INFECTIOUS DISEASES (AMENDMENT NO. 2) BILL
Thank you, Mr Speaker, for making this facility so that we can all join in the debate without causing any anxiety to our colleagues. Early this week, I had to visit Tan Tock Seng Hospital, Intensive Care Unit, where SARS patients were being cared for. I was properly protected - N95 mask, gown and gloves. I did not have to get near any patient. There was no risk of my being exposed and infected. But, purely to allay anxiety, I decided to suspend all my activities in my constituency, including my weekly meet-the-people session. The risk of my becoming infected and, in turn, passing it on to the residents in my constituency is practically nil, but I would rather not cause any anxiety on their part. For the same reason, I decided that I should stay away from Parliament during this period. I will resume community activities from 1st of May. In fact, my first public function will be the NTUC May Day Rally, even as I continue to visit the hospitals. But I will no longer need to go inside hotspots like Intensive Care Units. By the way, I continue to go home every day to play my role as a father and husband. I take comfort in the fact that no Tan Tock Seng Hospital worker has been infected for some time now, ever since we got to know this virus better, and instituted full infection control and protection for staff and visitors. Mr Speaker, this virus is dangerous, but actually not that scary. You can get infected only if you are near a SARS patient and unprotected. In Singapore, where we have so far managed to control its spread, the high-risk areas are mainly hospitals and the homes of SARS patients. Outside of these areas, the risk of getting infected is insignificant, although not zero. We are working hard to maintain this state of affairs, while we continue to enhance infection control in the hospitals and achieve effective protection for our hospital workers, patients and visitors. This is the top priority of our SARS combat unit. It is to eliminate in-hospital infection. If we do our job well, we will be able to reduce the risk of hospital workers, patients or visitors becoming infected while they are in hospitals to the absolute minimum. And, with some luck, perhaps, even zero in some hospitals. How? We are focusing our efforts in five areas. First, equip our hospital workers, patients and visitors with proper protective gear, that means masks, 3Gs - gowns, goggles and gloves, and protective suits when doing procedures on patients like intubation or surgery. An unprotected or poorly protected worker handling a SARS patient is fighting a formidable enemy without weapon or shield. A few earlier cases of hospital workers being infected were due to inadequate protection. Second, train our hospital workers on infection control and proper use of protective gear, eg, an ill-fitted N95 mask that is not 100% sealed is no protection. Training and retraining now go on repeatedly. Third, ensure full compliance. A good infection control plan is only good if it is put into practice by all staff at all times. This calls for repeat reminders, frequent audits and peer pressure. Fourth, pick up early onset of symptoms. Without a reliable diagnostic kit, the next best thing is to measure temperature at frequent intervals. As soon as fever is detected in staff, patient or visitor, an alarm goes off and we spring into action. Finally, isolate immediately all those with SARS symptoms, with full protection and barrier nursing. Together, these five components make up what I call the PDI strategy - Protect, Detect and Isolate. We are now putting it into practice in all our hospitals. With the virus now out of the bottle and in the international community, it is no longer possible to eradicate it soon. Hospitals will now have to live with SARS. Procedures and processes will have to be re-engineered to cope with this changed environment. Infection control will have to be taken a lot more seriously than in the good old pre-SARS days. What it also implies is that, going forward, we cannot hope for no more new cases of infection. Instead, it is more likely that we will have occasional cases of infection. Hopefully, we will be able to quickly detect and isolate them before they do extensive damage, but this is something for the future. Meanwhile, I am mentally prepared for the situation to get worse, before it gets better. This is because we do not yet fully know the enemy. How is it transmitted? How long does it survive outside the human body? It is tough fighting an invisible enemy. In the early days of the outbreak, many of our hospital workers were infected. This is because, for many decades now, modern hospitals do not have to deal with serious infectious diseases. As a result, we have relaxed on infection control standards, as it was unnecessary, and it would have been an over-kill. But after we have understood the enemy better, and put ourselves on high alert, in protective gear, the number of hospital workers becoming casualties has come down drastically. We are now busily strengthening all the hospitals, getting them up to shape. This will take some time as old habits do take time to change, but we are learning quickly day by day and getting into full swing. A new complication for us is that some patients with other illnesses have been infected. Because of their other illnesses, the SARS symptoms are often masked. This has made early detection very difficult. That is why we may still have the occasional break-out in our hospitals, despite the best of efforts. There is no shortcut to this problem, except to keep vigilant and to close in on the enemy as soon as its identity has been exposed. That is why we await so eagerly for a good reliable diagnostic kit. Without it, we are really fighting with a major handicap. Meanwhile, we should all be mentally prepared for new cases and some setbacks. But we should not allow such occasional eruptions to reduce us to frenzy and mass panic. To win this