Sars still casts a long shadow

It’s more than a year since the World Health Organization declared that Hong Kong was Sars free.

It’s more than a year since the World Health Organization declared that Hong Kong was Sars free.However, the shadow of the disease still hangs over the territory, for individual patients, politicians and the public health system.Ivan, who is 28, contracted the disease last winter and survived.”Surviving is even worse than dying,” he said.”I am now a full-time patient. I can’t work. I am not fully recovered.”I need to see lots of doctors; physiotherapists, Chinese medicine practitioners, even psychiatrists.”It takes three or four days a week. I’m very frustrated.”Ivan’s story is not unusual. In Hong Kong, 1,755 people were infected, and 299 died.Reliance on medicineFor many of those who survived life is a constant round of hospital appointments, doctors visits, pill-popping and physiotherapy.Some were left with debilitating bone disorders as a result of the drugs they were given to fight the disease.Ivan and many of his fellow patients are still angry about the way the government handled the crisis and its aftermath.”First of all the compensation came too late,” he said.”Secondly, the conditions for applying for compensation were too harsh.”Thirdly, the settlements have been too slow. You have to wait more than six months before you get the compensation.”ResignationThis week that anger boiled over after the publication of an investigation by a committee of law-makers into the government’s performance in fighting the Sars epidemic.It singled out five top officials for making mistakes which could have contributed to the spread of the crisis. The man in charge of health policy in Hong Kong, Dr Yeoh Eng Kiong, hung on for 48 hours after the publication of the report but in the end was forced to quit.In his resignation letter, Dr Yeoh said: “The emotions of the Sars outbreak have created intense debate in the community which I fully understand.”And while his boss, Hong Kong’s leader Tung Chee Hwa described him as committed, dedicated and courageous, the Sars patients were unforgiving.They say his resignation came a year too late.Hong Kong’s lawmakers have claimed a rare scalp by forcing Dr Yeoh to resign.Mr Tung had clearly not planned for this eventuality.He has asked Dr Yeoh to stay on for up to three months while he tries to find a replacement to run Hong Kong’s Health Welfare and Food Department.Some commentators here say the resignation will have wider repercussions for the Tung administration.It sets a precedent: that those members of the Executive censured by law-makers should go.That may be the norm in many democratic countries but it is unusual in Hong Kong.For the authorities here and their political masters in Bejing, it is a precedent that is probably feels deeply unsettling.Lessons learnedBut what of the lessons of Sars for the public health system? Woman and childThere are serious lessons to be learnt from the calamityMy apartment building still has a dispenser of alcohol wash sitting on the front desk for you to wash your hands.The lift buttons, as they are in many public buildings, are covered by a thin sheet of plastic which the sign says is replaced every few hours.The streets are clean. Everywhere you look higher standards of hygiene are in place than you saw here before the outbreak.”There are serious lessons to be learnt from the calamity,” the law-makers wrote in their report.”The epidemic has highlighted the need for more vigilant and effective disease surveillance and notification as well as a high level of preparedness to deal with outbreaks of unknown infectious diseases.”The preparations put in place to combat bird flu earlier this year were held up by the government as evidence that the lessons of Sars had been learnt.Officials moved fast to put in place a ban on all imports of poultry from affected areas.New hygiene measures were introduced in markets.Further threatsA high profile public information campaign got under way.”It is perhaps not a coincidence,” Dr Yeoh said shortly before he resigned, “that Hong Kong has remained free from Sars and bird flu this year when our neighbours have been adversely affected.”In recent weeks attention here has turned to Japanese Encephalitis, a brain disease spread by infected mosquitoes.In response to public concern in the worst affected areas the government has put in place pest control measures to try to minimise the threat.Professor K Y Yuen, head of the Department of Microbiology at Hong Kong University said: “Hong Kong is much better prepared after Sars.”There are over 1000 isolation beds in our hospitals. Most frontline health workers have attended infection control training courses.”The Centre for Health Protection has been set up to facilitate a rapid response to outbreaks, to improve the sharing of information between the mainland and Hong Kong, co-ordination of research effort and the education of the public.”The biggest lesson learnt from the Sars crisis was the importance of segregation between humans and animals.”Central or regional slaughtering of poultry will be pursued as a long term goal.”If Sars taught people anything here, it was that this crowded city where millions of people live literally on top of each other in cramped public housing they are particularly vulnerable to any outbreak of infectious disease.Dr Yeoh had to go because he and his officials were judged to have been too slow off the mark in response to the threat posed by Sars.Hong Kong knows it can’t afford to make the same mistake again. (Sorce: BBC Health, July 2004)