8.SARS plague: duty of care or medical heroism?
Annals of the Academy of Medicine, Singapore 2006;35(5):374-378
Severe acute respiratory syndrome (SARS) is a new infectious disease that emerged in mid- November 2002 in Guangdong, southern China. The global pandemic began in late February 2003 in Hong Kong. By the time SARS was declared contained on 5 July 2003 by the World Health Organization (WHO), it had afflicted 8096 patients in 29 countries. No other disease had had such a phenomenal impact on healthcare workers (HCWs), who formed about 21% of SARS patients. In Vietnam, Canada and Singapore, HCWs accounted for 57%, 43% and 41% of SAR patients, respectively. At the beginning of the outbreak, there was practically no information on this disease, which did not even have a name until 16 March 2003, except that it was infectious and could result in potentially fatal respiratory failure. Indeed, HCWs had lost their lives to SARS. Understandably, some HCWs refused to look after SARS patients or even resigned. Initially, much negative publicity was given to such HCWs. It was a very trying time for HCWs as many were also ostracised by the society which they served. They were perceived to be a potential source of infection in the community because of their contact with SARS patients, whom they risked their lives looking after. Subsequently, as we learnt more about the disease and educated the public about the plight of the frontline HCWs, the public gave the frontline HCWs tremendous support and even honoured them as heroes. Being in the medical profession, caring for patients is one of our expected responsibilities. On the other hand, as public citizens, HCWs have the right to resign when they feel that their responsibility to their families should take priority over that to their patients. As a result of this scourge, each HCW learnt to decide if caring for patients is their chosen profession and vocation. Many chose to live up the Hippocratic oath.
Delivery of Health Care
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standards
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Disease Outbreaks
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prevention & control
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Global Health
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Humans
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Severe Acute Respiratory Syndrome
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epidemiology
9.SARS in Singapore--key lessons from an epidemic.
Annals of the Academy of Medicine, Singapore 2006;35(5):345-349
The rapid containment of the Singapore severe acute respiratory syndrome (SARS) outbreak in 2003 involved the introduction of several stringent control measures. These measures had a profound impact on the healthcare system and community, and were associated with significant disruptions to normal life, business and social intercourse. An assessment of the relative effectiveness of the various control measures is critical in preparing for future outbreaks of a similar nature. The very "wide-net" surveillance, isolation and quarantine policy adopted was effective in ensuring progressively earlier isolation of probable SARS cases. However, it resulted in nearly 8000 contacts being put on home quarantine and 4300 on telephone surveillance, with 58 individuals eventually being diagnosed with probable SARS. A key challenge is to develop very rapid and highly sensitive tests for SARS infection, which would substantially reduce the numbers of individuals that need to be quarantined without decreasing the effectiveness of the measure. Daily temperature monitoring of all healthcare workers (HCWs) in hospitals was useful for early identification of HCWs with SARS. However, daily temperature screening of children in schools failed to pick up any SARS cases. Similarly, temperature screening at the airport and other points of entry did not yield any SARS cases. Nevertheless, the latter 2 measures probably helped to reassure the public that schools and the community were safe during the SARS outbreak. Strong political leadership and effective command, control and coordination of responses were critical factors for the containment of the outbreak.
Disease Outbreaks
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prevention & control
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Humans
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Quarantine
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organization & administration
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Severe Acute Respiratory Syndrome
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epidemiology
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Singapore
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epidemiology
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