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COVID-19 Outbreak: 313 Confirmed Cases in SG, 117 Discharged, 15 Critical (18 Mar)


Carbon82
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Having been very much involved in the 2003 pandemic outbreak, which spread across >35 countries and killing almost 800 people, I do not wish to see any diseases of such kind in my life again. I was one of the member in MOH committee to map out the quarantine and employee health screening requirement, and at the same time working closely with MOM and our regional team to map out the pandemic response plan, which include splitting functional team into 2 or more groups, to be stationed in different offices. I can tell you that everyone, including personnel from MOH and MOM, are clueless as to what is the best approach, so every suggestion and reasoning counts.

One of my colleague was infected when he went to SGH for his regular medical checkup and died a few days later. The saddest part is that none of us were able to send him off (he was in fact cremated on the same day for fear of spreading the virus further). Dr Alexandre Chao, the only son of Professor Chao Tzee Cheng (renowned forensic pathologist in Singapore), was one of the 33 who died from severe acute respiratory syndrome (Sars), while serving in a hospital fighting the deadly virus.

China probes pneumonia outbreak for Sars links: State media

online-200103-wuhanpneumoniaoutbreak.jpg

BEIJING (AFP) - China is investigating an outbreak of atypical pneumonia that is suspected of being linked to Sars, the flu-like virus that killed hundreds of people a decade ago, state media reported on Tuesday (Dec 31).

A team of experts from the National Health Commission were dispatched on Tuesday to Wuhan, in central China's Hubei province, and are "currently conducting relevant inspection and verification work", state broadcaster CCTV reported.

An emergency notification issued on Monday by the Wuhan municipal health committee said hospitals in the city have treated a "successive series of patients with unexplained pneumonia", without offering details.

Chinese news site The Paper reported 27 cases of viral pneumonia in Wuhan in December, citing unnamed health officials from the city.

"Of the 27 cases, seven were critical, the rest were under control, and two patients are expected to be discharged from hospital in near future," The Paper said.

It is unclear whether all these patients are suspected of having contracted severe acute respiratory syndrome (Sars), a highly contagious respiratory disease.

The emergency notification has urged hospitals to offer treatment and report cases in a "timely manner".

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Travellers arriving at Changi Airport from Wuhan to undergo temperature screening after pneumonia outbreak

yq-cparrival-02012020.jpg?itok=-7IOdkQe&

SINGAPORE - Travellers arriving from Wuhan in China will undergo temperature screening at Changi Airport from Friday evening (Jan 3), in light of a pneumonia outbreak in the Chinese region.

The Ministry of Health (MOH) said on Thursday evening it has told doctors to look out for suspected cases of people who returned recently from the area.

As a precaution, patients with fever and acute respiratory illness or pneumonia, who had travelled to Wuhan at least 14 days before the onset of their symptoms, will be isolated to prevent transmission, it added.

AFP had reported on Tuesday that China was investigating an outbreak of atypical pneumonia that is suspected of being linked to Severe Acute Respiratory Syndrome (Sars), the flu-like virus that killed 774 worldwide - including 33 in Singapore - during a 2003 outbreak.

The South China Morning Post newspaper said at least 27 infections had been reported as of Tuesday, most of whom were stallholders at a seafood market. It said that Hong Kong was on alert, with border screenings being set up.

At the time, AFP also quoted Wuhan’s health commission as saying that seven of the patients were in a critical condition, while the others were stable and two would be discharged soon.

According to the commission, initial lab tests found that there was no apparent human-to-human transmission and that no medical staff were infected.

As of Thursday, Chinese authorities could not confirm whether the pneumonia outbreak was linked to Sars. But MOH said it was aware of the cluster of severe pneumonia cases in the region and was monitoring the situation closely.

Suspected cases spotted by temperature screening at Changi Airport will be referred to hospitals for further assessment.

In addition, health advisory posters for all travellers will be put up at the airport, and a health advisory will be issued to all inbound travellers on flights from Wuhan.

As of 8.30pm on Thursday, MOH had not been notified of any suspected cases.

The ministry advised all travellers to Wuhan to monitor their health closely and seek medical attention promptly if they feel unwell, and to also inform their doctor of their travel history.

It added that travellers and members of the public should also adopt several precautions at all times, including avoiding contact with live animals and consumption of raw and undercooked meat, avoiding contact with people who are unwell or showing symptoms of illness, and practising frequent hand washing with soap.

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Glad to hear that there is no evidence of human to human transmission for the time being. Early 2003 was indeed a time of fear for both the general population and medical community.

