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The most important lesson from the SARS (severe acute respiratory syndrome) experience is the need to be prepared, the SARS Expert Committee Report said.
The overall conclusion of the Committee was that Hong Kong had handled the epidemic well although there were significant shortcomings in the system during the early phase of the epidemic.
The report was submitted to the Chief Executive, Mr Tung Chee Hwa, this morning (October 2) by the co-chairpersons of the Committee, Sir Cyril Chantler and Professor Sian Griffiths. The full report and its summary report were released simultaneously to the public. They are accessible on the Committee's website at www.sars-expertcom.gov.hk.
The Committee with 11 renowned experts from the UK, US, Australia, Mainland China and Hong Kong selected for their wide range of relevant experience was set up on May 28.
It was tasked to conduct a review on the management and control of the epidemic and identify lessons to be learned to better prepare Hong Kong for any future outbreaks.
In its report, the Committee commended the people of Hong Kong for the courage and dignity that they had shown during the SARS epidemic, and expressed members' sympathy for those who had suffered from the epidemic.
Speaking on the report, Sir Cyril said the Committee had undertaken a full and comprehensive review.
"We have conducted a lot of interviews and met wide variety of people from different backgrounds who had been involved in or affected by the epidemic, and we have had extensive discussions to arrive at the conclusions based on the facts that we have found and established.
"Where appropriate, additional information and clarification has been obtained, and the relevant authorities and persons have been given the opportunity to respond.
"The findings and recommendations contained in the Report represent the collective opinions and judgements of members of the Committee alone.
"The intention of every member of the Committee has been, and continues to be, to do his or her best for the people of Hong Kong.
"We have examined issues most relevant to the terms of reference of the Committee from the perspectives of public health, disease control, contingency planning, outbreak control mechanism and actions, as well as system designs to critically and professionally assess whether the Administration, the health authorities and the hospital management had properly discharged their duties and functions under the very difficult situations at that time," Sir Cyril said.
Sharing Sir Cyril's view, Prof Griffiths said that in reaching judgements, full account had been taken of the hazards of retrospective judgement, and therefore efforts had been made by the Committee in each instance to examine the subject matter in the context of what was known, and what could have been done, at the time.
"There were significant shortcomings of system performance during the early phase of the epidemic when little was known about the disease or its cause, some of which were aggravated by key personnel becoming ill with SARS as the epidemic progressed.
"Many shortcomings were rapidly put right, while others were compensated for by the extraordinary hard work of people at all levels of the system and in very difficult circumstances.
"The Committee has not found any individual deemed to be culpable of negligence, lack of diligence or maladministration.
"Looking backward through retrospective analysis, the Committee has identified things that could have been done better, and areas in which further improvement should be made.
"Looking forward, the Committee comes up with a total of 46 recommendations under 12 strategic themes to better prepare Hong Kong should an emergency or crisis stroke," Prof Griffiths said. (Details of these recommendations can be picked up from Chapter 18 of the full report.) (PDF format)
In general, the report noted the SARS experience had helped to identify a number of positive lessons as well as highlighting a number of challenges for future preparedness.
It stated: "The underlying concept is that of resilience, i.e., the ability at every level of the system to detect, prevent, control and recover from disruptive challenges. It depends on a well planned, carefully orchestrated and fully integrated emergency management response."
The report recommended that the organisational structure and the relationship between the Health, Welfare and Food Bureau (HWFB) and the constituent Government departments under the Bureau should be reviewed with a view to improving the capacity for coordination, and facilitating policy making and commissioning for health protection matters.
Specifically, it recommended the setting up of a Centre for Health Protection (CHP) with responsibility, authority and accountability for the prevention and control of communicable diseases. As it develops, the CHP should also have responsibility for advising on all aspects of health protection, including food safety and hygiene, veterinary issues, non-communicable diseases and their risk factors etc.
The report stressed that strengthening surveillance would be an urgent priority to provide early warning to the system. It also pointed out that an important gap in the system was the absence of comprehensive laboratory surveillance.
"There needs to be a high level of vigilance and alertness throughout all parts of the health system. This requires a culture where everyone recognises that their work, whether in primary care or hospital care, may have wider public health implications, and that an illness in one patient may have consequences for the whole community," the report said.
