World reaction to SARS

Government uses threats to publicly shame scofflaws

Toronto The Star
John Duncanson

Singapore has managed to avoid the damaging “travel advisory warning” label placed on Toronto by the World Health Organization even though it has had more deaths and sickness from SARS than Canada’s largest city.

But the price of avoiding the dreaded WHO label has come at a high price for Singapore’s citizens. The city-state has imposed strict rules on those in quarantine that are usually only seen by those serving jail sentences at home in Ontario.

People in Singapore face mounting fines, possible imprisonment up to one year, and the threat of being publicly identified if they break the government-ordered quarantine. There is also constant monitoring of suspected SARS carriers, including electronic tracking of those in isolation extreme measures the authoritarian government there insists is the best way to combat the continuing threat from the mystery illness.

And although Ontario is now considering “hospital incarceration” for those who continually defy orders to stay in quarantine, the province has no plans to adopt some of the severe measures seen in Singapore.

“What we are doing, we believe to be the right thing,” said John Letherby, a spokesperson for the Ontario ministry of health. “The thought here is that the containment and control of thing has started to turn the corner just in the last 48 hours.”

Letherby said they have been monitoring the efforts in Singapore to contain SARS, but the strategy isn’t one the province feels is needed here.

“Obviously, here we prefer to go about it in a more measured way,” Letherby said.

More than 2,500 people of Singapore’s 4.4 million population are under a virtual house arrest simply because its believed they came into contact with an infected person. About 190 people have officially been diagnosed as having SARS. Seventeen have died, compared to 16 in Canada.

Those in quarantine appear to have few rights. Reports say Web cams have been installed in some homes of suspected carriers. People in isolation are routinely called by officials to make sure they are at home, and those who don’t answer face even more intrusive surveillance electronic wrist tags.

The Singapore government has started using electronic tracking devices on some in quarantine to ensure compliance with the law. Singapore officials are even considering naming those that have broken the “home quarantine orders.”

A former drug rehabilitation camp is also being readied to hold people who violate the quarantine.

The Singapore government exercises so much control over its people and institutions that it has instructed the phone company to disconnect call-forwarding capabilities on the home telephones of those under watch. That way they can’t transfer the calls to mobile cell phones to escape reporting from inside their houses.

Measures for those travelling to Singapore are also among the strictest of the countries affected by the SARS outbreak. Thermal scanners, in which people’s temperatures are taken as the walk though a security check at the airport, are being used to detect abnormally high temperatures in arriving passengers.

People are also being made to fill in health declaration cards, a measure that has not been implemented in Canada.

Beijing’s ‘hell of forced isolation’

John Gittings
The Guardian
26 April 2003

WHO says compulsory quarantine is ‘victimising’ thousands

Sars suspects are being victimised in Beijing, where thousands have now been put in compulsory quarantine, a World Health Organisation specialist, Dr Wolfgang Preiser, said yesterday.

“If you make it hell for them, they go into hiding,” Dr Preiser, a German virologist, told reporters in Shanghai.

“It is a bit of an over-reaction. Health officials must know how to draw a balance and stop victimising people unnecessarily.”

China said yesterday that another five people had died from Sars and 180 were infected, taking the death toll to 115 and the number of cases to 2,601.

A health official in Beijing, Guo Jiyong, said his department had ordered 4,000 people who has had “intimate contact” with suspected Sars cases to stay at home under quarantine. Under new regulations applying to hospitals, factories, hotels, schools, residential blocks and anywhere else where the virus is found, anyone violating the compulsory quarantine would be “severely punished.”

Officials had to deny rumours, which have added to the panic in the capital, that martial law would be declared, or main roads and airports sealed off.

The People’s hospital, which has more than 3,000 staff and patients, remained cordoned off by police tapes yesterday. Clothes and food left for patients by visitors were handed through the gate to masked hospital employees.

Restrictions were imposed on a second hospital, the Ditan, which specialises in infectious diseases.

Dr Preiser spoke to journalists in Shanghai as his team prepared to brief city officials on its findings there.

The current number of suspected cases there is 15, but the team said later that the number would “increase substantially”. Although the city’s health system was working well, it had not yet been tested by a large number of cases.

The team has been in China for five weeks on a mission originally due to last only a week.

Further missions are being planned, to hard-hit rural provinces where there is a “major concern” that Sars cases are being identified or reported slowly, or not at all.

Cooperation between WHO and the Chinese government is now described as “extremely open” and the team has enjoyed free and unrestricted access to hospitals in Shanghai. This is in sharp contrast to the situation at the beginning of the mission, when meetings at the ministry of health in Beijing took place “in a very tense atmosphere”.

“We are not weapons inspectors, we’re not there to search hospitals from cellar to roof to see if there are patients hidden away,” Dr Preiser said.

Earlier this week WHO said it believed that the Chinese leadership was “now taking seriously the need for transparency in Sars”.

The latest figure for cases in is 877, an increase of more than 500 in five days, although it is not clear if all of them are new or some were previously unreported.

Even more worrying is another big increase in the number of suspected cases in Beijing, to 954.

China has finally been persuaded to let its scientists join in discussions on WHO-led international networks, and to contribute much-needed data.

Its data from Guangdong, the province where the virus first appeared in November, still awaits full analysis, to throw light on the origins of the epidemic.

Wu Yi, the vice-premier who is now acting health minister, announced yesterday that China would spend 3.5bn yuan ($420m) on a national health network for Sars and other emergencies.

Around the world

More than 4,400 probable cases of Sars reported worldwide – including 2,601 in mainland China, 1,510 in Hong Kong, 192 in Singapore, and 140 in Canada

WHO refuses to lift warning against travel to Toronto. Canada insists outbreak is coming under control

Health officials from nine Asian countries, including China, Japan and South Korea, draft joint plan to strengthen defences against Sars at meeting in Malaysia

In Britain, health minister Hazel Blears says screening travellers arriving at airports would be ‘pretty pointless’. She tells Radio 4’s Today programme: ‘I genuinely believe our response has been proportionate, responsible and effective.’

In Dublin, Chinese woman is given surgical mask and discharged from hospital to hostel where she is lodging; and in Waterford, a GP waits several days before telling health authority about a woman recently back from Toronto with Sars-like symptoms. Chief medical officer says initial negative tests are inconclusive. Both women now in isolation wards

Philippines confirms first two deaths from Sars

North Korea suspends joint tourism project with South Korea. South Korean company running project says North has ruled ‘no outsiders are allowed to visit Pyongyang and other parts’

Pakistan may suspend flights to Sars-hit countries, state-run news agency reports. So far, there have been no cases there

Three babies so far born in Hong Kong to infected mothers; doctors say the babies may be infected. Two mothers died within days of giving birth. Surviving mother is in stable condition

Taiwan authorities sealed off Taipei Municipal Ho Ping Hospital on Thursday. Those inside will have to stay for up to two weeks. Medical staff protest at the quarantine, which follows more than 25 suspected Sars cases, and affects some 1,000 patients, doctors, nurses and visitors