To prevent the resurgence of Severe Acute Respiratory Syndrome, the Hong Kong government has announced the adoption of a three-tiered emergency response mechanism. It integrates the response system of the Hospital Authority (HA) with community-based systems.

Under the new mechanism, there are three levels of government response. When there are laboratory-confirmed SARS cases outside Hong Kong, the territory will enter a state of alert. When a SARS case occurs here, the first level of response will be activated under the command of the secretary for health, welfare and food. When there are signs of local transmission of the disease, the territory will enter the second level of response under the direct leadership of the chief executive.

What is most commendable about the new system is that it tackles the possible return of the epidemic by the three-pronged approach of prevention, surveillance and containment.

In view of the divorce of the HA's early warning mechanism from that of the community's, the government has strengthened its co-ordination in areas such as medical services, hygiene, education, neighbourhood, catering and immigration.

For instance, when SARS first re-emerges in Hong Kong, the government will set the first level of response rolling: it will isolate the families of the victims in their homes within the first 12 hours and collect specimens in patients' homes within 24 hours in order to locate the source of the virus.

The authorities will update the public on the epidemic situation on a daily basis and keep in close contact with the World Health Organization and overseas government offices. These procedures will be effective in forestalling the spread of the disease in the community. They will also make the epidemic situation more transparent, help members of the public make the necessary precautions and prevent unnecessary panic.

When there are indications that the disease is spreading, the second level of response measures will be launched. Under the direct leadership of the chief executive, the government will continue to limit visits of patients in hospitals, encourage medical personnel to receive vaccinations and establish a prevention-and-training centre for infectious diseases.

It will also give the elderly and the handicapped injections of anti-flu vaccines and subsidize the refurbishment of homes of the aged and help them appoint an infection-control director.

The government will also adopt a series of measures to support the urgent response mechanism, such as the continuation of the quarantine measures at the border checkpoints.

By the end of October, 1,200 isolation beds will be in place and the health system will have enough N95 face masks in stock to last for 3 months. The disease control and prevention centre will be able to start operations towards the end of the year. All these measures and facilities are absolutely necessary and must be ready as soon as possible.

However, the new mechanism has still left something to be desired and there is room for improvement. First, the government should not wait until the epidemic breaks out to draw up instructions for the public, hospitals, schools, transportation companies and catering premises in light of the actual situation. Rather, it ought to be done whenever there is a sign that SARS could be reemerging.

Furthermore, the government should step up its co-ordination of the anti-SARS effort of private hospitals and clinics. The Baptist Hospital's delay in reporting suspected SARS cases to the Department of Health and in warning patients and their families, and private laboratories' producing incorrect test results that have sparked a false alarm lately have all proven the need to incorporate private hospitals and clinics into the new response mechanism.

(HK Edition 09/23/2003 page5)