SARS: experience from the emergency department, Tan Tock Seng Hospital, Singapore

Lessons learnt The severe acute respiratory syndrome (SARS) entered Singapore through three young women, who were in Hong Kong from 20 to 24 February 2003.1 They were infected by a doctor from Guangzhou by a chance encounter in the lift lobby of the hotel where all were staying.2 Two were admitted to Tan Tock Seng Hospital (TTSH) and one of them was what the World Heath Organisation (WHO) later described as a “super-spreader” (persons who directly infected ⩾10 other persons3). On the 22 March 2003, the Singapore government made a decision to centralise the care of suspect and probable cases of SARS including paediatric cases in TTSH. This facilitated the management of SARS patients and reduced the risk of secondary transmission of the disease.4 Ambulances were diverted and patients at the emergency department (ED) with non-SARS conditions who required hospitalisation were transferred to other hospitals. The screening centre was initially at the Centre for Communicable Disease (within the TTSH campus). This moved to the ED on the 26 March 2003. The ED then became the national screening centre. By the 31 May 2003 when WHO took Singapore off the list of SARS affected countries, we had screened more than 9000 patients. The aim of this article is to describe our ED experiences in dealing with this outbreak and the lessons learnt. Retrospectively, the first warning we received was through our emails on the 13 March 2003. The Ministry of Health, Singapore had sent out a medical alert warning of an outbreak of atypical pneumonia in Hong Kong, Vietnam, and Guangdong province in China. The medical alert commented that there were three cases that had returned from Hong Kong who had been treated for pneumonia but were well. Two had been discharged and one was recovering. …