SARS 2003
On 17 Sept 2015 Cru healthcare ministry organized a evangelistic session at NUS. The session started with a documentary video of Ms Esther Mok, the 1st SARS carrier who brought SARS from Hong Kong to Singapore. The video is titled “A tale of 2 Esthers” produced by Cru Singapore Mass media ministry.
A GP and I were invited to share our SARS experience in 2003. For this session I made the above set of 64 slides showing Straits Times headlines during the SARS episode. My father in law used to keep newspapers for an extended period so while halfway during the SARS outbreak, I felt this was an important time in Singapore healthcare history so I took photos of Straits Times headlines. I was then using my first digital camera a Sony DSCP-32. The photos brought back memories of the tumultuous times we had. f.
I have expanded what I shared during the talk in the following composition
I graduated from NUS medical school in 1996. I have been through 2 pandemics, SARS in 2003 and H1N1 swine flu in 2009. And 1 ongoing pandemic, the AIDS pandemic which started in the 1980s. I have also experience 2 financial crisis the 1998 Asian financial crisis and the 2008 subprime crisis which I will not discuss but I believe affected the lives Singaporeans in a greater way than the pandemics did.
One common emotion during a potentially fatal disease outbreak was fear. In the early years of AIDS in the 80s and 90s, it was a fearful disease. Death was certain, antivral drugs could only delay the onset of symptoms. I remembered healthcare staff really took extra care around confirm and suspect AIDS patients. I had a needle stick injury in the late 90s and was worried for some time.
During the SARS episode in Singapore, anxiety was clearly present among the healthcare professionals. I was then working in Bukit Batok polyclinic and was preparing for my Mmed (Family Medicine) exams scheduled for end of 2003. Attendance in the clinic was down because patients were afraid of coming. All staff had to put on full personal protective equipment PPE. I saw a lot of fever patients then but I only remembered a colleague who attended to a patient who was later identified as SARS. All the other cases of fever cases we attended either did not fit the description of suspect SARS or when referred to the hospital for further investigations proved not to have SARS. None of the medical staff in my clinic had SARS so all of us were not very afraid except we were more cautious. I remembered the major downside to SARS for us was the discomfort of putting on PPE daily.
A GP and I were invited to share our SARS experience in 2003. For this session I made the above set of 64 slides showing Straits Times headlines during the SARS episode. My father in law used to keep newspapers for an extended period so while halfway during the SARS outbreak, I felt this was an important time in Singapore healthcare history so I took photos of Straits Times headlines. I was then using my first digital camera a Sony DSCP-32. The photos brought back memories of the tumultuous times we had. f.
I have expanded what I shared during the talk in the following composition
I graduated from NUS medical school in 1996. I have been through 2 pandemics, SARS in 2003 and H1N1 swine flu in 2009. And 1 ongoing pandemic, the AIDS pandemic which started in the 1980s. I have also experience 2 financial crisis the 1998 Asian financial crisis and the 2008 subprime crisis which I will not discuss but I believe affected the lives Singaporeans in a greater way than the pandemics did.
One common emotion during a potentially fatal disease outbreak was fear. In the early years of AIDS in the 80s and 90s, it was a fearful disease. Death was certain, antivral drugs could only delay the onset of symptoms. I remembered healthcare staff really took extra care around confirm and suspect AIDS patients. I had a needle stick injury in the late 90s and was worried for some time.
During the SARS episode in Singapore, anxiety was clearly present among the healthcare professionals. I was then working in Bukit Batok polyclinic and was preparing for my Mmed (Family Medicine) exams scheduled for end of 2003. Attendance in the clinic was down because patients were afraid of coming. All staff had to put on full personal protective equipment PPE. I saw a lot of fever patients then but I only remembered a colleague who attended to a patient who was later identified as SARS. All the other cases of fever cases we attended either did not fit the description of suspect SARS or when referred to the hospital for further investigations proved not to have SARS. None of the medical staff in my clinic had SARS so all of us were not very afraid except we were more cautious. I remembered the major downside to SARS for us was the discomfort of putting on PPE daily.
