Update On SARS - 13 Apr

13 Apr 2003

Situation Update

As at 13 April 03, 81 SARS patients have been discharged. 58 SARS patients remain hospitalised.

There were 4 additional SARS cases reported today, 3 of whom are linked to the SGH cluster comprising a hospital staff and 2 visitors. The last case is the resident of the Orange Valley Nursing Home whose death as been reclassified as SARS. There were 2 deaths yesterday both linked to the SGH cluster comprising a visitor and an inpatient.

Situation Update at SGH

So far, 60 persons are linked to the SGH cluster, comprising 30 probable and 30 suspect SARS cases. They comprise 28 SGH staff, 12 inpatients and 20 contacts.

Four staff from SGH Urology Outpatient Centre and a visitor who was at the SGH Diagnostic Radiology Barium Investigation corridor were admitted to TTSH over the weekend. These two areas are adjacent and connected to each other. The visitor and a staff are probable cases. The other 3 staff are suspects.

Investigations showed that these cases can be traced back to the same Chinese man in his 60s who started the cluster at Wards 57 and 58.

Two of the urology staff are healthcare assistants in the Urology Outpatient Centre. One of them, a new employee, started work on 1 April 03 and became symptomatic on 4 April 03. The other was her supervisor and she became ill on 7 April 03. The other 2 urology staff are staff nurses.

The visitor to the Radiology Department was at the Department when the 'index' case was there for a procedure. He became ill on 9 April 03.

Additional Precautionary Measures from 12 April 2003

Active contact tracing of 110 staff who work in the urology and the radiology barium investigation corridor was started immediately and has been completed. Contact tracing of patients who may have been exposed is in progress.

The Urology Outpatient Centre has been closed and will remain so until 18 April 03. As an added precaution, the Urology ward (Ward 55B), has been isolated. 12 patients who were in the ward at the time have been isolated in 12 rooms. A "No Visitors" rule has been enforced at the ward.

The Radiology Barium investigation corridor which was affected has also been closed. In addition, the Radiology archives are closed.

Altogether 120 staff have been put on hospital enforced quarantine. This includes doctors from the Department of Urology.

All inpatients will now have their movement and contact history logged. All visitors to the Hospital will be registered at each visit location.

Cluster around the resident of Orange Valley Nursing Home

A 90 year old Chinese lady was discharged from TTSH to the Orange Valley Nursing Home on 23 March 03. She had been admitted to TTSH since 8 March 03 for non-SARS related condition. When the patient was in TTSH, she was in the same ward for a day as a patient who was later diagnosed as a SARS case. On 25 March 03, she became unwell and was admitted to the Changi General Hospital (CGH) Ward 18 and died of pneumonia on 30 March 03.

The 24 year old Fillipino nurse from the nursing home who had been attending to this lady was admitted to CGH on 4 April 03 for pneumonia and transferred to TTSH on 6 April 03 for probable SARS. A 57 year old CGH health attendant who had attended to the old Chinese lady was admitted to CGH on 10 April 03 and transferred to TTSH on 11 April 03 as a probable SARS case. They are both currently in intensive care.

The deceased lady's daughter-in-law who had visited her several times at the nursing home and CGH was admitted to TTSH on 7 April 03 for SARS. She is also in intensive care. A relative of hers and her son, a secondary student of Zhonghua Secondary were also admitted to TTSH on 8 and 9 April 03 respectively. They are both in stable condition.

In view of the epidemiological evidence that persons who had close contact with the old lady have been diagnosed with SARS, the cause of death for this lady has been reclassified as SARS.

Situation Update at CGH

Besides the 57 year old CGH healthcare attendant who was exposed to the 90 year old Chinese lady when she was in CGH, there has been no other cases reported in CGH. The hospital is now contacting 35 patients who could possibly be exposed to the healthcare worker at Ward 18.

The two nurses who was exposed to a patient who has not been diagnosed as a SARs patient then were transferred to TTSH on 5 and 6 April 03. They are in stable condition. The hospital has contacted 53 out of 59 patients who were possibly exposed to them. These are patients warded at Ward 15 on 29 & 30 Mar 03 and Ward 28 on 3 Apr 03. They are well. CGH is still trying to get in touch with 6 patients who remain uncontactable still.

Update on Super Star Virgo

Cruise ship Superstar Virgo arrived in Singapore on 9 Apr 03 at 1900hrs with 625 passengers and 1,354 crew onboard.

An Indian crewmember was examined by the vessel doctor and found to have high fever. The MPA and Port Health Office were later notified. ICA activated the ambulance to send the unwell crewmember to TTSH at 2015hrs. After examination, he was admitted as a SARS suspect at TTSH.

Nurses were deployed to do visual screening of all passengers and crew who disembarked from the vessel and none were found to be unwell. All were required to fill up the Health Declaration Cards (HDC), which were collected by the ICA officers.

The ship left Singapore for Port Klang on 9 Apr 03 at 2330hrs. The vessel had 188 transit passengers from the previous sailing, 677 new passengers and 1,353 crewmembers when it left.

In view of the SARS suspect case, it was decided that additional precautions were to be taken when the ship returned to Singapore on 11 Apr 03. The ship?s doctor was to take the temperature of the 125 transit passengers (63 of the 188 transit passengers had disembarked at Port Klang), and declare their temperature readings before passengers were allowed to disembark in Singapore. Star Cruises would also suspend crew shore leave and disallow its crew to disembark.

Superstar Virgo returned to Singapore on 11 Apr 03 at 1345hrs. Based on the temperature readings submitted by the ship?s doctor, none of the 125 transit passengers had a fever. All the transit passengers and new passengers were thus allowed to disembark and underwent visual screening by nurses when they did so. No one was found to be unwell. All filled in health declaration cards and these were submitted to ICA Officers.

The Indian crewmember, who was warded to TTSH as a SARS suspect case, is expected to be discharged tomorrow as he is no longer feverish.

Superstar Virgo is scheduled to depart Singapore at 2230 hrs on 13 Apr 03.

In preparation for its next sailing, the vessel left its anchorage at 0700hrs on 13 Apr 03 and arrived at the Singapore Cruise Centre (SCC) at 0800hrs. About 309 crew are to be repatriated, subject to temperature checks and confirmation that they are well. Star Cruises has a medical doctor onboard the vessel to conduct the necessary medical checks. Once cleared, these crewmembers are to be taken straight to the airport for their flight home. As of 1700hrs, a total of 82 crewmembers have been repatriated after they were confirmed to be well and fit for travel. The repatriation of the crewmembers is expected to complete at 0115hrs, 14 Apr 03.

Health screening for incoming air passengers

Between 4 pm yesterday to 4 pm today, there were 35 passengers from affected areas who required further screening by the nurses at the airport. None were sent to TTSH for further assessment.

Summary of SARS cases

Below is the summary of the SARS cases to date:

Discharged: 81

Hospitalised: 58

Intensive care: 16

Deaths: 10 + 2 (pending post mortem findings)

Total: 151

Suspected: 87 (including 2 children)

Under home quarantine orders: 608

Travel advisory

MOH urges the public to heed World Health Organisation (WHO)'s advice to postpone travel to Hong Kong and Guangdong until another time. We would also like to advise the public to avoid travel to other SARS affected areas - Shanxi, Taiwan, Hanoi and Toronto, unless absolutely necessary.