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SARSSARSSituation

Update

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Singapore has prepared at least 200 flats in move-in condition, readyto provide emergency housing in the event that what happened recentlyin Hong Kong’s Amoy Gardens apartment complex occurs in the country.

All the flats have water and electricity supply, and the rooms arefurnished with basics such as beds and chairs.

In the Amoy Gardens complex, more than 300 residents, most livingin one particular block had come down with SARS. The block wasquarantined and its residents were moved to two government holidaycamps, in an effort to contain the spread of the virus.

Between two and four blocks have been picked across Singaporefor this purpose. However, officials are quick to emphasize that the settingaside of the blocks is just a contingency plan. It will allow people to bemoved out of their homes while the authorities check on what washappening. Anyone relocated would only be under home quarantine,not ill, infectious or stricken with SARS.

Emergency Housing Prepared InCase of Amoy Gardens Outbreak

Patients at all six public hospitals in Singapore will not be allowedany visitors, one of the moves to stop the spread of SARS. This tightensthe earlier restriction on hospital visits, with only one visitor allowed perpatient.

The hospitals had asked for the added precaution, but would makeexceptions on compassionate grounds. Those who can continue to receivea visitor a day are children, women under the care of obstetricians, andthe seriously ill.

The hospitals affected are the Singapore General Hospital, NationalUniversity Hospital, Tan Tock Seng Hospital, Changi General Hospital,Alexandra Hospital and KK Women’s and Children’s Hospital.

Private hospitals have not asked for a ban on visitors yet.

About 44 per cent of SARS cases were family and friends of peoplewho were warded and some may have visited the hospitals.

However, in the latest development, the no-visitor rule at publichospitals will probably be relaxed by the end of the month if the SARSsituation stays stable. As of 5 May, no one has caught the virus in ahospital for the past 16 days, and the number of SARS cases has beendeclining.

No Visitors at Public Hospitals

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The Courage Fund was launched on 11 Apr through a collaborativeeffort by various groups in Singapore, including the National HealthcareGroup, Singapore Health Services, Singapore Medical Association,Singapore Nurses’ Association and Singapore Press Holdings, to providerelief to the families of needy SARS patients.

It provides a rallying point for Singaporeans to make a tangiblegesture to help the victims of SARS, and to show their appreciation,respect and support for the dedication and sacrifices of healthcareworkers.

Courage Fund Launched to HelpSARS Victims

Singapore would soon have its very own SARS diagnostic kit, whichcan detect virus in its early stages. This was revealed by Dr. Ling Ai Ee, avirologist heading the SARS investigation team in Singapore.

The Genomics Institute of Singapore is close to completing a kit.Even though the number of cases may be winding down, Dr. Ling saidthat having such a kit is still important. She said, “Even though we turnthe corner, it does not mean that the whole world has turned the corner.Also, we do not know if we are ever going to get a re-introduction of thisvirus.”

Dr. Ling said, “We do not know many things, so there are manyreasons why it will resurface and then we have to be ready for it.”

The Singapore-Malaysia Technical Working Group comprisinghealth, immigration and other officials met in Johor Bahru to discussareas of cooperation on controlling SARS.

The Group would put into action some issues outlined earlier lastweek by top health officials in Malaysia. The meeting discussed possiblemeasures like pre-departure checks, distribution of Health DeclarationCards and temperature checks for all travelers from land, sea and airports.

Both countries would also adopt a common protocol on the referralof suspected SARS travelers across land border between Singapore andMalaysia. The medical information of probable and suspected SARS caseswill also be shared between the Health Ministries.

Both countries’ health and immigration officials will meet regularlyto update each other on the SARS situation.

Singapore to have OwnDiagnostics Kit Soon

Singapore-Malaysia WorkingGroup Discusses SARS

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The WHO declared Vietnam SARS-free on 29 April as it had seenno new infections for 20 days. The world body also lifted all advisoriesagainst travel to the country, which had five SARS deaths.

Experts said that the key to Vietnam’s success was close cooperationbetween the government and the WHO, coupled with swift action toidentify and isolate victims.

