In Singapore, where the Pandemic occurred on a much smaller scale because the Government felt secure enough about their position with the people to quickly reveal timely and transparent information through instructional booklets, TV educational advertisements, radio etc. which was very important given the great deal of mis-information on SARS circulating. The successful containment of public anxiety and its re-direction into a positive force for community bonding and action unified Singaporeans in a similar goal to get rid of SARS as fast as possible. All measures undertaken by the Government were well though and comprehensive, there were screening of hospital staff, schools and airports preventing the “passing” of SARS, this heavily contrasts the epidemic in China gaining momentum because infected travelers to Guangzhou from Beijing infected co-passengers.
To summarise, In China there was an extremely slow acknowledgement and response, the Ministry of Health even denied WHO information. [5] The lack of information followed by sudden change in policy caused widespread fear and the indirect spread of SARS further. There was a lack of contact tracing and when done, often inaccurate.
To summarise, In Singapore however, Information was easy to access and easy to trust. Screening Measures were complete and largely effective. One indication of the effectiveness of these measures is the fact that 80 percent of Singapore’s SARS patients did not infect anyone else. [6] The only slight flaw is the very “wide-net” surveillance, isolation and quarantine, of the 12000 people on varying surveillance and quarantine only 58 individuals were diagnosed with probable SARS.[7] The strong, decisive and open political leadership backed by effective command, control and coordination systems ensured that strategies and decisions were properly implemented. Another key difference is the response time and its effect. In Singapore where the fore mentioned measures were imposed soon after identification of index cases. The chain of infection was quickly broken. By contrast China’s delayed response to the epidemic rendered contact tracing impossible, removing a key weapon they had against SARS.
However, when analyzing the effectiveness of each Country’s actions and measures. One must take into account China’s vast size and population caused the distribution of information to be more difficult. The “Archaic” mode of Healthcare especially in rural areas made getting healthcare for people (infected by the migrants) virtually impossible. The average cost of hospitalization was equal to the average rural families’ total income for a year. Thirdly because SARS started in China, the authorities may have felt embarrassed to admit or further admit to such a disease, which they started which they allowed to spread to other countries’, fearing a disruption to the economy, social lifestyle etc. Obviously this action caused quite the opposite effect. Fourthly, at the time in China, authorities and experts were confused because of a separate number of deaths of avian flu during the same period in Foshan. Lastly in China, Under Chinese law health epidemics are considered “state secrets” whereby national level authorities have control over all public announcements about disease outbreaks while provincial officials have no power to comment publicly. [8]
With regards to Avian flu, despite a nationwide disease-warning network and contingency plans for outbreaks there is a lack of details from news agency [9]-which the Government control. Also, despite post-SARS China cooperating with the WHO to improve disease surveillance and reporting it seems to have left out proper normal screening and security measures as Health Authorities in Vietnam discovered avian Flu in poultry illegally imported from China.
While Singapore has not yet had any cases of avian flu, there are websites, videos and newspaper articles informing the public of how to prepare and ministerial statements providing comprehensive precautionary plans including a “Q n A” session in Parliament.[10] Allowing Singaporeans to be prepared should anything untoward occur.
The role of the International organizations like WHO and centre for communicable diseases (CDC) in China was an important one; their experts conducted thorough research and provided much needed information booklets to inform and educate the masses, something the Government was very much opposed to. However it is important to note that the WHO was not present in Singapore and the latter handled SARS marvelously. Therefore we can conclude it was made important only because of the inefficiency of the Chinese Government and their ministry of health in recognizing the problem and appropriately responding to the crisis.
Also the role of the Community in staying calm and cooperating with the Authorities is extremely important, the country needs its citizens to comply with the decisions made so as to work toward the common goal united in mind and action. However oddly enough, speaking out against the Authorities also has its benefits, Should the Chinese doctor have kept the information about the large number of SARS cases with himself and allowed the Government to continue hushing up the cases and telling everyone things were under control. Who knows the extent of damage which would have occurred.
However, when the Government is thinking clearly and implementing positive measures, the importance of external organizations and the community while useful is actually rather minimal in the overall picture as only the Government is in the drivers seat, has the steering wheel to force changes in their country and its only them who hopefully can make things better for its people. Once the Government can’t fulfill that duty and only then, should external organizations come in to guide and educate them and their citizens.
In conclusion, the slow response made surveillance of the disease exponentially harder when they finally decided to do something about causing their following measures to be less effective. This can be contrasted with Singapore where quick response resulted in quick removal of SARS. The position of power and influence the Government is in compounded with the contrast in the Chinese and Singaporean Government measures, actions (or lack of in the case of China) also show a large contrast in the successfulness of their respective actions to controlling the crisis and totally supports my hypothesis that the role of Government actions and measures are instrumental in health crisis management.
The limitations of this essay are in my analysis of the effectiveness of each country’s actions, as because of my Singaporean nationality I may be biased especially when discussing the effectiveness of Singapore’s actions. Also being a member of the community, in my analysis of the roles besides Government measures, especially with reference to the role of community I may be biased in my analysis. I myself not having contracted the disease nor had a relative infected with the disease do not know first hand the real extent, intensity of quarantine and isolation in Singapore and especially China.
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Footnotes
[1] SARS in China prelude to pandemic? Page 55 Arthur Kleinmen, James L.Watson Stanford University press.
[2] SARS in China prelude to pandemic? Page 56 Arthur Kleinmen, James L.Watson Stanford University press
[3] SARS in China prelude to pandemic? Page 56 Arthur Kleinmen, James L.Watson Stanford University press
[4] SARS in China prelude to pandemic? Page 57 Arthur Kleinmen, James L.Watson Stanford University press
[5] China Syndrome The true story of the 21st century’s first great epidemic page 293 Karl Taro Greenfield
[6] Learning from SARS preparing for the next disease outbreak pg 9 Institute of medicine of the National academies.
[7] SARS in Singapore – Key Lessons from an Epidemic Chorh-Chuan Tan,1FRCP, FACP, PhD Review Article
[8] crisis management in China Zhong Kaibin
[9] avian flu what we need to know
[10] Mr mah bow tan ministerial statement and QnAs on Avian Influenze-6 Feb 04 parliament sitting.
Bibliography
SARS in China prelude to pandemic? Arthur Kleinmen, James L.Watson Stanford University press.
China Syndrome The true story of the 21st century’s first great epidemic, Karl Taro Greenfield
Learning from SARS - preparing for the next disease outbreak, Institute of medicine of the National academies.
International herald tribune Emergency measures in China to prevent avian flu outbreak
Published: Sunday, May 22, 2005
avian flu what we need to know Posted by Silviu Dochia on April 19, 2006
SARS in Singapore – Key Lessons from an Epidemic ,Chorh-Chuan Tan,1FRCP, FACP, PhD
crisis management in China Zhong Kaibin
http://www.nus.edu.sg/birdflu/ avian flu information by National University of Singapore
facts about Sars by Wilson da silva
BBC news “China sorry for slow bug response”
http://www.sars-dtv.nl/ site for therapy and vaccine research
Jonathan Taylor (14) 4.15
8/9/08
