OTGV #30 - SARS FREE?

Broadcast Date: 19/05/03

Singaporeans today will wake up to newspaper headlines proclaiming whether Singapore is SARS Free or must it wait another 20 days to achieve this status.

But what does this all mean?

Join Chong Ching Liang in this week's On the Grapevine to find out what being SARS Free means.

=============================

Chances are if you tune in to the radio, watch TV news or read your papers today, Monday the 18th of May, you will see proclamations of whether or not Singapore has achieved the SARS-Free badge.

It is obviously an achievement more valued by the individual countries than by the organisations fighting the global battle against SARS.

For an organisation such as the World Health Organisation or the W-H-O, a SARS Free country is a fluid category since the world isn't SARS Free says its Information Officer Iain Simpson.

"We don't really declare countries SARS Free routinely. We maintain a table where there have been local transmission and there are procedures for which countries are on that or rather which areas are on that and which are not."

More important is whether Singapore ever gets included in the list of countries that the W-H-O warns people to avoid.

Even after the SARS scare at the Pasir Panjang Wholesale Market, Singapore never made it to this list.

W-H-O's Dr Nelgaard on the criteria used to place countries on his organisation's travel advisory.

"I would also like to emphasise also that we will be in contact with the authorities in Singapore before any decision is taken. So it is not a unilateral decision but it is based on criteria that we are currently refining. There are 3 criteria. First one is the size of the outbreak; the second one is the extension of the outbreak beyond the first clear focus of close contacts. And the third one is the export of cases internationally."

Getting the SARS Free nod doesn't translate in a breather for the government or the immigration and health authorities says Mr Simpson's fellow Information Officer, Peter Cordingley.

"Hanoi has been on full alert since it became a SARS free area, and there has been no dropping of the guard, the government authority as well as the WHO team that is there, has actually been stepping up pre-cautions. These things weren't in place from the beginning quite obviously. Some of them got put in place and now even more are being put into place in terms of the airport. There's a long border with, virtually impossible to police that completely but a big effort is now being made to do the best they can."

This need to be constantly vigilant isn't lost on Singaporeans if the feedback from Newsradio's listeners in the TalkBack programme in AM Newstalk is anything to go by.

Mr Lee said being SARS Free is less important than doing the right thing.

"SARS is going to be a long-haul thing and sooner than later I think the whole world will have SARS. Rather than getting worried and all worked up about whether we are going to be SARS Free. What is more important is at the end of the day, people will evaluate how a country view SARS and how we take care of the problem, rather than to say whether we are free or not."

Another caller to Talkback, Johnny, acknowledged the importance of being certified SARS Free but highlighted it's what we do that'll impact us as a nation.

"As far as the May 18th is concerned, from within a Singapore context, it's not a critical day because all the precautions are in place. But I guess to be pragmatic in the sense that Singapore is dependent on the world for business, economy and what have you, achieving the SARS Free status is important for a SARS Free standpoint but within Singapore we should just get on with life as per normal."

W-H-O's Iain Simpson on the main significance to country after it has been judged by to be free of any local transmission by the W-H-O.

"It basically means that Singapore will no longer be asked to conduct exit screening at the airport for people taking flights to make sure there's no export of SARS. Because if there's no local transmission, there's no export of SARS."

Newsradio listener Johnny says whether Singapore can gain economic mileage from being declared "SARS Free" depends on how it maintains its alert against SARS.

"If precautions are in place in relations to the airport, land entry point and sea entry points, that SARS is being checked even after May 18th. If that is well publicise and accepted, that should put Singapore in a very good position."

Fellow caller to AM Newstalk's Talkback segment Mr Lee says Singapore may well have reaped some rewards for its handling of the SARS outbreak here.

"In fact in this bad economic times, this has actually given Singapore a premium, so to speak, over the other countries I mean. People have already holding back investments in China and Taiwan. Things like that. I think as a matter of fact, it is a good thing that has happened."

Yet another caller Mr Pereira thinks that life is returning to normal.

"I gave a Vesak Day talk to about 300 people, and we were expecting a little less than a hundred. Very surprised that everybody turned up. No one was wearing a mask and life was going on as any other Vesak."

But ultimately, until every country in the world is SARS Free or when there's a vaccine or cure found, Singaporean life will be changed.

