What Is Your Life Worth?
Just as H. G. Wells’ War of the Worlds announced the arrival of aliens –“The Martians are coming! The Martians are Coming!”, - we have to announce the arrival of our aliens:- “SARS is coming! SARS is coming”. The difference for us however, is in the fact that SARS has landed and we have to learn to cope with the disease.

It is now not the time for frivolity and light-hearted bantering Serious matters need serious thought and serious action. And SARS is a serious matter. Hence we must get down to brass tacks and dispense with silly trifle for the time being. It is in our interest to acquire and to disseminate as much information about SARS as is humanly possible so that we can all be protected from this dreaded affliction. And how, pray tell and where can we acquire such knowledge and information? With SARS, you start with what is known to date.

Facts You Should Know About SARS

• SARS which is a new type of atypical (unusual) pneumonia (an infection of the lungs), is the acronym for Severe Acute Respiratory Syndrome. It has its origin in Guangdong Province, China and has now spread to 26 countries world-wide. The most probable causative agent is the coronavirus.
• SARS is transmitted through droplets. When an infected person coughs or sneezes, these droplets (the spray produced by the cough or sneeze) are spread to a nearby contact who may then come down with the disease. Persons exposed to direct contact with infected body fluids like faeces and urine may also be susceptible. At present the bulk of evidence suggests that there is little or no airborne transmission of the infection.
• The most consistent feature of SARS is a sudden onset fever of 38oC or higher. The thermometer is vital in our war against SARS – hence to use the American Express Card advice, don’t leave home without it.
• The incubation period (the period when you are hatching the disease, the period between your picking up the disease from an infectious person to the time you manifest symptoms) is about 3 to 10 days. You are not infectious during this period and are unlikely to pass on the disease.
• From the cases dealt with so far, it appears that SARS becomes infectious only after symptoms appear and the sicker the patient, the more infectious he is.
• According to the World Health Organisation (WHO), more than 90% of patients gradually recover. Depending on which country provides the data, anything from 5 to 10% of patients die from this frightening condition.

Constant Updating Of Information
Because this is a new disease, we don’t know much about it but we are learning more everyday. How long this epidemic will last is unknown and we are not going to be rid of it until a vaccine is found. This may take anything up to 3 years. It is therefore prudent for us to keep abreast of new information as and when this comes to hand. Therein lies the problem.

The dilemma faced by governments and authorities is how much to divulge and when. How do you give out information without provoking panic or worse creating complacency? Singapore’s prime minister concedes that we have to win the trust and confidence of the public, “If you are not transparent, objective and open about the situation, you lose that trust and confidence. It is a difficult task to balance both, be transparent and open and yet not cause alarm”.

Conversely, the fear factor is made worse by a dearth of information, ignorance and despair. If we allow rumours to fly, dysinformation will be rife and will be difficult to rein in. Hence authorities must prevent rumour mongering. And the only way to do so is to give timely accurate information because the further rumours spread – the more difficult they are to control. To be informed is to be armed. [For example, many innocent dogs and cats that were pets of SARS patients were put to death in Beijing because of the rumour they carried the SARS virus]. Dr Donelson Forsyth, an American psychologist suggests that there should be an anti-rumour campaign “to check the contagion of fear from one person to another.” Fear could be worse than the disease; fear paralyses.

All said and done, the message that will not change is: “you’ve got to know the bug to beat it.”

Authoritative timely accurate updating of information by identified spokesmen and confirmed via hotlines is the way to go. In this regard, the public can call the Normah Medical Specialist Centre hotline and ask to speak to the SARS Taskforce Chairman for advice and updated information.

A Need For Definitions
As we read, as we listen, as we surf the net, we garner more information and we come across new words and terminology. It is important to have some of these words and terms explained, so that we can understand the bigger picture, so here goes:

• Exposed : You are said to be exposed if you have been in close contact with a person who has been diagnosed with SARS. “Close contact” here means having cared for, having lived with or having had direct contact with respiratory secretions and body fluids of a person with SARS.

• Suspect Case : You would be a suspect case if you have a high fever associated with respiratory symptoms including cough, shortness of breath or breathing difficulty and have been exposed to someone who has been diagnosed with SARS. This is especially so if you have been to Beijing, Guangdong, or Hong Kong within 2 weeks of the onset of symptoms.

• Probable Case : You probably have SARS and would be reclassified as a probable case if you were a suspect case previously but have now developed chest x-ray findings of pneumonia.

• Confirmed Case : All suspect cases and probable cases would be confirmed as SARS the moment evidence of coronavirus can be found in blood tests and body fluids.

