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Media Articles

Harsh lessons from Sars=20
Straits Times
By Ling Chang Hong
4 August = 2003=20
All countries must not let down their guard against = the killer=20 disease, for which there is no vaccine or cure yet=20

AFTER a recent study trip to Toronto, Dr Daniel Lucey = returned to=20 the United States with this message for the country's health = officials: Get ready for Sars now.=20
As director of the Centre for Biologic Counterterrorism = and=20 Emerging Diseases at Washington Hospital Centre, he toured = the=20 Sars-ravaged Canadian city's hospitals in June.=20
What he saw was enough to convince him that the US needed = to=20 start preparing for an outbreak of Sars, or severe acute = respiratory=20 syndrome. It had seen some 75 cases, but no deaths.=20
Next time, it may not be so lucky. Experts fear Sars = could make a=20 comeback late this year when the weather cools off in the = country.=20
Dr Lucey encountered precautionary measures in Toronto = even when=20 he was not looking for them. These included the screening of = visitors at building entrances and the use of coloured = stickers to=20 identify those cleared of symptoms, the Washington Post = reported on=20 July 27.=20
With 250 cases and 41 deaths, Toronto was the most badly = hit city=20 outside Asia.=20
Sars infected more than 8,400 people worldwide, but = China, Hong=20 Kong, Taiwan, Singapore and Vietnam were the worst hit.=20
Officials like Dr Lucey are studying how these countries = caught=20 Sars and coped with it, in the hope of learning from their=20 experiences - and mistakes - to prepare their own countries = for it.=20
If the disease does return, it is expected to spread = beyond Asia,=20 and scientists have yet to find a cure or vaccine.=20
Not surprisingly, the most obvious lesson in the Sars = outbreak=20 was that those countries which took open, swift action = managed to=20 get the virus under control faster than the ones which = resisted=20 acknowledging it and reacted slowly.=20
Many have heaped praise on Vietnam, which became the = first=20 country to be declared Sars-free by the World Health = Organisation=20 (WHO) on April 28.=20
It kept the number of infections to 63 and the death toll = to five=20 people who worked in hospitals.=20
After the first case was identified in late February, = Vietnamese=20 officials were open and quick to react. They welcomed a WHO = team of=20 international experts and embarked on an aggressive campaign = to=20 educate the public on Sars.=20
Vietnam also carefully monitored border areas with other=20 countries and isolated people arriving from affected = regions.=20
Dr Pascale Brudon, the WHO's chief Vietnam = representative, was=20 reported as saying: 'The most important factors were the=20 government's quick action, leadership and transparency.=20
'To control Sars, it was essential to quickly identify = the=20 infected and then properly isolate them, and Vietnam did = this very=20 well.'=20
Earlier, Deputy Health Minister Tran Van Thuong had = explained his=20 country's approach.=20
'We understood that such transparency could hurt the = country's=20 tourism industry - an important source of income - and = business, but=20 it was a matter of human lives.'=20
Singapore, where 33 people died from the virus out of 238 = infections, has also been held up as a shining example of = how to=20 respond to a crisis like the Sars outbreak.=20
On March 27, it became the first country in the world to = close=20 all schools.=20
It also enforced a strict quarantine on 861 people who = had been=20 exposed to Sars victims by installing closed-circuit cameras = in=20 their homes. Those who violated the quarantine orders were = tagged=20 electronically.=20
In terms of managing urgent health problems, 'Singapore = was the=20 master of this in the Sars crisis', said Dr Jody Lanard and = Dr Peter=20 Sandman, risk communication consultants in Princeton, New = Jersey, in=20 an e-mail interview with The Straits Times.=20
'Singapore knows it can't hide the problem but genuinely = can=20 respond as strenuously as needed,' said the two specialists, = who had=20 advised the WHO on communications during the epidemic.=20
'Singapore's leaders did not try to minimise how scary = Sars was,=20 and expected Singaporeans to be able to cope with their = fears.=20
'Its open and responsive risk communication is = impressive.'=20
The WHO's Dr Ali Khan agreed. He told the BBC: 'I think = the=20 Singapore Government has done an excellent job and I really = would=20 not characterise it as draconian.'=20
No less a critic than the Asian Wall Street Journal = (AWSJ)=20 pointed to Singapore's transparency and decisiveness as the = only way=20 to go when dealing with such a crisis.=20
In a March 27 editorial, the newspaper said: 'We've = sometimes=20 been critical of Singapore's degree of protection of civil=20 liberties, but when public health is seriously = threatened...it is=20 difficult to find fault with a quarantine...If only Hong = Kong and=20 China would take Sars seriously.'=20
Unfortunately, neither of them did.=20
China, where the killer virus apparently originated in = November=20 in southern Guangdong province, waited four months before it = sought=20 help from the WHO.=20
Even then, it hampered the health organisation's work by = not=20 allowing investigators to work in the province and not being = forthcoming about the seriousness of the Sars situation = there.=20
'Such inaction most definitely helped it spread,' said Dr = Howard=20 Markel, director of the Centre for the History of Medicine = at the=20 University of Michigan, who spoke to The Straits Times in a=20 telephone interview.=20
'The epidemic would likely have been contained much = earlier if=20 they had asked for help.'=20
