Update (XI) On SARS Cases In Singapore

24 Mar 2003

As at 24 March 03, a total of 65 people with SARS have been reported to the Ministry of Health (MOH). The 14 additional patients reported today comprise 4 hospital staff and 10 close contacts of patients. Among the close contacts are three siblings (two boys and one girl) aged 17, 13 and 5. Five patients have been discharged from hospital while the remaining 60 patients are hospitalised. All the patients are stable except for 12 patients who are in serious condition and being treated in the ICU.

Based on the detailed analysis of the 65 cases so far, the evidence is that SARS is transmitted only when a patient develops the symptoms of the illness. The incubation period is usually 3-7 days but could be up to 10 days. Epidemiological tracking of the outbreak shows that the initial 3 index cases resulted in 21 primary contacts developing probable SARS. This latter group of patients in turn have infected a further 41 cases of probable SARS. While stringent infection control measures have been instituted, their effect will only be apparent several days later, during which time we expect further increases in the numbers of SARS cases from secondary and tertiary transmission.

Since the implementation of the stringent control measures in hospitals, particularly TTSH/CDC, no new health care workers have been infected. The new cases of probable SARS involving healthcare workers are still traced back to the primary contacts.

At present, MOH/NEA officers trace contacts of cases and advise them to see a doctor in TTSH/CDC immediately if they develop fever or symptoms suggestive of SARS. In addition, the officers call the contacts every day to check on their condition. As a further step to reduce the possibility of transmission from symptomatic contacts to others in the community, MOH will be instituting home quarantine measures.

Home Quarantine Measures

MOH will be invoking the Infectious Diseases Act to isolate all contacts who have been exposed to infected SARS patients. They will be required to stay at home for 10 days and to minimise contact with other people. Those who do not heed the quarantine requirement are liable for prosecution under the Act.

During the home quarantine period, NEA officers will be checking with these contacts daily. If they develop symptoms suggestive of the illness, they will be immediately referred to CDC and TTSH for further evaluation and treatment if necessary. If they do not develop any of the symptoms of SARs after 10 days, they are unlikely to contract SARS.

There are presently more than 300 people on our contact tracing list who will be quarantined at home. These are mainly family and friends who have come into close contact with the SARS patients.

MOH will make provisions for those who experience financial difficulties arising from home quarantine.

Tighter Screening Measures in Schools

The 5-year-old boy is from the Pats School House in Lim Ah Pin Road. As a precautionary measure, the Ministry of Health has asked Pats School House to close for 10 days.

The 13 year old girl, a student at Pei Cai Secondary School had limited contact with her classmates during the school holidays. Although she was well at that time when she was with her classmates, as a precautionary measure Pei Cai Secondary School has asked about 200 students who may have come in contact with her to stay away from school for a week. The 17 year old boy did not attend school during the school holidays.

WHO has not recommended closure of all schools as cases of transmission are still confined to those who have been in close contact with infected persons.

To prevent any possible SARS outbreak in childcare centres, pre-schools and schools, the MOH, Ministry of Education, and Ministry of Community Development and Sports have tightened screening measures in these places. Any child with fever will be asked not to attend school, even though they may not have been in contact with infected persons or had not travelled to the affected areas. Nurses from the Health Promotion Board will also help to detect unwell children in childcare centres and kindergartens for early medical attention.

The Health Advisory to child care centres, kindergartens and schools is attached at Annex A.

The 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.

More stringent infection control measures at hospitals

To fully protect visitors, MOH is heeding WHO advice to stop visitations from family and friends for all SARS patients. At all other hospitals, patients with fever which may or may not be SARS will be isolated until a diagnosis is made. All discharges from TTSH from 10 Mar 03 will also be added to the contact tracing list for daily surveillance.

Travel advisory

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.

Concerned members of the public can call MOH hotline at tel: 1800-225-4122 during office hours.