Posted on 04/25/2003 4:06:04 PM PDT by Dog Gone
THINKING ALOUD
EVERY time it seems like Singapore has got a grip on the Sars bug, it slips away.
Every time a definitive statement is made about the containment of the disease based on information at that time, fresh Sars clusters break out.
It is hard to be upbeat about the state of Sars here given the changing story line, so to speak - and yet we must keep our chin up and understand that we are fighting a bug which we know very little about.
Singapore used to cling to the World Health Organisation data that the fatality rate was 4 to 5 per cent.
So getting the bug is not so bad, is it? It is not such a killer.
Then more people started dying and people had to start understanding the arithmetic behind the rate.
More deaths over a low base of infections means a higher mortality rate.
So if you want a lower mortality rate, you should be wishing, ironically, for more people to be infected.
Maybe the World Health Organisation shouldn't have stuck a death rate on Sars, given that there is still too little information on the bug and whether the spread has been contained.
In Singapore, the Sars story line has changed so much over the past six weeks.
When it looked like it was contained at Tan Tock Seng Hospital (TTSH), clusters broke out at Singapore General Hospital and Changi General Hospital.
The story line changed to 'Sars infections confined to mainly hospitals'. In other words, there was no 'community spread', although the danger of this was ever-present.
But that line had to be revised when the Pasir Panjang Wholesale Centre had to be shut for 10 days. The 'danger' was real.
Now, we are told that funeral wakes aren't safe, either.
There is not much point asking why those who died of severe acute respiratory syndrome weren't diagnosed earlier. This is a new bug which, it was recently found, is able to hide under other medical conditions a patient may have.
The thing is, Singapore is among the first countries afflicted by the disease, so it will be among the first to experience anything new related to it.
We'll just have to get used to this, find a way around it, and move on.
The Government is walking a tightrope when it dishes out information on Sars.
How do you give out information without provoking panic or, worse, creating complacency? How to tell people to lead normal lives when more and more are leading abnormal lives under home quarantine?
Prime Minister Goh Chok Tong concedes that it is difficult to be transparent and open and yet not cause alarm to Singaporeans and those abroad.
His own assessment was that the Government had struck the right balance here.
I am all for full and quick disclosure, so that people can make informed decisions. The trouble is, are people taking all the information in?
Health Minister Lim Hng Kiang knows the pitfalls of making predictions. At one press conference, he said he could give an 'all clear' signal on Sars in a few weeks' time - which is about now - if there were no new infections and the current Sars cases were contained.
It was a big 'if', but in tough times, people tend to remember the positive signals rather than the caveats that go with them. This prompted him to clarify his position the very next day in no uncertain terms.
Likewise, while the Government has been open about 'suspected' Sars cases - that is, people who have fever and a history of contact with Sars patients or areas - there is panic over whom they might be, and where they work or study.
Even the official word that someone has been sent to TTSH for 'observation' provokes the same outcry.
Sometimes, having no answers sparks the same panic. I count at least three Sars patients recently where the source of infection is still not known. If it was known, you would know what to do, right? Who or where to avoid?
In fact, Mr Lim pointed out last Saturday that as time goes by, pinning down the source of infection will become more and more difficult.
'We must be realistic. In one month's time, or two months or three months, there could be imported cases or sporadic cases where, despite all our contact tracing, we cannot pin it down conclusively.
'But what we can do is to isolate it and make sure it doesn't spread.'
Added PM Goh: 'It's like throwing a stone into the pond and then the concentric circles begin to widen.
'So the whole idea is to keep those few circles small before they move out. Because the further they move, the more difficult it is for us to know how a person got Sars.
'And that's what they call community spread.'
What is more important, therefore, is 'containing the community spread' and pinning our faith on the isolate-and-contain strategy.
All eyes should, therefore, be trained on this strategy, as this is where every individual can play his part to contain the bug.
But every individual should know the ins and outs of the disease too - how it spreads and all the caveats and conditions involved.
There should be no clinging to stray bits of information - all should be armed with a deep understanding of all facets of the disease so that we can carry on with our lives.
Can this be done?
One way is to not make any definitive statements about this new epidemic, because a change would cause misunderstanding and alarm.
