President¡¦s message ¡V Are you well prepared for a possible return of SARS?

As reported in the news, our Mainland China is preparing for a possible return of the SARS virus, with one northern city checking travelers for fever and experts warning the disease is certain to re-emerge. The virus will ¡§definitely come back,'' the official Xinhua News Agency quoted an official of the Government's China Disease Control Center on 13th October 2003 as saying, ¡§But the scale of the epidemic depends on the control measures we take.''

In Hong Kong, the SARS expert committee, an international panel of experts chosen by the HKSAR Government announced on 2nd October 2003 in her report ¡§From Experience to Action¡¨ that she had found some shortcomings in the HKSAR Government's response to the outbreak of SARS last spring but praised the overall response and singled out no officials for criticism. The report drew immediate criticism from the political opposition, which called for a separate investigation by the legislature.

Amidst the formation of Legislative Council's select committee on SARS, the ¡§Report of the Hospital Authority Review Panel on the SARS Outbreak¡¨ came to light on 16th October 2003. The report found that the Government was unprepared for an epidemic of that magnitude, and the delay in isolating patients at the Prince of Wales Hospital put the community at great risk. The report was more critical of the Government's handling of the outbreak than the SARS Expert Committee, but neither report singled out anyone for blame.

Before we predict who is going to step down in this Political turmoil, one thing isfor certain, we have to prepare ourselves well for the possible return of SARS virus. From our private practitioners¡¦ point of view, we can do a lot of measures to combat the next SARS but short of management since there is no universal accepted management protocol. May I suggest our members to stay alert and to remember my simple formula ¡V PDF.3R which stands for Protection against SARS virus, Detect any suspected SARS case and Follow up on suspected case by Refer, Report and Retreat if deemed necessary.

P stands for Protection - As for the level response in Protection, the HKDU would like to propose the following simpler 4-level SARS response system for private doctors with reference to the 3-level response system as stated in the "Checklist of Measures to Combat SARS" released by the Government on 22nd September 2003.

HKDU Level Response

Advice to Private Doctors

Government Level Response

Occurrence

Government Parties mainly in Charge

0

Stock up PPE(i) for one month; Vaccinated against Influenza

Alert (a)

SARS Outside Hong Kong

Department of Health

1

Wear masks

Alert (b)

Clinical SARS in Hong Kong

Hospital Authority

2

Wear "Voluntary" PPE(ii)

1

Confirmed SARS in Hong Kong

Secretary for Health, Welfare & Food

3

Wear "Mandatory" PPE(iii)

2

SARS Spread in Community

Chief Executive
  1. PPE (Personal Protective Equipments) - includes surgical or N95 masks,goggles, face shields, gowns, gloves, caps and shoe covers;
  2. ¡§Voluntary¡¨PPE ¡V means variable degree of protection ranging from wearing masks to fully equipped with PPE. To what degree of protection one should follow depends very much on the degree of risk one is facing. Factors affecting the degree of risk include which specialty you are in, what environment you are working in and the types of patients you are encountering everyday etc.;
  3. ¡§Mandatory¡¨PPE ¡V means the full set of PPE.

We have sent two health alerts to members after the incident of SARS return in Singapore and we do hope that members have stocked up enough PPE and got themselves protected against Influenza. Whether it is necessary to wear masks now is at your discretion. On your behalf, we have negotiated with the Hospital Authority to stock up one month of PPE for private health care workers in case of SARS return and the response is encouraging. As far as preventive measures in clinic operation, please go to Page xx of this Bulletin for reference.

D stands for Detection ¡V We would help our members to upgrade knowledge on SARS whenever necessary and would keep you informed through our circulars and Rapid Communication System. We have been discussing with the Hospital Authority and the Department of Health on organizing CME to update members on Infectious Diseases and other diseases of importance. These may take the form of routine CME meetings in hospitals, hotels, CME teleconferences and even web casts. With these measures, we do hope that our members are well equipped with updated knowledge to easily differentiate between SARS and Influenza when SARS strikes back.

F stands for Follow up action - When you come across a suspected SARS case in your practice, remember to do the following 3Rs:-

  • R stands for Refer to HA hospital, and NOT to private hospital;
  • R stands for Report to Department of Health for contact tracing and HKDU secretariat for follow up progress on the patient;
  • R stands for Retreat if necessary. The question of whether to close clinic if one of the clinic staffs is admitted to hospital for suspected SARS is at your discretion and it very much depends what degree of protective measures the health care workers have taken.

By adhering to the above-mentioned measures in case of SARS return, you have helped us to win the next SARS war and the scale of the epidemic would be minimized. Good luck!

Dr. Yeung Chiu Fat Henry

President's message ¡V November 2003 HKDU (2)/email02