INTRODUCTION
What a difference a few months make. Before February 2003, no one in the world had heard of the word ‘SARS’ or ‘sudden acute respiratory syndrome.’ Yet, within the last few months, every healthcare worker and billions in the world have heard this dreaded word and the disease that brought many countries in the Asia‐Pacific region almost to their knees, Singapore included.
SARS TIMELINE
According to records, the first case of an atypical pneumonia was reported in Guangdong province in Southern China on 16 November, 2002. Almost 3 months later on 11 February, 2003, the Chinese Ministry of Health reported to the WHO an outbreak of a mysterious respiratory illness affecting 305 individuals with five deaths in the same province. On 26 February, 2003 the first case of an unusual pneumonia was reported in Hanoi, Vietnam. Two days later, WHO officer Dr Carlo Urbani examined an American businessman with an unknown form of pneumonia in a French hospital in Hanoi. The American businessman had recently visited China. Both subsequently succumbed to the disease., Before his death, Dr Urbani on 10 March, 2003 reported to WHO an unusual outbreak of the illness which he called ‘sudden acute respiratory syndrome’ or SARS among 22 healthcare workers in the French hospital. Clusters of such cases began to appear in Hong Kong, Toronto, Taiwan and Singapore. In China alarmingly large numbers also surfaced in Beijing with sporadic cases in Inner Mongolia, Hubei Province and a few smaller cities. Immediately, WHO and CDC swung into action and within 1 week an international network of 11 leading laboratories was established to determine the cause of the disease and develop potential treatments. On 24 March, CDC officials presented evidence that a new strain of coronavirus might be the likely cause of SARS.
SARS‐WATCH AND SARS‐PANIC
Meanwhile panic gripped people in the major cities affected by the disease. In Hong Kong everyone appeared with masks on the streets. Major airports in Beijing, Singapore and Hong Kong were almost empty. Air travel plummeted by over 70%. One major airline jumbo‐jet took off with more staff than passengers. Hotel occupancy dropped to single digits and one major restaurant in Singapore had no diners for a week. Orchard Road, the major shopping area in Singapore was like a ghost‐town even on weekends. All you had to do was to sneeze or cough and people would run away from you. It is estimated that the Singapore government lost S$1.5 billion in revenue and Singapore Airlines is expected to go into the red for first time in its history. Hong Kong reported that if SARS cases exceeded 3000, the whole health system would collapse.
HEALTHCARE WORKERS SHINE
Inspite of obvious danger to themselves and their families, the vast majority of healthcare workers remained at their posts. A few doctors (including a dear friend of mine), nurses and paramedical staff perished. Yet they fought on doggedly, relentlessly and fearlessly supported by their families, the hospitals, the healthcare authorities, their colleagues and the public. This was and is their finest hour. Speaking to one medical intensivist in the Tan Tock Seng Hospital which was designated the SARS treatment centre in Singapore, he confided in me and said: ‘At the height of the outbreak I was so scared that any day might be my last day and that my wife would be a widow and my young children orphans.’ His eyes then clouded.
At the time of writing, fortunately the disease is coming under control. Hong Kong has just been declared SARS‐free and Singapore has had no new cases for over a month. Yet SARS hangs over our heads like the proverbial Sword of Damocles. New outbreaks can occur any time as Toronto has shown and the whole calamitous cycle can repeat itself.
CONCLUSION
In the last few months, SARS has changed completely the way we practise medicine in the region. All visitors to hospitals are now screened for fever. Staff have to report their temperatures on‐line three times a day. Doctors must be gowned, gloved and masked to examine febrile patients. At the outpatient clinics, after every patient encounter, doctors are to wash their hands and their stethoscopes are wiped with alcohol. The free‐and‐easy way in which we practised medicine is probably gone forever. At the height of the outbreak, all SARS contacts and their family members were quarantined and a few recalcitrant quarantine‐breakers were electronically tagged and one was even sent to an isolated cell in prison. Some patients complained that their doctors are now unrecognizable because of the masks they wear. Clearly stricter infection control measures will be instituted leading to higher healthcare costs. The ultimate loser may be medicine itself. A senior member of the profession remarked to me: ‘It is no longer fun to practise medicine. I think I will call it a day.’ That is the real tragedy of SARS. The world indeed has changed.