Health Minister Lim Hng Kiang speaking to reporters about the impact of the Institute of Mental Health SARS-scare.

"Well we can do everything that we do and we will still be facing such situations weeks, months later on. So I think we have to accept the fact that this problem requires utmost vigilance and if there's one breach, one mistake, one mis-diagnosis one carelessness, one selfishness, the problems comes with us. It's not the end of the world. We isolate, we contain, we ring fenced it. It may costs us 15 cases, 10 cases, twenty cases but we will definitely contain it and don't let it spread, provided everybody works with us."

In a world changed by the SARS scourge, any country, SARS Free or not, getting complacent is doing so at its own peril.

This is Chong Ching Liang for Newsradio 938. (now 938Live)


==========================
Related Links:

Newsradio938 (now 938Live)
http://www.938live.sg/

Ministry of Health SARS website
http://www.moh.gov.sg/corp/sars/index.html

World Health Organisation SARS website
http://www.who.int/topics/sars/en/

National Development Ministry's News Release on Pasir Panjang Wholesale Market
http://www.mnd.gov.sg/Newsroom/newsreleases/2003/news280403.htm

OTGV #29 - SARS Contact Tracers

Broadcast Date: 12/05/03

Intro:

In this week's On The Grapevine, join Chong Ching Liang as he looks at the silent but crucial role that contact tracers play in the fight against SARS.

===========================

SARS is such a new bug that there's no real medical fight against it.

There isn't yet a reliable test kit to detect it.

So the containment of its spread is achieved through very exhaustive detective work.

Aside from the healthcare professionals, another front in the battle fought against SARS is engaged by the contact tracers.

Hi I am Chong Ching Liang and welcome to On the Grapevine as I look at the work done by this group of nearly invisible SARS combatants.

Health Officer Han Wee Kiong sheds some light on the working hours of the contact tracers.

"Basically our shifts breaks into 2, the morning shift is from 8 to 4 pm. The afternoon shift is 2 to 10 pm. Basically we work a lot more than our shift. [Average of how many hours ot?] Two to 4 hours just to get all the contacts in because sometimes the cases were hospitalised and we are unable to call them, So we have to call the family members to get the information and most of the time they are unable to give us the information that we need. So we have to try a lot other means to get the information."

Very often, the work follows the contact tracers home even when the shifts or the over-time has ended.

Mr Han admits to thinking about cases which he couldn't or didn't manage to contact even when he is at home and getting ready for bed.

Minister of State for Education and Manpower Ng Eng Hen says the fight against SARS provides a constantly evolving learning curve for the government.

One of the lessons learnt is that it is not only a medical battle but a logistic battle to allocate resources to help the Health Ministry.

"If you think about it, how have we fought this war? Not with drugs at all. It's not a medical war. It's a logistical war. So putting 9 Div commander contact tracing, what is contact tracing? Asking who you've been in contact, there's nothing medical about it. Doctors are never meant to do that."

Initially, the Health Ministry started with a team of some 20 contact tracers.

This grew to 60 and then 80 in total strength.

The biggest test for the endurance and resourcefulness of the Health Ministry's contact tracers was when the SARS bug escaped the confines of Tan Tock Seng Hospital and spread to the Singapore General Hospital in late March.

Mr Han on the workload then.

"The workload was quite tremendous for our team. Basically we have to investigate about 6 to 7 cases a day. Imagine the number of visitors and the visitors who visit the hospital. We basically have to make quite a number of calls per officers. There were cases where actually the contacts could grow up to one, two hundred. So we've break down to a group of ten, we all have to make about ten calls. If we have more cases, if one person is handling one case, you have to call 50 to a hundred times."

But something else happened that stretched the initial team of contact tracers even more.

The Pasir Panjang Wholesale Market.

The workload became nightmarish with an anticipated list of some two thousand contacts to be traced.

So the government beefed up the stretched resources of the Health Ministry by sending one hundred and sixty MINDEF personnel to help out the contact tracers on the 25th of last month.

Here's one of them.

"I'm Captain Thomas Neo, I am from the Ministry of Defence. I am assisting by operating as one of the four executive officers that's running the shift in the contact tracing team. currently there are two shifts. One shift comprises of 12 teams of approximately ten men so it makes a total of 240 of which 160 men are from the Ministry of Defence whereas the other 60 men are from the Ministry of Health."