fight, we need cooperation from all Singaporeans. To stop the spread in the community, we need cooperation from the entire community, not 80-90% but 100% of cooperation. Just a few super-spreaders who are irresponsible and we will have a major setback. Singaporeans are not helpless in this fight. We should certainly not be mere frightened, passive spectators of this battle. We have much to do, and if we do it well, we can win this battle together, and decisively. What can you do? I suggest we focus on three areas. First, raise our personal and public hygiene to the Japanese standard. SARS appears to be spread by droplets. So regular wiping and cleaning would help. Everyone should stop irresponsible people from spitting in public, sneezing or coughing, without covering their face, or littering. Frown on them, stare at them, make sure they get the message. I cannot help noticing that Japan, despite very intensive business and people-to-people contact with China and Hong Kong, remains unaffected by SARS. I do not think they are merely lucky. I think years of keeping high personal hygiene must have contributed to this state of affairs. So let us clean up our act in hospitals, homes, offices, hawker centres and everywhere. Second, support our hospital workers. They are working flat out for weeks now. As I walked the hospital floor, I can see fatigue in their faces. Many are now doing extended shifts - double shifts. I worry that some may break down. They need all the support and help that we can give. Many Singaporeans are indeed doing so. I see Milos, Ovaltines, essence of chickens, vitamin Cs being sent regularly to the wards, together with flowers, lovely poems and paintings - absolutely heartwarming. Believe me, if they are able to keep their body and soul together, despite having to live with the risk and punishing work pace, it is due to this wonderful moral support that they are getting from fellow Singaporeans. Unfortunately, a small number of Singaporeans remains determined to make our lives difficult. Some lie about their history, and some break home quarantine. This Bill will directly address these deliberate acts of dishonesty. However, there are also some Singaporeans who make our lives more difficult, perhaps without realising it. These are the visitors of patients to the hospitals, A&E Department and wards. Our staff are already busy, protecting themselves and their patients, besides rendering medical care. With visitors, they have the added responsibility to ensure their safety. This is not theoretical. There was a visitor who accompanied her husband to an A&E Department for treatment. The husband was in a trolley, closely monitored. His trolley was next to another patient who was also in a trolley, who subsequently turned out to be a SARS patient, although unknown at that time. But there was proper separation procedure and infection control. The husband never became infected. However, the lady visitor, despite constant advice and pleas by our A&E staff, insisted on hanging around in the observation ward for a good five hours, moving from trolley to trolley. She became infected by the SARS patient and is now in Tan Tock Seng Hospital. We have cut down visits to hospitals to one visitor per patient but, really, the hospitals would strongly prefer a "No Visitor" rule during this period, except for compassionate cases, like for children, and seriously ill patients. Toronto Hospital has already imposed such a rule. This will help minimise risk of inadvertent spread through hospital visitors, besides reducing the load on the hospital workers. On the ground, we will be flexible to address the emotional needs of some patients and their loved ones. We hope Singaporeans will support this no-visitor rule. Third, think out creative, practical ideas to help fight SARS. For example, I was most pleased to read about the taxi driver who prints his namecard and gives one to each passenger with a receipt. In this way, in the event that contact tracing has to be done, with him as a SARS suspect, his passengers will more likely be able to recall. Likewise, someone suggested that all counter staff in the shops, banks, supermarkets and hawker stalls place a bowl in which all their customers can throw in their namecards. Every day, the collections can be bagged and dated. In the event that contact tracing has to be done involving this particular outlet, the process can then be speeded up. To make it fun, we can have a monthly lucky draw of these namecards before they are discarded with prizes for the lucky winners. There are so many ways in which Singaporeans can get involved in fighting this battle. The fun part is not to trivialise the matter, but to help raise public awareness. For example, there can be a song or jingle competition on how to remind Singaporeans to take temperature twice a day, wash hands every other hour. Mr Speaker, this is a major crisis. We cannot duck it. But we should turn it into an opportunity to bond Singaporeans and to strengthen our spirit as one people. A few of our hospital workers have sacrificed their lives in this battle. A few are fighting for their lives. I saw them in the Tan Tock Seng Hospital's Intensive Care Unit. Many more are quietly but courageously fighting in the trenches, not knowing which patient will turn out to be SARS. As I walk the ground, talk to them, I know I am talking to true heroes and heroines. They are risking their lives every day, every hour, so that we can all be safe. The minimum we can do is not to hamper their work but to help them get on with their job. We are now many times better prepared than when we started 43 days ago. We know the enemy better, although still not fully. We are better equipped, better trained, better protected. Preliminary diagnostic kits have arrived, and we are perfecting them. So, even if the next few days may turn out to be worse than today, we know that we will win the battle sooner rather than later. Mr Speaker, I support the Bill.