that may threaten our communities

Governments are held accountable, internationally and nationally for failures in conveying straightforward, reliable information

The mass media play a critical role in public health emergencies

4000 article daily in English

WHO headquarters in Geneva assigned skillful media officers

Besides regular briefings, more proactive, systemic, and thoughtful dealings with the press and general public might have resulted in a better informed and less panic public

Emails

Web pages: kept the world informed, offered advice

International laboratory experts grouped their expertise in a virtual network to decode the virus’s secrets

Tracing households by electronic means:

6 Apr 2003 HK Police used its sophisticated Major Incident Investigation and Disaster Support System (MIIDSS) to assist the DOH

8 Apr e-SARS was launched = enhanced the swiftness and capacity of case investigation and contact tracing, reducing further spread of infection

Modern ally: Internet and ICT

Intelligence: rumours

SARS has the political, social and economic dimensions

Mission of safeguarding public health has to be balanced against the genuine interests of Member States

It has to work with Member States to share information and to find common ground in a situation that was new to all

The possible impact of travel advisories on the economies of affected areas and on the morale of people living there was one of the most difficult issues of the SARS experience

For WHO

Public health around the world has entered an

era where it need to be on constant guard

against threats from emerging diseases

Risk communication is about public perception,

people’s concerns, emotion, and confidence

Conclusion

“It was a challenge, I didn’t know a lot about

communicable diseases, but the truth is that none of

us --- the experts included knew much about SARS.

So we learnt together: how the virus was spreading,

how to spot it, and how to stop it. It was a long way

from what I had been hired to do, but, like everyone

else on the team, I found it experience of a lifetime.”

--- by Peter Cordingley, Head of Media Team of WHO Regional

Office in Manila

Websites of HK Government, WHO

Publications of WHO

Reference

THANKS, VIEWS, QUESTIONS

ARE WELCOME…

annitaskmau@yahoo.com.hk