Captain Neo on what his team faced when they arrived.

"There were a lot of contacts to be made. The workload then was more. More calls to be made, more people to establish contacts, for us to compile the figures. Per person I would say it'll depending on day to day but on average, we are talking about 50 to 60 depending on the number of cases at hand. Depending on how voluminous the cases have churned out in terms of contacts."

But contact tracing is a skill, each tracer has to ferret out information that the interviewees have either forgotten, can't recollect or willfully tried to keep it from coming out.

Minister of State for Health Balaji Sadasivan on the importance of contact tracing even on the tracking of SARS worldwide.

"Contact tracing is an important medical tool in the control of SARS and the fact that there's a border doesn't reduce it's importance. The reasons why you need to contact trace are if you have SARS you need to catch it from someone. So you want to go back and find the source of the SARS because if the source can be identified, then other people who may have caught SARS can be identified and ring-fenced."

So good contact tracers are essential.

Captain Neo on the training his team received.

"the focus was really what we really deem necessary was to give our guys who are new, hands-on training. That is what we deem as relevant. They were attached to the teams that were already functioning in the MOH. There were attached to them, they had some hands-on training. After 3 days when we deem they are ready to be on their own, before we branch them out as a support to the current batch of people doing contact tracing."

Thrown straight into the deep-end, a lot of the lessons are learnt on the job.

The worse may be over after the extreme case of Pasir Panjang Wholesale Market but at least, Singapore now has a team of two hundred and forty contact tracers to deal with whatever may come.

This is Chong Ching Liang for Newsradio 938. (now 938Live)

==========================
Related Links:

Newsradio938 (now 938Live)
http://www.938live.sg/

Ministry of Health SARS website
http://www.moh.gov.sg/corp/sars/index.html

World Health Organisation SARS website
http://www.who.int/topics/sars/en/

National Development Ministry's News Release on Pasir Panjang Wholesale Market
http://www.mnd.gov.sg/Newsroom/newsreleases/2003/news280403.htm

OTGV #28 - SARS Lessons

Broadcast Date: 05/05/03

It's nearly two months.

Gradually the initial suffocating fear loosens its grip somewhat as the world learns to deal with a new disease, SARS.

Hi Welcome to On the Grapevine as I take a look back at Singapore's fight against SARS.

In the beginning there was SARS and nothing much at all.

There's no information, there's no experience in dealing with an infectious outbreak involving an entirely new disease.

In fact, most ministries, including the Health Ministry, are not prepared at all says Minister of State for Education and Manpower, Ng Eng Hen.

"Indeed any other ministry was not geared to fight this. Even the Ministry of Health. Because this disease, the last time was polio in 1950s. I mean, all our systems were not geared for infectious disease and therefore the set-up of ministerial committee where all the ministers put their resources together."

A lot of the fear is generated by the fact that there is no cure or vaccine against SARS.

There may not be a cure for a very long time if the fight against AIDS is anything to be compared against.

But what's even more crucial is that there isn’t a lab-based diagnostic kit accurate enough to detect the new virus.

This means the fight against SARS so far isn't an entirely medical one says Dr Ng.

Each branch of the government is drawn into battle and their expertise and knowledge challenged.

The learning curve is very steep and quick, assured actions are crucial and absolutely necessary.

National Development Ministry was drawn in by the unexpected closure of the Pasir Panjang Wholesale Market that disrupted Singapore's supply of leafy veggies for a while.

This lesson of having just one distribution centre is swiftly learnt says National Development Minister Mah Bow Tan.

"We are now in the process of building redundancies. In other words, duplicating the facilities that we currently have but we have to be careful that beyond a certain point, the additional points involved will have to be factored in. But yes the answer is we will be building redundancies. The main idea is to protect our sources of supplies to make sure our food supply coming in whether it is fish meat vegetables eggs whatever is safe, is protected."

Pasir Panjang also brought in an interesting lesson for the Health Ministry.

How can a relatively small team of people do contact tracing for an estimated group of some two thousand people and still hope to have the Home Quarantine orders out as soon as possible?

