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• W2340891314 abstract "This issue of the Annals contains articles on the severe acute respiratory syndrome (SARS). One might wonder what else there is to write about SARS. There is already a glut of articles on SARS – type in the keyword “SARS” into Ovid and you will get more than 2400 references. There are several reasons to add more articles on SARS to the literature. The most important one is that there is some local data describing the events of that difficult time still not published. The second reason is that because the epidemic is over, all analyses may be performed in a cool and detached fashion. One might be surprised that there is still unpublished local data when we even have a book on those defining moments in Singapore!1 Yet we urge you to read the articles by Leong et al2 and by Chen et al.3 The paper by Leong et al is late, very late indeed. The papers that first described the clinical characteristics of SARS were published in the heat of the epidemic.4-7 But better late than never. And we would argue that it is a particularly useful publication, containing as it does, data from cases of SARS, the majority of which were confirmed by serology or polymerase chain reaction (PCR). The early and much-quoted papers on the clinical features of SARS were based only on case definitions.4-7 There is nothing wrong with this – epidemiologists have long relied on case definitions to investigate and control epidemics.8 Many an epidemic has been described based on appropriate case definitions which permitted case ascertainment, the creation of an epidemic curve and the formulation of a hypothesis. In practical terms, documentation of outbreaks and their containment based on case definitions have allowed us to adopt and modify the disease control strategies used by the authors when we ourselves are faced with similar situations. Yet case definitions have their limitations. Rainer et al9 evaluated the World Health Organisation (WHO) case definition of SARS prospectively – their main outcome measure was the number of confirmed cases of SARS. They found that the overall accuracy of the WHO criteria was only 83%, the sensitivity was 26%, the specificity was 96%, and the negative predictive value was 86%.9 Hence there is value in a paper that bases its description of SARS on confirmed cases. Reviewing the situation in a cool and detached manner is always valuable. This is of particular importance in the assessment of the various measures taken to control the epidemic. Singapore has been a favourite target of critics who frequently decry its social policies. In its battle against SARS, however, Singapore won much praise – this is summarised by Menon10 in this issue. Interestingly, unpopular policies like the home quarantine and a no-visitor rule for hospitals, for example, were widely implemented in SARS-affected countries.11 We were not unique! To be precise, however, it was our risk communications strategies that won accolades. Let us hence reflect on some of the more valuable lessons of the SARS epidemic. In this issue, Tan12 (who was the Director of Medical Services during the SARS crisis and who chaired the Health Ministry’s SARS Taskforce) reflects on the usefulness of the various measures that were taken. The “widenet” surveillance, isolation and quarantine policy, in retrospect, were responsible for the progressively earlier isolation of probable SARS cases as the outbreak progressed. But Tan admits that such a policy resulted in large numbers of individuals being put on surveillance or on quarantine, most of whom turned out not to have SARS. Whilst Menon speaks effusively of the thermal scanner (a Singaporean invention!), Tan notes that its yield was very low.10,12 None of Singapore’s imported SARS cases were picked up by the screening. Indeed, Tan notes that the last imported SARS case was admitted to hospital on 2 April 2003, prior to the institution of temperature screening via thermal scanners at the airport.12 For those who wonder why we still had all those cases of SARS if all these effective and draconian measures were in place, the answer may be found in this issue also. In a revealing and honest article, Chen et al describe how the patient from one of the affected wards of Tan Tock Seng Hospital (TTSH) seeded the Singapore General Hospital (SGH).3 Like Gopalakrishna et al before them, these authors noted from their analyses that an early decision to stop all admissions to and discharges from TTSH would have averted the outbreak in SGH.3,13 For those of us who cannot remember when that decision was taken, Chen et al reminds us that it was 22 March 2003. It might be distressing, but allow us to juxtapose the painful phrase “main missed opportunities” used by Chen et al with a few important dates mentioned by Chen et al and Tan.3,12 Chen et al felt that 14 March 2003 represented a “missed” opportunity. Tan records that the requirement for passengers on inbound flights to Singapore to complete a Health Declaration Card commenced on 9 April 2003, and twice daily temperature monitoring in schools became mandatory on 30 April 2003.12 The lesson cannot be more obvious today, with our daily battles against multi-resistant organisms and our preparations for a possible influenza pandemic. Isolate early. Implement the “drastic” measure early. How can this be done? After SARS, our restructured hospitals have built “isolation” wards. The analyses of Chen et al, as well" @default.
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• W2340891314 date "2006-05-15" @default.
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• W2340891314 title "Lessons From the SARS Crisis – More Relevant Than Ever" @default.
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• W2340891314 doi "https://doi.org/10.47102/annals-acadmedsg.v35n5p299" @default.
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