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1. Hi-tech suits issued to medics

2. Swathed in protective suits, Doctors and Nurses are still at risk

3. Body-dumping probe says no one should take blame

4. Doctor jailed for abortion in backstreet clinic

5. Your Sars Questions and Answered

6. S*A*R with Tom Hilditch

7. Cartoon

8. Tung's $11.8b Sars rescue package

9. Wheeler

10. Protecting Doctors

1. Hi-tech suits issued to medics
Peter Michael, SCMP 24 April 2003

The protective outfits being worn at two hospitals are designed for dealing with chemical spills and radioactive substances

Hi-tech protective suits designed to be worn by workers dealing with chemical spills and radioactive substances are being provided to medical workers in the Hong Kong hospitals worst hit by the Sars outbreak.

The 'barrierman' suits have been issued to all staff working in isolation wards in the Prince of Wales Hospital in Sha Tin and Alice Ho Miu Ling Nethersole Hospital in Tai Po.

Their use follows alarm over the rising number of frontline medical staff being struck down by severe acute respiratory syndrome (Sars).

Nurses get two suits a day to wear and doctors discard them every time they have completed their rounds.

The suits cost $25 each and there have been calls to use them in all hospitals across Hong Kong.

Staff in other hospitals are currently only issued with paper gowns, eye visors and face masks.

The manufacturer of the barrierman suits, Du Pont, boasts that the outfits can be used while dealing with liquid chemical spills, radioactive substances and agricultural chemicals.

The suits are made of a special microfibre and include a hood and visor.

Medical sources said that Hospital Authority officials at first baulked at providing the suits, which have been used for the first time this week, because of their cost. However, they agreed to pay for them as the infection rate of frontline health workers continued to rise.

Tim Rainer, Accident and Emergency specialist at Prince of Wales Hospital, said: 'Very high levels of barrier control [such as spacesuit-style or barrierman outfits] are expensive, unpleasant to work in and to date have been thought unnecessary, especially as every health worker would have to wear one. But we cannot predict where the next source [of infection] is hiding.'

Legislator and Medical Association president Lo Wing-lok said: 'These biological warfare or astronaut-type suits are only part of the answer. You can see that Sars is the one and only issue in Hong Kong at the moment. We cannot talk about economic recovery, we cannot talk about anything else. We must make this ongoing threat to our health workers the top priority.' Frontline health workers account for one-quarter of all people infected, he said.

Professor Sydney Chung Sheung-chee, dean of medicine at the Chinese University of Hong Kong, said: 'The critical issue is to prevent more staff getting infected. Every single incident of staff getting the infection means one less soldier to fight the disease and one more patient to look after. It is also a heavy blow to the morale of the frontline team.'

He called for better measures to protect staff. 'Much is still unknown about the virus. The more we know about it the better we can protect our staff. We must provide the best protective gear for our frontline staff and make sure that these are supplied on time to the staff when they need them.'

New tests have found that the coronavirus believed responsible for Sars can survive on some surfaces without a host for up to three hours, making it contagious to the touch. This comes amid global concerns that Sars may be becoming more virulent.

There were four medical workers among the 24 new infections yesterday. The total number of health-care workers admitted to hospital with atypical pneumonia hit 335 yesterday out of a total 1,458 infections.

Respiratory medicine specialist David S.C. Hui, of the Prince of Wales Hospital, said that in addition to the distribution of barrierman suits, new measures taken over the last few days included the installation of exhaust fans on all Sars wards to improve ventilation, and hence decrease the viral load in the air.

Sars has infected an estimated 4,000 patients in 27 countries, and killed 229, according to the World Health Organisation.

A 71-year-old Sars patient sparked panic last night when he wandered out of Tai Po Hospital and went missing for almost two hours. Police were put alert after the patient, surnamed Chan, walked out of his ward. He was still wearing his hospital gown when it later emerged that he caught a taxi outside the adjacent Alice Ho Mui Ling Nethersole Hospital at about 5pm. He was found at 7pm and returned to the hospital, the Hospital Authority said.

Health authorities want the taxi driver to contact them as soon as possible on 2891 1452. The driver took the patient to Hei Wo House in Tai Wo Estate, Tai Po.

2. Swathed in protective suits, Doctors and Nurses are still at risk
SCMP, 24 April 2003

Visible through a porthole looking into isolation ward 9C at the Prince of Wales Hospital, frontline medical staff could be seen shuffling about tending to patients hidden by curtains.

