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Transcript of SHWF on SARS Expert Committee


Following is a transcript of the remarks made by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, at a stand-up media session on the SARS Expert Committee today (June 20):

Reporter: (inaudible)

Dr Yeoh: Well, I just keep on emphasizing that the review is really to get as much information as possible, to have as much, as objective of information as possible so that we can better prepare ourselves for any future outbreaks. In that context, then it is really in our interest to make sure we get as much objective information as possible and that is why I have asked these two experts to chair these two separate groups so there would be greater objectivity in the review.

These are very renowned and highly respected experts. Their integrity are beyond question. These are individuals that would provide as honest advice as possible to us. I believe they would do so. So, we would enable them to do that because this review is administrative in nature. It is out of the executive function of the government. We will be able to get all the information possible that is within the control of the government. So, there is no question about hiding information because in the administrative structure, we will be able to call for all the relevant papers, all the relevant documentation. We will be able to ask anyone within the system to give information to the experts. So the experts will be doing the review in a very objective way and we would ensure that they can do it because it is in the interest of both the community and the government that the review is done in as objective way as possible. This is what we ask experts to advise us on. So, there is no question about trying to influence them in any way.

The two experts: Sir Cyril Chantler is a very experienced clinician. He has been the dean of Guys, King's College. He was also the manager of Guy's Hospital during the reforms in the United Kingdom. So, he is an academic with experience. He has clinical experience, hospital management experience. And he is also very familiar with Hong Kong's system because in fact Sir Cyril Chantler was one of the expert advisers to the Hospital Authority in the early days of the reform. So, he was involved in the management changes of Hospital Authority and did an evaluation of the reform in the 1990s. So, Sir Cyril is very knowledgeable in different areas of hospital management and as a clinician highly respected. He is also knowledgeable about Hong Kong's operations.

The other chairperson is Professor Sian Griffiths. Professor Sian Griffiths is trained in public health. She is the President of the Faculty of Public Health Medicine of the Royal Colleges of Physicians in the United Kingdom. Sian is in fact also very familiar with Hong Kong's system. She has visited here before. She has very close liaison with our College of Community Medicine in Hong Kong. So, she is aware and knowledgeable of our system. She has got very broad international perspective and being the President of the Faculty of Community Medicine, she is highly respected. So, you can expect these individuals would do an excellent job for Hong Kong.

Reporter: (inaudible)

Dr Yeoh: I think the outbreak is absolutely under control. As you know, both the Centre of Disease Control and Prevention and the World Health Organisation have lifted the travel advisory to Hong Kong. So, one of the criteria that required for this uplifting is not just the numbers, but also for this international and US agencies to be assured of our control measures. In our discussion with WHO and with the CDC, we did not just present the figures, we also present to them the control measures that Hong Kong has put in place. I think both the Director-General of World Health Organisation and Dr Heymann, the Executive Director of Communicable Diseases have really been full of praise for the control measures that have been done in Hong Kong. I think they have absolute confidence in our control measures. And then you look at the figures, they speak for themselves. That although we have a very large outbreak in March before World Health Organisation recognised SARS as a syndrome, our measures have been very effective in bringing these numbers down. And then when you look at the numbers for the last four weeks, that has been below five. In the last eight days, and today will be the ninth day, where we have no cases. Today, we will be also announcing that we also have no new cases. So, you can see our measures are very very effective and that we don't have lapses in our cases as we have seen in certain places. It has been a very steady downward trend. Obviously, I think the travel advisory has to base on the fact that we don't have local transmission. So, for people from other countries, the message is that it is safe to come to Hong Kong because the very few cases that we have up to the end of last month, they were still associated with the hospital setting and there are no infection in the community.

Reporter: (inaudible)

Dr Yeoh: I think we need to go back to this particular review first before going to other issues.

