The patient was recovering in a ward in the Singapore General Hospital (SGH) when he developed a fever and other symptoms that suggested he might be infected with something unfamiliar. Could it be the Middle East Respiratory Syndrome Coronavirus (MERS - CoV) or the more deadly Ebola virus?
To play it safe, the hospital immediately swung into emergency mode and took a series of steps and procedures to avoid the spread of the disease while further tests were being done on the patient.
Other patients in the ward were tested to find out if they too were infected, as were hospital staff who had contact with the patient.
Visitors were tracked down for testing to make sure the virus – if it was confirmed to be one or the other – had not spread to the larger community. Those were the immediate concerns. Also important were questions on how SGH and other hospitals would cope if the infection spread widely.
Luckily, this was just a scenario that was played out during a Ministry of Health (MOH) emergency drill that SGH underwent earlier this year.
Since the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, SGH and other hospitals in Singapore regularly go through emergency exercises to ensure that they are able to protect themselves and their patients in the event of another disease outbreak.
“It’s like fighting an unknown enemy,” said Dr Ling Moi Lin, Director, Infection Control, SGH.
It isn’t just more unusual viruses like MERS -CoV and Ebola that hospitals have to be on guard against. Common flu viruses can turn deadly and/or spread widely as they circulate and mutate.
Flu vaccines, developed each year to fight what research indicates will be the most common mutations during the two yearly flu seasons, offer some protection.
Then, there are also threats from common infections like dengue, chicken pox and measles.
When a case such as MERS -CoV or Ebola is confirmed, certain emergency hospital protocols will be activated. What hospitals have to do depends on what they are trying to contain.
For instance, if a patient were suspected to have Ebola, the affected ward would be quickly locked down to isolate the patient and everyone who was in contact with him from the rest of the hospital. To avoid infecting others, he would have to be managed at the Isolation Ward. MOH would be informed of the suspected case, and everyone who had contact with the patient, including those who visited other patients in the same ward, would have to be tracked down.
If the patient fulfilled the MOH criteria for a probable suspect with the Ebola virus, he would then be transported quickly to Tan Tock Seng Hospital (TTSH) as care and treatment of Ebola patients is centralised in Singapore at TTSH , said Dr Ling.
The use of personal protective equipment is important in containing the spread of a disease. The use of a regular hospital gown, gloves and a surgical mask may be enough when dealing with MERS -CoV patients. But enhanced protective equipment is needed in the management of an Ebola patient.
“Ebola is spread through contact with blood and body fluids, so staff managing an Ebola suspect patient should be appropriately protected,” said Dr Ling.
Should the number of people having to be screened for an infectious disease increase during a pandemic, space at Multi-Storey Car Park H on the SGH Campus can be converted within three days into a screening centre to avoid overwhelming the Accident and Emergency Department (A&E).
Exigency plans are necessary for large acute care hospitals like SGH to continue functioning as normally as possible.
Using negative pressure to keep the germs in
Negative pressure in the rooms in the Isolation Ward prevents airborne pathogens from escaping. Because air flows from areas of higher to areas of lower pressure, the negative pressure in the isolation rooms helps prevent cross-contaminations and protects people outside from being infected. The isolation rooms, which must have a negative pressure of at least 2.5 Pascals relative to the outside, are used regularly for patients with measles, tuberculosis, and chicken pox. Patients infected with diseases like the avian flu and SARS will also be managed at the Isolation Ward. The air in the isolation rooms is filtered before it is released outside. Patients with weakened immune systems can also be managed in the isolation rooms; in such cases, their rooms will have positive pressure to keep germs out.
DORSCON alert levels
Nature of disease: Mild or severe but does not spread easily
Impact on daily life: No disruption
Action: Maintain good personal hygiene and stay at home when unwell.
Nature of disease: Severe and is spreading outside Singapore, or mild and is spreading in Singapore
Impact on daily life: Minimal disruption
Action: Maintain good personal hygiene and stay at home when unwell. Look out for health advisories.
Nature of disease: Severe and spreads easily, but is contained
Impact on daily life: Moderate disruption
Action: Maintain good personal hygiene and stay at home when unwell. Look out for health advisories and comply with control measures.
Nature of disease: Severe and is spreading widely
Impact on daily life: Major disruption
Action: Maintain good personal hygiene and stay at home when unwell. Look out for health advisories and comply with control measures. Avoid crowded areas.