Vietnam Declared SARS-Free byWHO

As a result of assessments as to the nature of outbreak of SARS inToronto, Canada, WHO recommended on 23 April, as a measure ofprecaution, that persons planning to travel there consider postponing allbut essential travel.

According to WHO, the outbreak in Toronto, Canada continued togrow in magnitude and had affected groups outside the initial risk groupsof hospital workers, their families and other close person-to-personcontacts, although all the cases reported had identified links to knownSARS cases.

In addition, a small number of persons with SARS, now in othercountries in the world, appeared to have acquired the infection while inToronto.

However, following protest by the Canadians, WHO announcedofficially on 29 April that it had decided to lift the warning againstunnecessary travel to Toronto, despite fear over the spread of SARS.

According to WHO Director-General Dr. Gro Harlem Brundtland,the decision was made after talks with the Health Minister of Ontario.Besides, there had been no new SARS cases being reported (outsidemedical community) for 20 days.

However, WHO still classifies Toronto as a SARS-affected area.

Travel Advisory Lifted on Toronto

Two Hospitals Dedicated to SARSHealth authorities in Japan have appointed two hospitals dedicated

exclusively to SARS patients, despite having few suspected SARS casesin the country.

Meanwhile, a special team of doctors and nurses more was set up amonth ago to deal with this disease. A few doctors from the team weresent to provide help in SARS-hit places such as Hong Kong, Guangdongand Hanoi.

Even though the Japanese travel extensively, Japan has yet to see anoutbreak because they seldom mingle with the local community, thereforereducing the level of contact with local infected people.

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On 1 May, it was reported that 12 SARS patients in Hong Kongsuffered from relapse after recovering from the disease and health officialswere investigating the cases. All 12 cases went back to the hospital, sixcases were described as “stable” while the remaining six had beenreleased from the hospital.

According to an expert, the relapse could be due to the use ofsuppressive drugs for SARS treatment and caused a delay in thedisappearance of virus.

Meanwhile, another expert commented that the outbreak in HongKong could be under control within one month. Nonetheless, residentsof Hong Kong were reminded to keep vigilant.

Hong Kong Investigating Relapses

Hong Kong researchers were concerned about the fast viral mutatingrate and worried over the possibility of complication over thedevelopment of diagnosis and vaccine against SARS.

Doctors from the Chinese University of Hong Kong had sequencedthe specimens containing SARS virus from 11 SARS patients. The teamfound two different strains of SARS among the 11 cases, and this indicatedthat the coronavirus is undergoing rapid evolution in human population,according to chemical pathologist, Dr. Dennis Lo.

It is crucial now to find out if any recovered SARS patient havedeveloped immunity to any strain of the virus. If not, it will be difficult tofind a better diagnosis and vaccine against the infection. Meanwhile, itis still too early to say whether the virus has evolved to be more lethaland infectious, commented Dr. Lo.

Virus Fast Mutating CausesConcern

Travel Advisory Hurts TourismSince the official imposing of travel advisory upon Hong Kong, it

had seen a 40 percent drop in tourism money and a 60 percent drop inpassengers arriving into Hong Kong.

Dr. Yeoh Eng Kiong, Secretary for Health, said that the travel advisoryimposed upon Hong Kong had devastated the territory’s economy. Hewill be discussing this matter with Dr. David Heymann, Head of theWHO’s Communicable Diseases Section.H

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WHO Team in TaiwanA WHO team arrived in Taipei to support health authorities in

combating the SARS outbreak. The two-person team, with expertise inepidemiology and virology, will visit hospitals and consult with localhealth authorities. As the outbreak has affected a number of hospitalstaff, a principal focus would be on the possible need to strengtheninfection control procedures. The WHO team will also advise Taiwanofficials on how best to stop the spread of the virus on the island.

SARS Trail in TaiwanThe spread of SARS in Taiwan accelerated considerably since end

of April. On 3 May, Taiwan announced a cumulative total of 100 probableSARS cases, a number representing almost a tripling of cases over thepast ten days. Since the outbreak began, eight deaths have occurred.

