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Following is the speech (English only) by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, on the motion of "Better contingency mechanism and preventive measures on the Severe Acute Respiratory Syndrome (SARS)" moved by the Hon Michael Mak at the Legislative Council today (October 15):
Madam President,
I would like to thank the Hon Michael Mak for moving this motion which highlights the importance and urgency of preparing Hong Kong for the possible resurgence of SARS, and for all the comments and suggestions made by other Members which will be helpful in our preparation. I can assure Members that we are vigilant and will remain vigilant in our fight against any possible resurgence of SARS.
I would like to take this opportunity to sum up what has been done so far to prepare for this possible resurgence of SARS. I would first describe our preparatory work, and then discuss how we propose to take forward the recommendations of the SARS Expert Committee Report.
Checklist of Measures
We announced in September a comprehensive strategy, presented as this Checklist of Measures, to combat SARS. The Checklist reflects the three-pronged approach adopted by the Government and I would encourage Members of this Council to actually read them: -
First, we have put in place comprehensive and cross-community disease preventive measures to guard against the resurgence of the disease;
Secondly, we have maintained a close and effective disease surveillance system; and
Thirdly, we have prepared contingency plans to deal with the possible resurgence of SARS at all levels to combat the disease swiftly and responsively.
The package of measures in this booklet covers both short term and some of the longer-term measures, which should have addressed the major concerns raised by Members at today's meeting. I do not propose to repeat them in detail but suffice it to say that these measures cover a large variety of the work in tackling SARS, which focus on quarantine and health measures in forestalling import and export of cases, strengthening the disease prevention in 17 different sectors of the community, including the educational, housing and welfare sectors, overall environmental hygiene, public education and mobilisation of various sectors of the community, strengthening and enhancing collaboration and cooperation with the Mainland and the international community, and developing different levels of contingency plans.
In this context, Members may be aware that we have formalised the notification system with our colleagues in Guangdong Province and last month, we have for the first time exchanged information on 28 infectious diseases and this occurs on a monthly basis in the future. We have also established a mechanism whereby we will be informed of any unusual diseases or outbreaks in Guangdong Province as soon as they are aware of it. I think Members need to be aware there are limitations in notification system in Mainland because in the infectious diseases ordinance in Mainland, the information needs to be provided only by the Central Government and these are some of the constraints in notification system. However, we have now overcome these barriers and the Central Government has already agreed to provide this information to us by the Guangdong Province.
Comprehensive Preventive Measures
In terms of preventive measures, our preventive measures cover a large number of sectors. I would like to just highlight some of them which have been the subject of comments by some of the Members today.
Infection Control
First, we have heightened our state of preparedness in our public hospital system. One of our most important priorities is to minimise the risk of infection by our health care workers. With the support of Honourable Members, the Government has already established the Training and Welfare Fund for the Hospital Authority (HA) in June this year for the purpose of providing infection control training to all levels and disciplines of our health care staff. Under the Fund, $130 million has been earmarked for the HA to set up an Infectious Disease Control Training Centre under the Hospital Authority Institute of Health Care and to finance various infection control training programmes. The new Training Centre is tasked to identify and develop training programmes for HA staff across all disciplines. In order to ensure that all staff will have the essential knowledge and skills in infection control, HA will provide all staff with induction training, and those staff who have daily contact with patients will be asked to attend an annual refresher course. More intensive training will be developed especially for doctors, nurses and allied health professionals. Apart from the programmes to be provided internally by the HA, we will take advantage of the training opportunities provided by tertiary institutions, health care establishments and professional bodies both locally and aboard. Between March and September, 1,860 classes were conducted to train health care workers in infection control. The Authority will also send over 800 staff each year to attend training programmes of various types and durations outside, such as clinical attachments and post-graduate diploma courses.
Personal Protection Equipment
To allay the concern of staff over the supply of personal protective equipment and as part of HA's contingency plan, HA has already built up a three-month contingency stock of all the necessary items. HA has also strengthened its network of suppliers so as to ensure a more reliable supply assuming a peak usage rate. The arrangement for distributing personal protective equipment to the cluster and hospital levels has also been reviewed. The Department of Health (DH) has also stocked adequate quantities of protective gears for the use of staff during disease outbreak.
As part of its effort to strengthen training in infection control, the Authority will step up staff education on the Authority's guidelines on the recommended personal protective equipment and on the proper use of such equipment. DH has also strengthened infection control training and organised SARS-specific courses for nurses working in DH and Food and Environmental Hygiene Department since September 2003.
