Childhood SARS in Singapore

H Van Bever; C Hia; Q Swee Chye

doi:10.1136/adc.88.8.742

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CORRECTIONS - October 01, 2003

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Childhood SARS in Singapore

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Author's reply
Hugo P Van Bever
Published on: 22 March 2016
Re Childhood SARS in Singapore
Lik Eng Loh
Published on: 22 March 2016

Published on: 22 March 2016
Author's reply
- Hugo P Van Bever, Professor in Paediatrics
- Other Contributors:
  CPP Hia, SC Quek
Dear Editor
We thank Drs Loh et al. for their comment [1] to our letter.[2]
We wish to clarify that our letter was to share our own experience and it reflected our perspective during a very turbulent period when we had to deal with SARS. It highlighted practices which were carried out at our institution, a tertiary teaching hospital, in tandem with Singapore's efforts against SARS. Although ther...
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Dear Editor
We thank Drs Loh et al. for their comment [1] to our letter.[2]
We wish to clarify that our letter was to share our own experience and it reflected our perspective during a very turbulent period when we had to deal with SARS. It highlighted practices which were carried out at our institution, a tertiary teaching hospital, in tandem with Singapore's efforts against SARS. Although there was a SARS-designated hospital, all other hospitals were fully geared in the frontline battle against the disease. There were adult patients diagnosed with SARS at our hospital who were eventually transferred to the designated hospital. Doctors and nurses from our department contributed to the paediatric team based at the SARS- designated hospital as part of our nation's fight against the virus. We therefore have first-hand knowledge that there was no mortality or paediatric patients who required assisted ventilation. This, together with the relatively fewer number of paediatrics patients compared to adults, led us to hypothesize that the coronavirus causing SARS might affect children differently, and cause a milder form of disease. Data from other countries with outbreak appear to be similar to our observation. However, this does not imply that we have over-reacted in our preventive measures in children. On the contrary, as was pointed out in our letter, even paediatricians should keep their guard and remain vigilent at all times (as we are even now), not knowing if children may be a carrier-source. The changes to our lives brought on by SARS affected all Singaporeans, with medical personnel shouldering much, including the responsibility of caring for the sick, and learning more about the disease.
References
(1) Lik Eng Loh, Janil Puthucheary, Irene Chan, Oh Moh Chay. Re Childhood SARS in Singapore [electronic response to Bever et al. Childhood SARS in Singapore] archdischild.com 2003 http://adc.bmjjournals.com/cgi/eletters/archdischild;88/8/742#524
(2) Van Bever H, Hia C, Swee Chye Q. Childhood SARS in Singapore. Arch Dis Child 2003;88:742.
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Re Childhood SARS in Singapore
- Lik Eng Loh, Paediatrician
- Other Contributors:
  Janil Puthucheary, Irene Chan, Oh Moh Chay
Dear Editor
Van Bever et al. have described their experience with Paediatric SARS in Singapore. We are concerned that some facts were not highlighted.
Their institution, the National University Hospital (NUH) was not designated to be a centre for the care of SARS in Singapore, it was therefore not surprising that they did not encounter any cases. They failed to mention in their detailed summary of th...
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Dear Editor
Van Bever et al. have described their experience with Paediatric SARS in Singapore. We are concerned that some facts were not highlighted.
Their institution, the National University Hospital (NUH) was not designated to be a centre for the care of SARS in Singapore, it was therefore not surprising that they did not encounter any cases. They failed to mention in their detailed summary of the protective measures employed by their hospital, the key measure employed by the Singapore government to prevent the spread of SARS. In an effort to contain and curb the spread of this highly contagious coronavirus all cases of suspected SARS, based on travel to afflicted countries and/or positive contact history with the appropriate symptomatology, clinical and radiological findings, were re-directed to Tan Tock Seng Hospital (TTSH), the only SARS designated hospital in Singapore. Physicians were required to refer any suspected SARS patients there for care and isolation. Although TTSH does not have a paediatric unit, a team from KK Children’s Hospital, the largest paediatric centre in Singapore, were based there to care for all paediatric cases. There were over 70 paediatric patients seen and investigated for the possibility of SARS. The findings are reported elsewhere (Paediatric SARS in Singapore, J Puthucheary et al, manuscript submitted for publication), and describe several cases of adult-to-child transmission within family clusters, with no child-to-child or child-to-adult transmission.
Their statement that SARS is mainly a disease of adults and adolescents is not incorrect, but the same may be said for any number of infectious agents; nevertheless it has enough significance within children to be a concern to paediatricians. The initial suggestion that the measures put in place may have been an over-reaction does not fit with the data compiled in TTSH and available through the Singapore Ministry of Health, demonstrating a significant reduction in transmission associated with the adoption of the described measures.
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Conflict of Interest:
None declared.
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