Severe acute respiratory syndrome

Editor—When an outbreak of severe acute respiratory syndrome (SARS) was first reported in Singapore, drastic measures were taken, including the closure of schools and hospitals. Such measures were deemed necessary as important epidemiological data on transmission dynamics and infectivity rates of the SARS virus were largely unknown. Early reports indicated a highly contagious infective agent,¹ and the number of exposed patients who may potentially become affected could overwhelm the capacity of existing medical facilities.

Seventy patients and 131 healthcare workers on two surgical wards were exposed to the virus after a sudden outbreak at this hospital. They were quarantined and relocated to a SARS designated hospital for 21 days. They underwent triage and were put into cohorts on three open plan wards, where facilities were shared. However, they were closely monitored and isolated immediately on manifestation of a raised temperature or symptoms suspicious of SARS. Strict infection control measures for droplet and contact transmission were undertaken between healthcare workers and patients.

All the healthcare workers remained well at the end of the quarantine period. This is a testament to the good protection afforded by current infection control measures against the virus. Seven patients were diagnosed as having SARS, and in one death was related to SARS. The patients with SARS initially presented with fever, radiological changes occurring three to six days after isolation. There was no uncontrolled clinical transmission within the cohort with early identification.

This clinical outcome is reassuring during the current SARS crisis. Health authorities faced with a similar outbreak and a shortage of isolation facilities may take comfort from the observed clinical incidence and case fatality rate.