Isolation Facilities in Public Hospitals
The recent SARS outbreak revealed the need to enhance and expand the isolation facilities in the public hospital system. To prepare for the possible resurgence of SARS, we have to urgently enhance the isolation facilities for handling SARS in the public hospital system. As Members are aware, on July 18, 2003, the Finance Committee of this Council approved a funding allocation of $409.6 million for carrying out conversion works in nine major public acute hospitals to provide 1,290 isolation beds which should improve infection control facilities for handling SARS.
In drawing up the detailed design of the isolation facilities, we have made reference to international standards to ensure that the appropriate infection control provisions would be incorporated. Staff have also been consulted to ensure that the new isolation facilities would be able to meet the requirements of future users. The new isolation rooms, which the Hon Mr Mak and the Hon Dr Lo had a chance to view, would have features including creation of negative pressure gradient in patient rooms, provision of 100 per cent fresh air supply, dilution of bio-load in sufficient air change rates, installation of high efficiency particulate air filters to filter out droplets and aerosols, and provision of en-suite toilet / shower facilities in ward cubicles. Infection control facilities for hospital staff, such as gowning / de-gowning areas, changing rooms, shower facilities and clinical wash-hand basins, would also be provided.
As the works involve in-situ conversion of existing wards, the Architectural Services Department and the Hospital Authority have had to overcome very considerable difficulties in expediting works progress without affecting the operations of the hospitals concerned. We expect that the first batch of approximately 900 isolation beds would be made available in the nine hospitals the end of this month and we will certainly expedite the works of the remaining 390 beds if possible.
We would also carry out conversion works in the remaining five public acute hospitals, namely, Caritas Medical Centre, Yan Chai Hospital, North District Hospital, Tseung Kwan O Hospital and Ruttonjee Hospital, to provide in addition to the 1,290 isolation beds, another 150 isolation beds towards the end of this year, certainly by the early part of the year 2004 using other funding sources.
Centre for Health Protection (CHP)
We will enhance Hong Kong's capacity to prevent and control future communicable disease outbreaks by setting up a Centre for Health Protection (CHP). The new organisation should not only have professional knowledge and expertise in combating communicable diseases, but also the administrative skills and statutory power to co-ordinate various Government departments and the community when dealing with health threats and emergency response to outbreaks.
I think it is in this context, it is the question asked by several Members, in
terms of why there wasn't the capacity in the public health system at this point in time. I think this is a question which the (SARS) Expert Committee did try to answer. When you look at trying to deal with new infectious diseases, all over the world, public health systems have great difficulties. And even in America, there is a very large Centre for Disease Control and Prevention, it is no easy task to be able to identify a new disease and to combat it within a very short time frame. The instances that we have recalled that Members are aware of are how AIDS was dealt with in America. It took more than two years before the HIV virus was identified in the United States. It took a long time before the pattern of HIV was recognised leading to the syndrome been coned and recognised and subsequently public health measures been taken. When you look at the instances of the West Nile virus which led to a very large outbreak in New York and then which has now been spreading right through the east coast of America, the public health authorities took several months before the West Nile virus was even recognised. So I think it is in this context that Members need to realise the difficulties and challenges new diseases pose to public health systems. In Hong Kong, we have a small public health system. The experts have talked about the necessity to link up with other public health systems in this part of the world and in other parts of the world and this is something that we are working towards, and thereby we are trying to strengthen this public health function by creating this Centre of Health Protection.
Elderly
We have paid special attention to the protection of another high-risk group who are relatively more prone to infection by SARS. They are the elders living in elderly homes. DH has already visited all elderly homes to assess possible improvement areas in their infection control measures to be addressed in future training programmes. The Social Welfare Department (SWD) will be amending the Code of Practice for elderly homes, requiring them to designate an infection control officer in all elderly homes who is responsible for dealing with infection control measures, particularly the early detection and reporting of suspected outbreaks. My colleagues are already conducting briefing sessions and training programmes for the officers to remind them of their responsibilities. To ensure consistency and coherent information exchange during crisis time, an enhanced information exchange system has been set up among DH, HA, SWD and the elderly homes, where procedures and roles of parties concerned are clearly defined. DH will issue a new set of guidelines on prevention of infectious diseases in consultation with HA and SWD for distribution to all elderly homes this month.
We have also initiated a review of our infectious disease and quarantine ordinance to ensure that the old but still relevant ordinance will continue to meet our public health requirements.
Maintaining Close Surveillance
Our disease surveillance capacity in the community setting is now stronger. Our first line of defense, the health check measures at all border control points, have been and will continue to be strictly enforced, and have been strengthened.
