From: Subject: SARS Expert Committee - News Date: Fri, 3 Oct 2003 09:14:16 +0300 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_012B_01C3898E.B858E220"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1165 This is a multi-part message in MIME format. ------=_NextPart_000_012B_01C3898E.B858E220 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.sars-expertcom.gov.hk/english/news/news_reports.html SARS Expert Committee - News <= /TR>
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Lesson learned from SARS: be=20 = prepared
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The most=20 important lesson from the SARS (severe acute = respiratory=20 syndrome) experience is the need to be prepared, the = SARS=20 Expert Committee Report said.

The=20 overall conclusion of the Committee was that Hong Kong = had=20 handled the epidemic well although there were = significant=20 shortcomings in the system during the early phase of = the=20 epidemic.

The report=20 was submitted to the Chief Executive, Mr Tung Chee = Hwa, this=20 morning (October 2) by the co-chairpersons of the = Committee,=20 Sir Cyril Chantler and Professor Sian Griffiths. The = full=20 report and its summary report were released = simultaneously to=20 the public. They are accessible on the Committee's = website at=20 http://www.sars-expertcom.gov.= hk/.

The=20 Committee with 11 renowned experts from the UK, US, = Australia,=20 Mainland China and Hong Kong selected for their wide = range of=20 relevant experience was set up on May 28.

It was=20 tasked to conduct a review on the management and = control of=20 the epidemic and identify lessons to be learned to = better=20 prepare Hong Kong for any future outbreaks. =

In its=20 report, the Committee commended the people of Hong = Kong for=20 the courage and dignity that they had shown during the = SARS=20 epidemic, and expressed members' sympathy for those = who had=20 suffered from the epidemic.

Speaking=20 on the report, Sir Cyril said the Committee had = undertaken a=20 full and comprehensive review.

"We have=20 conducted a lot of interviews and met wide variety of = people=20 from different backgrounds who had been involved in or = affected by the epidemic, and we have had extensive=20 discussions to arrive at the conclusions based on the = facts=20 that we have found and established.

"Where=20 appropriate, additional information and clarification = has been=20 obtained, and the relevant authorities and persons = have been=20 given the opportunity to respond.

"The=20 findings and recommendations contained in the Report = represent=20 the collective opinions and judgements of members of = the=20 Committee alone.

"The=20 intention of every member of the Committee has been, = and=20 continues to be, to do his or her best for the people = of Hong=20 Kong.

"We have=20 examined issues most relevant to the terms of = reference of the=20 Committee from the perspectives of public health, = disease=20 control, contingency planning, outbreak control = mechanism and=20 actions, as well as system designs to critically and=20 professionally assess whether the Administration, the = health=20 authorities and the hospital management had properly=20 discharged their duties and functions under the very = difficult=20 situations at that time," Sir Cyril said.

Sharing=20 Sir Cyril's view, Prof Griffiths said that in reaching = judgements, full account had been taken of the hazards = of=20 retrospective judgement, and therefore efforts had = been made=20 by the Committee in each instance to examine the = subject=20 matter in the context of what was known, and what = could have=20 been done, at the time.

"There=20 were significant shortcomings of system performance = during the=20 early phase of the epidemic when little was known = about the=20 disease or its cause, some of which were aggravated by = key=20 personnel becoming ill with SARS as the epidemic=20 progressed.

"Many=20 shortcomings were rapidly put right, while others were = compensated for by the extraordinary hard work of = people at=20 all levels of the system and in very difficult=20 circumstances.

"The=20 Committee has not found any individual deemed to be = culpable=20 of negligence, lack of diligence or=20 maladministration.

"Looking=20 backward through retrospective analysis, the Committee = has=20 identified things that could have been done better, = and areas=20 in which further improvement should be = made.

"Looking=20 forward, the Committee comes up with a total of 46=20 recommendations under 12 strategic themes to better = prepare=20 Hong Kong should an emergency or crisis stroke," Prof=20 Griffiths said. (Details of these recommendations can = be=20 picked up from Chapter 18 of the full = report.)

In=20 general, the report noted the SARS experience had = helped to=20 identify a number of positive lessons as well as = highlighting=20 a number of challenges for future = preparedness.

It stated:=20 "The underlying concept is that of resilience, i.e., = the=20 ability at every level of the system to detect, = prevent,=20 control and recover from disruptive challenges. It = depends on=20 a well planned, carefully orchestrated and fully = integrated=20 emergency management response."

The report=20 recommended that the organisational structure and the=20 relationship between the Health, Welfare and Food = Bureau=20 (HWFB) and the constituent Government departments = under the=20 Bureau should be reviewed with a view to improving the = capacity for coordination, and facilitating policy = making and=20 commissioning for health protection = matters.

Specifically, it recommended the setting up = of a Centre=20 for Health Protection (CHP) with responsibility, = authority and=20 accountability for the prevention and control of = communicable=20 diseases. As it develops, the CHP should also have=20 responsibility for advising on all aspects of health=20 protection, including food safety and hygiene, = veterinary=20 issues, non-communicable diseases and their risk = factors=20 etc.

