Channel NewsAsia 10 Mar 08;
SINGAPORE: Five years after a deadly SARS outbreak, Singapore has put in place a robust surveillance system as well as an infectious disease response plan to counter any possible outbreak in future.
The respiratory disease first surfaced in Singapore's Tan Tock Seng Hospital when a woman, who came back from a holiday in Hong Kong, came down with flu-like symptoms and sought treatment at the hospital's emergency department.
She then became a super-infector, with more than 100 cases - including family members, visitors and hospital staff - traced back to her.
Back then, all patients who went to the emergency department were put in the same waiting area, regardless of their conditions.
But today, a triage station is a permanent fixture, and anyone with fever - the first symptom of flu or any other infectious diseases - will be asked to wait in a separate area.
Patients are then classified as high- or low-risk, depending on their travel history and background, such as whether they had any contact with a possible infectious person or even poultry. This also aims to facilitate contact tracing if there is a need for it.
An isolation area has also been purpose-built at the emergency department. Consultation rooms in the isolation area have one-way air flow to minimise the risk of contamination, and the air is also filtered before it is released into the environment.
In fact, the isolation area can be completely sealed off into a self-contained facility if there is an outbreak. It has its own consultation rooms, x-ray rooms, separate toilets and even separate entrance and exit points to ensure that patients who are potentially infectious can be moved to a nearby isolation facility without putting other patients at risk.
Among healthcare workers, a sick leave tracking system has been implemented to track any possible infection among them. Any spike in the number of fellow healthcare workers falling ill with similar symptoms will trigger off an alarm.
Director of Communicable Diseases Centre, Associate Professor Leo Yee Sin, said: "This system, in my mind, proves to be a useful tool for the hospital... (It) could give us an early warning that (there) could potentially be some unusual transmission going on among the healthcare workers."
Despite these measures, concerns remain as to when and how the next outbreak will be.
"The challenge will come in terms of what is the mode of transmission, and the mode of transmission will determine as to the impact of the outbreak and also the transmissibility of the disease," said Associate Professor Leo.
Therefore, the Infectious Diseases Act is up for amendment to allow authorities to respond more effectively to public health emergencies. This includes empowering authorities to declare a public health emergency during an outbreak, and allowing the health minister to designate the whole or parts of Singapore as a restricted zone.
Singapore also had numerous exercises simulating an infectious disease outbreak.
Dr Lyn James, director of the Health Ministry's communicable diseases division, said: "By these exercises, we are able to identify gaps, put in measures to strengthen our plans. We are definitely more vigilant and more prepared than we were before the SARS outbreak."
The robustness of this surveillance system was put to the test recently when Singapore experienced a spate of food poisoning and chikungunya virus outbreaks.
With the looming threat of an avian flu pandemic, these measures will definitely put the city-state in good stead. - CNA/ac
