I am pleased to have this opportunity to share Hong Kong's experience in combating SARS. We have been working under the advice and guidance of the World Health Organisation. We have also been co-operating closely with our neighbours in the region and other countries on this matter. But opportunities like this are extremely useful, and I am sure we shall emerge from this special meeting better armed to fight this disease.
Present position
Hong Kong had its first reported SARS case on March 11. As of yesterday (April 25), we had a total of 1,510 confirmed SARS cases. Of these, 614 patients have recovered and been discharged from hospital. We have had 115 deaths. The remaining 781 patients are receiving treatment or convalescing.
In the past two weeks, the number of new cases has fallen and seems to have stabilised at around 20 to 30 daily. With the rigorous preventive measures that we have put in place, we hope the number of new cases will continue to downtrend.
The Amoy Gardens experience
The Government has conducted a thorough investigation into the outbreak at Amoy Gardens. The major findings of the investigation were published sometime ago and covered in some detail at yesterday's senior officials meeting, and I shall not repeat them here. But I think it would be useful for me to briefly re-cap the salient features of the Amoy Gardens experience.
Amoy Gardens is a one of the typical high-rise private housing estates in Hong Kong, providing accommodation to about 19,000 residents in 19 high-rise blocks each of 33 storeys.
The main findings of our epidemiological, environmental and laboratory investigation have indicated that there were probably a number of causative factors of the Amoy Gardens outbreak. First, the presence of the index patient who caused the first batch of infections. Second, the residents then transmitted the disease to others through persons to persons spread. Third, transmission of the disease due to the contaminated sewage system via the empty U-trap and fourth, environmental contamination through the shared use of communal facilities.
Following the Amoy experience, the Government has taken swift remedial actions by cleansing and disinfecting all the flats in block E. A guide to advise residents to fill up the U-trap with water was published. The building management of Amoy Gardens as well as the management of other housing estates were advised to conduct thorough assessment and investigation into the sewer-piping system. Pest-control measures were also stepped up and environmental-hygiene improvements were made to clean up the black spots.
We have also introduced an early warning system whereby we would give advance notice to alert the building management of the need to step up their cleansing and disinfection operations in buildings where the SARS patients reside. These measures will hopefully enable us to prevent a re-occurrence of the Amoy Gardens incidence by taking timely remedial measures.
Government strategies
The Government has adopted a four-pronged strategy to tackle the situation: effective treatment, preventive measures, intensive public education, and close liaison and collaboration with the Health Authorities of our country, the World Health Organisation and the international community.
Effective treatment
The standard treatment regime in Hong Kong is to administer high dose steroids and the drug Ribavirin. Our clinical experience is that response to this treatment regime depends on a number of factors, including:
*the age of patients;
*severity of the illness;
*whether there co-exits any other illness; and
*how early people seek treatment.
I understand that there have been doubts expressed about the effectiveness of this treatment regime. I wish to emphasise that according to our clinical experience, more than 80% of patients respond well to this treatment. Of the 115 who, unfortunately, have succumbed to the disease, 96 were elderly people or had chronic illnesses.
For those who do not respond to the standard treatment regime, we have been exploring alternative treatment methods. They include using recovered patients' sera, immunoglobulin and traditional Chinese medicine. We remain open to new modalities based on international experience and scientific evidence. On this front, we are keeping in close touch with the international medical community.
Preventive measures
The first and foremost mission is to prevent the spread of SARS. In formulating measures to control the spread of the disease, we have taken into account the specific characteristics of our crowded city. We are also mindful of the need of whatever we adopt must have both the local and international communities behind us. We have taken the following preventive measures:
*Health Checks At Border Points
Initially, we set up medical posts at the airport, ports and border points to watch for travellers displaying symptoms of the disease, and all incoming travellers have been required to complete a health declaration since mid-March. We also took steps to stop suspected SARS patients from boarding flights. This measure was later extended to apply to the close contacts of SARS patients who are under a home quarantine order.
Most recently, we have instituted temperature checks for all arriving, departing and transit passengers at the airport. For people arriving at ports and land boundary crossings, they are subject to screening under a cooperative scheme with our Mainland counterparts. In this connection, we plan to install about 300 infra-red devices for fever screening at all border control points in the coming weeks, eventually to mandate all passengers to undergo screening.
We are confident that these enhanced health checks will protect not only our community but also overseas communities from being infected. As an international city, we also live up to our international obligation of "NOT exporting" any case to the world and we shall devote all resources to achieving this end.
*Protecting Health Care Workers
Our No. 1 priority is to protect our healthcare workers so they can remain on full alert when handling SARS patients to avoid being infected by the disease. It is, of course, essential that our hospital staff be provided with adequate protective gear. We have improved ventilation systems in our hospitals to ensure that they will not become a conduit for transmission.
Our hospital staff are also provided with training in infection control before being deployed to high-risk areas. We discourage the public from visiting hospitals so as to minimise the risk of the disease spreading from the hospital to the community. At the same time, non-urgent services in hospitals have been reduced by over 30% so we can handle more SARS cases.
