ON FRIDAYS, the Infectious Diseases (ID) community in Singapore gathers to present clinical challenges to one another. That Friday in March 2003, we heard the Tan Tock Seng Hospital (TTSH) ID team describe a pair of fellow travellers who were down with pneumonia of unknown aetiology. Most ominously, healthcare staff who had looked after them had fallen ill.

We were all novices then. The toll that novel pathogens could take on people, hospitals and societies was not something we understood. We were filled with a vague sense of unease, but we did not know what we were uneasy about.

One week later, an ID doctor developed fever while on his way back to Singapore from a course in New York. Television footage showed how, upon landing in Frankfurt, he was transported by men in full protective gear to an isolation hospital. The Germans did not miss the opportunity to show off their virological prowess – within days, they had identified, via electron microscopy, the culprit virus responsible for the pneumonia spreading in the wards in Singapore, Hong Kong and parts of China.

Meanwhile, at the Singapore General Hospital (SGH), a man who had recently been treated at TTSH was admitted for gastrointestinal bleeding and fever. Due to his recent admission to TTSH, isolation was considered, but he was deemed too ill to be in a single room. Ignorance of the wiles of the coronavirus was bliss.

The word “super-spreader” was soon to be coined. Eleven SGH nurses reported sick – all from the ward where the ex-TTSH patient had resided. As suspicion once more zeroed in on him, his chest X-rays were reviewed by several senior doctors, and all confirmed the absence of pneumonia. Still, the fact had to be faced that contagion had set in. At an evening meeting that stretched into the night, the decision was made to amputate the entire ward of doctors, nurses and patients, and implant it in TTSH – a massive operation called humiliation.

A punishing series of bad news followed. Staff fell ill, and a few perished. Contact tracing linked one, and then another, of Singapore’s rising numbers to the SGH super-spreader. At press conferences, pressmen, armed with the wisdom of hindsight, grilled SGH’s leaders mercilessly. The hospital floundered on, with staff struggling with new and strict infection control rules, while feeling helpless in a sea of adverse publicity.

Of all the lessons SARS taught us, one would become a guiding principle – never again.

Editor’s note: 

The SARS outbreak in Singapore lasted from February to May 2003. A total of 238 people were infected, 33 of whom died. Many of those infected were healthcare workers and their family members. In April 2003, SGH lost surgeon Alexandre Chao and health attendant Kiew Miyaw Tan. SGH had to close two wards and transfer 71 patients to Tan Tock Seng Hospital. The Urology Centre and sections of the Radiology Department were also forced to close temporarily.