Update On SARS - 22 Apr

22 Apr 2003

Situation Update

As at 22 April 2003, 6 additional SARS patients have been discharged, bringing the total number of patients who have recovered from SARS to 110. 60 SARS patients remain hospitalised, of which 19 are in intensive care.

SARS Cases

There are 2 additional SARS cases reported today.

One is a 41 year daughter of the 72-year-old man who was admitted as a suspect SARS case on 19 April 03 and who works in the Pasir Panjang Wholesale Market.

The other case is a 39-year-old inpatient of SGH Ward 57.

Update on Pasir Panjang Wholesale Market (PPWM)

To date there are 8 probable SARS cases linked to the Pasir Panjang Wholesale Market. They are as follows:

Patient 1: 64 year old man who works at the PPWM. He had visited his brother at SGH Ward 58 on 31 March 03. He became unwell on 5 April 03, was admitted to NUH on 8 April 03 and died at TTSH on 12 April 03.

Patient 2: 54-year-old taxi driver who ferried Patient 1 from his home to PPWM on 5 Apr 03. He became unwell on 14 April 03 and was admitted to TTSH on 18 April 03.

Patient 3: 45-year-old man who works at PPWM. He became unwell on 8 April 03 and was admitted to TTSH on 16 April 03.

Patient 4: 45-year-old who works at PPWM. He became unwell on 20 April 03 and was admitted on 21 April 03.

Patients 5-7: The 3 grandchildren aged 4, 8 and 9 years of a 72-year-old man who was admitted as a suspect SARS case on 19 April 03 and who works at the PPWM. The 3 children became unwell on 15 and 16 April 03 and were admitted to TTSH on 19 April 03.

Patient 8: 41 year daughter of a 72-year-old man who was admitted as a suspect SARS case on 19 April 03 and who works at the PPWM.

All the cases are in stable condition except for Patient 1 who died on 12 April 03.

In addition to the 8 probable cases, 14 suspected SARS cases linked to the market have been admitted. They comprise 8 persons with direct links to the PPWM (3 workers and 5 visitors) and 6 of their family members. Among the family members are 2 children aged 18 months and 10 years.

So far, 1,204 home quarantine orders have been issued.

The Ministry strongly urge members of the public who had been to the Pasir Panjang Wholesale Market during the period from 5 to 19 April 2003 and who have a fever or symptoms of muscle ache, cough or difficulty in breathing, to call the MOH Special Ambulance Hotline at 9-178-8477 / 9-178-8478 immediately. An ambulance will be despatched to bring them for screening at the Emergency Department, Tan Tock Seng Hospital (TTSH). The 24-hour ambulance service is free of charge.

Remember, the sooner you are screened at TTSH to exclude SARS, the better you can protect yourself, your families and other people. We appeal to the public not to use the ambulance line as a general inquiry hotline as it will clog up the service for those who need it.

KK Women's and Children's Hospital (KKH)

Update on the 16-month-old toddler admitted to KKH for severe asthma, and passed away on Tuesday, 15 April

The child had died from severe asthma and lung infection, leading to Acute Respiratory Distress Syndrome (ARDS).

Post-mortem findings confirm that this child died from ARDS. To date, tests for coronavirus are negative. A specimen taken from the child's airway showed the presence of adenovirus.

Adenovirus is not a new virus, but it is not a common respiratory virus. It is one of the causes of community-acquired pneumonia. Persons infected with the adenovirus usually have symptoms such as cough, high fever and red eye.

ARDS is also not new. KKH sees about six cases a year. The usual causes of ARDS include viral infection, severe pneumonias, near drowning and aspiration pneumonias (choking). The mortality rate for ARDS is up to 80 percent.

Siblings of 16-month-old toddler admitted to TTSH for observation

Child who shared a cubicle with toddler at KKH, admitted to TTSH for observation of pneumonia

All three children have been discharged well from TTSH. The older sibling of the toddler was also found to have adenovirus.

Management of SARS Death Cases

SARS is a new infectious disease and many of the properties of the SARS virus are unknown, especially after death.

In order to protect public health, the Ministry has used the Infectious Diseases Act to impose conditions for the handling and disposal of bodies of persons who die from SARS. However, some patients may not have the typical clinical features of SARS e.g., when the person suffers from other conditions like cancer or kidney disease. Therefore in some cases who have died from other causes, doctors may not be able to totally exclude the concomittant presence of SARS.

To safeguard public health, such cases also need to be treated as potentially infectious and the appropriate precautions taken. These precautions include double bagging of the body, placing the body in a sealed casket without embalming, and not having a wake. Cremation is to be carried out immediately after the body is prepared. In the case of Muslims or other religions that strongly oppose cremation, burial is allowed but this has to be carried out immediately.

Health Screening for Airport and Sea Passengers

Between 4 pm yesterday to 4 pm today, 1 passenger was screened at Changi Airport and the passenger was referred to TTSH. Between 4 pm yesterday to 4 pm today, there were no passengers who required further screening by the nurses at the ferry terminals.

Summary of SARS Cases

Discharged:110

Hospitalised: 60 (including 19 in intensive care)

Deaths: 14 + 2 (Pending post-mortem findings)

Total: 186

Suspected: 87 (including 5 children below 18)

Under Home Quarantine: 1,798

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 advise the public to avoid travel to other SARS affected areas - Beijing, Shanxi, Hanoi and Toronto, unless absolutely necessary.