Reporter: (inaudible)

Dr Yeoh: On the Japanese encephalitis, as you know that in Hong Kong, every year we have zero to two cases and most of these are imported. The last local cases are in 1996. We have a surveillance system of encephalitis. What we now need to know is to understand the extent of the outbreak in the Mainland and to see whether there will be any impact in whether we need to have additional measures. Certainly we have stepped up our surveillance systems in Hong Kong to see if there is any risk of Japanese encephalitis coming to Hong Kong, and if so, what measures would be needed to take such as vaccination. Certainly we have stepped up our surveillance systems in the hospitals and in farm areas. So these are the issues we are looking at. What we are doing now today is Dr P Y Leung, the Deputy Director of Health, is in Guangzhou. He is really discussing with our colleagues in Guangdong relating to our notification systems. As you know, we need to first understand the notification system in China itself because China is a vast country and the information fed into the provinces and cities is not easy. So when you have an outbreak, the information goes into the centre and that there must be an investigation because China has got the centre of disease control. So they need to investigate the outbreaks and they then need to form a report. What point in time do we expect the Guangdong authority to inform us? What diseases do we wish them to inform us of because there are thousands of infectious diseases that have the potential to spread to man? Do we want routine information? Do we want information relating to outbreaks? We really need to talk to our colleagues on the Mainland to understand the notification system first and then to get the information from them as soon as they have relevant information that we should know. We really need to go into the details, the types of diseases, the type of alerts we require from them. How soon it can be given to us? What are the mechanisms? So we have started the discussion in April and in the initial discussions, we agreed on the list of infectious diseases that they will give us the information. I think they are certainly very willing to do that. What we really need to do now is that early alerts. What we like to see is not just notification on the numbers because that sometimes occurs a bit late. For established diseases, it is alright, so when you look at trends, you can understand if the trends are increasing month by month, those are alright. But for outbreaks, what we need is to have alert systems. I think those alert systems, we need understand whether they are available in the Mainland itself and if they are available, then we should be alerted through those systems as well. So those are the discussions about potential threats that we are discussing. So it is going to need quite a lot detailed discussions with the Mainland so that they will provide information relating to potential threats.

Reporter: (inaudible)

Dr Yeoh: Will any country in the world guarantee if there is no outbreak? Can you guarantee America will not have an outbreak? One needs to be clear about the changes for outbreak, reintroduction of the disease and the control measures. What we are saying is that in the World Health Organisation's definitions of when an area becomes an affected area, you don't have any cases of transmission for two incubation periods, so for 20 days. Usually one incubation period is the period that you will expect cases to arise but for safety, usually in most public health policies, you use at least two incubation periods, so you have the assurance that you don't have a case. In Hong Kong, we have a good system of surveillance. We are quite confident that we will be able to pick up cases. When there are no cases in two incubation periods and there is no introduction of disease, the disease is not present. In the case of SARS, there is no evidence to say that it is endemic. In places where it is endemic, you will expect there are background SARS cases. But so far from SARS, you can see that it's been introduced into Hong Kong, it's been introduced into the estates. But because we've been able to control in the estates so that's why you've never had the travel advisory and the estates have ever been called the SARS affected area.

In Hong Kong because of the large outbreak and there was infection in the community, these have been infected without under control, and so to both the CDC (Centre for Disease Control and Prevention) and to the World Health Organisation, we have demonstrated to them the measures and the information required for them to have confidence. Whether there will be an outbreak in the future obviously will depend on whether there is reintroduction of the coronavirus in Hong Kong. At the moment we are uncertain. No one in the world is certain because we still have not established the source of the coronavirus. There is postulation in wild game but I think generally the risk is not as high as it was in February because the SARS is also under control in Guangdong Province. It is under control in China. The authority there realise that wild game is a potential source and they have put in measure to prevent the source from getting into people again.

I think we are in a much better position to make sure we don't have an outbreak in the future but obviously nobody can guarantee that. What we need is to have this surveillance system to alert us if there is any possibility of a reintroduction. With international travel, any place in the world is likely to have introduction of infectious diseases. So when you look at what is happening at SARS because of the global alert. Many countries have had SARS introduced but they were able to contain it and limit it to a few people, so then there is no risk to travellers. Equally this is what we intend to do in Hong Kong is to be able to detect any introduction early and to contain the spread to as few people as possible and for a short period as possible.

Of course, we are in a better position now because we understand a bit more about SARS than we did in March, and because we have a whole series of public health measures that enable us both to detect and to contain. I think there is a lot of speculation whether it will occur in winter or not. That's really quite speculative. What we're interested is to make sure there is no introduction at any time of the year and not just in winter.

(Please also refer to the Chinese portion)

End/Friday, June 20, 2003


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