Dressed in protective suits and wearing full-face visors, the doctors and nurses were shielded from head to toe in the latest bio-hazard equipment.

And yet doctors still wonder if it is enough to protect them against the deadly virus sweeping the globe.

"My opinion is that we will not fully eradicate atypical pneumonia until a vaccine is released on the market," said Vincent Wong Wai-sum, a medic who has been working at the coalface of the Sars outbreak since it began last month.

Head of respiratory medicine at Prince of Wales, David S. C. Hui, said senior medical staff had pushed for the suits because of the "evolving" and "virulent" nature of the virus. But despite the measures, staff were still being exposed, and an average of one or two nurses a day were falling ill with Sars.

"There are several reasons why health-care workers still get infected despite the safety measures," he said.

"Some of the patients with Sars on the wards - mainly older males - have rather poor personal hygiene. They pull off their masks, cough and even spit."

"Some older patients have required help with oral feeding and during the process, a patient has vomited and infected a registered nurse.

"Some patients are incontinent and during the cleaning process, the health-care workers are at risk as the excreta may contain viruses." Peter Michael

3. Body-dumping probe says no one should take blame
Stella Lee, SCMP 24 April 2003

The HKU inquiry identifies 'institutional responsibility' for the bungle, but an activist calls the report a whitewash

An investigation into a scandal over the dumping of body parts has concluded that no one at the University of Hong Kong should be disciplined for discarding medical school specimens into a landfill. Instead, the probe identified a failure of 'institutional responsibilities' that lay behind the bungle.

University vice-chancellor Tsui Lap-chee ordered the probe in January after a preliminary investigation confirmed that the five body parts - including torsos and legs - found on a Tseung Kwan O landfill that month belonged to the medical faculty.

The inquiry panel was chaired by the university's pro-vice-chancellor, Howell Tong. Its other members were associate dean of medicine Raymond Liang Hin-suen and Walton Li Wai-tat, deputy medical superintendent of the Hong Kong Sanatorium and Hospital.

Tim Pang Hung-cheong, a patients' rights advocate, accused the university of a whitewash.

The incident took place after the faculty moved to new premises in the university's Pokfulam campus last summer. A total of 23 bodies and 120 body parts were supposedly moved to the new building. But some parts were apparently left behind at the site, where building work later took place.

The investigation report said the most probable explanation was that some body parts were left behind in one of the mortuary chambers during the removal.

It said the panel was told that there was hidden space between the floor panel and the lowest movable tray in the mortuary chamber, and the door of one of the chambers was known to be malfunctioning. Because of shortage of storage space, the panel said it did not rule out the possibility that the five human body parts were stored in the hidden space behind the malfunctioning door.

'The panel was of the view that the officers in charge might not have opened the malfunctioning door during their checking before the relocation of the cadavers and human body parts, but instead relied on shining a torch at an angle after opening an adjacent functioning door of this particular mortuary chamber,' the report said. The body parts then went unnoticed by the workers because of poor lighting at the demolition site, it added.

The panel said the probability of this incident taking place could have been drastically reduced if the department had a proper system of record-keeping of the body parts. 'While the panel does not think that the evidence allows it to hold any single individual or group of individuals wholly responsible for the sequence of events leading to the unfortunate incident ... it is of the view that there are unquestionably issues of institutional responsibilities,' the report said.

It blamed the Department of Anatomy for failing to implement a record-keeping system for the un-dissected human parts and to provide adequate supervision during the removal process.

'Accordingly, the panel does not think it appropriate to take disciplinary action against any individual,' the report said.

It recommended that the Department of Anatomy adopt an effective record-keeping system and review it annually.

Professor So Kwok-fai, head of the department, said it had started reviewing procedures and establishing a record-keeping system for body parts.

But Mr Pang, of the Patients' Rights Association, said: 'What does it mean by institutional responsibilities? So no one needs to be responsible because it is a collective responsibility system? This amounts to total disrespect for the people who donated their bodies.'

However, Hong Kong Medical Association president Lo Wing-lok said he found the report acceptable as it was more constructive to focus on improvements in the system. stella.fylee@scmp.com

4. Doctor jailed for abortion in backstreet clinic
Sara Bradford, SCMP 24 April 2003

A mainland doctor who performed a backstreet abortion in an unregistered Mongkok clinic was jailed for 18 months yesterday.

Passing sentence on Hung See-tat, 55, Deputy High Court Judge Michael McMahon said that while the defendant was a trained and registered doctor on the mainland, he had still put his patient at risk since the clinic was ill-equipped to deal with any medical clinic.