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Yeah I wanted to begin a thread on this last night but couldn't work up the energy. Thanks for doing so.

Yes, I don't want a repeat of SARS either (I was in the thick of things right from the start, as you were), but the key difference is that our vigilance is much higher now and the systems put in place are more robust and capable of a very quick ramp-up.

We have the DORSCON system to give a snapshot of our disease situation.

Information is going out much quicker and in an organised, informative and actionable fashion from more authoritative sources to the front-line practitioners. Key people in the field (myself included) were alerted by email on 31st Dec, and that was quickly followed a formal MOH circular to the heads of hospitals with case definitions and management guidance.

Hospitals are already dealing with test requests for respiratory viruses like MERS-CoV and avian influenza on a regular basis (even though there haven't been positives here, touch wood, the exercise of fitting cases to definitions, sending samples and testing them keeps everyone on their toes). The Emergency Departments have proper fever triage protocols and training in the use of PPE is emphasised. So I think we're reasonably equipped to handle a respiratory-borne agent. Once this agent is identified, testing should quickly become available and I think we'll be OK. I don't expect a repeat of the pandemic-onium (sorry for the bad pun) of the bad old days of SARS, when there were Chinese (again sorry for the unfortunate pun) whispers early on with much confusion regarding the nature of the agent and a lot of lethargy in getting things organised.

Generally, respiratory agents like this are relatively easy to control on a population level as long as there is a strong government taking early action, and the people respond constructively. Unfortunately, even now I see people not covering their coughs or practising basic hygiene - these things really do need to be improved, it's just common sense. I don't want what you have, and I'm sure the feeling's mutual.

(The Ebola scare we had some time back - now that was a really worrisome thing. Simply because it would've paralysed even basic lab testing since blood samples could potentially be infectious by aerosol formation. Luckily, nothing came of it).

Anyway, stay tuned and have faith in the system...

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yes, ptsd thinking of the days back then, where we had daily media reports at MOH brief room and the reports of casualties daily.  

 

We are better prepared now BUT keep vigilance

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We are ok as long as the Chinese govt doesn't hide or cover or delay info to the world..........

At that time of SARS, the Chinese health minister covered up (if my memory doesn't fail me) 

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1 hour ago, Carbon82 said:

Travellers arriving at Changi Airport from Wuhan to undergo temperature screening after pneumonia outbreak

yq-cparrival-02012020.jpg?itok=-7IOdkQe&

SINGAPORE - Travellers arriving from Wuhan in China will undergo temperature screening at Changi Airport from Friday evening (Jan 3), in light of a pneumonia outbreak in the Chinese region.

The Ministry of Health (MOH) said on Thursday evening it has told doctors to look out for suspected cases of people who returned recently from the area.

As a precaution, patients with fever and acute respiratory illness or pneumonia, who had travelled to Wuhan at least 14 days before the onset of their symptoms, will be isolated to prevent transmission, it added.

AFP had reported on Tuesday that China was investigating an outbreak of atypical pneumonia that is suspected of being linked to Severe Acute Respiratory Syndrome (Sars), the flu-like virus that killed 774 worldwide - including 33 in Singapore - during a 2003 outbreak.

The South China Morning Post newspaper said at least 27 infections had been reported as of Tuesday, most of whom were stallholders at a seafood market. It said that Hong Kong was on alert, with border screenings being set up.

At the time, AFP also quoted Wuhan’s health commission as saying that seven of the patients were in a critical condition, while the others were stable and two would be discharged soon.

According to the commission, initial lab tests found that there was no apparent human-to-human transmission and that no medical staff were infected.

As of Thursday, Chinese authorities could not confirm whether the pneumonia outbreak was linked to Sars. But MOH said it was aware of the cluster of severe pneumonia cases in the region and was monitoring the situation closely.

Suspected cases spotted by temperature screening at Changi Airport will be referred to hospitals for further assessment.

In addition, health advisory posters for all travellers will be put up at the airport, and a health advisory will be issued to all inbound travellers on flights from Wuhan.

As of 8.30pm on Thursday, MOH had not been notified of any suspected cases.

The ministry advised all travellers to Wuhan to monitor their health closely and seek medical attention promptly if they feel unwell, and to also inform their doctor of their travel history.

It added that travellers and members of the public should also adopt several precautions at all times, including avoiding contact with live animals and consumption of raw and undercooked meat, avoiding contact with people who are unwell or showing symptoms of illness, and practising frequent hand washing with soap.

Checking for temperature only for people flying in from Wuhan may not be foolproof, as there will be traveler / passenger who had been to Wuhan for maybe a day or 2, and then move to other cities before arriving our airport. I hope they also set up a screening point just before the immigration counter to check for any fever case and ask for travel history. 