Taiwan’s Center for Disease Control reported the first two suspectedSARS cases, in a couple, on 14 March. The man had a February travelhistory to Guangdong Province and Hong Kong. On 26 March, aTaiwanese resident of Hong Kong’s Amoy Gardens flew to Taiwan andtook a train to Taichung to celebrate the traditional festival, Qing Ming.The man’s brother became Taiwan’s first SARS fatality, and a fellowpassenger on the train also became a case.

By 16 April, 27 probable cases had been detected in Taiwan.Investigation of cases determined that all either had a travel history to anaffected area, or had been in close contact with patients.

The number of cases began increasingly steadily in the last weeks ofApril. Several staff at two hospitals become infected. The governmentsealed off Jan Chi Hospital for 14 days on 29 April after 17 health workersfrom the hospital were suspected to have SARS. Two more new fatalitiesfrom SARS reported, adding the total to three. The number of suspectedcases was reported at 174. A total of 2621 people had been placed inquarantine, including 1100 health workers, patients and visitors at theTaipei Municipal Ho Ping Hospital.

Quarantine for those Returningfrom SARS areas

In an attempt to contain the spread of SARS, Taiwan closed its bordersto all visitors from SARS affected areas, including China, Hong Kong andSingapore on 27 April, and order a mandatory ten day quarantine forTaiwanese returning from these areas.

On 28 April, the Taiwanese government imposed a mandatory 14-day quarantine on all incoming travelers from China, Hong Kong,Singapore, Macau and Toronto, Canada.

It has been made compulsory for travelers from SARS affected areasto put on protective facemasks during the entire flight.Taiw

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Emergency Fund to Combat SARSThe Taiwan parliament has set up an emergency fund totaling at

US$1.7 billion to combat SARS. The fund will be used for governmentmandated quarantine costs, and also for SARS-hit companies to overcomecash flow difficulties.

Chen Shui Bian, President of Taiwan, described this outbreak as a“national security issue” and the CDC of the United States has issuedtravel advisory against Taiwan.

Travel Advisory Extended toBeijing, Shanxi

As a result of assessments as to the nature of outbreaks of SARS inBeijing and Shanxi Province, China, WHO recommended on 23 April,as a measure of precaution, that persons planning to travel there considerpostponing all but essential travel.

This temporary advice, an extension of travel advice previouslyissued for Guangdong Province and Hong Kong, would be reassessed inthree weeks time.

The magnitude of the SARS outbreaks in Beijing and Shanxi Provincehad been carefully reviewed by WHO. This assessment considered themagnitude of the outbreak, including both the number of prevalent casesand the daily number of new cases, the extent of local chains oftransmission, and evidence that travelers were becoming infected whilein one area and then subsequently exporting the disease elsewhere.

Situation in China WorseningChina reported 181 new probable SARS cases on 3 May, 114 of

which were from Beijing, bringing the cumulative total in the countryand capital to 3971 and 1741 respectively. There were also 9 deathsreported, five of which were from Beijing.

New probable SARS cases were also reported in Shanxi (18), Tianjin(18), Inner Mongolia (10), Hebei (9), Guangdong (11) and Ningxia (1).Ten of the new cases in Tianjin were among health care workers.

Nearly 20% of cases in Beijing have occurred among health careworkers in hospitals. Among the 114 new probable cases reported inBeijing, 20 were among health care workers. These figures underscorethe importance of rigorous infection control in hospitals and the need tostrengthen measures in place in Beijing.

As of 3 May, 13 688 people in the capital were in quarantine. Amongbuildings quarantined are 27 SARS-designated hospitals, two buildingsites and three apartment buildings belonging to universities.

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China’s SARS Statistics

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WHO UpdateAs of 3 May, a cumulative total of 6234 probable SARS cases with 435 deaths havebeen reported from 27 countries across the globe. This represents an increase of191 new cases and 18 deaths compared with the day before. The new deaths occurredin China (9) and Hong Kong (9).