The report=20 stressed that strengthening surveillance would be an = urgent=20 priority to provide early warning to the system. It = also=20 pointed out that an important gap in the system was = the=20 absence of comprehensive laboratory = surveillance.

"There=20 needs to be a high level of vigilance and alertness = throughout=20 all parts of the health system. This requires a = culture where=20 everyone recognises that their work, whether in = primary care=20 or hospital care, may have wider public health = implications,=20 and that an illness in one patient may have = consequences for=20 the whole community," the report said.

While=20 noting the success of advanced information technology=20 applications -- e-SARS and MIIDSS (Major Incident=20 Investigation & Disaster Support System) - = developed=20 during the epidemic, the report said investment should = be made=20 in order that the technology is harnessed to better = prepare=20 the Department of Health (DH)/CHP to meet the = challenges of=20 future outbreaks.

It also=20 recommended that efforts should be made to ensure that = all=20 laboratories promptly and routinely report all = laboratory=20 diagnosis of public health importance to DH/CHP. A = more=20 fundamental reform would be to integrate all hospital=20 microbiology laboratories within the new = CHP.

"Establishing a CHP will deal with many of = the=20 shortcomings in public health resources, particularly = the need=20 for more communicable disease epidemiologists and = public=20 health specialists which is critical," the report=20 said.

The report=20 placed heavy emphasis on contingency planning which = would=20 serve as the basis for dealing with most health = service and=20 public health emergencies, including communicable = disease=20 outbreaks.

"It should=20 be a requirement that HWFB, DH and the Hospital = Authority=20 (HA), and each regional office, cluster and hospital = should=20 develop and implement a major outbreak control plan, = which=20 specifies in detail the composition of the outbreak = control=20 team, roles and responsibilities of key individual = team member=20 and the mechanism of activating the plan."

"The plan=20 should be developed in collaboration with CHP and = adopt a=20 population-based approach, and be regularly tested. = Management=20 of communicable disease outbreaks should be viewed as = an=20 integral part of contingency planning."

"There is=20 also a need for site-specific plans, event or scenario = specific plans, and plans that take account of the=20 increasingly international dimension of public health=20 incidents."

"Similar=20 plans and arrangements should exist in the private = sector and=20 in other support agencies and organisations," the = report=20 said.

In case of=20 a public health emergency, the report recommended that = a clear=20 chain of command would be needed for effective = management as=20 the Committee had observed that various mechanisms and = bodies=20 were established on an ad hoc basis in response to the = SARS=20 epidemic.

"These=20 arrangements need to be clarified and formalised in=20 preparation for any future emergency."

"A=20 framework of command is needed to manage the response = at one=20 or more of three levels: operational; tactical and = strategic.=20 Command and control arrangements need to reflect the = fact that=20 the chain of control is normally activated from the = bottom=20 upwards."

The report=20 recommended the establishment of a small command = group,=20 chaired by the Secretary for Health, Welfare and Food = (SHWF),=20 with a limited number of personnel, such as the = Permanent=20 Secretary, the Director of Health, the Head of CHP and = the=20 Chief Executive of HA, responsible for taking all = major=20 decisions during an outbreak.

"A=20 suitable legislative framework is also needed to = enable an=20 appropriate public health response.

"Contingency planning cannot be carried out = in=20 isolation, but must involve close collaboration with=20 neighbours in the Pearl River Delta region, Mainland = China=20 generally, and the international community as a = whole," the=20 report said.

In this=20 respect, the Committee stressed the importance of=20 international links and the need to engage with the=20 WHO.

The report=20 noted that inadequate surge capacity in hospitals and = the=20 public health system had clearly been a major problem = with=20 SARS.

It=20 recommended the HA to urgently invest in improvements = to=20 hospital facilities, especially isolation rooms, and = to review=20 shortages in some clinical skills and specialty areas = and make=20 plans to redress them. The Committee endorsed = Government's=20 proposal to develop infectious disease units attached = to=20 selected acute hospitals, rather than to build a = single=20 standalone infectious disease hospital.

HA was=20 also urged to develop detailed plans on how resources = would be=20 shared to deal with an incident that would overwhelm = the=20 capacity of any one part of the health = system.

Noting=20 that probably the group most vulnerable to infection = are older=20 people living in residential care homes, the report=20 recommended that infection control arrangements in = residential=20 care homes for the elderly, including infection = control=20 training for staff and improving isolation facilities, = should=20 be strengthened; and that the Visiting Medical Officer = scheme=20 should be made permanent.

On=20 communication with the public, the report noted that=20 communicating risk to the public has never been easy,=20 particularly in the face of an overwhelming = crisis.

"It is=20 important to build a level of trust within the = community by=20 ensuring that professionals with appropriate expertise = and=20 seniority are properly trained in dealing with the = media, that=20 long-term partnerships are built with the media and = that they=20 are involved in the contingency planning process, and = that=20 there is an on going programme of public education on = public=20 health issues," the report said.

