Severe Acute Respiratory Syndrome in Hong Kong --latest update Hong Kong Special Administrative Region Government 7 May 2003

Update of SARS situation in Hong Kong As of 7 May 2003, New Cases8* Total confirmed cases1654 Recovered984 Died204 Still in hospitalization466** * The number of new cases has been in single-digit for 4 days. **Those in hospitalization include 89 recovering patients in convalescence.

Malaysian vessel entering HK waters The Government received calls for assistance from a Malaysian freighter on 2 May. The shipmaster sought assistance because 10 of its 24 crew members had fallen ill with symptoms of fever, cough and aching joints. Based on humanitarian ground and obligations under international convention and regulation, the HKSAR Government decided to allow the vessel to enter Hong Kong waters.

The freighter entered Hong Kong waters on 4 May. Doctors and medical personnel conducted clinical examination on the crew and thorough cleansing of the vessel. The sick crew members were sent to the hospital for further treatment. The remaining crew members were arranged to stay on board the freighter for isolation. The sick members were later discharged in the evening of 4 May. None of them had contracted SARS. The vessel left HK on 5 May. Malaysian vessel entering HK waters

The Chief Executive (chairs the steering group) Secretary for Health, Welfare and Food (responsible for public health issue) Other Directors of Bureau (assist in other various policy areas) Multi-Sectoral Task Force to combat SARS HKSAR Government Steering Group on SARS

Secretary for Health, Welfare and Food (chairs the expert group for the investigation and cure of disease) Permanent Secretary for Health, Welfare and Food (chairs the inter-departmental meeting (involving more than 10 depts) for the coordination of disease prevention works and public education) Hospital Authority Statutory body overseeing public hospitals in HK Clinical treatment of SARS Department of Health HK’s public health authority Disease surveillance, contact-tracing Containment of disease via public health and environmental hygiene measures Coordination of multi-disciplinary teams for follow-up

Government’s Strategies 1.Infection Control Measures 2.Public Education 3.Treatment Protocol 4.Collaboration with the Mainland, WHO and international community

1.1Stepping up health checks at boundary points 1.2Minimising the no. of healthcare workers affected 1.3Prompt case investigation & active contact tracing 1.4Home quarantine 1.5Setting up multidisciplinary response team 1.6Publicizing list of names of building blocks where SARS patients resided on DH website to ensure disinfection by all residents 1. Infection Control Measures

1.1 Step up health checks at boundary points Comprehensive temperature check for all incoming, departing & transit passengers at the Airport Temperature check for arriving passengers at sea-landing checkpoints Agreed with the Mainland authorities that each side will carry out temperature check for in-coming passengers at all land-crossing points Shenzhen and HK each installed infrared temperature scanners in phases 1. Infection Control Measures

1.1 Step up health checks at boundary points Passengers on arrival at HK must fill in health declaration forms. Medical posts are set up at the airport, ports & border points for medical checks and for further referrals to hospitals. Close contacts of SARS are barred from leaving Hong Kong during the quarantine period since April Infection Control Measures

1.2 Protecting health care workers Hospital staff are provided with adequate protective gears and apparel for their clinical services Ventilation and environment improvements Staff training in infection control is reinforced before deployment to SARS wards The public is discouraged to visit hospitals. No visit to SARS wards is allowed. Hospitals reduce one third of non-urgent services to reserve resources to handle SARS cases. Provision of residential flats in addition to HA ’ s dormitories for self- quarantine of doctors and nurses 1. Infection Control Measures

A&E Cohort SARS ward Clinical management System Online eSARS database Proactive contact tracing Home confinement Proactive environmental decontamination triage 1.3 Proactive Contact tracing (1) 1. Infection Control Measures

1.3 Proactive Contact tracing (2) – Use of Technology eSARS Clinical information system developed by HA Performs real-time database function for information of SARS patients, facilitates knowledge-sharing among clinicians Linked with MIIDSS Major Incident Investigation & Disaster Support System (MIIDSS) An investigation system of the Police on loan to Department of Health for contacts analysis and hot-spot identification Staff working on MIIDSS

Suspected / Confirmed cases of SARS admitted to hospitals (eSARS) SARS Command Centre Under the Department of Health (for case investigation, outbreak detection & contact tracing) (MIIDSS) Household contacts Other contacts Multidisciplinary response team Collects information on clinical features of cases and information of contacts Preliminary identification of clusters Further case investigation to identify clusters and contact tracing Home confinement Designated Medical Centres 1.3 Proactive Contact tracing (3) 1. Infection Control Measures Close contactsHot spots