Dr Ng Eng Hen who's also part of the SARS combat Unit says this taught the lesson that getting help to the Health Ministry is very important.

"The second tipping point was allocating resources to MOH because it was not geared up to fight this national crisis. Because if you think about it, how have we fought this war? Not with drugs at all. It's not a medical war, its a logistical war. So putting 9 Div commander contact tracing, what is contact tracing? Asking who you've been in contact, there's nothing medical about it. Doctors are never meant to do that."

But contact tracing by authorities isn't enough.

Singaporeans are urged, begged or even cajoled to be forthcoming and honest about their health status and do self-assessment of their own risks.

In his dialogue session with the grass-roots leaders, Prime Minister Goh Chok Tong was asked if the government should name people who are home quarantined so that his or her neighbours can take the necessary pre-cautions.

Mr Goh turned the question back to the floor.

"Now should we tell the neighbours about the family that's been quarantine? In other words, do you agree that we should in fact be quite open about this? What do you think? Those who support there should be more openness please put up your hand."

Not enough hands up.

So Mr Goh clarifies what he actually means.

"My own view is there's nothing shameful about being quarantined and I will let people know. Mrs Lee was quarantine and we knew. And SM told everybody. So I think if you take that attitude, your neighbours know, well we’re just a little careful that there's somebody being quarantine but there's nothing, really embarrassing about it. So can ask those who support a more open stance, please put up your hands. Those at the top? I think there's a clear majority."

As the PM proves, people will even accept radical measures that may compromise their confidentiality if they can understand why these measures are being undertaken.

Of course they mustn't feel singled out and ostracised by the community.

After all, a person on quarantine isn't even sick so why should they be treated as lepers?

Senior Minister of State for Transport and incoming Acting Minister for Health Khaw Boon Wan says more can be done to the current system to rid it of stigma.

"I also get some anecdotes on why people are reluctant to call 993. Because... ambulance will come and the whole neighbourhood is be shuttered you know, we are trying to look into this whole process, whether we could humanised it. Most of this contacts who developed fever are mobile. There's actually no need to move them in ambulance or whatever. there could be other means. So a few of us have been thinking about how to make it more user friendly. Less frightening to the person and to the whole community. And I have an idea. You could come in one of those beautiful SQ tour coach, you know, and we will send to Tan Tock Seng!"

Mr Goh Chok Tong says it is imperative that all must their part because the best reactive system in the world will crumble to naught if even the most minute population doesn't play ball.

"While we do in controlling the problem, we cannot allow one selfish act, one selfish individual to destroy the lives of all of us. So that is my simple message."

It is still early days yet but the world and Singapore has learnt so much about SARS and so much more.

It's been a quantum leap of experiential learning that may well equip Singaporean leaders and population to deal with the next curve ball nature decides to throw at them in the form of another new infectious disease.

This is Chong Ching Liang for Newsradio 938. (Now 938Live)

==========================
Related Links:

Newsradio938 (now 938Live)
http://www.938live.sg/

Ministry of Health SARS website
http://www.moh.gov.sg/corp/sars/index.html

Hong Kong University SARS Fund website (with links and info)
http://www.hku.hk/sarsfund/

World Health Organisation SARS website
http://www.who.int/topics/sars/en/

National Development Ministry's News Release on Pasir Panjang Wholesale Market
http://www.mnd.gov.sg/Newsroom/newsreleases/2003/news280403.htm

OTGV #27 - SARS Summary

Broadcast Date: 31/03/03

New disease, new challenges and the government took drastic steps last week to tackle them.

"I have invoked the Infectious Diseases Act and we will be serving notice on all these people and so this will prevent them from interacting with the rest of community and presenting a risk to them."

"Ministry of Education and Ministry of Health have decided to close all primary schools, secondary schools, junior colleges and centralised institutes to Sunday, 6th of April."

Hi Welcome to On the Grapevine with me Chong Ching Liang as I take a look back on a furious week of activities to combat the Severe Acute Respiratory Syndrome or SARS.

The government actions to impose home quarantine and temporary closure of the national schools up to JC level stem from an effort to try and calm frayed public nerves.

Education Minister Teo Chee Hean.

