STATEMENT FROM THE MINISTER FOR HEALTH
HEALTH MEASURES AGAINST SARS OUTBREAK

Current situation of SARS in Singapore
I had previously explained our strategy to contain SARS in Singapore. The main components of this strategy are to identify and isolate symptomatic cases early, to quarantine contacts who have been exposed to patients with SARS and to minimize the number of new imported cases.

My Ministry decided early on to concentrate all SARS cases in TTSH and CDC. Enhanced infection controls were put in place. No TTSH staff looking after known SARS patients have caught the disease for the last six weeks.

An important characteristic of SARS is that it is more infectious when the patient is sicker. Hence, it tends to be transmitted quickly among healthcare workers who are not appropriately protected when they take care of SARS patients. The lack of a rapid diagnostic test that can be applied early, the non-specific nature of SARS symptoms (fever, cough) and the possibility of the co-existence of multiple illnesses masking the presence of SARS in the same patient have made it difficult to identify SARS patients early and reliably. The outbreak in SGH that started in early April involved a single super-spreader with multiple illnesses. The outbreak in SGH led to a cluster of SARS cases in NUH. We are still mopping up the consequences of that setback.

My Ministry has implemented additional measures to contain the outbreaks in hospitals and other health care institutions, including nursing homes. Firstly, all health care workers in all hospitals are now required to wear N95 masks, gloves and gowns and to practice frequent handwashing after every patient contact. In isolation facilities, Emergency departments and ICUs, they are also required to wear goggles. This is to ensure that they do not get infected by patients who have SARS but have not been diagnosed to have the disease. Secondly, all health care institutions are now required to monitor their staff closely through twice-daily temperature monitoring. Strict instructions have been given to disallow any staff member who has fever or is unwell to start or continue working. Thirdly, all health care institutions have set up special teams to prevent and control SARS. The Ministry is carrying out audits on health care institutions to ensure compliance with the infection control practices. The Ministerial SARS Combat Unit headed by SMS Khaw Boon Wan will give leadership and political weight to the hospital audit teams.

In response to Mdm Ho Geok Choo's questions, selective closure of affected areas of SGH have been carried out instead of closing SGH completely. For example, the patients and staff in wards 57 and 58 were all transferred to Tan Tock Seng Hospital en-bloc. At the same time, staff who may have been exposed to SARS patients have all been quarantined. SGH has also changed its work practices so that teams of doctors work in only one physical site, hence limiting the potential of cross-infection. All public hospitals are closely monitoring their capacity so that they can take the necessary measures to match the need against their capacity. As for using private hospitals, to supplement the public hospitals, this is being explored. One option is to refer some subsidised patients for selected treatment in private hospitals.

The outbreak in SGH in early April also led to a cluster of SARS cases at the Pasir Panjang Wholesale Centre. We shut down the Centre for ten days and imposed Home Quarantine Orders on all the stallholders and their workers in the Centre. The aim is to keep them isolated at home and prevent the infection from spreading. Regular buyers at the Wholesale Centre are closely monitored through telephone surveillance. This is a massive effort to systematically isolate and contain the spread. We have harnessed all the government resources to this end. We need the co-operation of all those involved, in order to break the chain of infection.

We have also put in place a number of measures to ensure that clusters of infection do not develop from new imported cases of SARS. To reduce the number of imported cases, we are carrying out health screening through temperature checks on incoming air and sea passengers from affected areas. This complements the checks that airlines have put in place at check-in counters. Flight crews are also on the lookout for ill passengers on board aircraft. All visitors to Singapore have been required to complete a Health Declaration Card from 9 April 2003. All travellers who enter Singapore from affected areas are also given a Health Alert Notice to explain the symptoms of SARS and how they can get help if they fall ill with suspected SARS. We will continue with these measures for the long term.

About 120,000 persons enter Singapore from Malaysia each day and half of those travel daily. My Ministry is working closely with our Malaysian counterparts on measures to prevent and control SARS in our countries. A delegation of MOH and MHA officials met with their Malaysian counterparts last week to discuss joint measures and the regular exchange of health information.

But we have to be realistic. Global travel means that new imported cases will occur in the future. Screening of travellers is limited in its effectiveness as it will not pick up persons during the incubation period. Persons can therefore be well as they pass through the screening procedures and develop SARS later. A single imported case can trigger off an outbreak involving many cases, especially if he or she is a super-spreader even though we quickly institute the control measures to isolate and ring-fence ill persons and their contacts so as to limit disease transmission. Hence, we must all be prepared to accept that we are in this for the long haul.