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    HK rebuilds health system a year after SARS

2004-06-23 06:49

It has been a year since Hong Kong emerged slowly but surely from the shadow of one of the greatest threats to public health in living memory.

On June 23, 2003, Hong Kong was finally taken off the World Health Organization's list of areas with local transmission of SARS (severe acute respiratory syndrome), after some 15 weeks of hard-fought battle against the disease. The shockwave sent by the epidemic was felt not only in the health sector, but reverberated throughout all aspects of our society. Further afield, the outbreak also highlighted that in the age of globalization, a single public-health event in one corner of the world could have consequences affecting citizens of nations far and wide.

The SARS epidemic was, indeed, a painful experience for all of us. On this day, my special thoughts are with all the families who have lost their loved ones to SARS, particularly the families of the healthcare workers who sacrificed themselves while saving others in the epidemic. My thoughts are also with all the SARS patients who are still recovering from the physical and psychological sequelae of SARS.

When the SARS epidemic began in Hong Kong in March 2003, little was known about the disease; it did not even have a name. We, and indeed, the whole world had undergone a steep learning curve. Despite the severe challenges and difficulties, the outbreak had brought out the best in our community, with many people having contributed to the SARS battle through their extraordinary service, hard work, professionalism and attention to duty.

Overall, our efforts to control the spread of SARS in Hong Kong and beyond our borders was recognized by health experts and the international community. The WHO has commended that Hong Kong's efforts to stem the spread of SARS were nothing less than "heroic". Much more recently, the prestigious Stockholm Challenge Award 2004 bestowed its top award in the Health Category to Hong Kong in recognition of our innovative application of information technology to control the outbreak through the e-SARS system, which was a real-time clinical information system developed during the epidemic last year and linked to the police tracking system which enabled us to trace contacts of SARS patients for timely isolation and treatment.

Everyone involved in fighting the SARS epidemic, ranging from management to frontline staff on the public health and hospital front, in the private and public sectors, had worked tirelessly and did their best. With the benefit of hindsight, it may be easy to find inadequacies in the work that was carried out under extremely trying circumstances when faced with an unknown and vicious enemy. To quote from the report by the Honourable Mr Justice Archie Campbell, Commissioner for the Canadian investigation into the SARS epidemic in Toronto, "it is easy, with the benefit of what we now know, to judge what happened during SARS. It is easy now to say which systems were inadequate and which decisions were mistaken. That is the great benefit of hindsight, a gift not available to those who fought SARS or those who designed the systems that proved inadequate in face of a new and unknown disease..."

There is, of course, a proper role for retrospective wisdom and hindsight, which is in helping to draw lessons from the experience and make improvement to better prepare our system for any future outbreak. To quote from Honourable Mr Campbell again, "hindsight becomes suspect when inferences are drawn that systems or people 'should have' acted differently even though they lacked vital knowledge that became available only later".

The former director of the Centers for Disease Control and Prevention of the United States, Dr Jeffrey Koplan, once likened our public healthcare system to that of a dam wall protecting us from floods. For 50 years, it worked well. However, with global warming an unprecedented massive flood strikes and the wall is found to be inadequate. So there is a need to build a higher wall.

This is where we found ourselves during the SARS epidemic when we learnt to build our capacity during the outbreak. In the last 12 months, we have rebuilt our new public health defence system to protect us from the threat of any new infectious disease of the magnitude and scale we encountered during SARS outbreak. These new defences include:

Centre for Health Protection

The establishment of a Centre for Health Protection (CHP) to enhance the prevention and control of diseases in Hong Kong in collaboration with major local and international stakeholders.

The CHP came into operation on June 1 this year and is expected to be fully developed by 2005. The surveillance of infectious diseases to provide early warning has been considerably strengthened. The epidemiological and contact-tracing capabilities have also been beefed up.

Emergency preparedness

We have established an overall contingency mechanism, underpinned by detailed contingency plans to enhance emergency preparedness. We have conducted over 40 drills to test our responses. In this autumn, a full-scale multi-party drill including observers from overseas health-protection agencies will be conducted.

Improved information and data management

We are in the process of developing a Communicable Disease Information System to facilitate more systematic information exchange and sharing on infectious diseases between the CHP, the Hospital Authority and other healthcare providers. The system will be enabled to link up with community points-of-care and sentinel sites such as homes for the elderly, schools and childcare centres.

Cross-boundary and international co-operation

The CHP is building on the communication and notification mechanisms developed by the Department of Health over the years with mainland and overseas health agencies. For example, it has signed a Memorandum of Understanding with the Health Protection Agency of England and Wales.

Enhanced isolation facilities

Improved isolation facilities including some 1,400 isolation beds have now been made available in 14 public hospitals throughout the territory. We have also planned to construct a modern, state-of-the-art infectious disease centre in Princess Margaret Hospital.

Infection control training

To raise the skills of our healthcare workforce in infection control, we have provided systematic training to more than 31,000 staff since last September. The training programme is on-going.

Research and development

To capitalize on our research strength, we have established a HK$500-million research fund to support further research projects on the prevention, treatment and control of infectious diseases. Among others, we have commissioned the University of Hong Kong, the Chinese University of Hong Kong and a consortium comprising Hong Kong University of Science and Technology, the Polytechnic University and the Hospital Authority to undertake different portfolios of research projects.

Community involvement

Tackling infectious diseases requires the joint efforts between the government and the community. Since last November, we have rolled out a wide variety of publicity and educational measures to remind the public to stay vigilant and prepared for SARS and other infectious diseases.

Many lessons have, indeed, been learnt from the SARS epidemic. One year on, we have made significant progress to improve our infrastructure and enhance our system capabilities. Although we should continue to remain vigilant and not be complacent, it is perhaps not a coincidence that Hong Kong has been free from SARS and avian flu this year when our neighbours have been adversely affected.

The author is Hong Kong's secretary for health, welfare and food.

(HK Edition 06/23/2004 page2)