120130 the sars experience
TRANSCRIPT
The SARS Experience
From Global, Public Healthcare
Policy and Communication
perspectives
Annita Mau
30 January 2012
A long holiday (a few months before summer
2003)?
Special Administrative Region = Hong Kong
SAR
Severe Acute Respiratory Syndrome
What is SARS to u?
The family of the 774 fatalities all over the
world?
The family of the 299 fatalities in HK?
The 8096 people infected all over the world?
The 1755 people infected in HK?
What is SARS to…
As a Chief Public Affairs Manager in the
Hospital Authority working among front line
healthcare workers, mass media, general public,
key opinion leaders, government, clinicians,
patients, management …
It is a trauma
What is SARS to me…
What SARS is to me is not important
What SARS is to HK Government, and
Governments all over the world, and World
Health Organization (WHO) is
What SARS is to public healthcare system is
Why?
We don’t want to repeat our mistakes
But…
Major events from end 2002 to July 2003
Lessons learnt
We will go through
16 Nov 2002
45 year old man in Foshan City, Guangdong (GD) becomes ill, with fever and respiratory symptoms, retrospectively identified as the first SARS case
Nov 2002 to Jan 2003
numerous flu cases in GD ~~~rumours start to spread
20 Jan 2003
GD CDC invites China CDC to provide guidance
30 Jan 2003
Mr ZZF, 44, hospitalised in GZ, passes on the virus to 50 hospital staff and 19 relatives
Chronology
11 Feb
GD health authorities report an outbreak of atypical pneumonia that has sickened 305 people
11 Feb
Hong Kong Department of Health (DOH) closely monitors the situation, finds no unusual pattern of flu-like illness. A working group is formed to step up surveillance and advise on pneumonia cases
14 Feb
Ministry of Health of China informs WHO that the GD outbreak is coming under control
21 Feb
index case Prof LJL of the Metropole Hotel
outbreak arrives from GD, an international
spread of virus begins, hospitalised 22 Feb
26 Feb to 2 Mar
index cases hospitalised in Hanoi, Singapore,
Beijing
4 March
index case Mr CT of outbreak at Prince of
Wales Hospital (PWH) hospitalised
10 March
outbreak at PWH begins
12 Mar
WHO issues first global alert about cases of atypical pneumonia
19 Mar
link to the Metropole Hotel is identified
22 Mar
Amoy Garden index case hospitalised
22 Mar
Coronavirus is identified as possible cause of SARS by the University of HK
27 Mar
DOH legislates SARS as a statutory notifiable disease by revising the Quarantine and Prevention of Disease Ordinance
31 Mar
Amoy Garden residents (109 hospitalised)
quarantined under DOH’s exceptional order to
isolate all residents of Block E for 10 days
1 Apr
Amoy Garden residents evacuated
2 Apr
WHO issues travel advisory for HK and
GD: postponing all but essential travel
(most stringent travel advisory in 55-year
history)
3 Apr HK
Government announces school suspensions
7 Apr
WHO reports three types of tests for SARS
10 Apr
HK Government announces home quarantine of household contacts of SARS patients
11 Apr
HK Government announces close contacts of SARS patients bared from leaving HK during quarantine period
16 Apr
WHO confirms that a new form of
coronavirus is the cause of SARS which is
officially named SARS-CoV
16 Apr
a WHO team in Beijing, China attends a media briefing, the media are frustrated by the lack of information from the Government amid fears of a larger outbreak in Beijing
20 Apr
Chinese officials (Health Minister Zhang Wenkang and Beijing Major Meng Xuenong) are fired for downplaying SARS
Beijing starts more accurate daily reporting of cases, and reports 295 previously unreported cases.
16 May
The Health Minister of Taiwan and Director of Taiwan CDC resign over criticism of its handling of the SARS outbreak
21 May
Singapore devotes a TV channel exclusively to news on SARS
23 May
WHO remove its travel advisory for HK and GD which have successfully contained SARS outbreak
23 June HK is declared SARS free
July
HK Secretary for Health, Welfare and Food and
the Chairman of the Hospital Authority resign
Does the story end there?
What did we learn from SARS?
SARS was the first emerging disease of the age
of globalisation
Before time of international travel, it would
probably have remained as a localised problem
Virus travelled around the world on passenger
jets make the disease one of the 21st century
Prompt and clear travel guidance is needed
Public health is a serious business
People and products travel vast distances in an instant, threats to health, whether real or imagined, can be economically disastrous
A clearly reasoned, well planned, and effectively managed and publicised response to such threats is important in mitigating the damage to the economy, and public confidence in Government
Risk communication policy, strategy and tactics
have to be in place and reviewed all the time
SARS: new disease, unknown virus, no treatment
New virus and disease can be found again
Impact on public policy
In health
Training and expertise in barrier nursing and
hospital infection control are deficient
Building of infection control facilities
Healthcare workers, management, and policy
makers have to stay alert
Food trade, animal husbandry and market
practices
Central culling
Environmental consideration and measures
Air flow, wind direction, sewage
Partnerships worked, but the partners need to
clarify and agree on their relative roles
Governments: legislation, drastic and decisive
measures
Country CDC’s collaboration with WHO
Human rights issues must be attended to
There should be international standards for
the carefully considered use of
countermeasures against communicable
diseases, such as accessing police databases
and imposing quarantine, community
surveillance
Transparency is the best policy
Diseases do not observe international borders
World community expects accurate, complete, and timely information
We expect government to provide transparent, up-to-date information about communicable diseases that may threaten our communities
Governments are held accountable, internationally and nationally for failures in conveying straightforward, reliable information
The mass media play a critical role in public health emergencies
4000 article daily in English
WHO headquarters in Geneva assigned skillful media officers
Besides regular briefings, more proactive, systemic, and thoughtful dealings with the press and general public might have resulted in a better informed and less panic public
Emails
Web pages: kept the world informed, offered advice
International laboratory experts grouped their expertise in a virtual network to decode the virus’s secrets
Tracing households by electronic means:
6 Apr 2003 HK Police used its sophisticated Major Incident Investigation and Disaster Support System (MIIDSS) to assist the DOH
8 Apr e-SARS was launched = enhanced the swiftness and capacity of case investigation and contact tracing, reducing further spread of infection
Modern ally: Internet and ICT
Intelligence: rumours
SARS has the political, social and economic dimensions
Mission of safeguarding public health has to be balanced against the genuine interests of Member States
It has to work with Member States to share information and to find common ground in a situation that was new to all
The possible impact of travel advisories on the economies of affected areas and on the morale of people living there was one of the most difficult issues of the SARS experience
For WHO
Public health around the world has entered an
era where it need to be on constant guard
against threats from emerging diseases
Risk communication is about public perception,
people’s concerns, emotion, and confidence
Conclusion
“It was a challenge, I didn’t know a lot about
communicable diseases, but the truth is that none of
us --- the experts included knew much about SARS.
So we learnt together: how the virus was spreading,
how to spot it, and how to stop it. It was a long way
from what I had been hired to do, but, like everyone
else on the team, I found it experience of a lifetime.”
--- by Peter Cordingley, Head of Media Team of WHO Regional
Office in Manila
Websites of HK Government, WHO
Publications of WHO
Reference