China finally came clean on April 20, admitting that it = had been=20 under-reporting its Sars figures, after mounting pressure -=20 especially from Asian neighbours which it had in effect = allowed the=20 disease to spread to by keeping quiet about it.=20
By then, the number of Sars cases on the mainland had = soared to=20 1,959, including 346 cases in Beijing.=20
That was almost 30 times more than the 12 cases reported=20 previously by then health minister Zhang Wenkang on April 3. =
The admission came at a great political cost, including = the=20 removal of Mr Zhang and Beijing mayor Meng Xuenong from = their=20 official posts.=20
By April 23, the Chinese authorities had reported 2,305 = Sars=20 cases and 106 deaths.=20
'The world is furious with them because they lied,' said = Dr=20 Lanard and Dr Sandman.=20
'They need to put in place accountability mechanisms to = credibly=20 guarantee that it won't happen again.'=20
In all, 5,327 people in China came down with Sars and 349 = died=20 from it.=20
In Hong Kong, there had been much more transparency about = Sars=20 figures.=20
But officials there had also attempted to play down the = problem=20 initially. They had hoped to minimise the economic impact on = the=20 tourism industry.=20
On March 14, Hong Kong's Health Secretary Yeoh Eng Kiong = even=20 denied what was obvious to everyone else.=20
'Hong Kong does not have an outbreak, OK? We have not = said that=20 we have an outbreak. Don't let the rest of the world think = that=20 there is an...outbreak in Hong Kong,' he said angrily to a = reporter=20 even as new cases were being reported in the territory.=20
Hong Kong saw its first Sars case in mid-February but did = not=20 close its schools until March 27 when it also placed 1,080 = people=20 under quarantine.=20
The AWSJ editorial said: 'This failure to act in a = resolute and=20 timely fashion has created distrust of the government.'=20
Even worse, it led to 1,755 cases and 299 deaths. In = terms of the=20 size of the population compared to China's, that made Hong = Kong the=20 worst-hit place in the world by far.=20
Similarly, there was a cover-up at Taipei's Hoping = Hospital,=20 where the first Sars cases were concentrated. Its chief, Mr = Wu=20 Kang-wen, was sacked on May 16.=20
The virus spread to even the far southern parts of the = island.=20 The final toll: 671 cases, 84 deaths.=20
These three governments learnt their lessons the hard = way.=20
Dr David Heymann, the WHO's executive director for = communicable=20 disease, had been one of the leading sceptics of China's = previous=20 claims of low Sars figures.=20
On June 12, he told reporters in Beijing that his office = had=20 finally been given access to the information it needed from = the=20 Chinese provinces.=20
'It's been informative, complete and reflects the huge = effort=20 that has been made by China to contain Sars,' he said.=20
If China learnt its lesson the hard way, Toronto learnt = it the=20 even harder way - and in the process taught everyone an even = tougher=20 lesson.=20
On April 23, the WHO issued an advisory against = unnecessary=20 travel to the city. The decision sparked a storm of protest = from=20 Canada.=20
Just seven days later, the WHO lifted the travel advisory = as no=20 new cases had been reported for 20 days. It took Toronto off = the=20 Sars list completely on May 14.=20
Health officials began to relax some of the Sars = preventive=20 measures, such as the use of gloves and gowns.=20
Then, less than two weeks later, a second outbreak = surfaced. To=20 its shame and embarrassment, Toronto went right back on the = list of=20 Sars-hit places.=20
Dr Donald Low, chief microbiologist at Mount Sinai = Hospital,=20 regretted the complacency.=20
'As soon as the masks and the gloves came off, you could = see this=20 dramatic spike in the cases,' he said in June.=20
Experts and critics have also singled out another crucial = move as=20 a critical factor in the fight against the virus - the = designation=20 of certain hospitals for treating Sars patients.=20
They say this prevented the virus from spreading into the = wider=20 communities.=20
Singapore's Tan Tock Seng Hospital was turned into a Sars = hospital. Vietnam designated two places - the Hanoi French = Hospital=20 and the Bach Mai Hospital - for Sars patients.=20
Hong Kong's failure to do so at first may have been a key = reason=20 it was hit so hard.=20
Mr Phar Kim Beng, senior research associate with the City = University of Hong Kong, told The Straits Times: 'In Hong = Kong, when=20 Sars began spreading in hospitals from March 12, the = government did=20 not move quickly enough to centralise Sars patients in one = location.=20
'As a result of this lapse in judgment, Sars patients = could be=20 treated in all 44 public hospitals, although in the end, = only 19 of=20 them had Sars cases.'=20
Mr Phar had done research comparing how Sars was handled = in Hong=20 Kong, Singapore, Vietnam and Canada.=20
As the dust settles slowly on the deadly virus, experts = are=20 warning that there is no room for complacency when dealing = with=20 infectious diseases.=20
The Sars outbreak is a wake-up call to governments to = work=20 together, they say.=20
Medical historian Dr Markel summed it up.=20
'Everyone has to accept that we live in a world of = emerging or=20 re-emerging infections,' he told The Straits Times.=20
'We have to keep our public health 'police force' strong, = even in=20 quiet times, and we have to make sure it's international and = global=20 in perspective.=20
'That's the cautionary tale that I hope Sars teaches us = most.'=20
=
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THE TOLL=20
VIETNAM: 63 cases, 5 (all hospital staff) deaths=20
TORONTO: 250 cases, 41 deaths=20
CHINA: 5,327 cases, 349 deaths=20
HK: 1,755 cases, 299 deaths=20
TAIWAN: 671 cases, 84 deaths=20
SINGAPORE: 238 cases, 33 deaths=20
US: 75 cases, no deaths=20

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