Prosecutor Paul ho told the Court of First Instance that a 21-year-old woman visited Hung on April 2 last year believing she was pregnant. He said the patient returned the next day, when Hung gave her two tablets and performed a 30-minute procedure on the woman, at a cost of $1,000.

Hung's defence counsel, James McGowan, argued that the April 3 abortion was a "one-off". But the judge said he could not accept the mitigation. He also said Hung had five previous convictions for operating an unregistered clinic which had failed to deter him.

Hung was jailed for seven months for operating the clinic, with three months to run consecutively to the 15 months he received for performing the abortion.

5. Your Sars Questions and Answered
SCMP, 24 April 2003

Doctor Margaret Cheng is on hand to answer your questions o the atypical pneumonia outbreak. If you have any questions for her, e-mail them to mharris@netvigator.com. More questions will be answered in tomorrow's City section.

Q There has just been a confirmed case in the tower next to mine. It's in the same complex but is not joined to mine. How worried should I be? Should I stop meeting friends?

A Watching the "infected cases in buildings" chart is a bit like watching the enemy approach your gates, isn't it? The closer it gets to where you live the more worried you get. But if the building next to you is not joined in any way and you do not share sewerage systems your risk of catching Sars has not significantly increased. However, treat all surfaces as potentially infectious and wash your hands with alcohol hand-wipes or the different gels available to allow hand washing without water while you are out and about. By the way, this applies to everywhere in Hong Kong. You have to assume people with the virus may have touched surfaces in different parts of Hong Kong so you should never touch your mouth, nose or eyes with a hand that has not just been cleaned. You can still meet up with friends but remember that they, too, may have touched contaminated surfaces, so avoid close physical contact.

Q I always post letters to my mum in the Philippines, and now she has asked me not to write till the outbreak is over. She's worried that the virus might travel by mail. Please advise me.

A you will be please to hear that the World Health Organisation ahs looked into this and asked a couple of its sister United Nations bodies, including the Food and Agriculture Organisation, to check whether this disease is being passed via cargo and mail services. The answer has come back as a very clear no. Tell your mother the UN has checked it out and it is safe to receive letters from you.

6. S*A*R with Tom Hilditch
SCMP, 24 April 2003

Dr WHO?

Reader Warren Wong wonders why the World Health Organisation (WHO) decided to call this virus severe acute respiratory syndrome (Sars). After all, he writes: "Severe and acute have similar meanings". However, acute respiratory syndrome poses another problem.

Lips under a mask
A ventriloquist city
Only the eyes talk
(Barbara Watson)

Rhyming slang
Definitely, our last instalment of Canto Rhyming Slang.

Maggie Q = flu
As in: "If you're gonna get Maggie, you want plain Maggie not super Maggie."

Stanley Ho = low
As in: "The Hang Seng's a bit Stanley these days."

Run Run Shaw = floor
As in: "My advice is hit the Run Run running."

7. Cartoon
HSCMP, 24 April 2003

8. Tung's $11.8b Sars rescue package
Jimmy Cheung and Chris Yeung, SCMP 24 April 2003

As the Hong Kong death toll tops 100, the chief executive outlines stimulus measures - including salary tax rebates

Emergency relief measures worth $11.8 billion were unveiled by the Hong Kong government yesterday amid growing concerns that the atypical pneumonia outbreak will continue to have a devastating impact on the economy for months to come.

The sweeping package includes salary tax rebates worth up to $2.3 billion, a business loan scheme and concessions on various government charges, which officials say will help millions of households and traders ride through the difficulties.

The announcement came as Hong Kong's death toll surpassed 100 yesterday, rising to 105 after six more patients died.

A further 24 patients were admitted to hospital, bringing the total number of infections to 1,458. A total of 522 patients have recovered, 61 of whom were discharged from hospitals yesterday.

Unveiling the stimulus package, Chief Executive Tung Chee-hwa said the nine measures would ease the short-term impact on the economy.

'Our priority remains to prevent and control the disease. However, it is necessary for us to plan for arrangements to revive our hard-hit economy in the medium and longer term,'' he said.

Businesses badly hit by the outbreak, including restaurants, cinemas, tourism and retail outlets, will have the government acting as guarantor on bank loans to pay for staff wages under a $3.5 billion scheme.

Rent reductions of up to 30 to 50 per cent will be granted to most of the commercial tenants of the Housing Authority and certain tenancies managed by the government. Rates, water charges, sewage charges and trade effluent surcharges are to be waived for between three and four months to reduce costs for affected sectors.