"The advice from the medical profession is that there is no reason to close the schools on purely medical ground. But there has been concerns express by parents and we received this feedback directly from parents directly and also from general practitioners. Basically this move is to reassure parents to give them peace of mind so that know their children are not put at risk."

Why is the public panicking?

First, SARS is a disease that humanity has never seen before.

The World Health Organisation's advisor to the Singapore government Dr Osman Mansoor explains.

"So we are still learning. WHO's role is to coordinate the activities that is going on in different countries and to learn, a lot to learn from Singapore. But WHO does not know what is the right thing to do to control this disease nor would anyone else know. I can tell what we do know; we do know that the transmission appears to be extremely limited. Nearly all the transmission has happen in hospitals when people have become very sick."

With a new disease, information about it is constantly evolving and the public is simply too impatient to wait.

So that's how rumours start.

There are already different versions of SARS-related e-mails that have been snaking into Singaporean computers.

One says SARS only affect the Chinese and another, more damagingly, accused the government of information blackout.

Elisabeth is a 4th or 5th generation recipient of the second type of chain mail.

"When I first read it, regarding a news media blackout, I was thinking to myself, ha ha. So now the truth comes out because last week, there was a speech from Lim Hng Kiang, he did mentioned that we have everything under control, no panic but now suddenly this week things seems to be moving in another direction."

But because it is on something as unknown as SARS, her first thought was to forward the letter on to people she cares about.

So these e-mails become a cyber-virus that's propagated the same way as an uncontrolled flu bug.

Dr Wong Sin Yew, an infectious disease physician in private practice feels the public needs to support the public sector healthcare professionals at this time, and he urges Singaporeans to be cautious when dealing with such alarmist e-mails.

"I have no doubt that everyone is trying to provide as much reaction as possible but I would like the readers and your listeners to concentrate on actually what are the facts. And the facts are MOH, WHO, and many other countries are collaborating to try and find out what the bug is. There are a lot of speculations and I think these speculations do a great disservice to public health policies makers who grapple with a rapidly evolving disease."

So has the government been withholding information?

Health Minister Lim Hng Kiang has been chairing media briefings and personally answering all questions every alternate day or so.

Transparency will help but battling the disease will take a lot of hard work and good solid detective work coupled with sound medical knowledge.

Mr Lim Hng Kiang on how Singapore and Hong Kong worked together to determine the course of infection for Singapore's first three patients.

"Well, we are in contact with the Hong Kong authorities and their hypothesis to us is that the 7 patients who're infected stay on the same floor and they hypothesised that they could have contracted from this Guangzhou doctor who's the source, either while waiting for the lift or inside the lift. Their hypothesis is close direct contact when they were waiting for the elevator or they were inside the elevator itself and the Guangzhou doctor may have sneezed or coughed and that could have pass the droplets to the others. And that's how the infection got started. That's their hypothesis and I don't think anybody can pin-point the cause but because the other hotel workers are not affected, they think that it's a plausible explanation."

But it seems the future is getting a tad brighter.

A team of micro-biologists from Hong Kong University claims the first step to stopping the SARS bug has been reached.

Dr Malik Perius.

"Growing, identifying the virus is very important; you can call it a breakthrough if you like. Of course we are not at the end of the road but I think we have taken a big step along that road. It also opens the door to testing what anti-viral drugs would be effective against this virus to the longer term, developing vaccines. It is a long way to go but I think this is an important first step."

In about a week's time, the schools will be re-opened.

Whether or not the public will accept this will depend on how aware they are of the SARS bug.

So Mr Lim Hng Kiang promised an information blitz before the reopening of schools to educate Singaporeans.

"I think we have to do quite a lot more in the following days to get the public educated, to understand the nature of SARS. We'll be taking out ads; we go and attend talk shows to get the message across in all the different ways."

It will be awhile before the public regains its composure but at least, we can rest assured that scientists worldwide are working hand-in-hand to wipe out the SARS bug.

This is Chong Ching Liang for NewsRadio 938.

==========================
Related Links:

Newsradio938 now 938Live
http://www.938live.sg/

Ministry of Health SARS website
http://www.moh.gov.sg/corp/sars/index.html

Hong Kong University SARS Fund website (with links and info)
http://www.hku.hk/sarsfund/

World Health Organisation SARS website
http://www.who.int/topics/sars/en/