Speech by Minister for Health Gan Kim Yong, at Tan Tock Seng Hospital "Remembering SARS: 10 Years On", 20 March 2013

Mdm Kay Kuok, Chairman of National Healthcare Group;

Professor Chee Yam Cheng, Group Chief Executive Officer, National Healthcare Group

Professor Philip Choo, CEO, Tan Tock Seng Hospital

Distinguished guests,

Ladies and gentlemen

Good morning.

Remembering SARS

At this time 10 years ago, in March 2003, it would have been unthinkable to have so many people gather in the atrium of Tan Tock Seng Hospital (TTSH), like what we are doing today. Back then, Singapore was in the grip of the SARS epidemic and TTSH became the epicenter of the action when it was designated as the hospital to manage SARS patients on 22 March that year.

2.            SARS was with us for just three months, but it left an indelible mark on our healthcare landscape and on our national memory in that short period of time.  When SARS cases first appeared in Singapore, there was widespread confusion and anxiety.  Public alarm escalated rapidly when the first cases of death from SARS were reported here.

3.            There was a climate of fear as the public avoided hospitals and clinics. This was understandable, as SARS was a new disease which we knew very little about - how it spread and how, or even if, it could be treated.  Healthcare workers were shunned during the early days of the epidemic.  For example, nurses in uniform were ostracised by the public on buses and MRT and some even reported being evicted from their rented homes.

4.            Its high mortality rate similarly invoked fear among healthcare workers who had to face the potential risk of infection from day to day.  At the risk of their personal safety, as well as their family’s, healthcare workers bravely soldiered on and continued the fight at the frontline taking care of patients and ensuring that there was no disruption in the provision of health services to Singaporeans though they had more reason to be fearful than any one of us.

5.            In Singapore, about 40 percent of SARS cases were reported in healthcare workers. Professionalism was at its finest moment.  Many answered the call of duty in the battle against SARS. Both our foreign and local healthcare workers stayed on to fight alongside one another.  This was not always the case elsewhere in the world.

6.            The designation of TTSH as the “SARS hospital” did not eliminate the threat of SARS from other hospitals. Besides TTSH, Singapore General Hospital (SGH) and the National University Hospital (NUH) also reported SARS clusters.  With TTSH, the second largest public hospital, effectively locked down, our other public and private hospitals had to step up their operations to continue providing medical care to Singaporeans.

7.            The whole nation watched as our healthcare workers worked selflessly to care for SARS patients, and we mourned as a nation when some of these heroes succumbed to the infection so that patients they cared for could live on and recover.  Singapore lost five exemplary healthcare workers who died in the line of duty, they are: the late Dr Ong Hok Su, a Medical Officer at TTSH; the late Mdm Hamidah Bte Ismail, a Nursing Officer at TTSH; the late Dr Alexandre Chao, a Consultant at SGH; the late Mr Jonnel Pabuyon Pinera, a Nursing Aide at the Orange Valley Nursing Home; and the late Mdm Tan Kiew Miyaw, a Health Attendant at SGH.  Let us remember their courage, dedication and sacrifice.

8.            Ten years on, the mention of SARS still strikes a deep chord in our hearts.  It was one of the darkest moments in Singapore’s history and yet, is also remembered as one of our finest triumphs – when the nation bonded together with resilience, determination and compassion.  Our healthcare workers especially fought a valiant war and the episode brought a renewed appreciation for the nobility and importance of their profession.  I would like to take this opportunity to pay tribute to the nurses, doctors and healthcare workers in all our hospitals and healthcare institutions.  You are the nation’s vanguard when it comes to saving precious lives day after day, both during peacetime and in crisis, and we thank you for making a difference with your dedication and skill. 

Ready for the next “SARS”

9.            Even as we stand here today to remember the 10^th anniversary of the SARS epidemic, we need to learn from the past so that we can be ready for the future. 

10.          The ever-present threat of infectious diseases remains a concern worldwide. In September last year, the World Health Organisation (WHO) issued an international alert announcing that a new virus belonging to the same family as the SARS virus known as Novel Coronavirus, had emerged in the Middle East and infected two persons.  To date, the WHO has recorded a total of 15 confirmed cases, including nine deaths. Information on this new virus remains limited.  So far, the cases have been sporadic and secondary infections among the close contacts of these cases appear uncommon. Nevertheless, we cannot let our guard down. We have raised the level of vigilance for this disease in our medical community, so that suspect cases can be detected, isolated and investigated quickly. So far, there have been no confirmed cases reported in Singapore.

11.          However, in our highly globalised world, where cities are well connected by air travel the transmission of infectious diseases has become much harder to control.  There is a real risk of epidemics or an outbreak of a new infectious disease spreading to Singapore, given our global connectivity. We must remain vigilant and be prepared all the time.

12.          The healthcare family’s experience with SARS in 2003 has taught us many valuable lessons, many of which have since been instituted into our healthcare systems and translated into a set of emergency preparedness and response measures.

13.          For example, we restricted visitors at our hospitals to limit the possible spread of SARS in 2003. To this day, hospitals still practice visitor registration and this has become commonly accepted by the public.

14.          During SARS, arrangements had to be made in the emergency departments to promptly identify individuals with fever and separate them from the other patients.  Triaging has now become an established workflow at our hospitals where patients with symptoms of infectious diseases are segregated and managed differently with added emphasis on infection control.

15.          Another lesson we learnt was the importance of having a sufficient number of isolation rooms to contain potential spread of infectious diseases.  Our public hospitals did not have enough isolation rooms nationwide pre-SARS.  To cope with the sudden increased demand during SARS, we built makeshift cabin isolation facilities within a month.

16.          Ten years later, the number of isolation rooms has increased to close to 400.  These rooms are spread across all the major acute public hospitals.   We also now have over 3 times more, or 48, Infectious Disease physicians in Singapore.  All these add up to the building of capacity and capability to be better prepared for the new challenges of emerging and re-emerging diseases.  

Conclusion

17.          As we stand here as a healthcare family to remember our battle with SARS – the lives lost and victories won – let us also remember that we couldn’t have done it without the support of Singaporeans who fought by our side.  We did not face the crisis alone but as a people.  Generous donations, from bottled drinks and herbal tea to fruits and food of all kinds, poured in abundantly from members of the public to keep our healthcare workers going.  There were also numerous messages and handmade cards to encourage and thank these workers. I thank all Singaporeans who had rendered their support to us as we fought the war against SARS.

18.          Our healthcare family stood united in the battle and showed exceptional commitment to their profession in the face of adversity and danger.  From the general practitioners to the public and private hospitals, each doctor, nurse, and healthcare worker played their part in our response against SARS.   

19.          The threat of emerging infectious diseases remains a clear and present danger for countries around the world, and all of us must continue to be vigilant.  Individuals can do their part by learning and practicing good personal hygiene habits and being socially responsible, which - as simple as it sounds - is the key to curbing the spread of any infectious disease in the community.  Let us continue to stay alert and be ready to face the next challenge when it comes our way – and surely it will come one day.  We’ve fought with SARS and won. It was a reminder that while we may be vulnerable, if we stand together as a nation and as a people, we can overcome and emerge stronger.

Thank you.