*Contact Tracing
The key to preventing the spread of SARS is early detection, swift contact tracing and prompt isolation and quarantine. We have developed an enhanced computer surveillance system that will enable us to trace the contacts of confirmed and suspected SARS patients in a relatively short time.
Through this system we can also collect essential information on the clinical features of cases and identify hot spots or buildings needing investigation. In addition, we have set up hotlines so hotel guests and air passengers can obtain medical advice when a SARS patient is confirmed to have resided in the same hotel or travelled on the same flight.
*Home Quarantine
The first home quarantine exercise started at Amoy Gardens. As of April 24, 815 peoples from 312 households of confirmed SARS patients have been quarantined. Our home quarantine has produced results. There were 44 referrals to medical institutions, of whom 11 were confirmed to have contracted SARS. On the same day, we decided to cast our net wider by extending the home quarantine to all household members of suspected SARS patients in order to further reduce the risk of spreading the disease.
*Multi-disciplinary Response Team
We have established a multi-disciplinary response team comprising building and environmental-hygiene experts to help control the spread of the disease. When a cluster of SARS cases appears to be forming, the team immediately investigates the buildings or areas in question. Households are interviewed and building services, such as drainage and other piping systems, lifts and sewerage systems, are thoroughly investigated.
Environmental swabs are taken for laboratory testing. The cleanliness of the building and its surroundings is inspected, with particular attention paid to refuse storage and collection. The building management is alerted to the need to step up cleaning and to disinfect common areas.
Where necessary, the building management is asked to conduct a detailed assessment of its drainage, sewerage and fresh water piping systems. Guidelines or directives may be issued to rectify any health hazards. Individual households are given pamphlets with advice on proper household cleansing and disinfection.
Public education
We believe there is a need to further raise the awareness of environmental hygiene among the community. This is an integral part of our long-term strategy. Publicity programmes have been made to educate the public on all aspects of the disease, including the symptoms, the mode of transmission, the importance of seeking early treatment and various preventive measures, namely personal and environmental hygiene.
A territory-wide cleansing day was held on April 19. This will be followed by an intensive education publicity programme covering housing estates, public transport operators, schools, kindergartens, childcare centres, elderly centres and food premises.
Close collaboration with the Mainland and WHO
We have in Hong Kong a group of experts from the World Health Organisation investigating the outbreak. We continue to work closely not only with them but also with the Health Authorities of our country and other international agencies to prevent the spread of the disease.
We are grateful to WHO's leadership in Geneva and the Western Pacific region through Dr Omi's office for their support and swift response to our invitation of a team of experts to join us in conducting studies on SARS transmission in residential buildings in the territory. The environmental health expert leader Dr William Cocksedge has just arrived in Hong Kong and the rest of the team will arrive soon.
Hong Kong's strengths
It is unfortunate that Hong Kong should be hit by the SARS outbreak. But it is a real blessing that our institutional strengths in our public health system continue to demonstrate resilience and high sustainability. Our public health system is under tremendous stress. But it soldiers on, serving our community unswervingly and with commitment. I would therefore very much like to share with you our particular strengths and how they will see us through this adversity.
First, we are extremely proud to have a team of dedicated professional, medical and support staff to fight this awful disease. We have a transparent system of communication, so that both the international and local communities are kept up-to-date on the latest developments. There are important lessons to be learned and it is vital that we learn them.
Second, we are fortunate to have an understanding and co-operative public, who have stood behind us in our fight against the disease despite considerable inconvenience. Home quarantine for the household contacts of SARS patients could not have been successfully implemented without the willingness and self-discipline of those affected. We are also moved by the humanity of so many people who wanted to make donations to the affected residents.
Last but not least is the determination of the Hong Kong Government in taking stringent public-health measures to control the spread of the disease. We will continue to do more as the situation develops. It is true that we were caught unawares at the first signs of the outbreak. But let us not forget that the virus we face is completely new to the world, and we were among the first to be hit. But in the light of experience, we now have developed four key areas in our strategy as mentioned earlier and we shall continue to devote resources and expertise to make our strategy work.
Concluding remarks
I mentioned earlier the Hong Kong Special Administrative Region Government's close collaboration with Mainland authorities, the World Health Organisation and other international bodies. This underlines the importance of partnership, co-operation and the free and frank exchange of views between different jurisdictions. In Hong Kong, the Director of Health and I give regular briefings to update all the Consuls-General on what we are doing and not doing, and why.
I am confident that by joining hands through these kinds of partnerships - and meetings such as this one - we will together prevail over the SARS virus. In closing, may I thank Minister Chua and his team for organising this excellent forum for all of us here to learn from each other best practices to combat SARS; and foster closer collaboration and cooperation among us.
Carrie Yau gave this address at the ASEAN Health Ministers Meeting on severe acute respiratory syndrome on April 26 in Kuala Lumpur.