The=20 Committee also noted the contribution of the media in = the SARS=20 outbreak and suggested that the media should have a=20 responsibility of communicating risk.

It also=20 offered observations and comments on several key = issues that=20 were prominent and about which concern or = dissatisfaction was=20 expressed in the Committee's discussion with various = parties.=20 (Details of these can be found on Chapter 4 of the = full=20 report.)

The=20 Committee had formed two groups to focus on hospital=20 management and administration, and public health. The = hospital=20 group convened its meeting on June 26-28 while the = public=20 health group had its meeting on July 7-11. The = Committee held=20 its plenary session on August 13-19.

End/Thursday, October 2, = 2003
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2003 3D"copyright= |=20 Important=20 notices

Last=20 revision date: 02 October=20 = 2003

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(locapath.toString().search('/gb/')!=3D -1){=0A= atgb =3D true;=0A= org_path_start =3D locapath.indexOf("/gb/") +4;=0A= org_path_end =3D locapath.length;=0A= sitepath =3D locapath.substring(org_path_start, org_path_end);=0A= }else{=0A= atgb =3D false;=0A= sitepath =3D locapath.substring(7,locapath.length);=0A= }=0A= =0A= if (locapath.toString().search('/textonly/english/')!=3D -1){=0A= atlang =3D "entxt";=0A= org_part =3D entxt_path;=0A= }else=0A= if (locapath.toString().search('/textonly/tc_chi/')!=3D -1){=0A= atlang =3D "tctxt";=0A= org_part =3D tctxt_path;=0A= }else=0A= if (locapath.toString().search('/textonly/sc_chi/')!=3D -1){=0A= atlang =3D "sctxt";=0A= org_part =3D sctxt_path;=0A= }else=0A= if (locapath.toString().search('/english/')!=3D -1){=0A= atlang =3D "en";=0A= org_part =3D en_path;=0A= }else=0A= if (locapath.toString().search('/tc_chi/')!=3D -1){=0A= atlang =3D "tc";=0A= org_part =3D tc_path;=0A= }else=0A= if (locapath.toString().search('/sc_chi/')!=3D -1){=0A= atlang =3D "sc";=0A= org_part =3D sc_path;=0A= }else=0A= if (locapath.toString().search('/textonly/eindex.html')!=3D -1){=0A= atlang =3D "txteindex";=0A= org_part =3D "textonly/eindex.html";=0A= atindex =3D true;=0A= }else=0A= if (locapath.toString().search('eindex.html')!=3D -1){=0A= atlang =3D "eindex";=0A= org_part =3D "eindex.html";=0A= atindex =3D true;=0A= }else=0A= if (locapath.toString().search('/textonly/cindex.html')!=3D -1){=0A= atlang =3D "txtcindex";=0A= org_part =3D "textonly/cindex.html";=0A= atindex =3D true;=0A= }else=0A= if (locapath.toString().search('cindex.html')!=3D -1){=0A= atlang =3D "cindex";=0A= org_part =3D "cindex.html";=0A= atindex =3D true;=0A= }else=0A= if (locapath.toString().search('/textonly/sindex.html')!=3D -1){=0A= atlang =3D "txtsindex";=0A= org_part =3D "textonly/sindex.html";=0A= atindex =3D true;=0A= }else=0A= if (locapath.toString().search('sindex.html')!=3D -1){=0A= atlang =3D "sindex";=0A= org_part =3D "sindex.html";=0A= atindex =3D true;=0A= }=0A= =0A= =0A= function chglang(lang){=0A= =0A= switch(lang){=0A= case 'entxt': =0A= des_part =3D entxt_path;=0A= des_ind_part =3D "textonly/eindex.html";=0A= base_path =3D "http://";=0A= break;=0A= case 'tctxt':=0A= des_part =3D tctxt_path;=0A= des_ind_part =3D "textonly/cindex.html";=0A= base_path =3D "http://";=0A= break;=0A= case 'sctxt':=0A= des_part =3D sctxt_path;=0A= des_ind_part =3D "textonly/sindex.html";=0A= //base_path =3D scserver;=0A= base_path =3D "http://";=0A= break;=0A= case 'en':=0A= des_part =3D en_path;=0A= des_ind_part =3D "eindex.html";=0A= base_path =3D "http://";=0A= break;=0A= case 'tc':=0A= des_part =3D tc_path;=0A= des_ind_part =3D "cindex.html";=0A= base_path =3D "http://";=0A= break;=0A= case 'sc':=0A= des_part =3D sc_path;=0A= des_ind_part =3D "sindex.html";=0A= //base_path =3D scserver;=0A= base_path =3D "http://";=0A= break;=0A= }=0A= =0A= if (atindex =3D=3D true){=0A= tail =3D sitepath.replace(org_part, des_ind_part);=0A= }else{=0A= tail =3D sitepath.replace(org_part, des_part);=0A= }=0A= =0A= //alert(base_path+tail)=0A= window.location =3D base_path+tail;=0A= =0A= } ------=_NextPart_000_012B_01C3898E.B858E220--