1.4 Home quarantine All household contacts of confirmed or suspected SARS patients are required to undergo home confinement for monitoring and treatment up to a maximum of 10 days. Daily necessities and financial assistance are provided to the affected persons As of 1 May, a total of 1041 persons from 408 households have been confined. There are 71 referrals to the medical institutions, of whom 17 were confirmed to have SARS. Our community is understanding – nearly 100% compliance 1. Infection Control Measures

Investigation of SARS cases at the Amoy Gardens shows that environmental factor is a major cause for the outbreak there Swift, proactive actions are needed to eliminate risk factors which might contribute to the spread of SARS  The setting-up of the Multi-disciplinary Response Team Led by DH, the team comprises Buildings Dept, Housing Dept, the Police Force & Food & Environmental Hygiene Dept. It swiftly move in any buildings with 2 or more households affected by SARS for investigation, contact-tracing, disinfection & cleansing. Health advice is offered to the residents and management companies. 1.5 Multidisciplinary response team 1. Infection Control Measures

2. Proactive public campaigns Education campaigns held  in various places (e.g housing estates, public transport operators, schools kindergartens, childcare centers travelers, food premises)  for various target groups (e.g. the travelers, medical practitioners and the general public)  through various means (e.g TV/radio messages, newspaper supplements, health talks, website, posters/pamphlets, hotline ( )) Key Messages:  Personal and environmental hygiene (including disinfection method)  Non-discrimination towards people affected by SARS Leaflets distributed in public places Poster on Prevention against SARS

Multi-Language Version for Foreigners

Team Clean, the special task force chaired by the Chief Secretary for Administration, Mr Donald Tsang, is established promote a sustainable, cross-sectoral approach to improve environmental hygiene in Hong Kong A series of durable measures, which would involve all government departments and the community would be developed to keep Hong Kong permanently clean Microbiologists, experts in architecture and town planning sectors, the business sector, voluntary organisations and district personalities would be invited to take part in various aspects of the team ’ s work 2. Proactive public campaigns

3. Treatment protocol Treatment regime High dose steroids Ribavirin Response to treatment depends on: Age of patients Severity of illness Presence of co-existing illness (past health) How early people seek treatment Consider: New modality based on international experience & scientific evidence

Effectiveness of treatments

4. Closer Collaboration with the Mainland & WHO International collaboration through WHO in areas of epidemiology, clinical management, laboratory and environmental studies Meetings between HK and Guangdong health authority was held in mid- April with consensus on: Information exchange on regular basis, including statistics, experience on clinical treatment, preventive measures and pathological study findings A point-to-point exchange mechanism between the health departments, disease prevention & control divisions & hospitals Director of Health with WHO’s Senior Adviser Dr William Cocksedge on SARS HKSARG discusses with Dr. Heymann of WHO on criteria for WHO to lift its travel advice through videophone

As part of the WHO laboratory network, the Department of Health and HKU has obtained more findings about the stability and resistance of SARS coronavirus in collaboration with our Japanese and German lab partners Main findings (released on 4 May) are: the virus is stable in faeces and urine at room temperature for at least 1-2 days the virus is more stable (up to 4 days) in stool from diarrhea patients the virus loses infectivity after exposure to different commonly used disinfectants 4. Closer Collaboration with the WHO

Institutional strengths Our public health system demonstrates resilience and high sustainability Our team of dedicated professional, medical and support staff serve our community unswervingly under tremendous pressure Our public health authority, the Department of health, has extensive experience in disease outbreak management (recent cases: stopping the potential avian flu H5N1 pandemic in 1997 and local dengue fever epidemic in 2002) Our public health laboratory, designated by WHO as a national centre for virus detection, actively participate in decoding the virus Our highly effective surveillance infrastructure on infectious diseases is greatly enhanced by our close collaboration with WHO and health authorities and research laboratories all over the world Our multi-discipline response team of civil servants for emergency operations Hong Kong’s Strength

An understanding & co-operative public Nearly 100% compliance in home quarantine shows self-discipline and civil-mindedness of our people. Transparency daily press briefings, press releases to keep local and international community informed of latest developments Commitment $200 million for treatment, disease prevention and public education $200 million for training and welfare of healthcare workers $1.3 billion for further disease control measures, medical research $500 million (Jockey Club’s donation) for establish of a center for disease control $500 million for on-going research in universities Hong Kong’s Strength

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