The atmosphere was different among doctors working in the hospitals especially Tan Tock Seng hospital where most of the SARS patients were warded. My colleague who was working in Tan Tock Seng told me his experience of a young ophthalmologist registrar refused to attend to a referral concerning a SARS patient. She walked away from the ward after realizing it was a SARS ward. I had a doctor friend whose wife was a nurse working in ICU. They had 2 young kids. She quit her job for the sake of her children when her ICU started admitting SARS patients. This fear was not unfounded. 5 healthcare personnel died in Singapore during SARS. 2 doctors, 2 nurses and 1 health attendant. The mortality rate for SARS was also higher than typical pneumonia and Singapore SARS mortality rate was >10% which was above international average. In Singapore 238 people were infected with 33 deaths over the SARS episode
| list_of_medical_professionals_who_died_during_the_sars_outbreak.pdf |
When SARS first started, nobody knew even doctors did not recognized it. One my of university classmates was Dr Leong Hoe Nam. He was mentioned by Esther Mok as the infectious disease physician who treated her. She was initially treated as a typical pneumonia patient. Dr Leong himself later developed SARS and was warded in Germany. I have attached a newspaper article on him talking about his own experience being infected with SARS.
| leong_hoe_nam.docx |
One of the doctors who succumbed to SARS was Dr Alexandre Chao. He was 37 years old and the son of Prof Chao Tze Cheng. Professor Chao Tzee Cheng was a renowned forensic pathologist in Singapore. Prof Chao was respected for helping solve several notorious crimes in Singapore. Though I didn’t know Alexandre personally, most medical students of my time loved his dad Prof Chao forensic lectures because he would turn his lectures into a story telling time marrying forensic pathology and tales of the people he had to cut up. I also worked under Alexandre wife’s Prof Koh Woon Puay when she was a medical officer and I a house officer in a renal ward.
When the SARS epidemic started, no one knew about the condition, pathogen or potential severity. SARS coronavirus or SARS-CoV was only discovered later as pathogen responsible Apart from supportive therapy, there is no definitive treatment for SARS until today. There are many examples of epidemics in the bible. The earliest mentions were the plaques in Egypt in the book of Genesis. Plaques frequented the Old testaments and again in Revelation describing the coming plaques during the last days. In between the New Testament and today, plaques / pandemics / epidemics would occasionally rear their heads. The most famous being The Black Death in the 14th century, 1918 Spanish flu and HIV/ AIDS. 2 lesser known but devastating plagues were the plague of Justinian 541 AD and Antonine Plague 165-180 AD. A common feature of these plagues including the ones in the bible were the relative suddenness of its appearance, spread, mortality, the fear/panic/ confusion created and then just as suddenly the spread stops. Though credit must be given to the isolation efforts of governments and healthcare professionals during epidemics, I felt the the SARS and H1N1 swine flu epidemic stopped suddenly. The same for the recent 2014 Ebola outbreak in West Africa and MERS outbreak in South Korea Even with the advent of modern medicine and sanitation, man has difficulty dealing with the spread of such diseases. In fact modern travel has made new infectious diseases proliferate quickly and turning them into a international problem. I think government and health authorities will disagree with me on this point and will give more credit to their own efforts.