If SARS does re-emerge, DH will be alerted promptly because SARS is now a statutorily notifiable disease. We have also informed the medical professions of the World Health Organisation (WHO) definition of SARS Alert, the clinical case definition of SARS and the laboratory case definition of SARS, which are all revolving and which are also adopted in Hong Kong, so that the health care professionals will be able to contact DH if they encounter cases which fulfill these criteria. The incident of a woman who was once suspected to be a SARS case but subsequently confirmed negative shows that greater support to the private medical sector in laboratory tests for SARS is necessary and will be beneficial. In this aspect, I would like to point out the Public Health Laboratory Centre (PHLC) of the DH has been providing laboratory support for SARS-corona virus testing to private laboratories and has carried out Polymerase Chain Reaction (PCR), culture and serology tests for SARS from private laboratories and public hospitals since the SARS outbreak in March. The particular laboratory that turned out this false negative test of SARS was really not licensed to provide the test. To facilitate early detection and reliable testing of SARS, the PHLC will provide public health laboratory consultation services for private hospitals and SARS tests for hospital patients with clinical indication for testing. For public hospitals, there is a Hospital Infection Control Officer who will verify with the physician in-charge for cases suspected of SARS, and inform the Chairman of the Central Committee on Infectious Disease of the HA Head Office on a 24-hour basis, and register this in the eSARS system. Both the HA Headquarter, the DH Headquarters and the relevant Regional Office of DH would be notified as soon as possible within the same day and the DH will be given access to the eSARS system within 24 hours, when HA issues a SARS Alert or if there is a clinical and laboratory confirmed SARS patient in Hong Kong.
Contingency plan
The Health, Welfare and Food Bureau has prepared an overall Government emergency response mechanism. The mechanism categorises virtually all possible scenarios into three levels and establishes government response at each level. The plan provides a clear command structure for strategic decision-making, sets out distinct roles and responsibilities for different parties and establishes the line of command for launching various types of operations and the required response time where appropriate. The plans have largely been put in place and necessary exercises are being or will be conducted. Indeed, DH and HA have already conducted a number of these drills.
I would like to clarify the comments made by Members relating the systems of the HA and the Government's SARS alert system. I think if Members read the alert system of the HA, you will be aware that in fact what the HA is talking about is an outbreak alert system. It is not a SARS alert system. The outbreak alert system is intended to capture early pre-alert signs when there are groups of individuals in a hospital who come up with the respiratory illness but who are not SARS or who have not been diagnosed SARS. This alert system in fact is a pre-SARS alert system that then denotes the management has to be alerted and to investigate it. The Government SARS alert system is very definitive and the HA system is intended to complement the Government system. So the red-yellow-green system is a complementary system to the Government SARS alert system. It is not a system in parallel to the Government system.
Apart from the clear command and control arrangements, the requirement for various government departments and agencies to develop their own emergency plans in collaboration with our neighbours in the Pearl River Delta and the international community are also an integral part of our contingency planning. Because each subsector has got to develop its own contingency plans. It is Government overall plan that then coordinates the totality of the plans of each sector. We are also encouraging and facilitating different sectors to prepare their own contingency plans and to conduct regular drills to ensure that all parties concerned are familiar with these plans.
The health sector's outbreak control plan actively involves the private sector. DH will disseminate the latest information to private hospitals and medical professionals in the private sector, and HA will communicate closely with the private sector medical professionals on clinical management and the provision of medical services.
The Government has been in close liaison with the private sector to work out mechanisms of communication and initiate discussion on provision of medical services. We have held a series of discussions to assist the private sector in establishing outbreak control plans and channels of communication in case of an outbreak. We have also initiated discussions to develop models of cooperation between the public and the private sectors. The HA will share with private hospitals guidelines on infection control and information on infectious diseases.
All the Government departments and agencies concerned are working hard to implement the measures listed in the checklist. I am confident that with all these enhanced notification and response system and improved facilities, we are certainly much better prepared should there be a reemergence of SARS.
SARS Expert Committee Report
I am turning to last part about the SARS Expert Committee Report. The SARS crisis, as Honourable Members said, has been a painful experience for all of us. It has also been a very humbling experience for all of us in particular myself. As Sir Cyril Chantler, the Co-Chairman of the SARS Expert Committee said, I totally agree that one of the ways of doing justice to those who have suffered or to those who have lost the ones they love is to offer our very best to be sure that such a situation will not even happen again. Most of the things included in the Checklist, and what I have mentioned earlier, are only the fundamental things we must continue to do. Obviously, we need to do much more.
