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Home Eurosurveillance Weekly Release  2003: Volume 7/ Issue 40 Article 1
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Eurosurveillance, Volume 7, Issue 40, 02 October 2003

Citation style for this article: Hong Kong SARS Expert Committee publishes its report. Euro Surveill. 2003;7(40):pii=2303. Available online:

Hong Kong SARS Expert Committee publishes its report

Editorial team (, Eurosurveillance editorial office

Hong Kong’s SARS Expert Committee (, which was set up by Hong Kong’s Chief Executive at the end of May to review the management and control of the severe acute respiratory syndrome (SARS) outbreak in Hong Kong, has today published a 279 page report and a 63 page summary report, both of which are entitled SARS in Hong Kong: from Experience to Action and are available at The committee was composed of local and international experts from the fields of public health, health service administrators, and communicable disease control.

The reports gives a timeline of major events in the SARS epidemic earlier this year, and then addresses key issues arising from the epidemic, lessons and themes, and conclusions and recommendations. In an accompanying letter, the committee’s co-chairs stress that they have not laid blame or accusations of negligence or maladministration on any individuals, but that the lessons drawn from the investigation must be learnt and recommendations followed through.

Among the key issues addressed are:

Did the Hong Kong authorities react appropriately to news of early unusual events in Guangdong and Hong Kong? The committee considers that the authorities acted reasonably on the information available.

The SARS outbreak at the Prince of Wales Hospital: the committee notes the absence of pre-determined hospital outbreak control plan and that Department of Health (DH) staff were not sufficiently involved in critical decisions about outbreak control measures. There was a lack of understanding between DH and the Hospital Authority (HA, the independent body responsible for all public hospital services in Hong Kong) on how to respond to such a large communicable disease outbreak, and there was lack of clear leadership in contact tracing. The committee concludes that although those involved worked very hard, inadequate contingency planning led to an inadequate initial response.

Did the Hong Kong government play down the seriousness of the epidemic in the early stages? The committee concludes not, but that it could have been handled better and the situation described more accurately.

Was there a delay in making SARS a notifiable disease? The committee concludes that it would have been a prudent precaution to have added it to the list earlier, given the WHO emergency travel advisory on 15 March.

The handling of the Amoy Gardens outbreak, which has attracted much criticism.
The committee considers that the outbreak was well handled overall, and that it was reasonable to discharge the primary case in the Amoy Gardens outbreak from the Prince of Wales Hospital. Delay in the epidemiological investigation was unavoidable because of diagnostic ambiguity and delay in clinical diagnosis. As far as the epidemiological investigation is concerned, lack of field epidemiology expertise and manpower meant that initial objectives were ill defined and did not inform decisions on public health control measures.

Collaboration with the private sector. The private sector was insufficiently engaged during the epidemic, and the authorities must develop better partnerships with the private sector to cope with future public health emergencies.

Case fatality rate for SARS in Hong Kong. After controlling for age, the standardised mortality ratio for SARS is comparable to those of Canada and Singapore, higher than Mainland China and lower than Taiwan. The explanation for this not known, and is anyway beyond scope of the committee.

Some of the lessons and themes from the committee:

Hong Kong needs to be better prepared for new and emerging infectious diseases. The SARS epidemic has shown that there is an imbalance between responsibility, authority and accountability in the health system. There are also shortcomings in surveillance and information systems, and a lack of manpower, and of experts in field epidemiology and infectious disease control. A new public health infrastructure is needed, and the committee recommends that the government organise a Centre for Health Protection (CHP) to have authority and be responsible and accountable for the prevention and control of communicable disease.

There is a need for health protection coordination within Hong Kong, and for better collaboration within the Pearl River Delta region and with the international community.

Also, hospital infection control standards have been shown to be inadequate, because they had not previously been considered important. The committee recommends that each hospital have an infection control team.

Training currently emphasizes clinical practice, and is very inadequate in the areas of infection control and public health. Medical personnel who do study public health receive very little training in field epidemiology. A sustained field epidemiology training programme should be introduced as soon as possible.

Communications between the health authorities and the public were considered to have been unsatisfactory during the outbreak, and need to become much more sophisticated.

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