Areas with Recent Local Transmission ofSevere Acute Respiratory Syndrome (SARS)

3 May 2003

Area Extent of local transmission

Toronto, Canada ++

Beijing, China +++

Guangdong, China +++

Hong Kong, China +++

Inner Mongolia, China Uncertain

Shanxi, China +++

Tianjin, China Uncertain

Ulaanbaatar, China +

Taiwan ++

Singapore ++

Notes:Recent local transmission has occurred when, in the last 20 days, one or more reported probable cases of SARS have most likely acquiredtheir infection locally regardless of the setting in which this may have occurred.

+ LowImported probable SARS case(s) have produced only one generation of local probable cases, all of whom are direct personal contacts ofthe imported case(s).

++ MediumMore than one generation of local probable SARS cases, but only among persons that have been previously identified and followed-up asknown contacts of probable SARS cases.

+++High Transmission pattern other than that described above in + and ++.

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Cumulative Number of Reported Probable Cases ofSevere Acute Respiratory Syndrome (SARS)

From: 1 Nov 20021 To: 3 May 2003, 18:00 GMT+2Areas with recent local transmission, 3 May 2003

Notes:Cumulative number of cases includes number of deaths.As SARS is a diagnosis of exclusion, the status of a reported case may change over time. This means that previously reported cases maybe discarded after further investigation and follow-up.

1. The start of the period of surveillance has been changed to 1 November 2002 to capture cases of atypical pneumonia in Chinathat are now recognized as being cases of SARS.

2. A decrease in the number of cumulative cases and discrepancies in the difference between cumulative number of cases of thelast and the current WHO update are attributed to the discarding of cases.

3. Includes cases that are “discharged” or “recovered” as reported by the national public health authorities.4. One death attributed to Hong Kong occurred in a case medically transferred from Vietnam.

Country Cumulative No. of new case No. No. recovered3 Date last Date for whichno. of case(s)2s since last WHO of deaths probable case cumulative

update2 reported number of casesis current

Australia 4 0 0 4 23/Apr/2003 2/May/2003

Brazil 2 0 0 2 10/Apr/2003 24/Apr/2003

Bulgaria 1 0 0 0 24/Apr/2003 28/Apr/2003

Canada 149 0 22 94 1/May/2003 2/May/2003

China 3971 181 190 1406 3/May/2003 3/May/2003

Hong Kong 4 1621 10 179 898 3/May/2003 3/May/2003

Macao 1 0 0 0 30/Apr/2003 30/Apr/2003

Taiwan 100 0 8 25 2/May/2003 2/May/2003

France 5 0 0 4 11/Apr/2003 2/May/2003

Germany 7 0 0 7 22/Apr/2003 2/May/2003

Indonesia 2 0 0 1 23/Apr/2003 30/Apr/2003

Italy 9 0 0 4 29/Apr/2003 2/May/2003

Kuwait 1 0 0 1 9/Apr/2003 20/Apr/2003

Malaysia 6 0 2 3 28/Apr/2003 1/May/2003

Mongolia 8 0 0 4 1/May/2003 1/May/2003

New Zealand 1 0 0 1 30/Apr/2003 2/May/2003

Philippines 3 0 2 1 28/Apr/2003 29/Apr/2003

Poland 1 0 0 0 1/May/2003 1/May/2003

Republic of Ireland 1 0 0 1 21/Mar/2003 24/Apr/2003

Republic of Korea 1 0 0 0 29/Apr/2003 3/May/2003

Romania 1 0 0 1 27/Mar/2003 22/Apr/2003

Singapore 203 0 25 147 2/May/2003 3/May/2003

South Africa 1 0 0 1 9/Apr/2003 3/May/2003

Spain 1 0 0 1 2/Apr/2003 24/Apr/2003

Sweden 3 0 0 2 18/Apr/2003 23/Apr/2003

Switzerland 1 0 0 1 17/Mar/2003 1/May/2003

Thailand 7 0 2 5 12/Apr/2003 30/Apr/2003

United Kingdom 6 0 0 6 11/Apr/2003 1/May/2003

United States 54 0 0 24 30/Apr/2003 1/May/2003

Vietnam 63 0 5 58 14/Apr/2003 3/May/2003

Total 6234 191 435 2702