With reference to some of the comments made by Members relating to the death rate, the outbreaks of Amoy Gardens, treatment and rehabilitation, psychosocial support, I believe the Expert Committee has given a thorough account of some of the issues and how Government has dealt with them. It is not for me to explain the reasons why they came to such conclusions. However, I would like to touch on one or two issues. In term of the death rate, an Honourable Member said the Hong Kong has the highest death rate. I believe the Expert Committee has very clearly analysed in its report that Hong Kong's death rate was really no different from the death rate in other countries. In fact, the only exception was that there was a much higher death rate in Taiwan and a much lower death rate in the Mainland. In Toronto, in Singapore, in Hong Kong, the death rate was similar. So I just want to highlight that point.
I would also like to say something about treatment and rehabilitation because this was one of the recommendations made by the Expert Committee. In term of rehabilitation and better psychosocial support to families of deceased patients and to recovering patients, the SWD and HA have been putting a lot of efforts to support family members and some of the patients while recovering from SARS. However, these job are not easy and we do recognise the need to do more. And I have already asked the SWD and the HA to review the support we have given to the families of deceased patients and to rehabilitating patients. And we are reviewing the other financial support we need to provide to the families of the deceased patients because we know that some of the existing mechanisms are inadequate. So we will be reviewing that and we hope to be able to come up with a new package in the near future. In term of treatment to SARS patients, Members here have made a lot of comments relating to the death rate and the treatment. I think the medical professionals here, including Dr Lo and Dr Tang, will realise that with a new disease, there is no established or proven treatment, and doctors have got to do their best based on the clinical judgment as to what is best for patients. In the treatment of SARS in Hong Kong, all the treatment programmes were done or prescribed by doctors based on their best knowledge and acting in the best interest of the patients. Obviously, at the time when SARS broke out, when we did not even know which agent was responsible for SARS, these were really the best guesses. Certainly, there needs to be a review of the best treatment needed to be given to patients, and you cannot do this without doing a clinical trial. So there will be very continuous issues in the future should there be a new SARS outbreak, whether patients should be subject to clinical trials. I will be very happy if Members can suggest a better way of dealing with the problem.
Members, I would also like to make a few comments before I end on the select committee because Members here have mentioned about select committee. Obviously there are a lot of very valid questions and concerns expressed by Members. I think the select committee will deal with them. I look forward to working with the select committee to clarify some of your questions and concerns. But I am also quite concerned about some of the conclusions and pre-conceived opinions and conclusions expressed by some Members here today. I hope they will in no way affect the objectivity of the work of the select committee.
The SARS Expert Committee has also helped us a great deal in making the first important steps, that is to conduct a comprehensive review of our current public health system and to identify our weaknesses which we must address in order to avoid another attack by SARS. The Committee has proposed a total of 46 recommendations. We have set up a Task Force to coordinate the implementation of these recommendations. The Task Force has already met to discuss the recommendations and to assign tasks to respective parties. The Task Force has also set the time frame for each of these recommendations. Some of the more immediate tasks will be accomplished in the short term (within six months), while some will take longer to plan, develop and achieve. I must however add that all the urgent tasks in relation to the recommendations have already been put in place. And most of them have already been included in our checklist of measures to combat SARS. I will also ensure that the remaining tasks arising from these recommendations, taking into account comments from Members and from the Health Services Panel, are fully implemented in the soonest possible time. The Chief Executive has also appointed a Monitoring Committee comprising the two chairpersons and the two local members of the SARS Expert Committee, and we are also very pleased that the Hon Dr Lo Wing-lok will also be part of this Monitoring Committee which will monitor the implementation of the task group.
Public Support
Last but not least, we will continue to solicit support from the community. We have always emphasised public education and put public communications on the top of our SARS agenda in order to gain the cooperation of the public. To keep members of the public on high alert against SARS and awareness on environmental hygiene, we will continue with our public education work using all possible mass media channels. With the support from the public, 70 per cent of the 85 district hygiene blackspots including rear lanes and private streets drawn up in the Team Clean exercise have already been cleared, and Month-end cleansing exercise with community involvement was also introduced in all 18 districts since March this year.
Conclusion
In conclusion, Honourable Members, I hope you are convinced that many of our short term measures have already been put in place. The implementation of other medium or long-term measures is also in full steam, and I ask certainly for your support of these measures. To answer the Hon Eu Yuet-mee, my own personal commitment towards my work and the work of SARS is staunched and will not be influenced by figurative expressions of my preoccupation with many things in life. I think we all think about many things on the day to day basis, we think about life and death, we think about our work, we think about our families. But that should be in no way negate our obligations and commitment towards our primary work and I can assure the Hon Eu Yuet-mee that my commitment to my work will continue as long as I remain in my office. Please be assured that the Government will leave no stone unturn and we will provide our best endeavours to prevent and prepare for the resurgence of SARS. And we would also like to ask you for some of your confidence in the work that we do. Thank you very much.
End/Wednesday, October 15, 2003
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