In the Old testament, God clearly says he is in control of the plagues, He started them, spread them and stopped them when He wanted. I have attached a Christian article on “ What does the Bible say about pandemic diseases/sickness”
When the SARS epidemic started, no one knew about the condition, pathogen or potential severity. SARS coronavirus or SARS-CoV was only discovered later as pathogen responsible Apart from supportive therapy, there is no definitive treatment for SARS until today. There are many examples of epidemics in the bible. The earliest mentions were the plaques in Egypt in the book of Genesis. Plaques frequented the Old testaments and again in Revelation describing the coming plaques during the last days. In between the New Testament and today, plaques / pandemics / epidemics would occasionally rear their heads. The most famous being The Black Death in the 14th century, 1918 Spanish flu and HIV/ AIDS. 2 lesser known but devastating plagues were the plague of Justinian 541 AD and Antonine Plague 165-180 AD. A common feature of these plagues including the ones in the bible were the relative suddenness of its appearance, spread, mortality, the fear/panic/ confusion created and then just as suddenly the spread stops. Though credit must be given to the isolation efforts of governments and healthcare professionals during epidemics, I felt the the SARS and H1N1 swine flu epidemic stopped suddenly. The same for the recent 2014 Ebola outbreak in West Africa and MERS outbreak in South Korea Even with the advent of modern medicine and sanitation, man has difficulty dealing with the spread of such diseases. In fact modern travel has made new infectious diseases proliferate quickly and turning them into a international problem. I think government and health authorities will disagree with me on this point and will give more credit to their own efforts.
In the Old testament, God clearly says he is in control of the plagues, He started them, spread them and stopped them when He wanted. I have attached a Christian article on “ What does the Bible say about pandemic diseases/sickness”
| what_does_the_bible_say_about_pandemic_diseases.pdf |
We in the healthcare industry face death frequently so we can be a little apathetic to natural causes of death. But unnatural especially disasters events make us more aware of our mortality. To all humans especially non believers death is something to be feared. Jesus came to free us from death and the fear of it.
Hebrews 2: 15
“and free those who all their lives were held in slavery by their fear of death”.
Luke 13 :1-5
Now there were some present at that time who told Jesus about the Galileans whose blood Pilate had mixed with their sacrifices. Jesus answered, “Do you think that these Galileans were worse sinners than all the other Galileans because they suffered this way? I tell you, no! But unless you repent, you too will all perish. Or those eighteen who died when the tower in Siloam fell on them—do you think they were more guilty than all the others living in Jerusalem? I tell you, no! But unless you repent, you too will all perish.”
Luke 13:1-5 shows how Jesus responds to questions on why bad things happen. It is not the scale of disaster that happens or the cause of death that is important but that death itself is an anomaly. Everyone must die because of sin. Whether it be from a disaster or a personal tragedy or just common ailments. In Singapore up to 3 of 4 deaths come from the top 5 causes of mortality
Singapore mortality 2014 statistics
Death by %
cancer 29.4%
Pneumonia 19%
IHD 16%
stroke 8.4%
Fear of death can be a good starting point to talk about the good news of Jesus especially if the message is shared by a healthcare worker who have experienced dying and death.I have shared some of my experiences many times to acquaintances and medical students. The audiences were usually captivated by my stories. Medical students will listen when I make alive medical cases with doctors with whom I was acquainted or knew personally becoming patients and victims. Because stories of doctors brings about a feeling of kinsmenship and that we may know that we are not above natural biological laws.
Some stories I shared
Of those who died
Dr Lim Fang Kang who worked in NUH Obsterics & Gynaecology who perished in the 2004 Tsunami. Attached is a new snippet of his story.
Hebrews 2: 15
“and free those who all their lives were held in slavery by their fear of death”.
Luke 13 :1-5
Now there were some present at that time who told Jesus about the Galileans whose blood Pilate had mixed with their sacrifices. Jesus answered, “Do you think that these Galileans were worse sinners than all the other Galileans because they suffered this way? I tell you, no! But unless you repent, you too will all perish. Or those eighteen who died when the tower in Siloam fell on them—do you think they were more guilty than all the others living in Jerusalem? I tell you, no! But unless you repent, you too will all perish.”
