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Following is the speech by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, at the technical briefing session on severe acute respiratory syndrome (SARS) of the 56th World Health Assembly in Geneva today (May 20):
Director General Dr Brundtland, Executive Director Dr David Heymann, Regional Director Dr Shigeru Omi, Honorable Ministers,
On behalf of the people of Hong Kong, I would firstly like to express our sincere appreciation to the World Health Organisation (WHO), and member countries, for providing to us valuable advice and kind assistance during the challenging period of the SARS epidemic. Hong Kong has benefited enormously from your input, and I would like to take this opportunity to share with you the nature of the epidemic in Hong Kong and our experience in getting the outbreak under control.
Present Position
Hong Kong had its first reported SARS case in healthcare workers in early March. It was our notification that first led WHO to issue the global alert of atypical pneumonia two days later. However, as the disease was totally unknown at the time, and despite the general preventive measures that have been implemented, Hong Kong still, regrettably, took the full brunt of this ferocious SARS epidemic.
The initial outbreak, in a teaching hospital, was amplified by the use of nebuliser treatment on the index patient whose existence was not known until the outbreak became well established. Many health care workers became exposed through this aerosolised means. The spread to the community in the Amoy Gardens residential complex subsequently was exacerbated by a unique set of environmental circumstances that involved amongst other things a dry U trap, powerful exhaust fan and small bathroom space.
Through all these events, we had to learn fast and generate new knowledge as the outbreak unfolds. The body of new knowledge on SARS has been produced at an incredible speed, thanks to the hard work of our front line workers and others. There are two major factors which are critical in determining the magnitude and type of an outbreak. We now know that SARS virus is present not only in droplets but in all body fluid. It is spread not only by respiratory droplets through close distance contact; environmental routes contaminated by body fluids or faecal materials containing SARS virus from affected patients are also important. Such new knowledge has helped shape our preventive efforts, focusing on personal hygiene and environmental decontamination.
As at yesterday (May 19), we had a total of 1,714 confirmed cases. Of these, 71 per cent or 1,213 patients have recovered and been discharged from hospital. We have had 251 deaths. The remaining 187 and 63 patients are receiving treatment and convalescing in hospitals respectively.
For the past four weeks, there has been a steady and consistent decline in the number of new cases. Since May 4, the daily reported cases have been in the single digit territory, and since May 11, Hong Kong has more than achieved the WHO target of having an average of five new cases per day.
Government Strategies
To bring the outbreak under control, the Hong Kong Government has adopted a four-pronged strategy, centred on "early detection, swift contact tracing, prompt isolation and quarantine, and effective containment". The strategy has the effects of shortening the interval between onset of symptoms and admission to hospital, limiting the infectious period of the SARS cases, and preventing further spread of the disease.
Early Detection
Early detection is a key corner stone of infectious diseases control. It leads not only to prompt treatment, but also swift contact tracing. The Hong Kong Government therefore has implemented a comprehensive public education programme to heighten awareness of SARS symptoms, to bring about early presentation of cases to medical facilities.
Swift Contact Tracing
To achieve the aim of tracing contacts swiftly, we have made extensive use of modern technology. An on-line e-SARS database has been developed during the outbreak, linking all 14 public hospitals admitting suspected SARS patients with the Department of Health. This provides real time information of SARS patients to enable our public health nurses to carry out prompt case investigation and rapid contact tracing.
The work of contact tracing has also been considerably strengthened using the highly sophisticated computer system of the police, called the Major Incident Investigation and Disaster Support System, or MIIDSS in short. The system allows SARS investigators to validate addresses, map out the geographical distribution, reveal potential sources or routes of spread, and show the connectivity, or otherwise, between cases and contacts.
Prompt Isolation and Quarantine
Using information that is accurate and transmitted on-line, contacts of SARS patients can be identified swiftly, and actions of home quarantine and medical surveillance of up to 10 days implemented rapidly. In Hong Kong, we take extra step to prohibit SARS contacts from leaving the territory during the 10-day incubation period. We also deploy our public health nurses to monitor the health conditions of these contacts to ensure early presentation if they develop SARS symptoms, further enabling those infected to be given early treatment, and importantly, preventing them from spreading SARS to others.
Our measures have already produced results. As at May 18, a total of 1,185 persons from 467 households had been served home quarantine notice, with 23 of them subsequently found to have SARS.
Effective Containment
Multi-Disciplinary Response Teams
To contain SARS effectively, we have established multi-disciplinary response teams comprising experts in public health, building management and environmental hygiene. These response teams undertake the dual functions of investigating the cases and their environment, as well as carrying out remedial actions of environmental decontamination and pest control in hotspots or buildings with the potential of an outbreak.
Protection of healthcare workers
In the battle against SARS, protection of healthcare workers remains a key priority of the Government. Our hospital staff are provided with training in infection control before being deployed to high-risk areas, with the appropriate set of protective gear. In the control of hospital infection, environmental factors have also been found to be important, resulting in ventilation systems in the hospitals being improved. To minimise the risk of the disease spreading from the hospital to the community, no visitor is allowed in SARS wards, and visits to non SARS wards are strictly controlled and limited.
Health Checks at Border Points
As an international city, we are very conscious of our international obligation of not exporting any SARS cases to anywhere in the world. We have therefore devoted all resources at our disposal to achieving this end.
Apart from setting up medical posts at all border points to watch for travellers displaying symptoms of the disease, all incoming passengers have been required to complete a health declaration since mid-March. In mid April, we also instituted temperature checks for all departing, arriving and transiting passengers at the airport. The temperature measure has since been extended to all border points by land, rail and sea. By end of May, we will have installed approximately 300 infrared temperature scanning devices at all our border points.
Since the implementation of the above health checking measures, 79 persons had been referred to hospitals for suspected SARS as at May 18, of whom two were later confirmed to have SARS.
Concluding Remarks
Ladies & gentlemen, the stringent control measures that the Hong Kong Government has implemented have proved to be effective. Our daily reported cases have been on a steady downward trend. The daily figure has been in the single digit territory since May 4. There is also evidence that our contact tracings have been thorough and of good quality: 91 per cent of our SARS cases can be linked to a known source of exposure. Of those whose exposure cannot be determined, serology results show that more than half were negative for coronavirus, demonstrating our measures have been effective in managing the SARS epidemic.
Nevertheless, the outbreak has placed Hong Kong under tremendous stress. But we have been coping. This is because we have a team of dedicated healthcare workers, who demonstrate world class professionalism and who make selfless sacrifice to ensure our city is safe to all. We are also fortunate to have an understanding and co-operative public, who have stood behind us in our fight against the disease despite considerable inconvenience. Last but not least is the determination of the Government in taking difficult decision to implement the necessary public health and infection control measures. Our efforts have been backed up by an unprecedented level of resources and expertise being made available to contain the spread and to control the outbreak.
In getting the SARS epidemic under control, I am grateful to WHO's leadership in Geneva under Dr Brundtland and the Western Pacific region through Dr Omi's office for their support, guidance and help. I am also indebted to the Mainland authorities in China, nearby countries and other international bodies for their close co-operation and collaboration in tackling this outbreak.
Thank you very much.
End/Tuesday, May 20, 2003
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