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Mary Ann

Mary Ann Benitez

One year on, the legacy of SARS. Part three: a new era in public health

When the health minister testifies for the first time before the Legco inquiry on Sars tomorrow  he will do so against a backdrop of a more forgiving environment.

There is no Sars II, not even H5N1  bird flu.

A year ago this week it was altogether different.  Sars severely tested the resiliency of the health system headed by Secretary for Health, Welfare and Food Yeoh Eng-kiong  and found it wanting.

When the outbreak was declared over last June,  1,755 people had been infected in Hong Kong, and 299 died.

The city moved forward, its defences assessed.

'Hong Kong is fully prepared for the resurgence of Sars,' a spokesman for Dr Yeoh's  bureau said.

But, as a team of academics led by University of Hong Kong professor Gabriel Leung in the book At the Epicentre: Hong Kong and the Sars Outbreak contends: 'The litmus test of Hong Kong's disease prevention capability will be whether we can prevent the next epidemic of infectious disease.'

In October, the Sars Expert Committee issued 46 recommendations to prepare the city against a future outbreak.

The committee, formed by overseas, mainland and Hong Kong experts, was appointed by Chief Executive Tung Chee-hwa  to review the government's handling of the crisis.

Experts generally approved of the progress made but underlined shortcomings  in six of  11 main areas.

Dr Yeoh  had promised at that time to have most of the measures in place within six months.

Following the report, Mr Tung  set up a group to oversee the implementation of the 46 recommendations.

They were concerned that the opportunity for the creation of a Centre for Health Protection (CHP) would not be fully realised without a reorganisation of the Health, Welfare and Food Bureau.

Committee co-chairs Sian Griffiths  and Sir Cyril Chantler said:  'The effectiveness of the CHP depends in part on reorganisation being undertaken.'

The committee said Director of Health Lam Ping-yan  should take on the function of the chief medical officer within the bureau to advise Dr Yeoh  as appropriate.

Their concerns were raised in a letter  last month to Mr Tung.   The panel next meets in October.

The new health centre will start operating in June, funded by a $500 million donation from the Hong Kong Jockey Club.

The Department of Health's regional offices will be absorbed into its surveillance and epidemiology branch, while infection control workers from the department and the Hospital Authority will be reassigned to its infection control branch. Three more branches will be created  when it is fully operational by next year, with a full complement of 200.

Led by a Department of Health insider, most likely Leung Pak-yin, a deputy director of health,  the centre  will have the duty to prevent and control communicable diseases.

A spokesman for the Health, Welfare and Food Bureau said it had no comment about the review of the bureau's restructuring.

One committee member, Chinese University honorary professor Lee Shiu-hung,  urged the government to take up the proposal as a new chief medical officer within the bureau would provide the needed professional backup to policymaking while also enhancing co-ordination  across departments.

'Sars in a way was a blessing in disguise and has given a very strong signal to the government that there are a lot of deficiencies in our present health-care system,' Professor Lee said.

Another member, University of Hong Kong professor emeritus Rosie Young Tse-tse,  said: 'We are confident that Hong Kong is much better prepared to combat a Sars epidemic if it were to return. I think this is now borne out by the absence of spreading from neighbouring Guangdong.'

She was referring to four sporadic Sars cases this winter in the province.

Cross-border collaboration has been 'much improved both officially and unofficially', Professor Young  said.

The committee has also visited Princess Margaret Hospital and has expressed satisfaction with the infection control measures put in place there.

'Training of staff in infection control and building of isolation facilities are still on-going,' she said. 'I think Hong Kong is well prepared for Sars provided we all keep our vigilance. This applies to the whole community, not only the public hospitals.'

But Kwok Ka-ki,  convener of the Action Group on Medical Policy, disagreed. 'The isolation disease facilities have not been completed, the Centre for Health Protection is still on the agenda, and the reporting system with the mainland is not working. It took the mainland days or weeks to report to the department the cases of Sars. For the last case, the department  did not know until the patient was discharged,' Dr Kwok  said.

'We are just very lucky. I am not convinced we are prepared.'

The Sars battle plan has so far cost the government about $1.9 billion, of which $1.4 billion has gone to beef up the Hospital Authority isolation facilities and treatment of Sars patients.

So far, 1,200 isolation beds out of an initial target of 1,700 are ready.  The authority is seeking a further $552 million to build an infectious disease centre at Princess Margaret Hospital.

In the end, though, no amount of surveillance and control will be foolproof if the ecosystem of man, animals and the environment is continually being challenged, experts say.

'What we eat and drink practically come from outside. Unless other countries and areas are able to maintain a healthy environment, we will continue running the risk of introduction of infectious diseases,' Professor Lee said.



What has been done to keep us safe?