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1. This note provides updated information
of Hong Kong Special Administration Region Government’s effort in combating
severe acute respiratory syndrome (SARS).
Summary of cases
2. As at 1 p.m. 23 April, a total of 1,458 patients admitted
to public hospitals have been confirmed with SARS. Of these, 335 (22.9%)
are health care workers
or medical students while 1,123 (77.0%) are patients, family members or
visitors/contacts. A total of 522 patients (35.8%) have recovered and been
discharged from public
hospitals, of whom 61 were discharged on 23 April. There are 105 fatal
cases, most of whom had a history of chronic diseases or sought treatment at
a
relatively late stage of infection. There are however a growing number of
younger deaths
whose illness was severe and did not respond to treatment. Most of the
patients currently in hospital are showing positive responses to the treatment
protocol.
110 patients are receiving treatment in intensive care unit. There are
328 patients living in Amoy Gardens, accounting for 22.5% of all the cases.
The situation
in Amoy Gardens has however stabilised, with only 4 cases reported during
the 5-day period from 17 – 21 April. Furthermore, some of these recently
reported cases represent those with disease onset earlier during the outbreak
and now
being confirmed.
Latest Development
Home Confinement
3. With effect from 10 April 2003, all household contacts of confirmed SARS
patients are required to confine themselves at home for home treatment up to
a maximum of 10 days. As at 23 April, a total of 301 permits covering 787 persons
for the home confinement have been issued. The implementation has been smooth.
The majority of the confinees have stayed at home as required, and non-compliance
requiring the issue of warning letters has been few in number. As at 23 April,
a total of 33 warning letters have been issued. Follow-up action showed that
most of these defaulters have complied and stayed at home. As at 23 April, there
were 49 referrals to the Accident and Emergency departments of hospitals or
designated medical centres for people under home confinement having SARS symptoms,
of which 11 were confirmed to have SARS.
Border Control by Measuring Body Temperature of Passengers
4. With effect from 17 April, all passengers departing at the Hong Kong International
Airport are required to have their body temperature taken before check-in
under the Prevention of the Spread of Infectious Diseases (Amendment) Regulation
2003. Any outbound passengers with a body temperature of over 38 degrees Celsius
would be required to seek medical advice. Passengers who have fever or symptoms
suggestive of SARS should not board a plane. The measure is in line with the
World Health Organisation travel advice that people departing from affected
areas should be screened for possible SARS at the point of departure. The
operation has been smooth thus far. As at 22 April, no one was suspected to
have SARS among the cumulative total of 59,638 persons departing at the Airport.
As a continued effort to strengthen control measures at entry and exit points,
we will be taking body temperature for all inbound passengers at the Airport
starting later this week, followed gradually by similar body temperature taking
arrangement at other border check points.
Class Resumption
5. The Education and Manpower Bureau (EMB) announced on 16 April that Secondary
Three level and above of secondary schools would resume classes on 22 April
as scheduled, whereas classes for other levels of secondary schools, primary
and special schools, and kindergartens will continue to suspend for one week
and resumption is tentatively scheduled for 28 April.
6. EMB has issued to schools a comprehensive manual reiterating the various
precautionary measures against SARS, such as the necessity for schools to cleanse
their premises on daily basis, and teachers and students to pay heed to personal
hygiene. Schools are also reminded that tuck-shop, catering, school bus and
nanny bus services must maintain hygiene standards to the highest. In addition,
EMB initiated a school cleansing campaign on 20 April, calling on parents to
join forces to help out with school cleansing work.
7. Upon class resumption, EMB requires schools to implement a series of preventive
measures against the occurrence of SARS on their premises. These measures include
-
- Parents have to make sure that students are not feeling unwell before
sending them to school, observe whether there are any SARS symptoms and check
students' body temperature on a daily basis;
- All staff members (including drivers of and workers on school bus) must
measure their body temperature before they return to school on a daily basis.
Those
with a temperature should not return to school;
- Those staff members/students who have close contact with a confirmed SARS
patient must undergo home confinement for 10 days before returning to school;
and
- Schools should suspend classes for 10 days once a student/staff member
is confirmed to have contracted SARS.
Investigation into the outbreak of the Amoy Gardens
8. As of 23 April, there were a total of 328 SARS cases in Amoy Gardens. There
was an obvious concentration of cases in Block E, accounting for 40% of the
cumulative total. The rest of the cases (60%) were scattered in 13 other blocks.
In terms of onset dates, the outbreak reached its peak on 24 March and declined
steadily afterwards. Block E cases appeared earlier in the outbreak and showed
a point-source type of distribution. Cases in other blocks which appeared
3 days later were more evenly spread out in time.
9. In order to identify the cause of the outbreak of SARS at Amoy Gardens,
the Government has conducted a detailed investigation covering epidemiological,
environmental, public hygiene, building design and utilities considerations.
