An important implication arising from the way in which SARS spread among Singapore health institutions is the need for greater connectivity among agencies and workers in the health-care delivery system. Institutions need to put in place, processes in terms of cooperative procedures for information sharing and co-management of cases particularly that of emerging infectious diseases such as, SARS.
An urgent need for open and transparent collaboration among countries has been highlighted Heymann Indeed, such collaboration led to the interruption of human-to-human transmission of SARS at all sites within six months. The SARS crisis was a tragic way of showing up the gaps in the institutional processes of health agencies in Singapore for effective response to hazards, such as emerging infectious diseases, that global travel can bring.
Nonetheless, Singapore has been praised by WHO and others for the establishment of public health control measures involving cross-sectional inter-ministerial collaboration and coordination James et al. These were the measures that eventually led to the containment of the spread of the disease. The economic costs of SARS were high. In addition, the hotel industry and related activities were highly dependent on tourism as well as international business travel.
Much of the tourism sector came to a standstill and shoppers stayed away from eateries and other commercial outlets. Globally, Smith , p. In a rather macabre twist, a number of the hotels served as quarantine centres for staff of a mental health institute where another fever cluster had been identified during the original SARS outbreak.
While it proved to be a false alarm, it was a decision taken to quarantine health workers of the institute in hotels because the institute itself had no facilities to accommodate the staff. The measure taken underscores the limits to which the institutions of Singapore and in particular, its health delivery system as well as public health processes were stretched during the SARS crisis.
National Center for Biotechnology Information , U. Nat Hazards Dordr. Published online Jan 9. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received May 14; Accepted Nov 8. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source.
Introduction When SARS was identified in Singapore, both hospitals and the health-care delivery system appeared to have been caught unprepared despite being key institutions in a city—state that has been increasingly seeking integration with the global economy. Globalisation and health hazards The rapid transmission of SARS through global travel to cities across the world has prompted epidemiologists and public health specialists to observe that the world faces increasing risk from such emerging infectious diseases.
Institutional preparedness and ineptitude in responding to global forces Emerging infectious diseases or EIDs have been identified as a prospective new scourge because of their global dimension Morse Open in a separate window.
Discussion The intervention recommended by WHO is instructive mainly because of the implications that globalisation in the future would signal for cities as well as countries seeking closer integration with global economy and networks. Animal origins of SARS coronavirus: possible links with the international trade in small carnivores. Nipah virus: a recently emergent deadly paramyxovirus. Emerging and re-emerging infectious diseases: the perpetual challenge.
Acad Med. Ann Acad Med. The condition of postmodernity. Oxford: Blackwell; Severe acute respiratory syndrome SARS : breath-taking progress. J Med Microbiol. SARS and emerging infectious diseases: a challenge to place global solidarity above national sovereignty. Ann Acad Med Singapore. Public Health. Nipah virus encephalitis outbreak in Malaysia. Clin Infect Dis. Conceptualising global politics. Global politics: globalisation and the nation-state.
Cambridge: Polity Press; J Commun Manage. World society and the nation-state. Am J Sociol. Factors in the emergence of infectious diseases. Emerg Infect Dis. Beyond the port city—development and identity in 21st century Singapore. Singapore: Pearson-Prentice-Hall; However, one positive effect was the heightened awareness of proper hygiene habits and of the importance of good hygiene.
Volunteers came forward to help in various ways, such as conducting temperature checks at public events and helping those who had been quarantined at home. Individuals and organisations donated generously to the Courage Fund, which was set up to help healthcare workers and victims of SARS.
Zhong, N. In The Lancet , : — Chua, M. Singapore: Institute of Policy Studies, pp. Call no. Severe acute respiratory syndrome — Singapore, Weekly Epidemiological Record , 78 19 , Singapore: Institute of Policy Studies, p.
Hunde, E. The Business Times , p. Retrieved from NewspaperSG. SARS: How a global epidemic was stopped.
Nine days after admission, the patient began to improve clinically, the laboratory abnormalities returned towards normal, and the chest x-ray abnormalities stabilized and resolved. The patient has remained well. When the index patient was seen in early March, the clinical features and highly infectious nature of SARS were not known.
For the first 6 days of hospitalization, the patient was in a general ward, without barrier infection control measures. One of eight physicians who attended her became infected, as did 9 of approximately 30 nursing staff. SARS also developed in 1 of 12 patients in adjacent beds during her hospitalization and 9 of approximately 30 family members and friends who visited her during this time. Nineteen of these 20 patients were admitted to our hospital for treatment and isolation 1 was treated outside Singapore , and we recorded prospectively the clinical features of their illnesses with a standardized data collection form.
In addition to demographic data, this form elicited information on occupation, date s of exposure to suspected cases, travel history after February 20, dates of onset of various symptoms, results of blood tests, and chest radiographic findings. The demographic profiles of the index and 19 contact cases are shown Table 1. An epidemic curve of the index and contact cases is shown in Figure 2.
The median age of patients was 28 years. All were previously healthy, except one who had diabetes mellitus and end-stage renal failure and one who had a history of childhood asthma. One patient was a smoker. For seven patients who only had one exposure to the index patient, the median incubation period was 4 days estimated range 2—8 days. For those with multiple exposures 13 patients , median incubation period was either 7 days range 4—12 days, calculated from day 1 of exposure , or 5 days range 3—9 days, calculated from midpoint of exposure period.
The median period from onset of symptoms to admission was 6 days range 0—9 days. Index and contact cases of severe acute respiratory syndrome SARS , by date of symptom onset. At admission, all patients had fever, sometimes accompanied by myalgia and headache Table 2. Other symptoms, including dry cough, developed 2—4 days after onset of fever.
Shortness of breath when present generally manifested in week 2 of illness. Apart from elevated temperature, results of physical examination were generally normal.
The paucity of lung findings was often in striking contrast to the florid chest radiographic changes. Laboratory investigations at admission are shown Table 3. Other common laboratory abnormalities included leukopenia, thrombocytopenia, elevated LDH, mild hyponatremia, mild hypokalemia, and raised hepatic transaminases. Abnormal chest radiographs were seen in 14 patients.
Abnormalities developed in the remaining six patients by day 11 of illness. Right upper lobe infiltrates were seen in four patients, and involvement of both right upper and lower lobes was seen in three. One patient each had left lower lobe and bibasal infiltrates. Chest radiographs of two patients with severe acute respiratory syndrome SARS. He died on day 19 of this illness. Results of routine microbiologic cultures, serologic tests, and rapid antigen tests were universally negative.
However, viral particles characteristic of coronavirus were found on electron microscopy examination of nasopharyngeal aspirates in 4 of 10 patients. The clinical course of the illness is shown Table 4. Of these patients, six subsequently required mechanical ventilation for worsening respiratory failure. In general, it is important to practise good personal hygiene. Here are some tips to help prevent the spread of the virus:. Related A-Z. Health Promotion Board Depression.
Health Promotion Board Hepatitis B. Browse A-Z.
0コメント