Luke 13:1-5 shows how Jesus responds to questions on why bad things happen. It is not the scale of disaster that happens or the cause of death that is important but that death itself is an anomaly. Everyone must die because of sin. Whether it be from a disaster or a personal tragedy or just common ailments. In Singapore up to 3 of 4 deaths come from the top 5 causes of mortality
Singapore mortality 2014 statistics
Death by %
cancer 29.4%
Pneumonia 19%
IHD 16%
stroke 8.4%
Fear of death can be a good starting point to talk about the good news of Jesus especially if the message is shared by a healthcare worker who have experienced dying and death.I have shared some of my experiences many times to acquaintances and medical students. The audiences were usually captivated by my stories. Medical students will listen when I make alive medical cases with doctors with whom I was acquainted or knew personally becoming patients and victims. Because stories of doctors brings about a feeling of kinsmenship and that we may know that we are not above natural biological laws.
Some stories I shared
Of those who died
Dr Lim Fang Kang who worked in NUH Obsterics & Gynaecology who perished in the 2004 Tsunami. Attached is a new snippet of his story.
| lim_fang_kang.docx |
Dr Eugene Goh, a year my junior in medical school, who collapsed suddenly one day in 2012. There is now a Eugene Goh Yu Yue Bursary established to aid financially needy medical students. See https://inetapps.nus.edu.sg/odp/Public/FundsList.aspx?BCID=13,Yong+Loo+Lin+School+of+Medicine
Dr Richard Teo who died from lung cancer in 2012. He gave a very good testimony. Read https://www.heavenaddress.com/Dr-Richard-Teo-Keng-Siang/424153/379719/content
Of those who are still struggling with diseases
An unnamed classmate (confidential ) who is now struggling with metastatic colorectal cancer. She has 2 young children.
Dr Richard Teo who died from lung cancer in 2012. He gave a very good testimony. Read https://www.heavenaddress.com/Dr-Richard-Teo-Keng-Siang/424153/379719/content
Of those who are still struggling with diseases
An unnamed classmate (confidential ) who is now struggling with metastatic colorectal cancer. She has 2 young children.
Additional information on SARS in Singapore
Singapore SARS Timeline
From outbreak to eradication
March 1, 2003: Patient No. 1 is admitted to Tan Tock Seng Hospital (TTSH) for suspected pneumonia. She and two other women fell ill after visiting Hong Kong.
March 12: The World Health Organisation (WHO) issues a global alert on outbreaks of a severe form of atypical pneumonia in Hong Kong, Vietnam and Guangdong.
March 15: The term "SARS" is coined. Singapore reports 16 cases and its Ministry of Health (MOH) forms a SARS task force.
March 16: MOH issues hospital guidelines to screen emergency department patients for fever and travel history to SARS-affected areas. It also issues infection-control guidelines.
March 22: TTSH is designated the SARS hospital and a SARS hotline is set up. The number of cases rises to 44.
March 24: The Infectious Diseases Act is invoked and about 740 people are home-quarantined for 10 days.
March 25: Singapore experiences its first SARS death - Patient No. 1's father.
March 26: Pastor Simon Loh, who visited Patient No. 1, becomes the second person to die of SARS.
March 27: All schools are shut till April 6. MOH stipulates that those who die of SARS must be cremated within 24 hours.
March 29: Temperature checks are introduced for all passengers entering Singapore through Changi Airport.
April 5: Singapore General Hospital (SGH) is hit by a SARS outbreak. The closure of schools is extended.
April 6: A ministerial committee is formed as the death toll hits six.
April 7: TTSH doctor Ong Hok Su becomes the first hospital worker to die from SARS. Patient No. 1's mother also dies.
April 9 to 16: Schools finally reopen.
April 22: SARS kills SGH vascular surgeon Alexandre Chao.
April 28: Visitors banned from all six public hospitals, as death toll rises to 21.
May 11: Nurse Hamidah Ismail, one of the first nurses hospitalised for SARS, dies on Mother's Day.
May 18: Last SARS patient detected.
May 30: WHO declares Singapore SARS-free.
July 16: SARS eradicated in Singapore.
MOH youtube video Remembering SARS 31 March 2013
This article was 1st published on 20 Oct 2015
by Dr Benjamin Cheah
by Dr Benjamin Cheah