Hong Kong’s SARS Expert Committee (http://www.sars-expertcom.gov.hk/
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
and are available at http://www.sars-expertcom.gov.hk/english/reports/reports.html
The committee was composed of local and international experts from the fields
of public health, health service administrators, and communicable disease
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
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
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.