The findings of the investigation were announced on 17 April. A report on the
investigation was submitted to the World Health Organization on 18 April. In
gist, the findings showed that not one single factor could account for the
outbreak in Block E of Amoy Gardens and that the outbreak was likely to be
the result of a combination of factors, including -
- The presence of an index patient who caused the first batch of infections;
- Person-to-person spread;
- Transmission via the sewage system; and
- Environmental contamination.
10. The World Health Organization has agreed to send an expert team to visit
Hong Kong in end-April with a view to discussing the findings of the Amoy Gardens
investigation report.
Details of the notification mechanism between Guangdong and Hong Kong
11. Experts from Hong Kong and Guangdong held the first meeting of the Expert
Group on Prevention and Treatment of Infectious Atypical Pneumonia on April
17 and 18 in Guangzhou. The Guangdong expert group includes representatives
from the Health Department of Guangdong Province, Center for Disease Control
and Prevention and several hospitals in Guangdong. The Hong Kong delegation
comprises representatives from the Health, Welfare and Food Bureau, DH and
Hospital Authority (HA).
12. Experts from the two sides conducted in-depth discussions on the occurrence
of atypical pneumonia in the two regions from various perspectives, namely,
health administration and management, clinical treatment, epidemiology and
pathology. As regards the notification mechanism for atypical pneumonia between
the two places, the two sides reached the following consensus on detailed arrangements
-
- Periodic notification on the latest situation on infectious atypical
pneumonia
The two sides agreed to further improve the notification mechanism for infectious
atypical pneumonia. They will pass the latest information on the disease to
each other regularly through telephone, facsimile, emails, etc. which would
include cumulative case reports, figures on number of cases, deaths, patients
discharged as well as clinical treatment, epidemiological investigations, and
progress on pathological study. At the meeting, representatives of the two
sides exchanged the latest information on the disease. To protect the confidentiality
of information prior to release, a dedicated confidential information system
has been set up.
- Enhanced mechanism for exchange of information on disease control work
between counterpart organizations
Both sides agreed to set up a point-to-point exchange mechanism to enhance
communication and to draw on each other’s experience in disease control.
The point-to point exchange mechanism will be established between (a) the
Health Department of Guangdong Province and Hong Kong Department of Health;
(b) the
Center for Disease Control and Prevention of Guangdong Province and Disease
Prevention and Control Division of Hong Kong Department of Health; and (c)
Hospitals and pathological services institutions of the two regions. Experts
from the two sides will exchange information and share experience through
telephone and facsimile, etc.
- Enhanced Exchange of information on infectious diseases
In view of the emergence of atypical pneumonia, both sides saw the importance
of early exchange of information of infectious diseases which will facilitate
control and prevention. The two sides agreed to enhance the existing scope
of information exchange by expanding the list of notifiable infectious diseases
to include cholera, dengue fever, malaria, influenza and tuberculosis.
13. Both sides agreed to hold the second expert group meeting in Hong Kong
in May to exchange the latest information on control of the spread of atypical
pneumonia.
Public Hospitals
Procurement and supply of protective gear for public health care workers
14. For general protective gear such as goggles, masks, jackets and trousers,
gowns, disposable caps and gloves, HA is arranging procurement centrally. HA
keeps a stock of 14 days of these gears and there are weekly supplies locally,
from the Mainland and overseas. Current supply is steady and adequate. HA also
keeps stock of higher level protective gear such as “Barrier Man” (coveralls
for use in areas which require greater protection). HA is sourcing from the
USA and Mainland. Supply is so far adequate. As to ventilators, about 790 sets
are available for use by SARS patients. Currently, apart from the 109 patients
in the intensive care unit (ICU), about 100 patients are on ventilators. The
number of ventilators available is thus more than adequate.
Availability of intensive care facilities
15. HA has a total of 375 ICU beds. As at 22 April, 109 were used by SARS patients.
Non-SARS patients also occupied over 150 beds. As some of the existing non-SARS
ICU patients begin to receive their step-down care in non-ICU wards and in
conjunction with HA’s reduction of non-urgent clinical activities, some
ICU beds can be freed up for SARS patients. Assuming an ICU rate of 12% for
SARS patients and, taking into account the ICU utilization rate for SARS patients
during the past week, HA’s ICU capacity is considered to be adequate.
HA is also testing the use of breathing equipment such as “BIPAP” which
can enable patients intended for ICU to be taken care of in acute wards. As
regards ICU beds in private hospitals, the number is limited with only 50-60
beds. Generally, private hospitals will refer SARS patients to public hospitals
for further management. However, if in need, private hospitals can assist HA
in treating selected non-SARS urgent cases, thus releasing HA capacity to focus
on SARS patients.
Health, Welfare and Food Bureau
30 April 2003
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