Two million families will have their rates waived for a quarter, and water and sewage charges waived for four months at a cost of $1.77 billion to the public coffers.

Tax rebates worth $2.3 billion for 1.31 million taxpayers were also introduced as a surprise relief which officials hoped would help stimulate consumption.

The total package will cost $11.8 billion, including a $6.4 billion increase in government spending and $5.3 billion in lost revenue.

Mr Tung, who is facing the uphill task of eliminating the budget deficit by 2006-07, maintained that the measures had been considered thoroughly.

'They have taken into account the medium-term need to make sure our budget is in balance and the possible impact of the package on the financial markets,'' he said.

Speaking after a briefing to lawmakers, Financial Secretary Antony Leung Kam-chung said it was too early to say if balancing the budget would be achieved by 2006-07.

He maintained the package was 'affordable and appropriate'', adding that it was too early to say whether another rescue package would be needed if the severe acute respiratory syndrome crisis continued unabated.

'The most important thing is that we tackle the immediate difficulty, ,' Mr Leung said.

'If we can control the outbreak, the atmosphere of society and the economy will be quite different. At the moment, we can only cross the river by feeling the stones.''

Secretary for Economic Development and Labour Stephen Ip Shu-kwan said: 'From our discussions with groups in various sectors, they agreed a period of three [to four] months is the right time for relief measures.

'If we do a six-month plan, people will say we are too pessimistic.'

Political parties and businesses generally welcomed the package, though concerns have been raised that small businesses might not benefit much.

Hong Kong Chamber of Commerce chief executive Eden Woon Yi-teng said the economic measures were in line with the chamber's recommendations. 'The government has tried its best,' he said.

The Measures

Salary tax rebates Cost: $2.3b

Commercial water and sewage charges and commercial rents cut $1.09b
Licence fees reduced for affected businesses $280m

Domestic water and sweage charges cut $1.77b

Loan guarantee scheme for certain industries $3.5b

21,500 training places and temporary jobs created $430m

Overseas PR campaign $1b

Extra funding for medical research and public helath $1.5b

No increase to fees and charges for six months

9. Wheeler
SCMP, 24 April 2003

10. Protecting Doctors
Letters to the Editor, SCMP, 24 April 2003

It is worrying that medical personnel continue to be infected by severe acute respiratory syndrome (Sars).

They have been wearing masks but not until recently have they worn protective eye gear. The eyes are an obvious portal of entry for the virus and must be protected.

There are two types of protective eyewear - the anti-splash type, which acts as a shield to prevent droplets entering the eyes from the front (eg. Spectacles), and the complete-seal types, which prevents foreign particles entering from all sides (eg. Swimming goggles).

Only the latter should be used in high-risk areas. It pains me to see a photo of a nurse or lab technician obtaining a nasal aspirate sample from a patient with only a mask to protect themselves.

What happens when you stick something into the patient's nose? They either sneeze or cough and, lo and behold, the nurse or technician gets a dose of Sars virus in his or her eyes.

Also, it may help to explain treatments for the Sars virus if one does catch it. The virus kills in two ways - by directly damaging tissue, such as causing pneumonia, and by inducing an autoimmune response whereby a person's own immune system starts to attack their body, killing off white cells and lung cells, ie. Causing pneumonitis.

There are two current treatments. One consist of high doses of ribavirin, which is an antiviral and supposedly will kill the virus. The other uses high doses of corticosteroids, which suppress your immune system so that you stop attacking yourself.

Unfortunately both drugs have serious side effects. Ribavirin may cause haemolysis, liver dysfunction and heart problems, side-effects that increase in cadence and severity with high doses.

Corticosteroid suppresses the autoimmune response, but it also adversely affect one's ability to fight infection because of the immunosuppression. Using both together provides a perfect environment for the Sars virus to develop drug resistance.

A combination of ribavirin and corticosteroid was working well until recently, however, when more young, fit patients failed to respond to the treatment and died. The virus may have developed ribavirin resistance.

The way around drug resistance is to use multiple antiviral therapy, as in the treatment of HIV.

The best option at this stage to control Sars it to:

Develop a rapid and accurate diagnostic test for coronavirus;

Once Sars viral infection is confirmed, commence cocktail antiviral therapy; and

Only use corticosteroid if the patient develops an automimmune response and/or pneumonitis so that the immune system can continue to fight the virus, rather than use blanket steroid treatment to suppress the immune system and rely solely on ribavirin to inhibit the virus.

Dr Timothy Cheung, Causeway Bay.