Update On SARS - 27 Apr

27 Apr 2003

Situation Update on SARS

Today, there is only one SARS case reported. The patient was Dr Alexandre Chao who passed away on 22nd April. Post mortem results confirmed his case as SARS. Besides this, there are no other new cases. 3 more patients have been discharged, bringing the total number of patients who have recovered from SARS to 131. 47 SARS patients remain hospitalised, of whom 17 are in intensive care.

No Visitors Rule

Starting from 29 April 2003, all public hospitals will implement a No-Visitor Rule for their patients. Of the 199 SARS cases reported so far, about 38% of them were visitors to hospitals. The No-Visitor rule is an added precautionary measure to cut down the chances of visitors being infected while in the hospitals. In addition, it will also help prevent infection from being brought out of the hospitals into the community at large

The No Visitor rule will not apply for departments or hospitals treating children or providing obstetric care, where the 1 visitor per patient per day policy will continue. Individual hospitals will also exercise flexibility, on a case by case basis, in implementing the No Visitor Rule for patients who are seriously ill. The Ministry would like to appeal for public's understanding of the need for such a cautious and stringent rule so as to combat the spread of SARS. The No Visitor rule will be reviewed at the end of May.

Post-mortem results of Dr Alex Chao

Dr Alexandre Chao, Consultant Vascular Surgeon with the Department of General Surgery, SGH was on annual leave until 7 April 03 when he returned to SGH to work

He became febrile on the evening of 12 April 03 (37.4 degree C) and had isolated himself from his family in another house. The following day, 13 April 03, he became febrile again and visited the SGH Staff Clinic and was given 2 days medical leave.

On 15 April 03, he still had a temperature of 37.7 degree C and was admitted to an isolation room in SGH Ward 47, our Isolation Ward. He had no chest complaints. The clinical diagnosis was dengue fever.

On 16 April 03, he had developed symptoms which were consistent with that of dengue fever, including rashes over his body, back and limbs.

Blood tests done on 17 April 03 showed that his platelets were slightly low and further depressed on 18 April 03. This had returned to normal by 21 April 03.

His chest x-ray taken on 17 April 03 was normal. On 19 April 03, the x-ray film did not show significant abnormalities.

He remained afebrile on 21 April 03. Dr Chao had reported that he was feeling better in terms of his fever and myalgia, although he later complained of a sore throat.

On the morning of 22 April 03, Dr Chao had complained of a sudden onset of breathlessness. He was transferred to the intensive care unit and was intubated for respiratory distress. Chest x-ray done prior to intubation showed bilateral pneumonia. Despite intense treatment, he passed away at about 7.00 pm.

A post-mortem was carried out on 23 April 03. Testing of postmortem tissues subsequently confirmed SARS.

Dr Chao may have been infected by a critically ill patient from the Ward 57 & 58 cohort, whom he cared for during the week of 7 to 13 April 03. This patient collapsed on 6 April 03 when he was supposed to be transferred to TTSH. In view of the patient's critical condition, he was therefore isolated in the SGH Neurology ICU until his condition was stable for transfer on 14 April 03. He was subsequently classified as a probable SARS case at TTSH and passed away on 25 April 03.

Pasir Panjang Wholesale Market (PPWM): Update

On the 19 April, PPWM was closed down when 2 workers with probable SARS were identified. These two had come in contact with the brother of the SGH index case who worked in PPWM.

Active contact tracing was initiated immediately to trace all persons who might have come into close contact with the three SARS cases. A total of 1,825 persons who had frequented the Market between 5 and 19 Apr were identified as possible contacts, and they comprised 935 tenants and stall holders, 553 employees and workers, and 337 regular customers. As a precautionary measure, these persons were placed under home quarantine and monitored for fever for a 10-day period from 20-29 Apr. The quarantine will be lifted on 30 Apr.

There have been no new probable cases related to PPWM since 26 April.

Today 4 more suspect cases (3 visitors and 1 workers) related to the PPWM have been discharged. There are currently 10 suspect cases admitted in relation to PPWM. They consist of 8 visitors and 2 family & friend contacts.

Death of an NUS lecturer

A lecturer from NUS was brought to the CGH Emergency Department on 25 April 03. He was in a collapsed state and died at the Emergency Department.

Postmortem examination on 26 April showed the presence of pneumonia affecting both lungs. Microscopic examination of the lung tissue showed that this was due to a fungal infection.

Blood tests for SARS antibodies were negative. Postmortem tissues from the lung, heart and lymphnodes were tested for coronavirus by PCR. The PCR tests were all negative.

Post mortem result

The 64 year old man who died on 12 April is confirmed to have died from SARS. He had visited his brother at SGH Ward 58.

Summary of SARS Cases

Discharged: 131

Hospitalised: 47 (including 17 in intensive care)

Deaths: 21+1 (pending further investigations)

Probable cases: 199

Suspect cases: 111 (including 9 children under the age of 18)

Under home quarantine: 2836

Travel Advisory

MOH urges the public to heed World Health Organisation (WHO)'s advice to postpone travel to Hong Kong, Guangdong, Beijing, Shanxi and Toronto until another time. We would also like to advise the public to avoid travel to other SARS affected areas - Hanoi, unless absolutely necessary.