While noting the success of advanced information technology applications -- e-SARS and MIIDSS (Major Incident Investigation & Disaster Support System) - developed during the epidemic, the report said investment should be made in order that the technology is harnessed to better prepare the Department of Health (DH)/CHP to meet the challenges of future outbreaks.
It also recommended that efforts should be made to ensure that all laboratories promptly and routinely report all laboratory diagnosis of public health importance to DH/CHP. A more fundamental reform would be to integrate all hospital microbiology laboratories within the new CHP.
"Establishing a CHP will deal with many of the shortcomings in public health resources, particularly the need for more communicable disease epidemiologists and public health specialists which is critical," the report said.
The report placed heavy emphasis on contingency planning which would serve as the basis for dealing with most health service and public health emergencies, including communicable disease outbreaks.
"It should be a requirement that HWFB, DH and the Hospital Authority (HA), and each regional office, cluster and hospital should develop and implement a major outbreak control plan, which specifies in detail the composition of the outbreak control team, roles and responsibilities of key individual team member and the mechanism of activating the plan."
"The plan should be developed in collaboration with CHP and adopt a population-based approach, and be regularly tested. Management of communicable disease outbreaks should be viewed as an integral part of contingency planning."
"There is also a need for site-specific plans, event or scenario specific plans, and plans that take account of the increasingly international dimension of public health incidents."
"Similar plans and arrangements should exist in the private sector and in other support agencies and organisations," the report said.
In case of a public health emergency, the report recommended that a clear chain of command would be needed for effective management as the Committee had observed that various mechanisms and bodies were established on an ad hoc basis in response to the SARS epidemic.
"These arrangements need to be clarified and formalised in preparation for any future emergency."
"A framework of command is needed to manage the response at one or more of three levels: operational; tactical and strategic. Command and control arrangements need to reflect the fact that the chain of control is normally activated from the bottom upwards."
The report recommended the establishment of a small command group, chaired by the Secretary for Health, Welfare and Food (SHWF), with a limited number of personnel, such as the Permanent Secretary, the Director of Health, the Head of CHP and the Chief Executive of HA, responsible for taking all major decisions during an outbreak.
"A suitable legislative framework is also needed to enable an appropriate public health response.
"Contingency planning cannot be carried out in isolation, but must involve close collaboration with neighbours in the Pearl River Delta region, Mainland China generally, and the international community as a whole," the report said.
In this respect, the Committee stressed the importance of international links and the need to engage with the WHO.
The report noted that inadequate surge capacity in hospitals and the public health system had clearly been a major problem with SARS.
It recommended the HA to urgently invest in improvements to hospital facilities, especially isolation rooms, and to review shortages in some clinical skills and specialty areas and make plans to redress them. The Committee endorsed Government's proposal to develop infectious disease units attached to selected acute hospitals, rather than to build a single standalone infectious disease hospital.
HA was also urged to develop detailed plans on how resources would be shared to deal with an incident that would overwhelm the capacity of any one part of the health system.
Noting that probably the group most vulnerable to infection are older people living in residential care homes, the report recommended that infection control arrangements in residential care homes for the elderly, including infection control training for staff and improving isolation facilities, should be strengthened; and that the Visiting Medical Officer scheme should be made permanent.
On communication with the public, the report noted that communicating risk to the public has never been easy, particularly in the face of an overwhelming crisis.
"It is important to build a level of trust within the community by ensuring that professionals with appropriate expertise and seniority are properly trained in dealing with the media, that long-term partnerships are built with the media and that they are involved in the contingency planning process, and that there is an on going programme of public education on public health issues," the report said.
The Committee also noted the contribution of the media in the SARS outbreak and suggested that the media should have a responsibility of communicating risk.
It also offered observations and comments on several key issues that were prominent and about which concern or dissatisfaction was expressed in the Committee's discussion with various parties. (Details of these can be found on Chapter 4 of the full report.) (PDF format)
The Committee had formed two groups to focus on hospital management and administration, and public health. The hospital group convened its meeting on June 26-28 while the public health group had its meeting on July 7-11. The Committee held its plenary session on August 13-19.
End/Thursday, October 2, 2003
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