Another way is a massive mobilisation of grassroots leaders, fanning out across the heartland to spread the anti-Sars message in all languages and dialects, coupled with tough measures.
A third way is to evolve an anti-Sars social culture that is defensive but not paranoid.
Let us not laugh at a person in a mask, or chafe at temperature-taking in the workplace.
In my view, the only Sars story line that will not change for some time is: You've got to know the bug to beat it.
By Jasper Becker in Beijing
26 April 2003
Independent (UK)
Every night, people in Beijing are stopping everything to watch a news programme Focus Talk (Jiaodian Fangtan) that reveals what new areas of the capital have been placed under quarantine.
On Friday night's list are the Carrefour supermarket, the Ditan Hospital, the Chaowai market, the Oriental Plaza, the 18th floor of the World Trade Centre – all famous landmarks in the city. Officially the government says 4,000 people have been forcibly quarantined but it could be many more.
Many believe city officials already armed with emergency powers may declare a state of martial law. But that merely means troops will be brought in to quarantine the city.
A new decree issued on Tuesday empowers imprisonment of up to seven years for those who refuse to comply with the orders of municipal or district health departments.
Cai Fuchao, a spokesman for the Beijing government, said: "I solemnly tell you it is rumour. We absolutely will not seal our airports and highways, and we also absolutely will not impose any sort of martial law."
The government now says Beijing has 877 Sars infections, up from 37 last Saturday, before the health minister and Beijing's mayor were fired for covering up the extent of the outbreak.
Among the reports not being publicised is the news of three deaths in a suburb of Beijing, the Gaobeidian area, where foreigners come to buy "new antique" furniture made by low paid chippies brought in from rural areas. A friend of one victim said: "Thousands of terrified workers have fled from the workshops. And when the news spread, lots of others left, too scared to be quarantined."
No one wants to be cooped up in an area where the mysterious virus is present but an exodus of migrant workers is going to make the disease impossible to control. Across the country, provincial officials in places as remote as Tibet are throwing up roadblocks and spraying vehicles.
In north-west China's obscure Ningxia Huizu Zizhiqu autonomous region, authorities set up 21 checkpoints along major highways, railways and airports to conduct medical examinations of Sars suspects. All motor vehicles in and out of Ningxia have to be disinfected.
Hospitals in Ningxia have designated special quarters for patients whose body temperatures are found to be higher than normal.
Although they have received 105 such patients, none has been diagnosed as having Sars. The fear that a greater health crisis is just over the horizon in rural China may prompt Wu Yi, the only woman in the 25-member Politburo who has been appointed commander-in-chief of the health campaign, to take much tougher measures.
Known as the "Iron Lady", she made her mark by running an extremely ruthless campaign to enforce the one-child policy in rural China and is believed to have the right experience for the job. She forced officials under her to forcibly arrest women and subject them to late-term abortions. She also ordered that peasants who had already flaunted the rules should lose their homes and livestock.
Outside China, the Philippines reported its first deaths from Sars and authorities in Taiwan quarantined over 1,000 doctors, nurses and patients in a hospital to halt the spread of the deadly flu-like disease.
A World Health Organisation (WHO) official said Sars could become a horrifying epidemic if it spread in China's provinces or in nations like India and Bangladesh, where people live cheek-by-jowl and medical facilities are poor.
"There will be various countries in the world where we would be really concerned because we don't think they have the capacity to stem the tide once it is introduced," the WHO official Wolfgang Preiser said in Shanghai. "It may have happened already, we don't know." Taiwan authorities sealed the Taipei Municipal Ho Ping Hospital on Thursday after more than 25 suspected Sars cases were discovered and doctors, nurses, patients and visitors will have to stay there for up to two weeks. Many were furious when they were informed. Some patients pasted signs and raised placards to the windows of the hospital in protest.
"Quarantining healthy people is against the law. Do not treat us like birds with bird flu or pigs with foot-and-mouth disease," wrote one patient.
Taiwan has strong business and ethnic ties with China and Hong Kong, but has reported only 41 probable cases of Sars. It introduced strict measures at airports and employs a liberal use of quarantine orders.
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