Enhanced Precautionary Measures To Break SARS Transmission

22 Mar 2003

Situation Update

As at 22 March 03, a total of 44 people with SARS have been reported to the Ministry of Health. The 5 additional patients reported today comprise 4 hospital staff and 1 close contact of a patient. Three patients have been discharged from hospital. The other 41 patients are still in hospital. All the patients are stable except for 8 patients who are in serious condition.

To date, apart from the 3 initial people who had travelled to Hong Kong, a total of 20 family, friends and those who had close contacts with the cases, and 21 hospital staff have been diagnosed with SARS. So far, all the cases of SARS have been linked to the initial 3 cases. No new index cases have been reported. In addition, no further cases have occurred among hospital staff as a result of infection from known or suspected cases of SARS after the implementation of enhanced infection control precautions.

Enhanced Precautionary Measures

Though the SARS situation in Singapore is contained, the Ministry of Health is stepping up precautionary measures to cut off secondary transmission especially among hospital staff and reduce risk of any community spread. These include:

A) Centralising all suspected and probable SARS cases

At present, the vast majority of suspect and probable cases of SARS are being isolated and treated in TTSH and CDC. As these cases require isolation facilities for up to 2-3 weeks, the initial provisions made by TTSH and CDC to handle these cases are becoming fully utilised. At the same time, TTSH is continuing to carry its normal hospital load of clinical care and this is stretching staff and other resources.

In view of these considerations, the decision has been made to continue to manage all suspected and probable cases, including pediatric cases, centrally at Tan Tock Seng Hospital (TTSH) and the Centre for Communicable Diseases. This will facilitate the management of these patients and reduce the risk of secondary transmission of the disease. To free up TTSH's resources to isolate and treat all SARS cases, TTSH will not admit new patients for the next 2 weeks. As such, ambulance cases will be diverted to other hospitals and the public will be advised to seek A&E care at other hospitals. TTSH will also scale down its Specialist Outpatient Clinics activities over the next 2 weeks. TTSH has also cancelled elective surgeries which might require ICU wards.

B) Added protection measures for hospital staff

No further cases have occurred among hospital staff from infection from recognised cases after we have implemented enhanced precautions and control measures. However, we are not taking any chances with any possible unrecognised cases. TTSH and CDC will be instituting tighter measures to break the cycle of transmission among hospital staff. These include physically cordoning off areas in TTSH which manage suspected or probable SARS patients. Entry of staff and relatives will be closely controlled. There will also be an exclusive set of hospital staff dealing with SARS patients and they will not perform outpatient clinics and other inpatient jobs.

As an added protective measure, hospital staff in open wards in TTSH and not treating SARS patients will also observe enhanced infection control measures. These include wearing masks, gloves and gowns.

Existing non-SARS patients in TTSH

Existing patients who are currently being treated as inpatients will continue to be managed there. There should be no cause of concern for these patients, as they will continue to be kept physically separate from SARS patients who will be under isolation.

C) Precautionary measures for School Children

Schools and pre-schools will reopen on 24 March. The Ministry of Health and the Ministry of Education have assessed that there is no need to extend the school break. The spread of SARS is still confined to family and friends, and hospital staff who have had close contacts with infected patients. As an added precautionary measure, the children of contacts of known cases will be asked to stay away from school for another week. This is to prevent any community spread.

MOH is also working closely with the Ministry of Education and the Ministry of Community Development and Sports to step up vigilance in schools, preschools and child care centres. Children who have fever will be asked to seek medical attention and to return to school only when they are well.

MOH would like to appeal to all parents whose children have been to Hong Kong, Guangdong province in China or Hanoi to closely monitor their children. They should not be sent to school if they have fever and should be seen by a doctor immediately. All schools and pre-schools have been advised through the Ministry of Education and Ministry of Community Development and Sports to look out for children who are unwell with fever and have been to the affected areas. Such children will be immediately isolated and their parents contacted to bring them to seek medical attention.

D) Pay Heed to Travel Advisory and symptoms

The public should continue to avoid travel to Hong Kong, Hanoi and Guangdong province in China for the time being, unless absolutely necessary. This would help us greatly in our efforts to contain the number of new cases.

We also advise you to stay calm and continue with your daily routine. Though SARS is infectious, there is no need for alarm as your risk of catching SARS is low. WHO has reported that the disease is spread from person to person but only through close contact with an infected person. There is no evidence to date that the disease spreads through casual contact.

The Ministry would like to reiterate that you should seek immediate medical attention if you have:

- Fever (more than 38 degree celsius) and respiratory symptoms including cough, shortness of breath or breathing difficulty;

AND

- have travelled to Hong Kong, Hanoi or Guangdong province in China, within 2 weeks of onset of the symptoms; or

- are a close contact of persons diagnosed with SARS. (Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS)

Unless you have the above symptoms AND a similar travel history or personal contact with infected persons, the Ministry urges the public to seek the advice of a GP first and not go to the Communicable Disease Centre to avoid bogging down its resources.

Related links:

Factsheets:

(a) Measures Taken To Control the Outbreak in Singapore

(b) About Severe Acute Respiratory Syndrome (SARS)

(c) Frequently Asked Questions on SARS