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Supercharged

With pork now hard to come by, the PRC chenghu has been promoting rabbit meat. A bacterial disease in rabbits that can cause pneumonia in rabbits is transmittable to humans:
http://www.fao.org/3/t0756e/T0756E09.htm
Pasteurella multocida causes chronic rhinitis, colds, snuffles, pneumonia, peritonitis and septicemia.
https://emedicine.medscape.com/article/224920-overview
P multocida infection in humans is often associated with an animal bite, scratch, or lick, but infection without epidemiologic evidence of animal contact may occur.

 

BTW the rabbit meat hot pot thingie started in Wuhan!

Edited by Kklim
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40 minutes ago, Kklim said:

With pork now hard to come by, the PRC chenghu has been promoting rabbit meat. A bacterial disease in rabbits that can cause pneumonia in rabbits is transmittable to humans:
http://www.fao.org/3/t0756e/T0756E09.htm
Pasteurella multocida causes chronic rhinitis, colds, snuffles, pneumonia, peritonitis and septicemia.
https://emedicine.medscape.com/article/224920-overview
P multocida infection in humans is often associated with an animal bite, scratch, or lick, but infection without epidemiologic evidence of animal contact may occur.

 

BTW the rabbit meat hot pot thingie started in Wuhan!

Pasteurellosis is most commonly limited to causing skin and soft tissue infections in humans, and is most commonly acquired by traumatic inoculation (specifically from the bites of cats and dogs). 

Human pneumonia due to Pasteurella is quite uncommon, although it has been described as a complication in those with compromised immunity and with pre-existing lung disease. 

I've never seen any case of Pasteurella pneumonia in humans. I have seen a case of bloodstream infection without pneumonia in a diabetic man with an open wound that had been licked by a dog (so that was the presumptive portal of entry) - don't worry, he recovered. 

So Pasteurella is not all that relevant as a zoonosis (animal to human disease) transmitted from rabbit to man. 

The bacterial infection that rabbits can carry and transmit to humans that medical professionals are worried about, is tularemia, caused by an organism called Francisella tularensis. Yes, it can cause pneumonia (of the severe kind) but it is not the most common presentation. I don't believe a single case of this organism has been found here. It's mostly of interest as a potential bioterrorism agent. 

When it comes to viruses, of course, rabbits can acquire and theoretically transmit rabies like any warm-blooded animal but the risk is much lower than with canids and bats. 

Rabbits can also harbour ticks which transmit a whole plethora of infections (including the aforementioned tularemia).

The short version is that the rabbit thing you mentioned is not likely to be relevant here. But good to think of all possibilities. 

Edited by Turboflat4
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1 hour ago, Mockngbrd said:

Nabuey, see PRC must soot photo on sgsecure liao. 

Ah see? This is when AI facial recognition comes into play.

Wanna do manual contact tracing like we did in nearly 20 years ago during SARS ?

In today's extremely connected world. there are better tools....Wuhan, like many higher tier cities in China are well connected by high-speed rail and major airports. Made worst in mid winter season as folks tend to stay indoor and with CYN approaching.. People are going to go places even more.

Vector vector vector...

 

World Health Organisation in touch with Beijing after mystery viral pneumonia outbreak

    Authorities in central city of Wuhan say market will be closed indefinitely ‘for sanitation and renovation’
    Law enforcement officers stand guard outside on Wednesday as stallholders allowed to remove seafood stocks

https://www.scmp.com/news/china/politics/article/3044207/china-shuts-seafood-market-linked-mystery-viral-pneumonia

2ccd2248-2c56-11ea-8334-1a17c6a14ef4_132

Edited by Wishcumsback
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5 hours ago, Jusnel said:

We are ok as long as the Chinese govt doesn't hide or cover or delay info to the world..........

At that time of SARS, the Chinese health minister covered up (if my memory doesn't fail me) 

You talking about a govt that to this day denies Tian an men or Uighurs concentration camps... I doubt any country takes China announcements at face value. Bad news will be covered up till last minute ..

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Turbocharged

Can't they just do check for all arrival esp from China.... that fella could have fly to Beijing then come SIN.... how....we kena screwed.....again!!!

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On 1/3/2020 at 7:43 PM, Playtime said:

You talking about a govt that to this day denies Tian an men or Uighurs concentration camps... I doubt any country takes China announcements at face value. Bad news will be covered up till last minute ..

I fail to see your point in getting political when this is a health related matter in which the Chinese gov is collaborating with the UN's WHO.

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