Update On SARS - 16 Apr

16 Apr 2003

Situation Update

As at 16 April 2003, 6 additional SAR patient has been discharged, bringing the total number of patients who have recovered from SARS to 91. 61 SARS patients remain hospitalised.

There are 5 additional SARS cases reported today. They comprise two staff of National Cancer Centre (NCC), namely a radiographer who had been admitted to TTSH since 9 April for observation and a porter who was admitted to TTSH on 14 April. Both patients developed lung changes on chest X-ray yesterday and hence were diagnosed to have SARS. The third SARS case is an inpatient at SGH Ward 58 who has been observed in TTSH since 13 April, and who developed lung changes yesterday. The other two cases comprise the son of a SARS patient and a doctor at NUH who looked after two patients prior to their diagnosis of SARS.

Situation Update at NCC

There are two NCC staff who have been diagnosed as probable SARS.

The radiographer developed a fever (37.8 deg) on his day off on Saturday 5th April. He did not see a doctor. He was well with no fever on the next three days (6/4 to 8/4). He worked in the radiology department of NCC on 7 April and 8 April. Twice daily temperature monitoring was performed each day and he was noted to have no fever. During these 2 days, he performed CT scans and MRI on a total of 11 patients.

In the early hours of 9th April, he developed fever of 38.4 deg C. He went to CGH and was transferred to TTSH on the same day. On admission he was classified as "low risk suspect for SARS". CGH observed all the infection control measures when the patient was there.

Another hospital staff (porter), who handles despatch work, developed a low grade fever (37.5 deg) on Thursday 10th April morning. He was not assigned any duties and during that time he only came into contact with the departmental staff. At noon, his temperature went up to 38.6 deg. He was seen at the SGH Staff Clinic and was given 2 days MC and asked to return for a review on 12th April.

He had no fever on 11th April. He did not return to the Staff Clinic on 12/4 and instead saw his neighbourhood GP. He was given 2 more days MC. He continued to have low grade temperature. On 14th April, he went directly to the Staff Clinic and was referred to TTSH and admitted on the same day.

Besides these two staff, the other NCC staff are currently well. As a precaution, NCC has closed its radiology department till 20 April. Urgent radiological x-rays will be done at SGH A&E Dept. Non-urgent appointments will be deferred. NCC has contacted 10 of the 11 patients who had X-ray investigations done by the radiographer and they are well. Although the radiographer did not go into the waiting room of the X-ray department, as a precaution, NCC has been contacting the 200 patients who have had other X-rays done during the period 7 - 9 April. Investigations are still in progress to trace the source of infection.

Situation Update at NUH

The doctor attended to a patient who was being treated for heart failure. The patient, who was admitted to NUH on 8 April, had been a visitor at SGH Ward 57 in end March. He had multiple medical conditions and did not have fever at that time. When he was reviewed in the ward, the possibility of concurrent pneumonia was recognised as his condition had deteriorated. The patient was unstable and required transfer to the NUH Intensive Care Unit where he was intubated. The transfer to TTSH took place later on the same day when the patient's condition stabilised. The patient had since passed away on 12 April 2003.

The NUH doctor developed fever on 11 April 2003 evening and was sent to TTSH Emergency Department on the same day. She has been diagnosed as a probable SARS case today, 16 April 2003.

Meeting with Malaysian Counterparts on SARS

Health and immigration officials from Singapore and Malaysia met this morning. The Singapore delegation led by Mr Moses Lee, Permanent Secretary (Health), and Mr Tan Guong Ching, Permanent Secretary (Home Affairs), comprised officers from the Ministry of Health and the Immigration and Checkpoints Authority as well as other officials.

At the meeting, the Singapore and Malaysian officials discussed and agreed on the need for the 2 countries to exchange medical information on SARS in a comprehensive, accurate and timely manner. The areas covered include epidemiological and clinical features, public health measures and infection control practices, and facilitating contact tracing arising from citizens and foreigners from one country being infected in the other. The exchange of information will allow the 2 countries to better understand and prevent transmission of the disease

Besides, the officials also discussed areas of cooperation at the land checkpoints to contain the spread of SARS virus. These include the implementation of Health Declaration Cards for travellers and the introduction of health screening including temperature checks of travellers arriving by land and rail. The meeting agreed to form a working group comprising health, immigration and other officials from both countries to discuss the issue in greater details. The group will meet in Johor Bahru next week.

Home Quarantine for non-SARS patients with chronic conditions discharged from SGH and TTSH

Contact tracing at SGH has identified the patients and healthcare workers who may have been exposed to SARS. These contacts have been quarantined or are being monitored. There are about 800 inpatients at present in SGH who have not been exposed. However, as a precaution, patients discharged from SGH from tomorrow onwards who have chronic co-morbid conditions will be issued HQO for 10 days. At end of 10 days, SGH will recall them for review, following which they will be on phone surveillance for a further 10 days. The other discharged patients who do not have any chronic conditions will not be on HQO but phone surveillance for 21 days. The same arrangement will be implemented for non-SARS patients with chronic conditions discharged from TTSH.

Health screening for incoming air and sea passengers

Between 4 pm yesterday to 4 pm today, there were 26 passengers from affected areas who required further screening by the nurses at the airport. A male passenger from Guangdong admitted for observation at TTSH. Between 4 pm yesterday to 4 pm today, there were no incoming passengers who required further screening by the nurses at the ferry terminals.

Summary of SARS cases

There was a SARS patient in intensive care who died late yesterday. She was the mother of a doctor who contracted SARS while looking after a SARS patient. The other deceased is the mother of a SARS patient. On 13th April, we reported two SARS deaths linked to the SGH cluster comprising an inpatient and the brother of an index patient. The preliminary findings of both patients were that they died of other medical conditions unrelated to SARS. We are awaiting results of further investigations.

Below is the summary of the SARS cases to date:

Number Discharged: 85 plus 6

Hospitalised: 61 (including 16 in intensive care)

Deaths: 13 + 2 (pending post mortem findings)

Total: 167

Suspected: 91 (including 8 children below 18)

Under home quarantine orders: 582

Updated 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 - Beijing, Shanxi, Hanoi and Toronto, unless absolutely necessary.