What is Quarantine?
The word “quarantine” is interpreted to mean isolation to prevent infection. It had its origin in the days when plague ravaged the earth. No one then knew the cause of plague but the Italians went about it by trying to contain the disease by keeping suspected travellers in a distant place from the cities for 30 days before being allowed in. When 30 days proved inadequate, this confinement period was extended to 40 days and that finally did the trick. Forty days in Italian was a quaranteria and from that, the word quarantine crept into English usage. Quarantine is now universally used to contain any epidemic, especially when the cause is not known.

In the context of SARS, quarantine implies restriction at home, or in the workplace such as hospitals or dedicated quarantine facilities. For quarantine to be effective, it must be enforced. There should be no half measures. It is a nuisance and an imposition but there should be no two ways about it. Singapore took a very disciplined approach in order to avoid a negative WHO categorization and travel advisory against the nation. The price of this extreme authoritarian high-handed technique came at a high price to its citizens. Strict rules on those in quarantine were enforced by threats of prohibitive monetary fines, possible imprisonment, public identification and by consistent monitoring of suspected SARS carriers.

If you are quarantined by health authorities you should do the following:

• Inform your employer and friends.
• Compile a list of people you have had contact with in the past one week and hand this to the authorities.
• do not leave your quarantine quarters for whatever reason or entertain visitors during this period.
• if you develop symptoms of SARS while quarantined, inform relevant parties immediately.

What is Social Responsibility?
If you spat on the floor, you are socially irresponsible. If you coughed or sneezed in someone’s face, you are socially irresponsible. If you broke quarantine rules, you are socially irresponsible. Lying, not answering questions truthfully is socially irresponsible. But the best way to define this expression is to use a real life example in the manner that was used by Prime Minister Goh Chok Tong: “A family of 8 related to a 72 year old man who came down with SARS while working at the Pasir Panjang Wholesale Market, went to see a doctor when they came down with fever. Suspecting SARS, the GP called for an ambulance, provided them with masks, placed chairs outside his clinic and told them to remain there till the ambulance arrived. But when he checked later, he found to his horror that they had wandered off to a nearby food centre and Chinese medicine shop” .As a result of their reckless behaviour a new cluster of SARS emerged.

To put this in simple parlance, social responsibility is common sense; it is civic consciousness. It is the concept of one for all and all for one as practised by the 3 musketeers; the concept of do to others what you would have others do to you. Socially irresponsible individuals are irrational and are a menace to society and there should be no qualms about how they should be dealt with.

SARS COMMITEE SCREENING SURVEY RESULTS

So says Shakespeare. In like manner, we all have a role to play. You can play your part to avoid infection and the spread of SARS in the community by observing some simple common sense guidelines:

• Protect yourself by practising good personal hygiene. To reduce the risk of infection, wash your hands regularly with soap and water; practise good toilet habits; avoid sharing food from a common dish without using a separate spoon.
• Stay healthy by taking heed of WHO travel advisory; have adequate rest; avoid stress; exercise regularly and maintain a proper diet.
• Increase your immunity by staying healthy – a varied balanced diet is enough to protect a healthy person. Should you want to supplement your diet do not exceed 1000mg of vitamin C and A and 3000mg of vitamin E.
• Be socially responsible
  - if you have a fever or are unwell, do not go to work. See a doctor immediately. Do not shoot the troops who are out there trying to protect you : wear a mask.
  - if you cough or sneeze and are not wearing a mask, cover your mouth and nose with tissue paper.
  - Keep your environment clean; do not spit; throw tissue or litter into rubbish bins.
• Parents too, have a role
  - Monitor your child’s body temperature.
  - If your child is unwell, do not send him to school; seek medical attention.

Finally, Not the Final Word
The last word on SARS has not been said – there is much more to learn and keep abreast of. In a strange way, the message of all epidemics remain unchanged: “Wash your hands and love your children. Life is a gift and a gamble.” And like all epidemics, SARS will soon pass on – it will just take up residence as another chronic infectious disease here to stay. So in the meantime, be cautious and do your bit to contain it. To succeed in this battle, everyone must co-operate and play his part. To quote Bertha Henson, “Every individual should know the ins and outs of the disease – how it spreads and all the caveats and conditions involved. There should be no clinging to stray bits of information – all should be armed with a deep understanding of all facets of the ailments so that we can carry on with our lives.” And once you are updated, disseminate this knowledge to one and all by word of mouth or in any way you can.

Written by: Datuk Prof. Dr. Saw Huat Seong
Chief Executive Officer of Normah Medical Centre in Kuching
And a Consultant Cardiothoracic Vascular Surgeon