Singapore: The handshake as a form of greeting may well be passé, no thanks to the outbreak of severe acute respiratory syndrome (SARS). Greeting with palms placed together, a la Thai or Indian style, or bowing as practised by the Japanese, are today preferred because the SARS virus can be spread through handshake. This is the extent that this respiratory disease is affecting daily lives and businesses in many countries, including Singapore.
The swiftness in which some patients succumbed, the speed in which it spreads, and its far-reaching impact on the economy has made SARS a top concern of governments. Not been known to affect humans before, the corona virus has been identified as the cause of this form of atypical pneumonia.
The first SARS case occurring early March 2003 in the republic was traced to Singaporean women holidaymakers returning from a trip in Hong Kong. At the Hong Kong hotel, they happened to stay on the same floor as a super-infector from China.
Where medical practitioners were initially stumped, the gravity of the matter coming to light with more information from World Health Organisation (WHO) soon galvanised the government into taking comprehensive action.
Realising the threat
In a May Day rally, Singapore Deputy Prime Minister Lee Hsien Loong put the issues in perspective. "The state of the economy depends on SARS - how quickly we can bring SARS under control, how well we can adapt ourselves to its consequences." Emphasising that SARS was a grave threat, he added that if Singapore failed to defeat SARS, the country would be overwhelmed.
Tourism and travel-related sectors are directly hit as the fear of SARS takes root. "Many trades are affected, such as the travel agents, hotels, restaurants, taxis. Whereas taxi drivers used to be able to earn about S$70 a day, now they will be lucky to earn S$20-30. Not only that, many are worried about being exposed to SARS by their customers," says Lee. A budget of S$230 million has been allocated to help companies and workers tide over the crisis.
He sounded a warning: "But if more people get SARS, and more workers have to be quarantined, then production will be disrupted. So far we have been quite lucky. One worker in a Motorola factory had SARS, and 305 workers on the same night shift had to be quarantined.
"Then we had the outbreak at the Pasir Panjang Wholesale Centre (PPWC) for vegetables. We had to quarantine nearly 2,000 people and shut down the PPWC for 15 days. Many market produce stalls could not get supplies. Multiply that disruption by 10 or 100 times, and you can imagine the damage to the economy."
Ministerial-level committees were formed to address the issues on three fronts - public health, the economy, and the society. The measures adopted are best summed up by Health Minister Lim Hng Kiang who touched on the extra precautionary steps taken, beyond recommendations by the WHO to minimise the spread of SARS.
Because there is no previous experience to draw upon, the strategy involves the implementation of many first-time measures to contain SARS locally, inculcate awareness of precautions among the population and preventing the influx or outflow of SARS at the borders.
Thus far, high fever is one symptom of SARS and temperature checks is a daily regime in schools, military installations, workplaces and on occasions where people gather in big groups. In fact, all schoolchildren and households will be given a thermometer by June 2003 as part of the long-term measures to combat SARS. Promising results from trials of temperature scanners at Singapore Changi airport will lead to greater use of this tool at international gateways.
Tooth and nail fight
The government initiated an ongoing campaign for workers in retail, hotel and food and beverage sectors to have daily temperatures taken, as part of an eight-point certification programme to instil pubic confidence in such places.
In the pursuit to detect, isolate and contain all SARS cases, one hospital has been designated to treat such patients, thus freeing other public hospitals to deal with other medical cases.
Contact tracing is stringently implemented to track all the people who may be infected by a SARS patient. The need for every suspect, probable or confirmed SARS patient to be truthful in declaring their movements and self-discipline in terms of measures to prevent the spread of SARS are being emphasised through all media.
The fight against SARS has brought into focus the critical need to balance community safety and individual liberties. Because it can take up to 10 days for symptoms to develop, home quarantine for those in contact with SARS patients is rigorously implemented. A six-month jail and $10,000 fine are penalties for flouting the quarantine rule. To minimise hardship, those on home quarantine can claim a daily allowance of up to $70 per day.
On the economic front, companies such as public utilities providers, financial services and police and armed forces, for example, are encouraged to work out contingencies to keep operating in the event of SARS outbreak among their employees.
At Singapore's initiative, two regional gatherings - one for health ministers and the other for country heads - have already been held to discuss cooperation in fighting SARS and to standardise health declaration cards and temperature checks on travellers.
With the slew of measures taken, Singapore has won praise from the WHO for its proactive approach in fighting SARS. There has been no new SARS case since 28 April 2003. If this record is kept for 20 days, with 10-day accepted as one cycle for gestation of the disease, the republic would regain its stature as a SARS-free country.
(Ng is a Singapore-based journalist. He can be contacted at firstname.lastname@example.org )